Maternal experience of intermittent kangaroo mother care for late preterm infants: a mixed-methods study in four postnatal wards in China.

OBJECTIVE: To describe how mothers of late preterm infants experienced the provision of intermittent kangaroo mother care (KMC) in four postnatal wards in different hospitals in China, under a pilot KMC project. DESIGN: A concurrent mixed-methods approach incorporating quantitative maternal questionnaires and qualitative semistructured interviews. SETTING: Four postnatal wards in level-III hospitals based in different provinces of Southeast and Northwest China. PARTICIPANTS: All 752 mothers who provided intermittent KMC to their late preterm newborns in the four participating postnatal wards consented to participate in the study (quantitative component), as well as six nurses, two obstetricians and two mothers from two of the participating postnatal wards (qualitative component). OUTCOME MEASURES: Maternal KMC experiences during a hospital stay, patients' perceptions of KMC initiation, processes, benefits and challenges. RESULTS: Most mothers had not heard of KMC before being introduced to it in the postnatal ward. On average, mothers and newborns stayed in postnatal wards for 3.6 days; during their stay, mothers provided an average of 3.5 KMC sessions, which is an average of 1.1 sessions a day. Each KMC session lasted an average of 68 min, though there was much variation in the length of a session. Common reasons given for discontinuing a KMC session included restroom use, infant crying and perceived time limitations. Some mothers would have preferred to provide KMC for longer periods of time and nurses encouraged this. Most mothers experienced no difficulty providing KMC, received support from family and medical staff and intended to continue with KMC postdischarge. CONCLUSION: In order to improve the maternal experience of KMC, it is recommended that raising awareness of KMC should be included in antenatal care and after birth. Longer periods of KMC provision should be encouraged, greater privacy should be provided for mothers providing KMC in postnatal wards and family members should be encouraged to support KMC.

Risk factors of enteral feeding intolerance in severe acute pancreatitis patients: A protocol for systematic review and meta-analysis.

BACKGROUND: Patients with severe acute pancreatitis (SAP) have gastrointestinal dysfunction, and enteral nutrition intolerance is easy to occur during the implementation of enteral nutrition, which leads to the suspension or termination of enteral nutrition. Enteral nutrition cannot tolerate the influence of many factors. At present, there is a lack of analysis on the influencing factors of enteral nutrition intolerance in patients with SAP. Therefore, this study analyzed the factors of enteral nutrition intolerance in patients with SAP by meta-analysis, to provide a basis for the protection of enteral nutrition in patients with SAP. METHODS: Databases (PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang) were searched using index words to find relevant studies published before March 2021. Meta-analyses of relative risk were performed for the identification of risk factors. RESULTS: We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals. CONCLUSION: This study systematically reviewed the existing evidence and determined the incidence and predictors of enteral nutrition intolerance in patients with SAP.

Intermittent kangaroo mother care and the practice of breastfeeding late preterm infants: results from four hospitals in different provinces of China.

BACKGROUND: China has an extremely low exclusive breastfeeding rate. Kangaroo mother care (KMC) has been shown to increase the exclusive breastfeeding rate among infants born extremely or very preterm. However, there is limited evidence surrounding intermittent KMC and exclusive breastfeeding in late preterm infants. In our study we investigated the association between the provision of intermittent KMC and breastfeeding practice for late preterm infants in four hospitals in different provinces of China. METHODS: Intermittent KMC was recommended to the mothers of all preterm infants admitted to the postnatal wards of participating hospitals between March 2018 and March 2019. Those who agreed to practice KMC were enrolled in the "KMC group", those who did not were enrolled in the "No KMC group". Basic maternal socio-demographic information was collected, feeding practice; outcome and method, were recorded daily whilst in hospital. A follow-up survey of feeding practice was conducted 42 days after discharge. Calculations for feeding practice were performed separately for both groups. Logistics regression was used to analyze the association between KMC and feeding outcome and method, adjusting for socio-demographic covariates. RESULTS: Among the 844 mothers participating in the study, 627 (74.3%) chose to perform KMC. More of the mothers who provided KMC were exclusively breast milk feeding their infants in the 24 h before hospital discharge (54.6%) and at follow-up (57.3%), compared to mothers who did not provide KMC (34.6% at discharge and 33.2% at follow-up,). Mothers in the KMC group were more likely to be breastfeeding (method) than mothers in the No KMC group (65.3% vs. 52.1% at discharge, and 83.1% vs. 67.3% at follow up). Logistic regression indicated that compared with the No KMC group, mothers who provided KMC were twice as likely to be exclusively breast milk feeding their infants at discharge (OR = 2.15 (95% CI 1.53, 3.02)), use breastfeeding method at discharge as opposed to other means such as bottle or cup feeding (OR = 1.61 (95% CI 1.15, 2.25)), be exclusive breast milk feeding at follow-up (OR = 2.55 (95% CI 1.81, 3.61)), and use breastfeeding method at follow-up (OR = 2.09 (95% CI 1.44, 3.02)). CONCLUSIONS: Intermittent KMC was associated with a nearly doubled increase in exclusive breast milk feeding (outcome) and breastfeeding (method) at both discharge and 42 days after discharge for late preterm infants. This is especially important in China where exclusive breastfeeding rates are low, intermittent KMC provides a feasible means to increase the likelihood of these vulnerable infants receiving the benefits of exclusive breastmilk.

Hypoxia-induced alterations of transcriptome and chromatin accessibility in HL-1 cells.

Cardiac hypoxia plays a significant role in various types of heart disease, and improper treatment of hypoxia often leads to myocardial cell damage or even death. Transcriptome profiling and open chromatin mapping have been used as powerful tools to understand the development of heart disease, but the interplay between gene expression and chromatin accessibility has not been extensively investigated in hypoxia-induced cardiac damage. In this study, with HL-1 cardiomyocytes as a model, we performed temporal profiling of transcriptome and chromatin accessibility to show the cardiac responses to hypoxia (for 4 and 8 hr) and reoxygenation (for 24 hr). With RNA-seq and ATAC-seq, we identified a total of 2,912 differentially expressed genes and 3,004 differential peaks across the whole genome and showed that these data were in good agreement with each other. For hypoxia-related genes, we also discovered high correlations between their ATAC-seq signals and mRNA levels, such as VEGF, Angpt1, Slc2a1, Bnip3, and Casp3 with Pearson correlations >0.7. Interestingly, after 24 hr reoxygenation, the expression levels of 235 genes were still significantly different from the counterparts in the control, suggesting that these genes need a longer recovery time after reoxygenation. In conclusion, our study shows the close relationship between alterations of transcriptome and chromatin accessibility after hypoxia exposure and reoxygenation, emphasizing the importance of open chromatin profiling in related studies. In addition, the profiled molecular responses here will be valuable resources for better understanding of the mechanisms responsible for hypoxia-induced heart disease in future.

Clinical factors affecting left ventricular end-diastolic pressure in patients with acute ST-segment elevation myocardial infarction.

BACKGROUND: An association between left ventricular end-diastolic pressure (LVEDP) and outcomes of ischemic heart diseases has been reported. The present study aimed to investigate the LVEDP patterns and the effecting factors in patients with acute ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 515 STEMI patients receiving immediate percutaneous coronary intervention (PCI) were divided into two groups according to their LVEDP before left ventricular angiography: LVEDP of 15 mmHg or less (group A, n=145) and LVEDP above 15 mmHg (group B, n=370). Blood samples were collected before and within 24 hours after PCI, and an ultrasonic cardiogram was conducted to measure left ventricular ejection fraction (EF%) and to evaluate ventricular structure changes. The narrowness of each artery was measured with coronary angiography. RESULTS: In comparison with group A, patients in group B had a more infarction-related artery (IRA) descending branch and regional wall motion abnormality, a larger left atrial end-diastolic diameter (LAEDd) and a left ventricular end-diastolic diameter (LVEDd), a smaller EF%, a higher level of myocardial necrosis markers, and a higher heart failure rate. Furthermore, LVEDP level was found to be positively correlated with Gensini score, LAEDd, LVEDd, N-terminal pro b-type natriuretic peptide, troponin T, uric acid, creatine kinase (CK), CK myocardial band, low-density lipoprotein cholesterol and fasting blood glucose, and negatively correlated with glomerular filtration rate and EF%. CONCLUSIONS: LVEDP elevation has a higher incidence of heart failure and a higher risk of death, which is associated with the criminal blood vessels.

Solvothermal synthesis of multiwall carbon nanotubes/BiOI photocatalysts for the efficient degradation of antipyrine under visible light.

Antipyrine (ANT), as a widely used relieve headache, fever anti-inflammatory pharmaceutical in medical treatment, is difficult to be removed completely in water. The application of photocatalytic removal of ANT is restricted to UV light irradiation (<5% of solar energy), and the degradation pathways of ANT require more theoretical evidence. In this study, a series of three dimensions (3D) hierarchical structure multiwall carbon nanotubes/bismuth oxyiodide (MWCNTs/BiOI) photocatalysts were systematically designed and firstly applied to remove ANT through visible light (>43% of solar energy) induced photodegradation. Consequently, the as-prepared MWCNTs/BiOI photocatalysts presented superior photocatalytic activities on ANT degradation with respect to that of BiOI under 60 min visible light irradiation (100% vs 82.2%). Especially, the enhanced photocatalytic mechanism on ANT was analyzed by morphology, optical and photo-electrochemical properties. Results revealed that the designed 3D micro-mesoporous structure could promote the diffusion of photogenerated electron-hole pairs, and the utilization of photoelectrons could be efficiently improved by MWCNTs (1.5 times). Furthermore, based on radicals scavenging experiments, the photogenerated hole (h+) and superoxide radical (O2-) were demonstrated as the dominant active species in ANT photocatalytic oxidation process. The photodegradation pathways of ANT were proposed with the calculation of frontier electron densities (FEDs) and the analysis of LC-MS/MS. This study presents a feasible approach for the high efficiency removal of trace pharmaceuticals under visible light photocatalytic process.

Relationship between Small Intestinal Bacterial Overgrowth and Peripheral Blood ET, TLR2 and TLR4 in Ulcerative Colitis.

OBJECTIVE: To investigate the relationship between small intestinal bacterial overgrowth (SIBO) and Endotoxin (ET) concentration in peripheral blood, and levels of toll-like receptors (TLR) 2 and TLR4 expression on surface of peripheral blood mononuclear cells (PBMCs) in patients with ulcerative colitis. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: The First Hospital of Hebei Medical University, from July 2018 to October 2019. METHODOLOGY: The 130 patients with ulcerative colitis were included in case group. Another 72 healthy cases were selected as control group. SIBO, ET, TLR2, and TLR4, were determined, and compared. RESULTS: Positive rate of SIBO in case group was higher than that in control group (p <0.001). Lactulose hydrogen breath test (LHBT) intestine set value, peripheral blood ET concentration, and TLR2 and TLR4 expression levels on surface of PBMCs in case group were higher than those in control group (all p <0.001); the above indexes in SIBO-positive patients in case group were higher than those in SIBO-negative patients in case group (all p <0.001). Pearson's correlation analysis showed that LHBT intestine set value of SIBO-positive patients in case group was positively correlated with ET concentration, and TLR2 and TLR4 expression levels on surface of PBMCs (r= 0.910, p <0.001; r = 0.970, p <0.001; and r = 0.965, p <0.001 respectively). ET concentration of SIBO-positive patients in case group was positively correlated with expression levels of TLR2 and TLR4 on surface of PBMCs (r=0.962, p <0.001; and r = 0.829 p <0.001 respectively). CONCLUSION: Patients with ulcerative colitis are easy to occur SIBO, and SIBO increases blood endotoxin, TLR2 and TLR4 levels. Synergistic effects of endotoxin and endotoxin receptors TLR2 and TLR4 overexpression mediate body inflammation and may be involved in progression of ulcerative colitis. Patients with ulcerative colitis with excessive growth of small intestinal bacteria are more likely to have hypertoxemia.

Development of a diagnosis model for coronary artery disease.

BACKGROUND: The purpose of this study was to develop a coronary artery disease (CAD) prediction model that optimally estimates the pre-test probability of CAD for patients suspected of CAD. METHODS AND RESULTS: This retrospective, multi-centre study included 7360 consecutive patients (4678 men, 57.87±11.42 years old; 2682 women, 61.60±9.58 years old) who underwent coronary angiography for evaluation of CAD. A prediction model was fitted for diagnosis of CAD with the help of eight significant risk factors including sex, age, smoking status, diabetes, hypertension, dyslipidaemia, serum creatinine and angina. All potential predictors were significantly associated with the presence of CAD. The prevalence of CAD was significantly higher in men than in women. The clinical model gives a relatively accurate prediction of CAD with an area under the curve (AUC) of 0.74 (95% CI, 0.88-0.96; P<0.001). Addition of angina to the prediction model improves the predictive precision of the model. The optimal cut-off for predicting CAD in this model was 0.79 with a sensitivity of 0.658 and a specificity of 0.709. CONCLUSION: A prediction model including age, sex, and cardiovascular risk factors allow for an accurate estimation of the pre-test probability of coronary artery disease in Chinese populations. This algorithm may be useful in making decisions relating to the diagnosis of CAD.

A study of IgG antibodies to the ApoB protein in non-ST segment elevation acute coronary syndrome.

OBJECTIVES: It has long been noted that there is an association of antibodies against oxidized low-density lipoprotein (oxLDL) with cardiovascular disease, but the anti-oxLDL antibody has not been confirmed as a biomarker for prediction of acute coronary syndrome (ACS). Apolipoprotein B (ApoB) may carry the epitopes for the immune response to oxLDL. The present work was thus undertaken to detect circulating antibodies to ApoB in non-ST segment elevation ACS (NSTE-ACS). DESIGN: A total of 130 patients with NSTE-ACS and 201 control subjects were recruited. Six ApoB-derived peptipe antigens (Ag1-Ag6) were used to develop an in-house enzyme-linked immunosorbent assay to examine circulating anti-ApoB IgG levels. RESULTS: The anti-Ag1 IgG level was significantly higher in the patient group than the control group (P < 0.001) and the non-ST segment elevation myocardial infarction appeared to be the main form of NSTE-ACS contributing to the increased levels of anti-Ag1 IgG (P < 0.001); there was no significant alteration in the levels of IgG to the other 5 antigens in NSTE-ACS. CONCLUSIONS: Circulating anti-ApoB IgG test may be useful for prediction of NSTE-ACS although further confirmation is needed in large-scale clinical studies.

Relationship Between Hematocrit Level and Cardiovascular Risk Factors in a Community-Based Population.

BACKGROUND: This study aimed to determine the relationship between hematocrit (HCT) levels and cardiovascular risk factors in a community-based population of middle-aged adults. METHODS: From April 2011 to February 2012, a total of 1,884 middle-aged adults were selected from a community-based population in China. Blood and urine samples were collected for routine blood and urine tests, and measurement of plasma glucose and lipid levels. Baseline information including traditional cardiovascular risk factors was obtained by standard questionnaire to analyze. We evaluated the distribution of the HCT values for middle-aged adults with or without cardiovascular risk factors. There were 548 males and 1,336 females in this study. The mean age of all subjects was 54.7 ± 6.7 years. There were 1,209 subjects with risk factors and 675 without risk factors. RESULTS: The HCT levels in subjects with risk factors were higher than those without risk factors (P = 0.005). According to a simplified tool for evaluation of the 10-year risk of ischemic cardiovascular diseases (CVDs) in Chinese populations, all subjects were divided into four groups: the ultralow-risk group (1,367, 72.6%), low-risk group (232, 12.3%), intermediate-risk group (201, 10.7%), and high-risk/ultrahigh-risk group (84, 4.4%). Compared with HCT levels in the ultralow-risk group, significant differences were found in the low-risk, intermediate-risk, and high-risk/ultrahigh-risk groups (all P < 0.05). CONCLUSION: Our results indicate that elevated HCT levels may be positively associated with cardiovascular risk factors. Thus, the combination of HCT values and cardiovascular risk factors may enable early diagnosis of CVDs.

Validated LC-MS/MS method for the simultaneous determination of hyperoside and 2''-O-galloylhyperin in rat plasma: application to a pharmacokinetic study in rats.

An LC-MS/MS method was developed for the first time to simultaneously determine hyperoside and 2''-O-galloylhyperin, two major components in Pyrola calliantha extract, in rat plasma. Following extraction by one-step protein precipitation with methanol, the analytes were separated on a Venusil MP-C18 column within 2 min, using methanol-water-formic acid (50:50:0.1, v/v/v) as the mobile phase at a flow rate of 0.4 mL/min. Detection was performed on electrospray negative ionization mass spectrometry by multiple-reaction monitoring of the transitions of 2''-O-galloylhyperin at m/z 615.1 → 301.0, of hyperoside at m/z 463.1 → 300.1, and of internal standard at m/z 415.1 → 295.1. The limits of quantification were 2 ng/mL for both hyperoside and 2''-O-galloylhyperin. The precisions were <13.1%, and the accuracies were between -9.1 and 5.5% for both compounds. The method was successfully applied in pharmacokinetic studies following intravenous administration of the total flavonoids of P. calliantha extract in rats.

Association between the adiponectin +45T>G genotype and risk of cardiovascular disease: a meta-analysis.

BACKGROUND: Numerous studies have investigated the association between adiponectin +45 nucleotide T/G (+45T>G) polymorphisms and cardiovascular disease (CVD). However, these studies have been inconclusive because of obvious inconsistencies among results. The present study aims to quantify the strength of the association between +45T>G (rs2241766) in the adiponectin gene and the risk of CVD. METHODS: We searched the PubMed, Embase, and Wangfang databases for studies related to the association between the adiponectin +45T>G genotype and the risk of CVD. We estimated the summary odds ratio (OR) with 95% confidence interval (CI) to assess the association. RESULTS: A total of 28 case-control studies, with 12,378 CVD cases and 19,368 controls, were included in the meta-analysis. The meta-analysis of the 28 studies showed that the single-nucleotide polymorphism (SNP) +45T>G genotype was associated with an increased risk of CVD (random-effects OR = 1.22, 95% CI 1.08-1.39, p = 0.002). After adjusting for heterogeneity, the meta-analysis showed that the SNP +45T>G genotype was associated with the risk of CVD in the analyses of the total population and the Caucasian population (for the total population, fixed-effects OR = 1.11, 95% CI 1.01-1.23, p = 0.012; for the Caucasian population, fixed-effects OR = 1.16, 95% CI 1.01-1.34, p = 0.039). No significant association was found in other populations. Evidence of publication bias was observed in the meta-analysis. CONCLUSION: A significant association between rs2241766 in the adiponectin gene and CVD was established by the meta-analysis.

Increasing gastric juice pH level prior to anti-Helicobacter pylori therapy may be beneficial to the healing of duodenal ulcers.

The aim of this study was to observe the efficacy of clarithromycin-based triple therapy for Helicobacter pylori (Hp)-infected duodenal ulcer when combined with different pH levels of gastric juices. A total of 160 patients with Hp-infected duodenal ulcers were randomly allocated into two groups. Patients in the treatment group (n=80) were administered a 20-mg dose of omeprazole twice daily for 1 week and then the treatment and control groups (n=80) received therapy for Hp infection and duodenal ulcers. We observed the ulcer healing stage, the content of anti-Hp IgA in gastric juice and the Hp eradication rate before and after proton pump inhibitor therapy in the two groups. Results revealed that the Hp eradication rate in the treatment group was 93% compared with 81% in the control group, and the difference was statistically significant (P<0.05). The ulcer healing rate in the treatment group was 93%, compared with 70% in the control group (P<0.05). A positive linear correlation was observed between gastric pH and the content of anti-Hp IgA in gastric juice (P<0.05). Increasing gastric pH prior to anti-Hp therapy may be beneficial to the eradication of Hp and for promoting the healing of duodenal ulcers.

Ionic liquid as an efficient promoting medium for fixation of carbon dioxide: a clean method for the synthesis of 5-methylene-1,3-oxazolidin-2-ones from propargylic alcohols, amines, and carbon dioxide catalyzed by Cu(I) under mild conditions.

[reaction: see text] The reactions of propargylic alcohols, aliphatic primary amines, and CO2 were conducted in CuCl/[BMIm]BF4 system to produce the corresponding 5-methylene-1,3-oxazolidin-2-ones under relatively mild conditions. The products could be conveniently isolated by means of liquid-liquid extraction. The solvent ionic liquid as well as CuCl catalyst can be recovered and reused three times without appreciable loss of activity. By this green approach, several new 5-methylene-1,3-oxazolidin-2-ones were prepared in excellent yields and purity and were well-characterized.