Long-term outcomes of endoscopic papillary large-balloon dilation (12-15 mm) with or without limited sphincterotomy for removal of bile duct stones.

BACKGROUND: Limited endoscopic sphincterotomy with large balloon dilation (ES-LBD) and endoscopic papillary large-balloon dilation (EPLBD) have been proven safe and effective for removal of bile duct stones. However, the long-term outcomes are not clear. The aim of this study was to assess the long-term outcomes of EPLBD (12-15 mm) with or without limited sphincterotomy for removal of common bile duct (CBD) stones. METHODS: Patients with EPLBD or ES-LBD referred for the removal of bile-duct stones between June 2008 and August 2020 were retrospectively reviewed. Complete stone clearance, endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events, and late biliary complications during long-term follow-up were analyzed. RESULTS: Basic patient characteristics were not significantly different between the groups that underwent EPLBD (n = 168) and ES-LBD (n = 57). EPLBD compared with ES-LBD resulted in similar outcomes in terms of overall successful stone removal (99.4% vs. 100%, P = 1.00) and ERCP-related adverse events (7.7% vs. 5.3%, P = 0.77). The mean duration of the follow-up were 113.6 months and 106.7 months for patients with EPLBD and ES-LBD, respectively (P = 0.13). There was no significant difference between EPLBD and ES-LBD in the incidence of stone recurrence [20 (11.9%) vs. 9 (15.8%); P = 0.49]. Multivariate analysis showed that a diameter of CBD ≥ 15 mm (OR = 3.001; 95% CI: 1.357-6.640; P = 0.007) was an independent risk factor for stone recurrence. CONCLUSIONS: The application of a large balloon (12-15 mm) via EPLBD is an effective and safe alternative to ES-LBD for extraction of large CBD stones. Endoscopic sphincterotomy prior to EPLBD may be unnecessary. A diameter of CBD ≥ 15 mm is a risk factor of stone recurrence.

A female with recurrent gastrointestinal bleeding: an obscure diminutive lesion requiring a massive blood transfusion.

Obscure gastrointestinal bleeding (OGIB) is bleeding of unknown origin after a negative initial or primary colonoscopy and upper endoscopy result. Small bowel bleeding accounts for 5% of GI bleeding but it is the most prominent cause of OGIB. We present a case with an obscure diminutive polypoid vascular anomaly of small intestine. In this case, intraoperative enteroscopy seems to be the last trump card for OGIB, especially for large amount loss of blood. It not only helped to find the obscure cause for bleeding, but also preserved the small intestine.

An application study-subjective cognitive decline Questionnaire9 in detecting mild cognitive impairment (MCI).

Objective: Subjective cognitive decline (SCD) complaints as the early manifestation of mild cognitive impairment (MCI) may be harbingers of objective cognitive decline. SCD-questinnaire9 (SCD-Q9) is developed to investigate the early sign for MCI. However, few studies have reported its power for discriminating MCI from healthy controls (HCs). Therefore, this study aims to investigate the discrimination power of SCD-Q9 as a brief screening tool for early detection of SCD in MCI.Methods: 84 HCs and 205 people with MCI were recruited. Their demographic information and scores of SCD-Q9 were compared. A binary logistic regression model was used to analyze the potential affecting factors of MCI, and the Receiver Operating Characteristic analysis was applied to test the discrimination powers of those factors, including SCD-Q9.Results: (1) Single and total scores of SCD-Q9 were all lower in the MCI group than those in the HC group. (2) Ageing, lower education and higher total scores of SCD-Q9 were associated with MCI. (3) Area Under the Curves (AUC) of SCD-Q9 for discriminating MCI from HC group was 0.815 and when integrating age and education, the AUC improved slightly and reached 0.839. Additionally, the sensitivity and specificity were 68.8% and 85.7%, respectively when a cut-off value of 3 was applied. Conclusions: SCD-Q9 may be able to detect the subjective cognitive decline in MCI early, but it may be used together with other screening questionnaires to improve its sensitivity and further verification of its power is needed.

Prevalence and Factors Associated with Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in Children.

BACKGROUND: Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). AIM: To assess the prevalence and factors associated with post-ERCP pancreatitis (PEP) in a Chinese pediatric population. METHODS: Sixty-six children who underwent ERCP between March 2018 and March 2019 at Shanghai Children's Medical Center were retrospectively recruited for the study. Clinical data, including demographics, indications, comorbidities, and procedural data, were reviewed to identify the prevalence and factors associated with PEP. RESULTS: Ninety-two ERCPs were performed on 66 pediatric patients aged from 8 months to 14 years. The indications for ERCP were chronic pancreatitis (49, 53.2%), pancreaticobiliary maljunction (19, 20.7%), pancreas divisum (19, 20.7%), and pancreatic pseudocyst (5, 5.4%). All ERCPs were performed for therapeutic purposes. PEP was identified in 19 (20.7%) patients; there were ten mild cases, eight moderate cases, and one severe case. The univariate analysis revealed that a history of chronic pancreatitis was negatively associated with PEP (P = 0.033), and sphincterotomy was positively associated with PEP (P = 0.01). The multivariate analysis showed that sphincterotomy was a risk factor for PEP (P = 0.017, OR 4.17; 95% CI, 1.29, 13.54). CONCLUSIONS: Our data revealed a high prevalence of PEP in a Chinese pediatric population. Chronic pancreatitis was a protective factor, and sphincterotomy was a risk factor for PEP development.

A meta-analysis of efficacy of topical steroids in eosinophilic esophagitis: From the perspective of histologic, clinical, and endoscopic outcome.

BACKGROUND: Swallowed topical steroids are a mainstay drug therapy for eosinophilic esophagitis (EoE), studies have demonstrated good histologic response, but with enormous discrepancy in clinical and endoscopic improvement. We conducted this meta-analysis to investigate the efficacy of topical steroids in EoE in histological, clinical and endoscopic improvement. METHODS: Several databases were searched from inception to August 1, 2019 for randomized controlled trials (RCTs) comparing topical steroids with placebo for EoE in the short-term. The outcomes of interest mainly included basic characteristics of the studies, histologic, clinical, endoscopic response rate and adverse events. The results were pooled together using Reviewer Manager 5.3.5 software, and inconsistency was quantified using I2 statistics. RESULTS: Nine studies were eventually selected. The results showed that topical steroids were effective in inducing histologic response compared with placebo for both complete (OR 35.82, 95% CI 14.98-85.64, P<0.0001; I2=0, P=0.72) and partial response (OR 28.44, 95% CI 8.56-94.47, P<0.0001; I2=70%, P=0.0009). Moreover, topical steroids were useful in gaining clinical response (OR 2.53, 95% CI 1.14-5.60, P=0.02; I2=60%, P=0.02) and endoscopic response (OR 3.51, 95% CI 1.47-8.36, P=0.005; I2=0, P=0.57). Generally, topical steroids are well tolerated. The most common adverse events are infections and infestations (59 cases). CONCLUSION: Topical steroids were effective in inducing histological, clinical and endoscopic response in the short-term, and the adverse events were almost tolerable; however, we should interpret the result of clinical and endoscopic response with caution.

Overexpression of eukaryotic initiation factor 5A2 (EIF5A2) is associated with cancer progression and poor prognosis in patients with early-stage cervical cancer.

AIMS: As one of the only two isoforms of the eukaryotic initiation factor (EIF)5A family, EIF5A2 plays an important role in tumour progression and prognosis evaluation. The aim of this study was to investigate EIF5A2 expression in International Federation of Gynecology and Obstetrics (FIGO) stage I-II cervical cancer and to evaluate its clinical significance. METHODS AND RESULTS: The mRNA and protein expression levels of EIF5A2 were analysed in 20 tissue samples of FIGO stage I-II cervical cancer and paired surrounding non-tumour cervical tissues by real-time polymerase chain reaction and western blot analysis. Immunohistochemistry was performed to examine EIF5A2 protein expression in paraffin-embedded tissues from 314 patients with cervical cancer. The mRNA and protein expression levels of EIF5A2 were significantly elevated in tumour tissues. The increased EIF5A2 expression was correlated with higher FIGO stage (P < 0.001), deep cervical stromal invasion (P = 0.026), lymphovascular space involvement (P = 0.002), pelvic lymph node metastasis (P < 0.001) and postoperative recurrence (P < 0.001) in patients with cervical cancer. Patients with tumours showing high EIF5A2 expression had a poorer survival time than those with normal EIF5A2 expression, especially the patients with negative pelvic lymph nodes and FIGO stage II. In addition, multivariate Cox analysis showed that high EIF5A2 expression was an independent prognostic factor for overall survival [hazard ratio 1.949; 95% confidence interval (CI) 1.116-3.404; P = 0.019] and disease-free survival (hazard ratio 1.980; 95% CI 1.189-3.297; P = 0.009). CONCLUSIONS: EIF5A2 overexpression may contribute to cancer progression and poor prognosis. Therefore, EIF5A2 could be a novel potential prognostic marker for FIGO stage I-II cervical cancer.

Transcriptomic analysis reveals the crosstalk between type 2 diabetes and chronic pancreatitis.

Background and Aims: Mounting evidence highlights a strong association between chronic pancreatitis (CP) and type 2 diabetes (T2D), although the exact mechanism of interaction remains unclear. This study aimed to investigate the crosstalk genes and pathogenesis between CP and T2D. Methods: Transcriptomic gene expression profiles of CP and T2D were extracted from Gene Expression Omnibus, respectively, and the common differentially expressed genes (DEGs) were subsequently identified. Further analysis, such as Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), protein-protein interaction, transcription factors (TFs), microRNA (miRNAs), and candidate chemicals identification, was performed to explore the possible common signatures between the two diseases. Results: In total, we acquired 281 common DEGs by interacting CP and T2D datasets, and identified 10 hub genes using CytoHubba. GO and KEGG analyses revealed that endoplasmic reticulum stress and mitochondrial dysfunction were closely related to these common DEGs. Among the shared genes, EEF2, DLD, RAB5A, and SLC30A9 showed promising diagnostic value for both diseases based on receiver operating characteristic curve and precision-recall curves. Additionally, we identified 16 key TFs and 16 miRNAs that were strongly correlated with the hub genes, which may serve as new molecular targets for CP and T2D. Finally, candidate chemicals that might become potential drugs for treating CP and T2D were screened out. Conclusion: This study provides evidence that there are shared genes and pathological signatures between CP and T2D. The genes EEF2, DLD, RAB5A, and SLC30A9 have been identified as having the highest diagnostic efficiency and could be served as biomarkers for these diseases, providing new insights into precise diagnosis and treatment for CP and T2D.

APOE ε4 Allele Distribution and Association With Scores of Subjective Cognitive Decline Questionnaire 9 in a Large Chinese Memory Clinic Cohort.

Background: Previous reports on APOE ε4 allele distribution in different populations have been inconclusive. The Subjective Cognitive Decline-Questionnaire 9 (SCD-Q9) was developed to identify those at risk of objective cognitive impairment [OCI; including mild cognitive impairment (MCI) and dementia groups), but its association with APOE ε4 and discriminatory powers for SCD with subtle cognitive decline (SCDs) and OCI in memory clinics are unclear. Objectives: To investigate demographic distribution of APOE ε4, its association with SCD-Q9 scores, and its ability to discriminate SCDs and OCI groups from normal control (NC). Methods: A total of 632 participants were recruited (NC = 243, SCDs = 298, OCI = 91). APOE ε4 allele distribution and association with SCD-Q9 scores were calculated and the effects on cognitive impairment were analyzed. Receiver operating characteristic (ROC) analysis was applied to identify discriminatory powers for NC, SCDs, and OCI. Results: Total APOE ε4 frequency was 13.1%. This did not vary by demography but was higher in patients with OCI. The SCD-Q9 scores were higher in APOE ε4 carriers than non-carriers in the OCI group. The area under the curve (AUC) for discriminating from OCI using APOE ε4 were 0.587 and 0.575, using SCD-Q9 scores were 0.738 and 0.571 for NC and SCDs groups, respectively. When we combined APOE ε4 and SCD-Q9 scores into the model, the AUC increased to 0.747 for discriminating OCI from NC. However, when OCI group was split into MCI and dementia groups, only total SCD-Q9 score was the independent affecting factor of MCI. Conclusion: This study demonstrated that the distribution of APOE ε4 alleles did not vary with different demographic characteristics in a large-scale cohort from a memory clinic. APOE ε4 alleles may be associated with scores of SCD-Q9 reflecting the degree of cognitive complaints but their additional contribution to SCD-Q9 scores is marginal in discriminating between NC, SCDs, and OCI.

The reliability and validity test of subjective cognitive decline questionnaire 21 with population in a Chinese community.

BACKGROUND: Subjective cognitive decline-questionnaire 9 (SCD-Q9) was developed to detect SCD complaints at risk of mild cognitive impairment (MCI). However, our previous findings indicated that its coverage might be insufficient. To test this hypothesis, we recently translated SCD-Q21. OBJECTIVE: To examine the reliability and validity of this translated SCD-Q21 and to explore its effectiveness for discriminating MCI from controls. METHODS: Item analysis was performed to understand its item discrimination and homogeneity. The Cronbach's α and Spearman-Brown's split-half coefficients were calculated to test its reliability. The Kaiser-Meyer-Olkin (KMO) value, Bartlett's sphericity test, and exploratory factor analysis (EFA) were used to examine its construct validity. The content validity was evaluated using five-grade Likert scale. Finally, the SCD-Q21 scores in MCI and controls were compared. RESULTS: The difference of each item between the extreme groups was significant. The Cronbach's α coefficient was .913 and Spearman-Brown's split-half coefficient was .894. When performing holding one-out approach, the Cronbach's α coefficient ranged from .906 to .914. The KMO value was .929 and the difference of Bartlett's Sphericity test was significant. All experts scored 5 points when assessing its content. Finally, a significant difference of score was found between MCI and NC groups. CONCLUSIONS: The reliability and validity of the SCD-Q21 are good, which may pave a way for its application in a wider Chinese-speaking population.

Caffeine intake improves the cognitive performance of patients with chronic kidney disease.

Objective: Cognitive impairment is a common complication of chronic kidney disease (CKD). Caffeine intake has been reported to improve cognitive performance in several studies. However, whether the benefits of caffeine intake on cognitive function apply to patients with CKD remains unknown. Methods: We performed a retrospective cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES). The data of CKD subjects and non-CKD subjects from NHANES 2011-2014 were analyzed. Propensity score matching (PSM) was performed based on age, sex, diabetes, cancer, educational level, energy intake and protein intake to select subjects. The Consortium to Establish a Registry for Alzheimer's Disease Word Learning Test (CERAD-WL), the CERAD Word List Recall Test (CERAD-DR), the Animal Fluency Test (AF) and the Digit Symbol Substitution Test (DSST) were used, whereby the occurrence of cognitive impairment was identified. Logistic regression models were performed to evaluate the association between caffeine intake and cognitive performance in CKD and non-CKD participants. Stratified analyses according to the stage of CKD and the urinary albumin/creatinine ratio levels were performed. Plot curves were then generalized to present a non-linear relationship, and the inflection point for each non-linear model was obtained by using a recursive algorithm. Results: Cognitive impairment was more prevalent in CKD patients than in non-CKD subjects. For CKD patients, caffeine intake was associated with higher CERAD-WL, CERAD-DR, AF and DSST scores. For non-CKD subjects, caffeine intake was associated with higher DSST scores only. Subgroup analysis revealed that caffeine only benefited the cognitive function of patients with CKD stages 2 and 3. The analysis showed non-linear relationships of caffeine intake and cognitive function for both CKD and non-CKD subjects. The inflection point of caffeine intake for CKD patients was 279 mg/day. Conclusion: The recommended dose of caffeine intake to improve the cognitive function of CKD patients is ≤279 mg/day.

The efficacy and safety of transcutaneous auricular vagus nerve stimulation in patients with mild cognitive impairment: A double blinded randomized clinical trial.

BACKGROUND: There are 9.9 million new cases of dementia in the world every year. Short-term conversion rate from mild cognitive impairment (MCI) to dementia is between 20% and 40%, but long-term in 5-10 years ranges from 60% to 100%. It is particularly important to prevent or prolong the development of MCI into dementia. Both auriculotherapy and vagus nerve stimulation are effective on improving cognitive functions. However, there is no double blinded randomized clinical trial to support the effectiveness of transcutaneous electrical stimulation of auricular acupoints in patients with MCI. METHODS: This randomized controlled trial involved patients with MCI, aged from 55 to 75 years old. Patients were randomly allocated to transcutaneous auricular vagus nerve stimulation (taVNS) group or sham taVNS group. In the taVNS group, two auricular acupoints were stimulated, including heart (concha, CO15) and kidney (CO10), which are in the distribution of vagus nerve. While in the sham taVNS group, two other auricular acupoints were stimulated, including elbow (scaphoid fossa, SF3) and shoulder (SF4,5), which are out of the distribution of vagus nerve. The primary outcome was the Montreal cognitive assessment-basic, MOCA-B. The secondary outcomes included auditory verbal learning test-HuaShan version (AVLT-H), shape trails test A&B (STT-A&B), animal fluence test (AFT), Boston naming test (BNT), Pittsburgh sleep quality index (PSQI), rapid eye movement sleep behavior disorder screening questionnaire (RBDSQ), Epworth sleepiness scale (ESS) and functional activities questionnaire (FAQ). These outcome measures were taken at baseline, 24 weeks later. RESULTS: After 24 weeks of intervention, the data of 52 patients were intended for analysis. After intervention, there was significant difference in the overall scores of MoCA-B between taVNS group and sham taVNS group (p = 0.033 < 0.05). In taVNS group, compared with before intervention, the overall scores of MOCA-B increased significantly after intervention (p < 0.001). As for N5 and N7, the two sub-indicators of AVLT-H, in taVNS group, compared with before intervention, both N5 and N7 increased significantly after intervention (both ps < 0.001). As for STTB, in taVNS group, compared with before intervention, STTB was significantly reduced after intervention (p = 0.016). For BNT, in taVNS group, compared with before intervention, BNT increased significantly after intervention (p < 0.001). In taVNS group, compared with before intervention, PSQI, RBDSQ, ESS and FAQ decreased significantly after intervention (p = 0.002, 0.025, <0.001, 0.006 respectively). 1 patient with a history of tympanic membrane perforation in taVNS group was reported with mild adverse reactions which disappeared a week after termination of taVNS. The intervention of taVNS is effective on increasing the overall scores of MoCA-B, N5 and N7. CONCLUSION: The clinical trial demonstrated that taVNS can improve cognitive performance in patients with MCI. This inexpensive, effective and innovative method can be recommended as a therapy for more patients with MCI in the prevention or prolonging of its development into dementia, but it is still required to be further investigated. TRIAL REGISTRATION: http://www.chictr.org.cn. (ID: ChiCTR2000038868).

Usefulness of an algorithm for endoscopic retrieval of proximally migrated 5Fr and 7Fr pancreatic stents.

BACKGROUND: Proximal migration of pancreatic stent (PMPS) is an infrequent event but its management can be technically challenging and there are no standard retrieval methods. This study aimed to determine the results of an endoscopic stent retrieval algorithm in terms of feasibility and efficacy of the endoscopic procedure. METHODS: During the period from January 2008 to December 2009, 15 patients (8 women and 7 men with a mean age of 51.9 years) with PMPS were included in this study. Stent retrieval was approached initially with balloon extraction followed by rat-tooth forceps and basket. A rescue approach such as using a stent retriever was attempted when other approaches failed. RESULTS: All the PMPSs (six 5Fr, nine 7Fr) were retrieved successfully within one ERCP session. Balloon extraction was successful in 9 (60%) patients. In the 6 failed cases of balloon extraction, wire-guided rat-tooth forceps grasp was successful in 4, and stone extraction basket grasp was successful in 1 in whom forceps grasp failed. One stent was finally rescued with a stent retriever when balloon extraction, forceps and basket grasp all failed. In patients with successful balloon extraction, 44.4% (4/9) developed post-ERCP hyperamylasemia but none of them developed post-procedure pancreatitis. CONCLUSIONS: With this algorithm, 5Fr and 7Fr PMPS were successfully retrieved in all of the patients. Most PMPSs can be safely retrieved with the commonly-used approaches in this study. Those less used approaches can be used as a rescue method.

Comparing the predictive values of five scales for 4-year all-cause mortality in critically ill elderly patients with sepsis.

BACKGROUND: Several severity scales have been documented to predict the short-term mortality of septic patients. However, the predictive efficacies of different severity scales in the long-term mortality of the elderly have yet to be evaluated. METHODS: In the retrospective study, a cohort of 4,370 elderly (≥65 years) septic patients admitted to the intensive care unit (ICU) were divided into three different age groups, i.e., the younger-old group (65 years ≤ age <75 years), the older-old group (75 years ≤ age <85 years) and the oldest-old group (age ≥85 years). Five scales, including the Simplified Acute Physiology Score II (SAPS II), the Oxford Acute Severity of Illness Score (OASIS), the Modified Logistic Organ Dysfunction System (MLODS), the Systemic Inflammatory Response Syndrome (SIRS) and Sequential Organ Failure Assessment (SOFA), were used for disease severity evaluations. The Kaplan-Meier survival curve, and the area under the receiver operating characteristic curve (AUC) were used to assess prognostic values of the long-term mortality of each severity scale. RESULTS: Compared with patients in the oldest-old group, those in the younger-old and the older-old groups had higher scores of SAPS II and OASIS, indicating more serious illness and worse prognosis. The survival time of patients was inversely related to age; the mean survival time was the longest in the youngerold group, followed by the older-old group and the oldest-old group. SAPS II had the best prognostic value (AUC: 0.648 for SAPS II, 0.579 for MLODS, 0.577 for SOFA, 0.612 for OASIS and 0.515 for SIRS, P<0.01) for the 4-year all-cause mortality. Elderly patients with an SAPS II score >43 had a lower survival rate regardless of age. CONCLUSIONS: The long-term mortality of elderly patients with sepsis is increased with age. SAPS II can better predict the long-term prognosis of elderly septic patients in ICU.

Does precut technique improve selective bile duct cannulation or increase post-ERCP pancreatitis rate? A meta-analysis of randomized controlled trials.

BACKGROUND: There is no clear answer regarding use of precut technique versus conventional method in achieving successful biliary cannulation. OBJECTIVE: To compare the effectiveness of precut technique with that of conventional biliary cannulation by meta-analysis of available randomized controlled trials (RCTs). METHODS: Databases including MEDLINE, EMBASE, Cochrane Library, and Science Citation Index updated to July 2009 were searched. Main outcome measures were success rates of biliary cannulation, incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) complications, and post-ERCP pancreatitis rate. Meta-analysis of these clinical trials was performed. RESULTS: Six RCTs were included. The primary biliary cannulation rate reported with precut and conventional techniques was 89.3 and 78.1%, respectively. Pooled analysis of all selected studies comparing precut cannulation technique with conventional techniques yielded an odds ratio (OR) of 2.05 [95% confidence interval (CI): 0.64-6.63]. Pooled analysis comparing post-ERCP pancreatitis rates for the precut-cannulation groups with those for the conventional-method groups yielded an rate ratio (RR) of 0.46 (95% CI: 0.23-0.92). CONCLUSION: This meta-analysis shows that the precut technique does not increase the primary cannulation rate. However, the technique reduces the risk of post-ERCP pancreatitis compared with conventional technique. Further large, well-performed, randomized controlled studies are needed to confirm these findings.

Red blood cell distribution width predicts long-term mortality in critically ill patients with acute kidney injury: a retrospective database study.

Acute kidney injury (AKI) is a serious complication in the intensive care unit (ICU), which may increase the mortality of critically ill patients. The red blood cell distribution width (RDW) has proved useful as a predictor of short-term prognosis in critically ill patients with AKI. However, it remains unknown whether RDW has a prognostic value of long-term all-cause mortality in these patients. The data of 18279 critically ill patients with AKI at first-time hospital admission were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. The tertiles of the RDW values were used to divide subjects into three groups, namely RDW < 13.6% for the low RDW group, 13.6% ≤ RDW < 15.2% for the middle RDW group and RDW ≥ 15.2% for the high RDW group. Demographic data, mortality, 4-year survival time and severity scale scores were compared among groups. The Kaplan-Meier analysis and the Cox regression analysis were performed to assess the impact of RDW on all-cause mortality in AKI patients. The receiver operating characteristic (ROC) curve analysis was done to evaluate the prognostic value of RDW on the long-term outcome of critically ill patients with AKI. The median age of the enrolled subjects was 65.6 years. AKI patients with a higher RDW value had significantly shorter survival time and higher death rate. By the Kaplan-Meier analysis, patients in the higher RDW group presented significantly shorter survival time and higher death rate. The Cox regression model indicated RDW as an independent risk factor of all-cause mortality of AKI patients (HR 1.219, 95% CI, 1.211 to 1.228). By the ROC analysis, RDW appeared more efficient in predicting long-term prognosis as compared with conventional severity scales. The AUC of RDW (95% CI, 0.712 to 0.725) was significantly higher than other severity scale scores. In conclusion, RDW is positively correlated to survival time of 4-year follow-up in critically ill patients with AKI, and RDW is an independent prognostic factor of long-term outcomes of these patients.

Demographic characteristics and neuropsychological assessments of subjective cognitive decline (SCD) (plus).

BACKGROUND: Since SCD (plus) was standardized, little is known about its demographic characteristics and its outcomes of neuropsychological assessments, including the SCD questionnaire 9 (SCD-Q9). OBJECTIVE: To characterize SCD (plus) by comparing the neuropsychological features among its subgroups and with normal controls (NC). Also, to explore its demographics and to understand the relation of the chief complaints and the scores of SCD-Q9. METHODS: Multistage stratified cluster random sampling was conducted to select participants. As a result, 84 NC and 517 SCD (plus) were included. SCD (plus) was further classified into several subgroups (SCD-C: concerned cognitive decline; SCD-F: complaints about SCD within the past five years; SCD-P: feeling performance being not as good as their peers; SCD+: presented> 3 of SCD (plus) features; SCD-: presented ≤ 3 of SCD (plus) features (see the diagnostic criteria for the details)) and between-group comparisons of neuropsychological scores were conducted. Point-biserial correlation and binary logistic regression analyses were performed to investigate the demographic characteristics of its subgroups. Finally, Spearman correlation was used to better understand the relation of SCD (plus) to SCD-Q9. RESULTS: (1) Scores of AVLT-LR (AVLT-LR: Auditory Verbal Learning Test-Long Delayed Recall) and MoCA-B (MoCA: Montreal Cognitive Assessment-Basic) were lower in the SCD-P group than those in the NC group, and the SCD+ group scored lower in the MoCA-B and CDT(CDT: Clock Drawing Test) than the SCD- group. (2) Females were more concerned than male participants. Individuals with lower education level felt that their cognitive performance were worse than their peers. Also, younger people might express concerns more than the more elderly. People who had complaints of SCD-P might be more likely to report SCD-C, but less likely to report SCD-F. (3) Positive correlations were found between the chief complaints of SCD (plus) and some items of SCD-Q9. CONCLUSIONS: SCD (plus) may be related to demographic factors. Individuals with SCD (plus) already exhibited cognitive impairment, which can be detected by SCD-Q9.

Prevalence of musculoskeletal symptoms among industrial employees in a modern industrial region in Beijing, China.

BACKGROUND: Growing industrialization of China exposes its labor population to the risk of musculoskeletal disorders (MSDs). This study aimed to investigate the prevalence and risk factors of MSDs in a modern industrial region of Beijing. METHODS: A cross-sectional study included 1415 employees in six industrial companies was conducted between January 2018 and May 2018 in Fangshan district, Beijng, China. Nordic Musculoskeletal Questionnaire (NMQ) was used to collect the information about MSDs. Demographic factors, lifestyle factors, health and medical factors, and work-related factors were collected as independent variables. Descriptive statistics, the chi-squared (χ) test, and binary logistic regression analysis were used to analyze data. RESULTS: Among 1415 participants, 498 reported MSDs. The regions involved were the neck (25.16%), shoulders (17.17%), and upper back (13.29%). There was a significant statistical difference between frontline industrial workers and other staff in the prevalence of self-reported symptoms involving the shoulders (χ = 4.33, P = 0.037), wrists and hands (χ = 8.90, P = 0.003), and ankles and feet (χ = 12.88, P < 0.001). Increased age (P = 0.005, OR = 1.63; P = 0.001, OR = 2.33), a high or a low salary (P < 0.001, OR = 0.49; P < 0.001, OR = 0.30), night-shift (P = 0.027, OR = 1.46), two-week-history of illness and treatment (P = 0.004, OR = 5.60; P = 0.013, OR = 4.19), concurrent chronic diseases (P = 0.001, OR = 3.45; P = 0.092, OR = 7.81), limited access to health information (P = 0.004, OR = 0.49), and negative attitude towards seeking healthcare (P = 0.010, OR = 1.77; P = 0.009, OR = 2.75) were associated with MSDs in frontline workers. Female gender (P < 0.001, OR = 2.30), high education (P = 0.001, OR = 1.96), no exercises (P = 0.027, OR = 0.59), night-shift (P = 0.017, OR = 1.98), concurrent chronic diseases (P = 0.002, OR = 3.73; P = 0.020, OR = 13.42), limited access to health information (P = 0.013, OR = 0.53), far distance to medical institution (P = 0.009, OR = 1.83), and negative propensity (P = 0.009, OR = 1.94; P = 0.014, OR = 2.74) were associated with MSDs in other staffs. CONCLUSIONS: The prevalence of MSDs among industrial employees has changed. Frontline workers had different prevalence and risk factors for MSDs compared with other employees. Negative propensity to healthcare, limited ways to obtain health knowledge, and concomitant chronic diseases were associated with MSDs. Surprisingly, highly educated and high-income employees had a higher risk of MSDs.

Risk Factors and Neuropsychological Assessments of Subjective Cognitive Decline (plus) in Chinese Memory Clinic.

BACKGROUND: Since subjective cognitive decline (SCD) was standardized in 2014, many studies have investigated its features. However, the risk of SCD (plus) progressing to AD is much higher, and yet there have been few studies reporting the risk factors and neuropsychological assessment characteristics of SCD (plus). OBJECTIVE: To characterize SCD (plus) by comparing it with normal control (NC), amnesic mild cognitive impairment (aMCI), and Alzheimer Disease (AD) regarding their demographics, lifestyle, family history of dementia, multimorbidity and the neuropsychological assessments. METHODS: A total of 135 participants were recruited, including 23 NC, 30 SCD (plus), 45 aMCI and 37 AD. Descriptive statistics were provided. A logistic regression model was used to analyze the affecting factors of SCD (plus), and finally the Receiver Operating Characteristic (ROC) analysis was applied to distinguish between SCD (plus) and NC. RESULTS: (1) SCD (plus) group was younger than both the aMCI group and AD group. It consisted of more participants with mental work and higher body mass index (BMI) than the AD group. (2) Scores of Auditory Verbal Learning Test - Immediate recall (AVLT-IR) and AVLT-Long delayed recall (AVLT-LR) decreased in the following order: NC→SCD (plus)→aMCI→AD. (3) The Area Under Curve (AUC) for discriminating SCD (plus) and NC group was from 0.673 to 0.838. CONCLUSION: Aging is an important risk factor of both NC progressing to SCD (plus), and SCD (plus) progressing to aMCI or AD. In addition to aging, lower education level and lower BMI were significantly associated with greater odds of SCD (plus) progressing to aMCI or AD patients, whereas mental work was a protective factor of SCD (plus) progressing to AD. Finally, AVLT is a sensitive indicator of the cognitive decline and impairment in SCD (plus) in relative to normal controls.

Prevalence, Risk Factors, and Complaints Screening Tool Exploration of Subjective Cognitive Decline in a Large Cohort of the Chinese Population.

BACKGROUND: Substantial studies have reported the prevalence and the affecting factors of subjective cognitive decline (SCD). The complaints screening scale has also been used for probing. However, little is known in China. OBJECTIVE: To investigate the prevalence and risk factors of SCD, and explore an SCD complaints screening scale in China. METHODS: Stratified cluster random sampling was conducted. 2,689 residents aged 60-80 years completed questionnaire 1. 814 residents were included for clinical and neuropsychological evaluations. Two standards were used to make the diagnosis of mild cognitive impairment (MCI) and SCD, and a preliminary screening rate comparison was carried out. Finally, we assessed the risk factors of SCD and the correlation between the SCD-questionnaire 9 (SCD-Q9) and the Auditory Verbal Learning Test-Long Delay Free Recall (AVLT-LR). RESULTS: 1) Standard 1 (ADNI2): the prevalence of SCD was 18.8% (95% CI = 14.7-22.9%) and zero conformed to six criteria (SCD plus). 2) Standard 2 (Jak/Bondi): the prevalence of SCD was 14.4% (95% CI = 10.7-18.1%). 3) Standard 1 had a relatively higher "false" positive rate, whereas Standard 2 had higher "false" negative rate. 4) Age, low education, fewer close friends, and daily drinking were independent risk factors for SCD progressing to MCI. 5) Total points of SCD-Q9 were negatively correlated to the value of AVLT-LR. CONCLUSIONS: The prevalence of SCD is high in the ShunYi District in Beijing, China. Age, low education, less social support, and daily drinking are independent risk factors. The brief SCD-Q9 can be used as a reference.

A meta-analysis of efficacy of topical steroids in eosinophilic esophagitis: From the perspective of histologic, clinical, and endoscopic outcome / Un metaanálisis de eficacia de los esteroides tópicos en la esofagitis eosinofílica desde la perspectiva del resultado histológico, clínico y endoscópico

Background: Swallowed topical steroids are a mainstay drug therapy for eosinophilic esophagitis (EoE), studies have demonstrated good histologic response, but with enormous discrepancy in clinical and endoscopic improvement. We conducted this meta-analysis to investigate the efficacy of topical steroids in EoE in histological, clinical and endoscopic improvement. Methods: Several databases were searched from inception to August 1, 2019 for randomized controlled trials (RCTs) comparing topical steroids with placebo for EoE in the short-term. The outcomes of interest mainly included basic characteristics of the studies, histologic, clinical, endoscopic response rate and adverse events. The results were pooled together using Reviewer Manager 5.3.5 software, and inconsistency was quantified using I2 statistics. Results: Nine studies were eventually selected. The results showed that topical steroids were effective in inducing histologic response compared with placebo for both complete (OR 35.82, 95% CI 14.98–85.64, P<0.0001; I2=0, P=0.72) and partial response (OR 28.44, 95% CI 8.56–94.47, P<0.0001; I2=70%, P=0.0009). Moreover, topical steroids were useful in gaining clinical response (OR 2.53, 95% CI 1.14–5.60, P=0.02; I2=60%, P=0.02) and endoscopic response (OR 3.51, 95% CI 1.47–8.36, P=0.005; I2=0, P=0.57). Generally, topical steroids are well tolerated. The most common adverse events are infections and infestations (59 cases). Conclusion: Topical steroids were effective in inducing histological, clinical and endoscopic response in the short-term, and the adverse events were almost tolerable; however, we should interpret the result of clinical and endoscopic response with caution.(AU)

Antecedentes: Los esteroides tópicos tragados son una terapia farmacológica principal de la esofagitis eosinofílica (EoE). Algunos estudios han demostrado una buena respuesta histológica, aunque con gran discrepancia en la mejora clínica y endoscópica. Hemos realizado este metaanálisis para investigar la eficacia de los esteroides tópicos en EoE en la mejora histológica, clínica y endoscópica. Métodos: Se buscaron varias bases de datos desde el inicio hasta el 1 de agosto de 2019 para ensayos controlados aleatorios comparando esteroides tópicos con placebo para EoE a corto plazo. Los resultados de interés incluyeron principalmente características básicas de los estudios, histológicas, clínicas, tasa de respuesta endoscópica y eventos adversos. Los resultados se agruparon mediante el software de Reviewer Manager 5.3.5, y la incoherencia se cuantificó mediante estadísticas I2. Resultados: Nueve estudios fueron finalmente seleccionados. Los resultados mostraron que los esteroides tópicos fueron eficaces en la inducción de la respuesta histológica en comparación con placebo tanto para la respuesta completa (OR 35,82; IC 95%: 14,98-85,64; p<0,0001; I2 0, p=0,72) como para la parcial (OR 28,44; IC 95%: 8,56-94,47; p<0,0001; I2 70%, p=0,0009). Los esteroides tópicos también fueron útiles en la obtención de respuesta clínica (OR 2,53; IC 95%: 1,14-5,60; p=0,02; I2 60%; p=0,02) y respuesta endoscópica (OR 3,51; IC 95%: 1,47-8,36; p=0,005; I2 0; p=0,57). Los esteroides tópicos suelen ser bien tolerados. Los acontecimientos adversos más frecuentes son infecciones e infestaciones (59 casos). Conclusión: Los esteroides tópicos fueron eficaces en la inducción de la respuesta histológica, clínica y endoscópica a corto plazo, y los eventos adversos fueron tolerables; sin embargo, debemos interpretar con precaución el resultado de la respuesta clínica y endoscópica.(AU)