Depression and Anxiety Mediate the Association between Sleep Quality and Self-Rated Health in Healthcare Students.

OBJECTIVES: This study aimed to investigate factors associated with sleep quality in healthcare students and to determine whether depressive and anxiety symptoms may explain some of the associations between sleep quality and self-rated health. STUDY DESIGN: This is a cross-sectional study at wave one. METHODS: A total of 637 healthcare students were recruited via a stratified random sampling method in Hangzhou, China. The Sleep Quality Questionnaire (SQQ) and the four-item Patient Health Questionnaire (PHQ-4) were used to assess sleep quality and depressive and anxiety symptoms, respectively. Self-rated health was assessed via a self-developed questionnaire of both physical and psychological health. Structural equation modeling was used to examine the direct and indirect effects of sleep quality on self-rated health through depressive and anxiety symptoms. RESULTS: Students engaged in part-time employment (p = 0.022), with poor perceived employment prospects (p = 0.009), and who did not participate in recreational sports (p = 0.008) had worse sleep quality. Structural equation modeling revealed a significant total effect of sleep quality on self-rated health (b = 0.592, p < 0.001), a significant direct effect of both sleep quality and depressive and anxiety symptoms on self-rated health (b = 0.277, 95% CI: 0.032-0.522), and a significant indirect effect of sleep quality on self-rated health through depressive and anxiety symptoms (b = 0.315, 95% CI: 0.174-0.457). CONCLUSIONS: Depressive and anxiety symptoms partially explain the association between sleep quality and self-rated health. Intervening upon sleep quality, depressive, and anxiety symptoms may bolster the self-rated health of healthcare students.

Palladium-Catalyzed Alkenyl C-H Activation/Diamination toward Tetrahydrocarbazole and Analogs Using Hydroxylamines as Single-Nitrogen Sources.

A palladium-catalyzed alkenyl C-H activation/diamination reaction of cycloalkenyl bromoarenes with hydroxylamines is described. A wide range of tetrahydrocarbazoles and analogs has been prepared using fine-tuning bifunctional secondary hydroxylamines as the single-nitrogen sources. Mechanistic investigations suggest that the selective alkenyl C-H activation/diamination cascade process should build the N-heterocycles.

Periodontitis and Number of Teeth in the Risk of Coronary Heart Disease: An Updated Meta-Analysis.

BACKGROUND A positive link between periodontitis and chronic systemic disease has been indicated. However, few studies focused on the loss of teeth. Our analysis aims to analyze the relationship of periodontitis and number of teeth with the risk of coronary heart disease (CHD). MATERIAL AND METHODS A meta-analysis was conducted on qualified data extracted from the PubMed, Embase, and Cochrane Library databases. Only cohort studies were included in this study. We screened articles that assessed the periodontal condition and teeth number as well as the incidence or mortality of CHD. Hazard ratio (HR) and relative risk (RR) were calculated by Stata SE software. RESULTS A total of 11 prospective studies with over 200 000 total participants were analyzed. Ten studies reported on periodontitis and CHD, and 4 studies included data on number of teeth. After adjusting for multivariate factors, there was a significant association between periodontitis and the risk of CHD (RR, 1.18; 95% confidence interval [CI], 1.10-1.26); the RR of CHD in the edentulous population was 1.20 (95% CI, 1.08-1.34). Moreover, results on the RR values for number of teeth were as follows: 24-17 teeth (RR, 1.12; 95% CI, 1.05-1.19); 16-11 (RR, 1.28; 95% CI, 1.15-1.42); and £10 (RR, 1.55; 95% CI, 1.43-1.69). CONCLUSIONS Our study showed that periodontitis is a risk factor for CHD and that the number of removed teeth is positively correlated with the risk of CHD. During clinical assessment, both factors need to be considered as factors associated with cardiovascular risks.

Effect of dexmedetomidine on prevention of postoperative nausea and vomiting in pediatric strabismus surgery: a randomized controlled study.

BACKGROUND: Postoperative nausea and vomiting (PONV) are common side-effects following strabismus surgery. The present study aimed to compare the effects of different doses of dexmedetomidine (DEX) on PONV incidence in pediatric patients undergoing strabismus surgery. METHODS: In this prospective randomized double-blinded study, 126 pediatric patients undergoing strabismus surgery were randomized into one of three groups: Placebo group, normal saline; DEX1 group, 0.3 µg/kg dexmedetomidine, and DEX2 group, 0.5 µg/kg dexmedetomidine. Oculocardiac reflex (OCR) events were recorded during surgery. PONV or postoperative vomiting (POV) was recorded for 24 h in the ward. Pediatric anesthesia emergence delirium (PAED) scale and emergence agitation (EA) scale were recorded in the recovery room. RESULTS: Intraoperative OCR was significantly reduced in DEX2 group (42%) as compared to that of Placebo group (68%) (p = 0.0146). During the first 24 h post-op, the overall incidence of PONV was significantly lower in DEX2 group (10%) than that of Placebo group (32%) (p = 0.0142). There was no significant difference in POV among the three groups. PAED or EA scores among the three groups were similar during recovery time. CONCLUSION: Dexmedetomidine (0.5 µg/kg) reduced OCR and PONV without lengthening extubation time or recovery time in pediatric patients undergoing strabismus surgery. TRIAL REGISTRATION: The trial was prospectively registered before patient enrollment at Chinese Clinical Trial Registry (Clinical Trial Number: ChiCTR1800020176, Date: 12/19/2018).

Access to Stereodefined (E)-2-Silylallylboronates via Regioselective Chloroboration of Allenylsilanes.

A catalyst-free method for the highly regioselective chloroboration of allenylsilanes is described. In the presence of BCl3 and 2,6-lutidine, chloroboration of allenylsilanes proceeds smoothly without any catalyst, and the product could be treated with pinacol to afford the corresponding pinacol borates in one-pot reaction. This reaction provides a direct approach to construct valuable 2-silylallylboronate frameworks with operational simplicity and high atom-economy.

Comparison of surgical field visibility during propofol or desflurane anesthesia for middle ear microsurgery.

BACKGROUND: To compare surgical field visibility between patients given propofol/remifentanil (PR) or desflurane/remifentanil (DR) anesthesia. METHODS: A total of 80 adult patients undergoing middle ear microsurgery due to cholesteatoma otitis media with American Society of Anesthesiologists physical status I and II were randomly assigned to the PR or DR groups. The depth of anesthesia was titrated to maintain a Bispectral index (BIS) between 40 and 50. Remifentanil was titrated to maintain the mean blood pressure within ±30% change of the pre-induction value. Surgical field visibility was rated at several timepoints by the surgeons using the Boezaart scores. RESULTS: Average Boezaart scores for surgical field visibility at different time points were < 2 in both PR and DR groups. Surgical field visibility score was lower in the PR group than in the DR group. Requirement for remifentanil was higher in the PR group (850 (488/1330) µg) than in the DR group (258 (143/399) µg, P < 0.0001). The site effect concentration of remifentanil was higher in the PR group (3.6(2.8/5.0)ng/ml) than in the DR group (1.7 (1.0/1.6) ng/ml, P < 0.0001). Hemodynamic profile (i.e., heart rate and mean blood pressure) was similar between groups (P > 0.05). Extubation time (PR group, 21 min vs. DR group, 19 min; P = 0.199) and post-anesthesia care unit time (PR group, 37 min vs. DR group, 34 min; P = 0.324) were comparable between groups. CONCLUSION: Although PR anesthesia resulted in lower surgical field visibility scores than DR anesthesia, both groups had scores < 2, meaning no clinical differences between the two groups. DR provided acceptable operative conditions as well, albeit more remifentanil consumption was noted in the DR group. TRIAL REGISTRATION: China Clinical Research Information Service, ChiCTR-1,800,015,537 . Registered 5 April 2018. Date of enrolment of the first participant to the trial: 2 May 2018.

Quality of recovery in patients undergoing endoscopic sinus surgery after general anesthesia: total intravenous anesthesia vs desflurane anesthesia.

BACKGROUND: For sinus surgery, some centers favor total intravenous anesthesia (TIVA) over inhalation anesthesia. However, whether TIVA affects the patient's perceived quality of recovery remains unclear. This study used the Quality of Recovery-40 questionnaire (QoR-40) to compare patient recovery between surgical patients who received TIVA and those who received desflurane (DES) anesthesia. METHODS: Eighty patients (20 to 65 years old) undergoing endoscopic sinus surgery were prospectively enrolled and randomized to either the TIVA (propofol and remifentanil infusion) or DES (desflurane inhalation and remifentanil infusion) group. The QoR-40 was administered before surgery, at 6 hours after surgery, and on postoperative day 1 (POD1). Incidence of nausea and vomiting, remifentanil consumption, blood loss, and pain treatment were recorded. The influence of lesion extent (indexed as Lund-Mackay [LM] score) on recovery quality was also assessed. RESULTS: Forty patients were randomized into the TIVA group, and 40 patients were randomized into the DES group. The QoR-40 score at 6 hours after surgery was significantly higher in the TIVA group compared with the DES group (188.2 vs 182.6, respectively; p = 0.049), indicating a better quality of recovery in the TIVA group. TIVA resulted in less blood loss (p < 0.0001). A high LM score (≥12) was associated with lower QoR-40 scores at 6 hours after surgery (180.2 vs 187.2, p = 0.028) and on POD1 (181.5 vs 190.3, p = 0.003). CONCLUSION: This study shows that the quality of recovery for endoscopic sinus surgery patients was better with TIVA than with desflurane anesthesia. A high LM score was related to poorer recovery quality.

Dexmedetomidine in combination with sufentanil for postoperative analgesia after partial laryngectomy.

BACKGROUND: Dexmedetomidine as an adjunct with opioids has been confirmed to spare opioids usage and improve analgesia for postoperative pain treatment. Furthermore, dexmedetomidine can attenuate the airway reflex. The aim of this study is to assess the safety and efficacy of dexmedetomidine combined with sufentanil for postoperative analgesia after partial laryngectomy. METHODS: A total of 60 adult male patients were recruited and randomly allocated to receive sufentanil 1.0 µg ml-1 (Group S) or sufentanil 1.0 µg ml-1 plus dexmedetomidine 4 µg ml-1 (Group SD) for postoperative analgesia. The IV patient controlled analgesia (PCA) device was programmed to deliver 1.5 ml per demand with a 10 min lockout interval and 1.5 ml per hour background infusion. Cumulative consumption of sufentanil and pain intensity during 24 hour (h) after surgery were recorded. Coughing episodes per day, sleep quality, hemodynamic and respiratory profiles were measured. RESULTS: Compared with Group S, patients in Group SD required less sufentanil during the 0-24 h postoperative period (p < 0.0001) and reported significant lower pain intensity from the second postoperative hour to the end of the study (P < 0.0001). Daily coughing episodes, sleep disturbance was lower and patients' satisfaction was higher in Group SD (P < 0.05). Decrease in heart rate and mean blood pressure from baseline at 1 h, 2 h, 3 h, 12 h, and 24 h after operation were significantly greater in Group SD (P = 0.00). The incidence of PCA related adverse events were comparable between the two groups. CONCLUSION: Dexmedetomidine/sufentanil combination for postoperatjve analgesia in partial laryngectomized patients resulted in significant sufentanil sparing, better analgesia, reduced frequency coughing episodes, and better sleep quality. TRIAL REGISTRATION: Chinese Clinical Registry (ChiCTR): ChiCTR-TRC-14004618 , date of registration: 08 May 2014.

Effects of a Single Dose Dexmedetomidine on Surgical Field Visibility During Middle Ear Microsurgery: A Randomized Study.

OBJECTIVES: To investigate whether a single dose of dexmedetomidine (DEX) improves surgical field visibility. STUDY DESIGN: Randomized, prospective, double-blind study. SETTING: Tertiary teaching hospital. INTERVENTIONS: ASA I or II patients undergoing tympanoplasty with ossiculoplasty were randomly assigned to receive either 0.8 µg/kg DEX (Group D) or the same volume of saline (Group N) 10 min before anesthesia induction. MAIN OUTCOMES: The primary outcome was the visibility of the surgical field rated by surgeons by Boezaart score. The secondary outcomes were consumption of anesthesia, hemodynamic profiles, and subsequent recovery. RESULTS: Boezaart scores for surgical visibility were lower in Group D than in Group N (1.3 ±â€Š0.8 versus 1.8 ±â€Š0.9, P = 0.014). Minimum alveolar concentrations of sevoflurane (Group D 1 [0.9/1.1] versus Group N 1 [1/1.2], P = 0.018) and remifentanil consumption (Group D 370 [218/504] µg versus Group N 583 [300/1028] µg, P = 0.002) were less in Group D. Except for a transient increase in blood pressure and a decrease in heart rate during DEX infusion, hemodynamic profiles were more stable in Group D than in Group N. More patients needed morphine rescue and presented with postoperative nausea and vomiting in Group N than in Group D (Group D 1 versus Group N 8, P = 0.029). Recovery time was comparable between the two groups (Group D 19 min versus Group N 18 min, P = 0.569). CONCLUSION: Use of a single dose of DEX resulted in improved surgical visibility, less consumption of anesthesia, and more favorable hemodynamic profile while not delaying recovery time.

Cellular MicroRNA Let-7a Suppresses KSHV Replication through Targeting MAP4K4 Signaling Pathways.

BACKGROUND: Kaposi's sarcoma (KS)-associated herpesvirus (KSHV) is the etiologic agent of KS, the most common AIDS-related malignancy. The majority of KS tumor cells harbor latent KSHV virus but only a small percentage undergoes spontaneous lytic replication. Viral reactivation from latency is crucial for the pathogenesis and development of KS, but the cellular mechanisms underlying the switch between viral latency and replication are not well understood. METHODS: The level of let-7 miRNAs and MAP4K4 in KSHV infected 293T cells were quantified by real-time PCRs. Let-7 expression was silenced by the miRNA sponge technique. In let-7a transfected 293T cells, the expression of MAP4K4 was measured by real-time PCR and western blot. Luciferease expression was employed to examine the effect of let-7a on the 3'-untranslated region (UTR) of the MAP4K4 gene in 293T cells. Real-time PCR was used to quantify the KSHV copy numbers in BC-3 cells in which the expression of let-7a and/or MAP4K4 were altered. Finally, ERK, JNK and p38 protein production and their phosphorylation status were detected by western blots in let-7a or MAP4K4 transfected BCBL-1 cells. RESULTS: The expression of microRNA let-7 was dramatically decreased in KSHV infected 293T cells, but that of MAP4K4 was increased significantly. Let-7a is physically associated with and targets the MAP4K4 3'UTR, and inhibits MAP4K4 expression at both mRNA and protein levels. MAP4K4 stimulates KSHV reactivation from latency, whereas let-7a inhibits the function of MAP4K4 by reversing the function of MAP4K4 on JNK, phospho-JNK and phospho-ERK1/2 levels. CONCLUSION: Our results establish that let-7a specifically suppresses MAP4K4 expression, and further inhibits KSHV reactivation by interfering with the function of MAP4K4 on the MAPK pathway, highlighting let-7a as a potential treatment for KS.

[Analysis on the relations between levels of change and the mental decisive factors on the physical exercise behavior among middle school students].

OBJECTIVE: To study the situation of sports and its influencing factors among students in order to improve health related education and promotion programs. METHODS: A multistage random sampling method was used on 3 600 students from three cities to understand their physical exercise behavior. Both t and χ(2) test were used to measure the scale of psychology and to describe the time spent on exercise. Single variance factor was used to measure the levels of change on behavior of physical activities, psychological and physical exercise behaviors. RESULTS: The weekly exercise time for students was 2.66 ± 1.801 days, with 81.4% of the students less than four days. Data showed that 37.3%, 23.6%, 20.5% of the high school students were in pre-contemplation stage, in contemplation stage, or in preparation stage respectively, with only 18.6 percent of the high school students in the action phase and maintaining phase. Students in the stages of change increase the amount of physical exercises. Scores with statistically significant differences were seen in the following areas: between five stages of behavior change on strategies (F = 77.442, P < 0.001), forward effects on the balance of decision-making (F = 29.498, P < 0.001), having negative effects (F = 14.784, P < 0.001)and self-efficacy (F = 135.544, P < 0.001). Changing strategy on the intention stage of front maintenance phase, positive effects on decision-making balance and self-efficacy scores were increasing along with the increasing stages of changing. The effect of balancing the negative effects increased when the change of phase decreased. CONCLUSION: Students were in lack of physical exercise per week. The differences related to the behavior on physical exercise did exist but most of the high school students were in the primary stage. Psychological factors played important role in the different stages of changing, suggesting that high school students should receive different health education and psychological intervention measures to enhance the effectiveness of physical exercise.

[The adolescent physical exercise behavior-psychological measurement scale on the Chinese version and its reliability and validity study].

OBJECTIVE: To develop a suitable physical exercise behavior-psychological scale for the Chinese adolescents and to evaluate its validity and reliability. METHODS: A total of 3600 junior students were recruited and tested through multistage sampling method. Reliability was assessed, using Cronbach's α and split-half reliability; while exploratory factor analysis and confirmatory factor analysis were used to test its validity, with entries-dimension correlation coefficient (IIC), correlation coefficient between the scores and the dimension, the dimension of correlation coefficient test content validity. RESULTS: The internal consistency reliabilities for total scale score (Cronbach's α = 0.888), Cronbach's α of four domains were 0.880, 0.706, 0.552 and 0.839, respectively. The four-domain split-efficacy reliabilities were ranged between 0.559 and 0.876. Data from the exploratory factor analysis revealed the following dimensions: the entries were all inclusive; the cumulative contribution rate was more than 40%. RESULTS: from the confirmatory factor analysis showed that the absolute fit measures of GFI = 0.972, AGFI = 0.958, RMSEA = 0.032 (90%CI: 0.030 - 0.034) could satisfy the condition while the model fit was better. The results of IIC showed: in the four dimensions, and the contained entries between Spearman correlation coefficient range were 0.396 - 0.700, 0.470 - 0.709, 0.696 - 0.771 and 0.665 - 0.813, while other dimensions from weak to moderate relationships, the r value range was from 0.386 to 0.935. With the change of the phase changing process, decision balance, self-efficacy scores were differently prompting the health-related intervention periodically and pertinently. CONCLUSION: The reliability and validity of the 'Adolescent physical exercise behavior-psychological scales (Chinese version) ' were good, and could be used to measure the adolescent's physical training behavior-psychological conditions.

Comparison of the effects of dexmedetomidine, ketamine, and placebo on emergence agitation after strabismus surgery in children.

BACKGROUND: Children undergoing strabismus surgery under sevoflurane anesthesia often experience emergence agitation (EA) and postoperative vomiting (POV). This study compared the effects of intraoperative dexmedetomidine, ketamine, and placebo on postoperative EA and POV. METHODS: Eighty-four children (aged two to seven years) undergoing elective strabismus surgery under sevoflurane anesthesia were randomly assigned to one of three groups (n = 28 each). Intraoperatively, the placebo, dexmedetomidine, and ketamine groups received normal saline, dexmedetomidine 1 µg·kg(-1) iv plus a 1 µg·kg(-1)·hr(-1) infusion, and ketamine 1 mg·kg(-1) iv plus a 1 mg·kg(-1)·hr(-1) infusion, respectively. Agitation scores (Pediatric Anesthesia Emergence Delirium [PAED] scale) and POV were assessed in the postanesthetic care unit (PACU) and for 24 hr on the ward. Pain scores and times to laryngeal mask airway (LMA™) removal, resumption of mental orientation, and discharge from the PACU were also assessed. RESULTS: Seventy-eight children completed the study. Peak PAED scores for EA were lower in the dexmedetomidine (P < 0.001) and ketamine (P = 0.002) groups than in the placebo group. Incidence of POV was lower in the dexmedetomidine group (15%) than in the ketamine (44%; P = 0.02) or placebo (45.8%; P = 0.02) groups. Pain scores on the ward were lower in the dexmedetomidine (P < 0.001) and ketamine (P < 0.001) groups than in the placebo group. Time to LMA removal was similar in all groups. Time for resumption of mental orientation and time to discharge from PACU were longer in the dexmedetomidine and ketamine groups than in the placebo group. CONCLUSIONS: Dexmedetomidine and ketamine appear to prevent postoperative agitation and pain after sevoflurane anesthesia for pediatric strabismus surgery. Dexmedetomidine also prevents POV.

Assessment of fruit and vegetable intake behavior among adolescents in Hangzhou, China.

OBJECTIVE: To evaluate the fruit and vegetable (FV) intake of adolescents, assess factors influencing intake and discuss health education strategies related to this behavior. METHODS: In Hangzhou, China, 861 students aged 13.68 ± 1.03 years were randomly recruited to carry out a cross-sectional, school-based survey. The design of the survey questionnaire was based on the Transtheoretical Model (TTM) of Behavior Change. Results of the survey rated FV consumption and children's readiness to assume healthier dietary choices. The study design incorporated the four core constructs of TTM: stages of change, processes of change, decisional balance and self-efficacy. Results were assessed by chi-square tests, analysis of variance, Tukey's post-hoc tests and logistic regression analysis. RESULTS: Majority of the participants were in the TTM contemplation stage of change. The average number of FV servings among participants was 3.12 ± 1.41 per day. The specific process of change, number of decisional balance pros (as opposed to cons), and self-efficacy ratings were positively correlated with stage of change transition (Spearman r > 0, P < 0.01). Stage transition, higher scores on self-efficacy and lower scores on cons predicted higher FV consumption (ß > 0, P < 0.05). CONCLUSIONS: The use of TTM may be a powerful personalized means of decreasing poor dietary behaviors and promoting healthy behaviors, compared to traditional methods of behavioral change.

[Evaluation on the effects of an education program regarding the sedentary behavior among school-aged children using Transtheoretical Model].

OBJECTIVE: To evaluate the outcome of a health education program on sedentary behavior among primary and secondary school children through Transtheoretical Model. METHODS: Five primary schools and four middle schools were selected and students from grade 3 to 5 in primary schools and grade 1 to 2 in middle schools were selected to take part in the program, as control and intervention groups respectively. Corresponding intervention measures were provided to the intervention group, with phase, process and level of changing on sedentary behavior measured for both groups during the follow-up period. Comparison to the above items on the two groups was measured statistically. RESULTS: Behavior among the intervention group was gradually changed regarding: phase contemplation, preparation and maintenance, with the proportions in phase action and maintenance higher than the control group. After carrying out of intervention programs, the sedentary time on weekdays between the two groups did not show significant differences. However, the sedentary time on weekends of intervention group was (2.53 ± 1.62) hours, significantly lower than the hours from the baseline survey (2.84 ± 1.82) and the control group (2.78 ± 1.72) respectively. During the follow-up period, the average score of intervention group in the changing process was (2.98 ± 0.77), higher than the control group (2.80 ± 0.81). At the same time, the average score of intervention group in the process of changing, decisional balance (pros) and self-efficacy were 2.98 ± 0.77, 3.06 ± 0.75 and 3.13 ± 0.72, respectively, all higher than data from the baseline survey. In the control group, the process of changing and the average score on self-efficacy had improved. CONCLUSION: The corresponding intervention program seemed to have played a significant role among the school-aged children on their sedentary behavior during the weekend but no significant difference was found in the weekdays.

[A cross-sectional study on the changes in dietary behavior stages in resident].

OBJECTIVE: To explore the possibility of applying the concept of various stages of dietary behavior changes in Hangzhou residents. METHODS: The dietary behavior was surveyed and analyzed in 1 388 Hangzhou residents with 18 year-old and older using the various dietary behavior change model model and stages of change. RESULTS: The proportion of Hangzhou residents with unhealthy dietary behavior was high and associated with gender and education level. The changes of dietary behavior could be divided into 5 stages, i.e. preintention, intention, preparation, action and maintenance. These stages of change happen consecutively. The changes of unhealthy dietary behavior do not match the improvement of health knowledge. Although a significant proportion of the residents understand that it is unhealthy to eat too much fat, pickles and high salt food, there are only a few of them really take action to reduce the consumption of these foods and to consume more milk, fruit and vegetable. CONCLUSIONS: There are multiple factors that affect the changes of dietary behavior in people. The changes of dietary behavior occur in various consecutive stages. Different intervention measures should be applied to people in different dietary behavior changes.