Linggui Zhugan Decoction Improves High Glucose-Induced Autophagy in Podocytes.

Objective To explore the influence of Linggui Zhugan Decoction (LGZGD) on high glucose induced podocyte autophagy Methods LGZGD containing serum were prepared by intragastric administation of 4.2 g·kg-1 (low dose), 8.4 g·kg-1 (medium dose), and 12.6 g·kg-1 (high dose) LGZGD into SD rats respectively. MPC5 and AB8/13 cells were treated with 60 mmol/L glucose to establish diabetic nephropathy podocyte model in vitro. Podocytes, MPC5 and AB8.13, were divided into control group, high glucose group, low dose LGZGD group, medium dose LGZGD group, and high dose LGZGD group, respectively. For the three LGZGD groups, before LGZGD intervention, podocytes were treated with 60 mmol/L glucose for 3 days. After treated with LGZGD containing serum, cells were collected to analyze cell migration using Transwell assay, proliferation using CCK8, apoptosis and cell cycle using flow cytometry,, autophagosome formation using transmission electron microscopy, and expression levels of Beclin-1, Atg5, LC3II/I, and P62 proteins using western blot.Results Compared with the control group, the proliferation and migration of MPC5 and AB8.13 cells in high glucose group showed slightly decreased, whereas these parameters restored after intervention with low and medium concentrations of LGZGD, with the medium dose LGZGD having the best effect. Flow cytometry analysis showed that the medium dose LGZGD group had a lower apoptosis rate (P < 0.05) and higher survival rate (P > 0.05) compared to the high dose group. High glucose arrested podocytes in G1 phase, whereas LGZGD shifted podocytes from being predominant in G1 phase to increasing into G2. High dose LGZGD significanly reduced increased autophagosome formation due to high glucose in both podocytes (P < 0.05). Western blot analysis showed that Beclin-1, Atg5, LC3Ⅱ/Ⅰ, and P62 expressions were increased in MPC5 cells treated with high glucose, and reversed after adminstration of low and medium doses of LGZGD (P < 0.05). Conclusion LGZGD reduced apoptosis and enhanced autophagy in high glucose treated podocytes via regulating Beclin-1/LC3II/I/Atg5 expression.

Face anthropometry for filtering facepiece respirators: analysis of the association between facial dimensions and respirator fit.

OBJECTIVE: Ensuring proper respirator fit for individuals remains a persistent challenge in occupational environments, yet there is limited knowledge about how respirators interact with the face to "'fit." Previous studies have attempted to understand the association between face dimensions and respirator fit using traditional head/face anthropometry not specifically tailored for respirators. The purpose of this study was to assess and compare the ability of filtering facepiece respirator (FFR)-specific face anthropometry with traditional head/face anthropometry in exploring the relationship between facial dimensions and the fit of FFR. METHODS: The study utilized 3D face scans and quantitative fit factor scores from 56 participants to investigate the relationship between face anthropometry and FFR fit. Both FFR-specific and traditional anthropometric measurements were obtained through 3D anthropometric software. Intra-correlation of anthropometry was analyzed to evaluate the efficiency and effectiveness of FFR-specific and traditional anthropometry respectively. Principal component analysis (PCA) was conducted to test the usefulness of the PCA method for investigating various facial features. Logistic regression was used to develop fit association models by estimating the relationship between each face measurement set and the binary outcome of the fit test result. The prediction accuracy of the developed regression models was tested. RESULTS: FFR-specific face anthropometry consists of a set of measurements that can inform the detailed facial shape associated with the FFRs more effectively than traditional head/face anthropometry. While PCA may have been effective in reducing the variable dimensions for the relatively large parts of the human body such as upper and lower bodies in previous literature, PCA results of FFR-specific and traditional anthropometry were inconsistent and insufficient to describe face dimensions with complex anatomy in a small-detailed area, suggesting that facial shape should be understood through a variety of approaches including statistical methods. Logistic regression analysis results confirmed that the association models of FFR-specific face anthropometry were significant with higher prediction accuracy and had a better model's goodness of fit than those of traditional head/face anthropometry in 3 conditions inputting all measurements, all PC scores, or top 5 measurements from PCA. CONCLUSIONS: The findings showed that the FFR fit association model enables an understanding of the detailed association between face and respirator fit and allows for the development of a system to predict respirator fit success or failure based on facial dimensions. Future research would include testing the validity of the model and FFR-specific measurement set on different respirator types, expanding the population set, and developing an integrated approach using automated and machine learning technologies to inform FFR selection for occupation workers and the general population.

Effect of levothyroxine on the pregnancy outcomes in recurrent pregnancy loss women with subclinical hypothyroidism and thyroperoxidase antibody positivity: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to explore the effects of levothyroxine on pregnancy outcomes and thyroid function in recurrent pregnancy loss (RPL) women with subclinical hypothyroidism (SCH) or thyroperoxidase antibody positivity (TPOAb+). METHODS: Literature search was performed from inception to 24 June 2022. The heterogeneity for each outcome was evaluated using Cochran's Q test and quantified with I-squared (I2). Pooled effect sizes were expressed as relative risk (RR) and weighted mean differences (WMD) with 95% confidence intervals (95% CIs). Stability of the results were assessed using the sensitivity analysis. RESULTS: Fifteen eligible studies with 1911 participants were included in this meta-analysis. The pooled data showed that levothyroxine decreased premature delivery rate (RR = 0.48, 95%CI: 0.32, 0.72), miscarriage rate (RR = 0.59, 95%CI: 0.44, 0.79), premature rupture of membranes (PROM) rate (RR = 0.44, 95%CI: 0.29, 0.66), and fetal growth restriction rate (RR = 0.33, 95%CI: 0.12, 0.89) in RPL women with TPOAb+. In RPL women with SCH, live birth rate was elevated (RR = 1.20, 95%CI: 1.01, 1.42) and miscarriage rate was reduced (RR = 0.65, 95%CI: 0.44, 0.97) by levothyroxine. In addition, levothyroxine substantially decreased TSH level (WMD = -0.23, 95% CI: -0.31, -0.16) and TPO level (WMD = -23.48, 95%CI: -27.50, -19.47). CONCLUSIONS: Levothyroxine improved pregnancy outcomes and thyroid function in RPL women with TPOAb+ or SCH, indicating that levothyroxine may be beneficial for RPL women if TPOAb+ or SCH occurs. Future studies are needed to verify our findings.

Survival Outcomes Associated With the Size of Opioid Prescriptions in the Management of Chronic Pain Related to Advanced Nasopharyngeal Carcinoma.

OBJECTIVE: Patients with advanced nasopharyngeal carcinoma (ANC) often experience chronic pain. Opioids are generally recommended to treat tumor-related pain, but increased opioid use may lead to detrimental aftereffects, particularly with respect to tumor progression, resulting in reduced quality of life and increased risk of death. Our objective was to investigate whether the high size of opioid prescriptions is associated with poor overall survival (OS) in patients with ANC. METHODS: A consecutive cohort of patients with newly diagnosed ANC who underwent high or low opioid prescription size treatment during 2012-2019 was retrospectively identified from our medical institutions. Survival was estimated with the Kaplan-Meier method with a log-rank test. Multivariate binary logistic regression was used to assess the association between opioid use and OS, adjusting for age, sex, body mass index (BMI), Eastern Collaborative Oncology Group performance status (ECOG PS), and ANC histology. The criterion to distinguish between the high opioid prescription size group [HD] and the low opioid prescription size group [LD] was 5 mg of oral morphine equivalents (OME) per 24 hours. RESULTS: The cohort consisted of 244 consecutive patients (HD: n = 120, median age = 66 years [range, 40-81 years]; LD: n = 124, median age = 65 years [40-82 years]. Patients who underwent treatment with a high opioid prescription size had a worse median OS than those who underwent treatment with a low opioid prescription size (5.1 vs 6.6 months), and the high opioid prescription size was associated with a remarkable 48% higher risk of death than the low opioid prescription size (HR 1.48, 95% CI 1.11-1.98; P = .005). The cumulative dose of opioids greater than or equal to 500 mg of OME was associated with a higher risk of death, adjusted for age, sex, BMI, ECOG PS, and ANC histology. CONCLUSIONS: In patients with newly diagnosed ANC experiencing palliative care, a high opioid prescription size may be associated with shorter OS than a low opioid prescription size.

Favorable revision-free survivorship of cemented arthroplasty following failed proximal femoral nail antirotation: a case series with a median follow-up of 10 years.

BACKGROUND: Given the ever-increasing rate of failure related to proximal femoral nail antirotation (PFNA), it is expected that an increasing number of PFNA individuals will undergo conversion to total hip arthroplasty (THA). The long-term survivorship of conversion of the initial PFNA to cemented THA is still debated. The aim of this retrospective study was to assess the long-term revision-free survivorship of cemented THAs after initial failures of PFNA in geriatric individuals. METHODS: Consecutive geriatric individuals who underwent secondary cemented THA after initial PFNA fixation from July 2005 to July 2018, were retrospectively identified from three medical centres. The primary outcome was revision-free survivorship estimated using the Kaplan-Meier method and Cox proportional hazards regression with revision for any reason as the endpoint; secondary outcomes were functional outcomes and key THA-related complications. Follow-ups occurred at 3 months, 6 months, 12 months and then every 12 months after conversion. RESULTS: In total, 186 consecutive patients (186 hips) were available for study inclusion. The median follow-up was 120.7 months (60-180 months) in the cohort. Kaplan-Meier survivorship with revision for any reason as the end point showed that the 10-year revision-free survival rate was 0.852 (95% confidence interval [CI], 0.771-0.890). Good functional outcomes were seen, and the HHS decreased markedly over the 24th month to the final follow-up interval from 92.2 to 75.1 (each p < 0.05). The overall rate of key THA-related complications was 16.1% (30/186). CONCLUSION: Cemented THA executed following initial PFNA failure may yield satisfactory revision-free survival and, at least for the initial 10 years after conversion, good functional outcomes and a 16.1% complication rate of key THA-related complications, which supports the trend towards increased use of cemented THA.

Long-term survival of hybrid total hip replacement for prior failed proximal femoral nail antirotation: a retrospective study with a median 10-year follow-up.

BACKGROUND: Hybrid total hip replacement (THR) is commonly used in the management of proximal femur fractures in elderly individuals. However, in the context of the revision, the literature on hybrid THR is limited, and differences in the long-term survival outcomes reported in the literature are obvious. This retrospective study aimed to evaluate the long-term survival of hybrid THR for failed proximal femoral nail antirotation (PFNA) in elderly individuals aged ≥ 75 years. METHODS: An observational cohort of 227 consecutive individuals aged ≥ 75 years who experienced hybrid THRs following prior primary PFNAs was retrospectively identified from the Joint Surgery Centre, the First Affiliated Hospital, Sun Yat-sen University. Implant survival was estimated using the Kaplan-Meier method. The primary end point was the implant survivorship calculated using the Kaplan-Meier method with revision for any reason as the end point; secondary end points were the function score measured using the modified Harris Hip Score (mHHS) and the incidence of main orthopaedic complications. RESULTS: In total, 118 individuals (118 THRs) were assessed as available. The median follow-up was 10 (3-11) years. The 10-year survivorship with revision for any reason as the endpoint was 0.914 (95% confidence interval [CI], 0.843-0.960). The most common indication for revision was aseptic loosening (70.0%), followed by periprosthetic fracture (30.0%). At the final follow-up, the median functional score was 83.6 (79.0-94.0). Among the 118 patients included in this study, 16 experienced 26 implant-related complications. The overall incidence of key orthopaedic complications was 13.5% (16/118). CONCLUSION: For patients aged ≥ 75 years old with prior failed PFNAs, hybrid THR may yield satisfactory long-term survival, with good functional outcomes and a low rate of key orthopaedic complications.

Implant survival of cemented arthroplasty following failed fixation of proximal femoral fractures in patients aged 30-60 years: a retrospective study with a median follow-up of 10 years.

BACKGROUND: Given the unremitting growth in the volume of failed fixations of proximal femoral fractures (PFFs) in recent years, it is predictable that total hip replacements (THRs) will be the preferred surgical procedure. The long-term survival of cemented THR (CTHR) revisions remains controversial in patients aged 30-60 years. The goal of this retrospective review was to evaluate the 10-year survival of CTHRs following prior failed primary fixations of PFFs in patients aged 30-60 years. METHODS: We retrospectively identified CTHR revisions implemented at four medical centres during 2008-2017 for a failed primary fixation of PFFs in consecutive patients aged 30-60 years. The primary endpoint was implant survival calculated using the Kaplan-Meier method with 95% confidence intervals (CIs); secondary endpoints included functional scores assessed by Harris hip scores (HHS) and main revision-related orthopaedic complications. Follow-up was executed at 1, 2, 3, and 8 years following revision and then at 1-year intervals until the revision, death, or study deadline, whichever occurred first. RESULTS: In total, 120 patients (120 hips) who met the eligibility criteria were eligible for follow-up. The median follow-up was 10.2 years (range, 8-12 years). Kaplan-Meier survivorship showed that implant survival with revision for any reason as the endpoint was 95% at 5 years (CI: 93-97%), 89% at 8 years (CI: 86-92%), and 86% at 10 years (CI: 83-89%). Patients treated with three hollow screws had better revision-free survival than patients treated with proximal femoral nail antirotation (PFNA), dynamic hip screw (DHS) or titanium plate plus screws (three p < 0.05). Functional scores were apt to decrease gradually, and at the final follow-up, the mean HHS was 76.9 (range, 67.4-86.4). The overall rate of main revision-related orthopaedic complications was 18.3% (22/120). CONCLUSION: CTHR implemented following prior failed primary fixations of PFFs tends to afford an acceptable 10-year survival, along with advantageous HHS and a low rate of main revision-related orthopaedic complications, which may support an inclination to follow the utilisation of CTHRs, especially in revision settings for intracapsular fractures.

Protective Masks Utilizing Nonendangered Components.

At the beginning of the COVID-19 pandemic when traditional N95 respirators were in short supply in the United States, there was a need for alternative products that did not rely on traditional avenues of sourcing and manufacturing. The purpose of this research was to develop and test alternatives to N95 respirators that could be produced locally without specialized materials and processes. Through an interdisciplinary team of experts, new mask designs that use repurposed filtration media and commercially available components were developed and tested for filtration and fit against current N95 standards. Filtration efficiency test results showed that the filtration media can be used for high-quality facemasks and quantitative fit testing demonstrated that the new mask designs could be viable alternatives to traditional N95 facemasks when those masks are in short supply. Manufacturing viability was tested utilizing a workforce to create 6000 masks over 10 days. The ability to quickly produce masks at scale using a workforce without specialized skills demonstrated the feasibility of the mask designs and manufacturing approach to address shortages of critical healthcare equipment, mitigate risk for healthcare and essential workers, and minimize the transmission and spread of disease.

Design considerations for protective mask development: A remote mask usability evaluation.

The design of N95 filtering facepiece respirators (FFRs) continues to pose usability concerns for healthcare workers, which have been exacerbated by the COVID-19 pandemic. The aim of this study was to develop a holistic model to guide mask design improvement. Dental students (n = 38) with experience wearing N95 FFRs participated in a randomized wear trial of three alternative protective masks. A mixed methods survey was used to examine usability of individual mask design components, the relationship of facial/head area to mask features, and overall mask design. Survey results indicated MNmask v1 demonstrated higher usability in seal confidence (M = 3.46), while MNmask v2 performed higher in satisfactory fit (M = 3.50). Design components of nose wire and head/neck bands were the most problematic, while conditions of skin irritation and tight/loose fit created an unfavorable wear experience. To consider healthcare workers' needs in improving the usability of protective masks, a model is presented to consider characteristics of fit, comfort, material, and design.

A Longitudinal Change Patterns of Depression and Its Relationship with Socioeconomic Deprivation among Middle-Aged Adults in South Korea.

This study aimed to identify the longitudinal pattern changes of South Koreans' midlife depression and determine the impact of socioeconomic deprivation on the observed change in patterns. In total, 3975 middle-aged individuals were examined by conducting a latent class growth analysis and multinomial logistic regression analysis on seven years of Korea Welfare Panel data (2012-2018) using STATA 16.0 (StataCorp LLC, College Station, TX, USA). The change patterns of midlife depression were classified into normal depression reduction group, mild depression maintenance group, and serious depression increase group. The impact of the experience of socioeconomic deprivation on the classified change patterns was examined using the normal depression reduction group as the reference group. It was found that the higher an individual's nutritional, housing, occupational/economic, and healthcare deprivation, the higher their risk of mild depression maintenance or serious depression increase. The serious depression increase group showed higher relative risk ratios in all domains. Comprehensive and integrated social welfare services, such as stable income, housing welfare, and healthcare services, should be provided along with appropriate clinical interventions for depression alleviation that account for the pattern changes in midlife depression.

Effect of the Mandibular Orthopedic Repositioning Appliance (MORA) on Forearm Muscle Activation and Grasping Power during Pinch and Hook Grip.

[Purpose] This study verified the changes in muscle activities and grasping power during maximal isometric exercise of the forearm and masseter muscle with and without a mandibular orthopedic repositioning appliance (MORA). It also offers basic data for defining the correlation of function of hand with mouth. [Methods] EMG was used to measure masticatory muscle, flexor bundle and extensor bundle activities with or without MORA while subjects performed the hook grip and pinch grip. The measuring tool used for measuring grip strength was the same as that used for measuring pinch and hook strength. The subjects were 28 healthy young adults. [Result] Muscle activity and grasping power significantly increased when wearing the MORA. [Conclusion] The result indicates that wearing MORA can increase muscle activity and grasping power of forearm and masseter muscle. We think wearing MORA might help improve the function of the forearm because it activates the function of the masseter.