Risk factors of cardiac complications in patients with end-stage renal disease undergoing maintenance peritoneal dialysis.

BACKGROUND: Cardiovascular disease (CVD) is the most frequent cause of death in patients on maintenance peritoneal dialysis (PD). This study aimed to identify the risk factors associated with cardiac complications and establish a multivariate logistic regression model for cardiac complications in patients with end-stage renal disease (ESRD) requiring PD. METHODS: This retrospective study included 232 patients undergoing PD. Data of sociodemographic information, comorbidities, medication history, laboratory examination, and medical history were extracted from the medical records of patients with ESRD who underwent maintenance PD between January 2015 and June 2020. Multivariate logistic regression analysis was performed to determine the independent risk factors. RESULTS: The mean age of the study participants was 51.29±13.17 years, with female: male ratio of 87:145. Multivariate logistic regression analysis indicated that lactate dehydrogenase (odds ratio, 1.002; 95% confidence interval, 1.001-1.004; P=0.004), albumin (odds ratio, 0.947; 95% confidence interval, 0.914-0.982; P=0.003), and left atrial diameter (odds ratio, 1.096; 95% confidence interval, 1.037-1.159; P=0.001) were independent risk factors associated with cardiac complications. The area under the receiver operating characteristic curve was 0.78. CONCLUSIONS: We identified the risk factors of cardiac complications in patients with ESRD requiring PD, which may be clinically useful to assess patients in PD and start their early treatment, which can help improve their prognosis.

Mental health status and quality of life in patients with end-stage renal disease undergoing maintenance hemodialysis.

BACKGROUND: This study aimed to identify the association of factors and poorer mental health status and examinate the correlation between mental health status and quality of life (QOL) in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis. METHODS: A total of 190 patients were included in this observational, cross-sectional study. Psychological states of ESRD patients undergoing maintenance hemodialysis were evaluated by the Chinese version symptom checklist-90 (SCL-90) and QOL was assessed using the Chinese Version Kidney Disease Quality of Life-Short Form (KDQOL-SF). RESULTS: A total of 190 patients with a mean age of 61.68 (13.39) years were included in this study. Multiple stepwise linear regression analyses suggested that when controlling for the confounding variables, prealbumin had the significant influence on average positive factors (Coef., -0.647; 95% CI: -1.314, 0.020; P=0.057), somatization (Coef., -1.334; 95% CI: -2.451, -0.217; P=0.020), obsessive-compulsive (Coef., -1.396; 95% CI: -2.255, -0.537; P=0.002), depression (Coef., -1.241; 95% CI: -2.252, -0.229; P=0.017), phobic anxiety (Coef., -2.576; 95% CI: -3.786, -1.367; P<0.001). In the correlation analysis, the score of average positive factors was significantly correlated with the score of the overall health rating (Coef., -0.343; P<0.001), symptom/problem (Coef., -0.337; P<0.001), effects of kidney disease on daily life (Coef., -0.198; P=0.006), burden of kidney disease (Coef., -0.233; P=0.001), cognitive function (Coef., 0.363; P<0.001), quality of social interaction (Coef., 0.292; P<0.001), social support (Coef., 0.237; P=0.001), physical functioning (Coef., -0.339; P<0.001), pain (Coef., 0.362; P<0.001), general health (Coef., -0.332; P<0.001), mental health (Coef., -0.537; P<0.001), social functioning (Coef., 0.202; P=0.005), vitality (Coef., -0.478; P<0.001), respectively. CONCLUSIONS: In our study, prealbumin, type 2 diabetes mellitus, heart rate, educational level, duration of hemodialysis, coronary artery disease, heart failure, marital status, hemoglobin A1C, hemoglobin were significantly associated with poorer mental health status of ESRD patients undergoing maintenance hemodialysis, and patients with poorer psychological states were more significantly associated with decreased QOL. The results may help clinicians to adopt an effective treatment for early interventions, thus improving the QOL in such population.

Evaluation of the construct reliability and validity of the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Chinese version in maintenance hemodialysis patients.

OBJECTIVE: The study aim was to assess the construct reliability and validity of the internal structure of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Self-Rated Level 1 Cross-Cutting Symptom Measure (CCSM)-Chinese version in maintenance hemodialysis (MHD) patients, and to clarify whether the CCSM is suitable for patients with psychological issues. METHODS: Participants were 190 MHD patients. Structural equation modelling was used to establish a measurement model to confirm the reliability and validity of the internal structure of the CCSM-Chinese version, and to compare it with the Chinese version of the Symptom Checklist-90 (SCL-90). RESULTS: Of the 13 CCSM domains, 8 showed stability and validity in the initial screening of psychological symptoms. Although the Chinese version of the SCL-90 is widely used, the measurement model of the 8-domain CCSM was a better fit than the SCL-90 (CCSM: chi-square = 35.668, chi-square/degrees of freedom [CMIN/df] = 1.877; root mean square error of approximation [RMSEA] = 0.061; adjusted goodness of fit index [AGFI] = 0.931 vs. SCL-90: chi-square = 89.159, CMIN/df = 2.972; RMSEA = 0.084; AGFI = 0.879). CONCLUSION: The Chinese version of the CCSM is a useful rapid screening tool to detect psychological symptom risk in MHD patients.

Mental health status and quality of life in elderly patients with coronary heart disease.

BACKGROUND: Coronary heart disease (CHD) is the leading cause of morbidity and mortality among elderly individuals. Patients with CHD are at high risk for mental health disorders, and psychological issues may affect the quality of life (QoL) of these patients. Nevertheless, there is little evidence regarding the psychological issues and QoL of patients with CHD among the elderly population. This study aimed to investigate the relationship between comorbidities and mental status as well as QoL among elderly patients with CHD. METHODS: Overall, 216 patients were included in this cross-sectional, observational, single-center study. The demographics and clinical manifestations of the patients were collected from electronic medical records. All patients were interviewed using the Chinese version of Symptom Checklist 90 (SCL-90) to assess the mental health status and the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF) to assess the QoL. RESULTS: In total, 96 men and 120 women, with a mean age of 71.69 ±  8.30 years, were included. When controlling for the patients' sex, marital status and stroke, multiple stepwise linear regression analyses suggested that for CHD patients, comorbid type 2 diabetes mellitus had the significant influence on average positive factors (Coef., 5.809; 95% CI [2.467-9.152] p = 0.001); when controlling for the patients' sex, marital status and type 2 diabetes mellitus, multiple stepwise linear regression analyses suggested that for CHD patients, comorbid stroke had the significant influence on average positive factors (Coef., 8.680; 95% CI [4.826-12.534]; p < 0.001); when controlling for the patients' sex, marital status, type 2 diabetes mellitus and stroke, multiple stepwise linear regression analyses suggested that for CHD patients, comorbid primary hypertension had the significant influence on phobic anxiety (Coef., 0.178; 95% CI [0.010-0.347]; p = 0.038). CONCLUSIONS: For elderly CHD patients, comorbid type 2 diabetes mellitus and stroke were at risk for psychological problems and lower QoL. Our findings may guide patients and clinicians to make better decisions and achieve better outcomes.

Prediction Model of Cardiac Risk for Dental Extraction in Elderly Patients with Cardiovascular Diseases.

BACKGROUND: With the rapidly increasing population of elderly people, dental extraction in elderly individuals with cardiovascular diseases (CVDs) has become quite common. The issue of how to assure the safety of elderly patients with CVDs undergoing dental extraction has perplexed dentists and internists for many years. And it is important to derive an appropriate risk prediction tool for this population. OBJECTIVES: The aim of this retrospective, observational study was to establish and validate a prediction model based on the random forest (RF) algorithm for the risk of cardiac complications of dental extraction in elderly patients with CVDs. METHODS: Between August 2017 and May 2018, a total of 603 patients who fulfilled the inclusion criteria were used to create a training set. An independent test set contained 230 patients between June 2018 and July 2018. Data regarding clinical parameters, laboratory tests, clinical examinations before dental extraction, and 1-week follow-up were retrieved. Predictors were identified by using logistic regression (LR) with penalized LASSO (least absolute shrinkage and selection operator) variable selection. Then, a prediction model was constructed based on the RF algorithm by using a 5-fold cross-validation method. RESULTS: The training set, based on 603 participants, including 282 men and 321 women, had an average participant age of 72.38 ± 8.31 years. Using feature selection methods, 11 predictors for risk of cardiac complications were screened out. When the RF model was constructed, its overall classification accuracy was 0.82 at the optimal cutoff value of 18.5%. In comparison to the LR model, the RF model showed a superior predictive performance. The AUROC (area under the receiver operating characteristic curve) scores of the RF and LR models were 0.83 and 0.80, respectively, in the independent test set. The AUPRC (area under the precision-recall curve) scores of the RF and LR models were 0.56 and 0.35, respectively, in the independent test set. CONCLUSION: The RF-based prediction model is expected to be applicable for preoperative clinical assessment for preventing cardiac complications in elderly patients with CVDs undergoing dental extraction. The findings may aid physicians and dentists in making more informed recommendations to prevent cardiac complications in this patient population.

Effects of the visual-feedback-based force platform training with functional electric stimulation on the balance and prevention of falls in older adults: a randomized controlled trial.

BACKGROUND: Force platform training with functional electric stimulation aimed at improving balance may be effective in fall prevention for older adults. Aim of the study is to evaluate the effects of the visual-feedback-based force platform balance training with functional electric stimulation on balance and fall prevention in older adults. METHODS: A single-centre, unblinded, randomized controlled trial was conducted. One hundred and twenty older adults were randomly allocated to two groups: the control group (n = 60, one-leg standing balance exercise, 12 min/d) or the intervention group (n = 60, force platform training with functional electric stimulation, 12 min/d). The training was provided 15 days a month for 3 months by physical therapists. Medial-lateral and anterior-posterior maximal range of sway with eyes open and closed, the Berg Balance Scale, the Barthel Index, the Falls Efficacy scale-International were assessed at baseline and after the 3-month intervention. A fall diary was kept by each participant during the 6-month follow-up. RESULTS: On comparing the two groups, the intervention group showed significantly decreased (p < 0.01) medial-lateral and anterior-posterior maximal range of sway with eyes open and closed. There was significantly higher improvement in the Berg Balance Scale (p < 0.05), the Barthel Index (p < 0.05) and the Falls Efficacy Scale-International (p < 0.05), along with significantly lesser number of injurious fallers (p < 0.05), number of fallers (p < 0.05), and fall rates (p < 0.05) during the 6-month follow-up in the intervention group. CONCLUSION: This study showed that the visual feedback-based force platform training with functional electric stimulation improved balance and prevented falls in older adults.

Correlations of EZH2 and SMYD3 gene polymorphisms with breast cancer susceptibility and prognosis.

The aim of the present study was to investigate the correlation of enhancer of Zeste homolog 2 (EZH2) and SET and MYND domain containing 3 (SMYD3) gene polymorphisms with breast cancer susceptibility and prognosis. A total of 712 patients with breast cancer and 783 healthy individuals were selected. Normal breast epithelial cells MCF-10A and breast cancer cells MCF-7, MDA-MB-231, T47D, and Bcap-37 were cultured. Polymerase chain reaction (PCR)-restriction fragment length polymorphism method was applied for genotyping. Reverse-transcription quantitative PCR (RT-qPCR) and Western blotting were used to examine EZH2 and SMYD3 expression in breast cancer tissues and cells. The risk factors and prognostic factors for breast cancer were estimated. The C allele of EZH2 rs12670401 (odds ratio (OR) =1.255, 95% confidence interval (95% CI): 1.085-1.452), T allele of EZH2 rs6464926 (OR =1.240, 95% CI: 1.071-1.435), and three alleles of SMYD3 variable number of tandem repeats (VNTRs) (OR =1.305, 95% CI: 1.097-1.552) could increase susceptibility to breast cancer. Combined genotypes of EZH2 rs12670401 (TC + CC) and EZH2 rs6464926 (CT + TT) were associated with breast cancer susceptibility. Breast cancer tissues had higher EZH2 and SMYD3 expression. EZH2 rs12670401, EZH2 rs6464926, age of menarche, and menopausal status were associated with breast cancer susceptibility. Patients with TT genotype of EZH2 rs12670401 or with CC genotype of EZH2 rs6464926 had higher overall survival (OS). EZH2 rs12670401, EZH2 rs6464926, and clinical staging were independent prognostic factors for breast cancer. SMYD3 VNTR polymorphism exhibited no association with susceptibility and prognosis. EZH2 rs12670401 and rs6464926 polymorphisms, EZH2 and SMYD3 expression, clinical staging, lymph node metastasis, human epidermal growth factor receptor-2 (HER2) status, and metastasis may be correlated with breast cancer susceptibility and prognosis.

Reliability and validity of center of pressure measures for balance assessment in older adults.

[Purpose] This study was conducted to assess the reliability and validity of center of pressure-based parameters for balance assessment. [Subjects and Methods] Two hundred and forty older adults were evaluated using a force platform and the Berg Balance Scale at 1-week intervals. The intra-class correlation coefficient and the Pearson correlation coefficient were used to test reliability and validity respectively. [Results] The reliability of the 12 selected center of pressure measures was satisfactory (intra-class correlation coefficient = 0.75-0.99) and the validity between the parameters and the Berg Balance Scale was moderate to good (r = -0.62 to -0.88). [Conclusion] Center of pressure-based parameters are reliable and valid measures in older adults.

Virtual reality for improving balance in patients after stroke: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of virtual reality interventions for improving balance in people after stroke. DESIGN: Systematic review and meta-analysis of randomized controlled trials. METHODS: Studies were obtained by searching the following databases: MEDLINE, CINAHL, EMBASE, Web of Science and CENTRAL. Two reviewers assessed studies for inclusion, extracted data and assessed trial quality. RESULTS: Sixteen studies involving 428 participants were included. People who received virtual reality interventions showed marked improvements in Berg Balance Scale (mean difference: 1.46, 95% confidence interval: 0.09-2.83, P<0.05, I²=0%) and Timed Up and Go Test (mean difference: -1.62, 95% confidence interval: -3.07- -0.16, P<0.05, I²=24%) compared with controls. CONCLUSIONS: This meta-analysis of randomized controlled trials supports the use of virtual reality to improve balance after stroke.

[Factors associated with attitudes toward tobacco control policy in public places among adults in three counties of China].

OBJECTIVE: vestigate the attitudes of urban and rural community members toward total banning on smoking in public places and to explore the factors associated with these attitudes, in three counties/cities in China. METHODS: A cross-sectional study was conducted in three counties/cities in 2004, including Xin' an county of Henan province, Anyi county of Jiangxi province, and Mianzhu city of Sichuan province. A total of 5642 residents at age of 18-69 years old were interviewed face-to-face with a uniform questionnaire by locally-trained interviewers, through a random three-stage stratified sampling in each county. Factors were assumed to be associated with attitudes, using chi-square test in univariate analysis and non-conditional logistic regression model in multivariate analysis. RESULTS: The prevalence of current smoking among respondents was 44.3%. 80.7% (1379/1709) of the current smokers reported smoking often or sometimes in public places. Only 9.6% (479/4983) of the respondents reported that their indoor workplaces had totally banned on smoking. 43.5% of the respondents supported a total smoking ban strategy in pubic venues. The results of multivariate logistic regression model showed that eight factors were significantly associated with support for the total smoking ban in public places included region, residency, age, gender, education, smoking status, awareness about passive smoking hazards, and hearing of any message on tobacco control through media differences of rates regarding the factors as: residents in urban to rural areas (OR = 1.29), elderly to youngsters (30-49 vs. 18-29, OR = 1.46; 50-69 vs. 18-29, OR = 1.71), female to male (OR = 1.27), high-educated to less-educated ones, quitters to current smokers (OR = 1.90), nonsmokers to current smokers (OR = 2.01). Those who know messages on health hazards of passive smoking (OR = 2.26), or heard of message on tobacco control through media (OR = 1.43). CONCLUSION: Results from our study revealed that a thorough smoke-free policy in public places should be developed and implemented in these three counties/cities.

[The current status of passive smoking in Chinese families and associated factors].

OBJECTIVE: To understand the prevalence of passive smoking in Chinese families and discuss its associated factors, as to providing scientific evidence for establishing tobacco control measures in China. METHOD: Cross-sectional survey: from June to September, 2004, we randomly selected six counties in three different provinces ( Mianzhu and Xichong of Sichuan Province; Anyi and Hukou of Jiangxi Province; Xinan and Yanshi of Henan Province) and performed face-to-face questionnaire survey on citizens between 18 and 69 years old. All the data were double independently input by professional data entry company to ensure data accuracy. The prevalence of home passive smoking exposure in families with different demographic characteristics was described by using prevalence, and the possible correlated factors of home passive smoking exposure as independent variables, multiple factors were analyzed using Logistic Stepwise Regression Analysis method. RESULTS: The analysis on 8142 nonsmokers revealed that the rate of passive smoking was 28.42%, with 27.38% of male and 28.93% of female suffering from passive smoking. All 87.19% of the smokers would smoke in front of their families. As many as 42.14% of the nonsmokers would offer cigarettes to their guests, while about 46.82% of the nonsmokers would suggest smokers to smoke outdoor. Home restriction on tobacco was extremely rare and only 6.33% of all the families completely forbade smoking. Multivariate logistic regression analysis of non-conditions revealed that, there was a lower level of involuntary tobacco smoke exposure in female, older age group, lower education level, divorced, or widowed families. There was no difference in involuntary tobacco smoke exposure between town dwellers and county dwellers, but such difference did exist in different districts. CONCLUSION: The three provinces under investigation should have severe involuntary tobacco smoking exposure. Gender, age, literacy level, occupation and region should be all factors that influence the status of involuntary tobacco smoking exposure in different families. There is a high percentile that smokers would smoke in front of their families and kids and a relative low pressure against smoking from nonsmokers. Cigarette offering is very prevalence. The knowledge and attitude about passive smoking should be separated from the situation of passive smoking exposure.

Exploring barriers to implementation of smoking policies: a qualitative study on health professionals from three county-level hospitals.

OBJECTIVE: This study was to identify factors limiting the implementation of smoking policies in county-level hospitals. METHODS: We conducted qualitative interviews (17 focus groups discussions and 6 one-to-one in depth interviews) involving 103 health professionals from three target county-level hospitals. A combination of purposive and convenience sampling was used to recruit subjects and gain a broad range of perspectives on issues emerging from ongoing data-analysis until data saturation occurred. The transcripts were analyzed for themes and key points. RESULTS: The main themes that emerged suggested that both smokers and non-smokers viewed smoking very negatively. However, it was clear that, underlying this acceptance of the health risks of smoking, there was a wide range of beliefs. Most of the health professionals pointed out that, as smoking was legal, addictive, and influenced by social norms, currently it was almost unrealistic to expect all smokers to give up smoking or not to smoke in the hospitals. Furthermore, they were concerned about the potentially detrimental effects of providing counseling advice to all smokers on the interpersonal relationship among colleagues or between doctors and patients. In addition, low level of employee participation influenced the sustainable implementation of smoking policies. CONCLUSIONS: Simply being aware of the health risks about smoking did not necessarily result in successful implementation of the smoking policies. Application of comprehensive intervention strategies such as implementing smoking policies in public places at the county level, creating supportive environments, promoting community participation, and conducting health education, may be more effective.

[Detecting nicotine and its metabolite cotinine in human hair with capillary gas chromatography].

OBJECTIVE: To develop a rapid method for determination of nicotine and its metabolite cotinine in human hair with capillary gas chromatography with flame ionization detector. METHODS: The hair sample was digested by 1.5 mol/L sodium hydroxide solution. The nicotine and cotinine in the hair sample were extracted with a mixed solvent of dichloromethane-methanol (3:1). Aliquot of the extraction solution was vaporized with nitrogen flow and then methanol was added to dissolve the analysts. The analysts were tested with capillary gas chromatography. RESULTS: The detection limits (signal to noise ratio of 3:1) were 4.3 ng/mL for nicotine and 10 ng/mL for cotinine, respectively. The spiked recoveries were 90.33%-113.1% for nicotine with relative standard deviation (RSD) of 2.1%-7.0% and 92.92%-117.4% for cotinine with relative standard deviation (RSD) of 4.4%-8.9%, respectively. CONCLUSION: The proposed method is sensitive, simple, easy and rapid. It can be easily extended to large scale applications in tobacco epidemiology studies.

Passive smoking in China: contributing factors and areas for future interventions.

OBJECTIVE: To reduce tobacco consumption and exposure to passive smoking in China. METHODS: Discussion consisting of 80 focus groups and 35 interviews were held in three rural intervention counties of Jiangxi, Henan, and Sichuan Provinces. Participants came from hospitals, schools, rural areas, and urban areas. RESULTS: Tobacco use and exposure to passive smoking were widely prevalent in the investigated schools, hospitals, county towns, and rural areas. Knowledge of the risks for passive smoking on health is lacking, especially in rural areas. Barriers to the control of tobacco use in public places include reluctance of administrators to implement tobacco control policies, lack of consistent policies, difficulties with regulations and enforcement, and reluctance of non-smokers to exercise their right to clean air. CONCLUSION: To curb the current tobacco epidemic in China, tobacco control efforts must focus on reducing exposure to passive smoking. A strategy should be formulated to reduce the factors that contribute to tobacco use and exposure to passive smoking.

[Comparison on growth, physiology and medicinal components of Dendrobium huoshanense hybrid and its parents].

OBJECTIVE: To compare the hybrid between species of Dendrobium huoshanense and its parents on growing, physiologic indexes and content of medicinal components, and provide theoretical basis for species quality improvement. METHOD: The chlorophyll content, the photosynthesis rate, the polysaccharides content and the alkaloids content were measured by anhydrous ethanol method, Cl-310 photosynthesis determination system, colorimetry of concentrated sulphuric acid-phenol and acid dyes colorimetry respectively. RESULT: The growth of hybrid was close to D. moniliforme, and apparently higher than D. huoshanense. The chlorophyll content and the photosynthesis rate of one-year-hybrid were markedly higher than its parents. The content of polysaccharides and alkaloids in two-year-stem and three-year-stem of hybrid were close to that of D. huoshanense. CONCLUSION: The hybrid integrates superiority of parents on growth and accumulation of medicinal components opens vast vistas for development and utilization.

Epidemiology of HIV and sexually transmitted infections in China.

As the most populous country in the world, China has been confronted with the huge challenges that HIV and sexually transmitted infections pose. The HIV infection rate among adults is lower than 0.1%, however, the estimated number of HIV infections sits around one million, according to the estimation of some experts. HIV infection is highly prevalent in some regional areas of China and the incidence rate of sexually transmitted infections has sharply increased since the 1980s. The number of HIV infections may reach 10 million if no effective measures are taken. This article aims to outline the profile of the epidemic in China as well as to elaborate on the contributing factors and the response of the government and community.