Enhanced recovery after gynecological surgery: A meta-analysis of randomized controlled trials.

Enhanced recovery after surgery protocol is a multidisciplinary and multimodal approach designed to improve perioperative outcomes for patients. This meta-analysis aimed to identify and elaborate on the efficacy of this protocol in women undergoing gynecologic surgery. Four databases were searched for randomized controlled trials from inception to December 2021. A total of 14 studies met the inclusion criteria and were analyzed. There was a significant reduction in the length of stay, the time to first flatus and first defecation, complications, and readmission rates in patients undergoing enhanced recovery after surgery when compared to routine care. The rate of discharge on the first postoperative day significantly increased in patients from the enhanced recovery group. There was no significant difference in the surgery time and blood loss. In conclusion, the enhanced recovery after surgery protocol might have a positive effect on patients undergoing gynecologic surgery. However, there is still heterogeneity between the included studies, and we need more research to draw reliable conclusions that enhanced recovery after surgery is favorable.

Effects of Yoga exercise on anxiety and fetus growth in pregnant women with small for gestational age fetus.

OBJECTIVE: To investigate the effect of yoga on anxiety and fetal weight of pregnant women carrying fetus small for gestational age (SGA). METHODS: In this retrospective analysis, a total of 186 pregnant women with SGA fetus in our hospital from January 2015 to December 2017 were enrolled in this study. Among them, 90 patients received routine check-up were included in the control group, and the other 96 patients who had professional yoga exercise were included in the observation group. The differences of anxiety scale scores and fetal weight between the two groups before and after intervention were compared. RESULTS: There was no significant difference in scores of anxiety scale (SAS) between the two groups before intervention. After intervention, the SAS score of pregnant women in intervention group was (46.48±3.79) was significantly lower than that in control group (60.13±4.25). There was also significant difference in fetal growth trajectory between the two groups, with a significant increase of 1021.36 g in the intervention group compared with 795.62 g in the control group (P<0.05). Furthermore, single regression analysis showed that average gestational weeks (r=0.064. P=0.011), yoga exercise (r=0.043, P<0.001), forceps use (r=0.338, P<0.001) and conversion to cesarean section (r=0.431, P<0.001) showed a significant correlation with anxiety and fetus growth in pregnant women carrying SGA fetus. Multiple regression analysis showed that yoga exercise (P<0.001) was selected as independent variables in the multiple regression model of anxiety and fetus growth in pregnant women with SGA fetus. CONCLUSION: Yoga can effectively reduce the anxiety of pregnant women with small gestational age fetus and good for the growth and development of the fetus.

Serum Cystatin C as a predictor of acute kidney injury in neonates: a meta-analysis

Abstract Objective: The objective of this meta-analysis is to evaluate the diagnostic value of serum Cystatin C in acute kidney injury (AKI) in neonates Sources: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and WanFang Database were searched to retrieve the literature related to the diagnostic value of Cystatin C for neonatal AKI from inception to May 10, 2021. Subsequently, the quality of included studies was determined using the QUADAS-2 tool. Stata 15.0 statistical software was used to calculate the combined sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Additionally, meta-regression analysis and subgroup analysis contributed to explore the sources of heterogeneity Summary of the findings: Twelve articles were included. The pooled sensitivity was 0.84 (95%CI: 0.74-0.91), the pooled specificity was 0.81 (95%CI: 0.75-0.86), the pooled PLR was 4.39 (95%CI: 3.23-5.97), the pooled NLR was 0.19 (95%CI: 0.11-0.34), and the DOR was 22.58 (95%CI: 10.44-48.83). The area under the receiver operating characteristic curve (AUC) was 0.88 (95%CI: 0.85-0.90). No significant publication bias was identified (p > 0.05).

Serum Cystatin C as a predictor of acute kidney injury in neonates: a meta-analysis.

OBJECTIVES: The objective of this meta-analysis is to evaluate the diagnostic value of serum Cystatin C in acute kidney injury (AKI) in neonates. SOURCES: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and WanFang Database were searched to retrieve the literature related to the diagnostic value of Cystatin C for neonatal AKI from inception to May 10, 2021. Subsequently, the quality of included studies was determined using the QUADAS-2 tool. Stata 15.0 statistical software was used to calculate the combined sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Additionally, meta-regression analysis and subgroup analysis contributed to explore the sources of heterogeneity. SUMMARY OF THE FINDINGS: Twelve articles were included. The pooled sensitivity was 0.84 (95%CI: 0.74-0.91), the pooled specificity was 0.81 (95%CI: 0.75-0.86), the pooled PLR was 4.39 (95%CI: 3.23-5.97), the pooled NLR was 0.19 (95%CI: 0.11-0.34), and the DOR was 22.58 (95%CI: 10.44-48.83). The area under the receiver operating characteristic curve (AUC) was 0.88 (95%CI: 0.85-0.90). No significant publication bias was identified (p > 0.05). CONCLUSIONS: Serum Cystatin C has a good performance in predicting neonatal AKI; therefore, it can be used as a candidate biomarker after the optimal level is determined by large prospective studies.

A best evidence synthesis in practicing early active movements in ICU patients with mechanical ventilation.

OBJECTIVE: This study summarized the best evidence of early active movements in mechanically ventilated patients in the ICU and applied it in the intensive care unit of our hospital to evaluate the practical effects. METHODS: The best evidence for early activity in patients with mechanical ventilation in the ICU was summarized by using an evidence-based nursing method, and the results were clinically applied in the ICU. Patients who were mechanically ventilated in the ICU from January to March 2020 were selected as the control-group, and their counterparts from April to June 2020 were enrolled as the practice-group. The control-group-patients received conventional early active mobilities, and the practice-group-patients performed the best evidence-based early active mobilities. The Barthel index, muscle strength, duration of mechanical ventilation and length of ICU stay between the two groups were compared. RESULTS: The scores of Barthel index and muscle strength of the practice group were remarkably higher than those of the control group, and the duration of mechanical ventilation and length of ICU stay were obviously shorter than those of the control group, and the difference was statistically significant (P<0.05). The incidence of deep vein thrombosis in practice group was substantially lower than that in control group (P<0.05), and the incidence of ICU acquired weakness in in practice group was critically lower than that in control group (P<0.05). The anxiety and depression scores of the two groups post-intervention were remarkably less than those before intervention (P<0.05), and the observation group had apparently lower scores than the control group (P<0.05). CONCLUSION: The application of the best evidence of early active movement in ICU patients with mechanical ventilation can improve the daily life ability, promote the recovery of muscle strength, reduce the incidence of deep vein thrombosis and ICU acquired weakness, decrease the duration of mechanical ventilation and length of ICU hospital stay, thereby improving the clinical outcomes.

Association between the use of antibiotics during pregnancy and obesity in 5-year-old children.

BACKGROUND: Obesity is an epidemic that must arouse our attention. The purpose of this research is to investigate the relationship between antibiotic use during pregnancy and childhood obesity in 5-year-old Chinese children. METHODS: A total of 132 5-year-old children born in our hospital from January 2014 to January 2016 were included. The children's genders, nationalities, chronic diseases, and other factors were collected as adjusted covariates. We also collected the pre-pregnancy body mass indexes (BMIs) of pregnant women, diagnosis of diabetes mellitus or gestational diabetes mellitus (GDM), maternal smoking, mode of delivery (cesarean section and vaginal delivery), and weight gain during pregnancy, which may affect childhood obesity. A linear mixed effect regression model was used to test the correlation between antibiotic use during pregnancy and the BMI of 5-year-old children, and a logistic mixed effect regression model was used to evaluate the correlation between antibiotic use during pregnancy and obesity outcome. RESULTS: When adjusted for the child's gender, birth weight, cesarean section, chronic diseases, maternal smoking during pregnancy, pre-pregnancy BMI, diagnosis of diabetes or GDM, mode of delivery (cesarean section and vaginal delivery), and weight gain during pregnancy (Model 3), antibiotic use during pregnancy was positively correlated with the BMI of 5-year-old children (ß=0.01, 95% CI: 0.01-0.03, P=0.04). Antibiotic use during pregnancy increased the risk of obesity by 4% in 5-year-old children (OR =1.04, 95% CI: 1.01-1.16, P=0.02). CONCLUSIONS: The use of antibiotics during pregnancy is positively correlated with the risk of obesity in 5-year-old children. KEYWORDS: Antibiotics; pregnancy; obesity; children.

ERCC1 rs11615 polymorphism and chemosensitivity to platinum drugs in patients with ovarian cancer: a systematic review and meta-analysis.

OBJECTIVE: To explore the relationship between ERCC1 rs11615 polymorphism and chemosensitivity to platinum drugs in ovarian cancer by the method of meta-analysis. METHODS: Pubmed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), and China Wanfang databases were comprehensively searched up to September 2020, to identify the relationship between ERCC1 rs11615 polymorphism and chemosensitivity of ovarian cancer. The data was analyzed by Stata 15.0 statistic software. RESULTS: A total of 10 published papers were included, including 1866 patients with ovarian cancer. The results showed that compared allele C at ERCC1 rs11615 locus with allele T, the pooled OR was 0.92 (95%CI:0.68 ~ 1.24, P > 0.05). There were no significant differences in recessive, dominant, homozygous, and heterozygous models. In accordance with a subgroup analysis of Ethnicity, all genotypes were statistically significant in the Asian population. In the allelic, dominant, recessive, homozygous and heterozygous models, the OR was 0.70 (95%CI:0.51 ~ 0.95), 0.20 (95%CI:0.07 ~ 0.56), 0.79 (95%CI:0.63 ~ 1.00), 0.21 (95%CI:0.07 ~ 0.59), 0.19 (95%CI:0.07 ~ 0.54), respectively, while in the Caucasian population, no statistically significant genotype was found. CONCLUSION: The ERCC1 rs11615 polymorphism is associated with chemosensitivity in patients with ovarian cancer, especially in the Asian population, but not in the Caucasian population.

Home-based nursing for improvement of quality of life and depression in patients with postpartum depression.

BACKGROUND: Postpartum depression is a common mental illness in puerpera, with an incidence of approximately 3.5%-33.0% abroad, and the incidence of postpartum depression in China is higher than the international level, reaching 10.0%-38.0%. Providing effective nursing care in clinical nursing activities is one of the key points of obstetrical care. However, little research has been designed to investigate the positive role of home-based nursing in the prevention of postpartum depression . AIM: To study the effect of home-based nursing for postpartum depression patients on their quality of life and depression. METHODS: The clinical data of 92 patients with postpartum depression treated at our hospital were retrospectively analyzed. The patients were grouped according to the nursing methods used; 40 patients receiving basic nursing were included in a basic nursing group, and 52 receiving home-based nursing were included in a home-based nursing group. Depression and anxiety were evaluated and compared between the two groups. The estradiol (E2), serotonin (5-hydroxytryptamine, 5-HT), and progesterone (PRGE) levels were measured. RESULTS: The SAS and SDS scores of the home-based nursing group were significantly lower than those of the basic nursing group (P < 0.05). The E2 and 5-HT levels of the home-based nursing group were significantly higher than those of the basic nursing group, but the PRGE level was significantly lower than that of the basic nursing group. The GQOLI-74 scores (material, social, somatic, and psychological) and nursing satisfaction were significantly higher in the home-based nursing group (P < 0.05). CONCLUSION: Postpartum depression through home-based nursing can effectively alleviate depression and improve the quality of life of patients, help modulate their serum E2, 5-HT, and PRGE levels, and improve their satisfaction with nursing care.

miR-219a-5p inhibits breast cancer cell migration and epithelial-mesenchymal transition by targeting myocardin-related transcription factor A.

Although many miRNAs are reported to be involved in tumor formation and progression, the effect of miR-219a-5p on breast cancer metastasis is not well-known. The aim of this study is to investigate the effect of miR-219a-5p on the migratory ability and epithelial-mesenchymal transition (EMT) of breast cancer cells. First, miR-219a-5p was found to be highly expressed in low-invasive breast cancer MCF-7 cells, but lowly expressed in high-invasive breast cancer MDA-MB-231 cells. Wound scratch assay and transwell assay showed that miR-219a-5p inhibited the migratory ability of MDA-MB-231 cells. miR-219a-5p also suppressed the cellular EMT, confirmed by suppressing the expression of mesenchymal markers vimentin and N-cadherin and increasing the expression of epithelial marker E-cadherin. Using the epithelial-mesenchymal-epithelial model in MCF-7 cells, we confirmed that the level of miR-219a-5p was highly expressed in epithelial-type cells and lowly expressed in mesenchymal-type cells. Importantly, we identified myocardin-related transcription factor A (MRTF-A) as a novel potential target gene of miR-219a-5p. Overexpression of miR-219a-5p in MDA-MB-231 cells could inhibit the expression of MRTF-A as revealed by real-time PCR and western blot analysis. miR-219a-5p inhibited the transcription of MRTF-A by targeting the 3'UTR of MRTF-A, which was confirmed by wild-type or mutant MRTF-A 3'UTR luciferase reporter system. Furthermore, knockdown of MRTF-A using siRNA for MRTF-A could depress breast cell migration. In conclusion, our present study revealed the tumor suppressive role of miR-219a-5p in regulating breast cancer migration by targeting MRTF-A, suggesting that miR-219a-5p might be a therapeutic target in breast cancer through regulating EMT.

Vascular endothelial growth factor stimulates endothelial differentiation from mesenchymal stem cells via Rho/myocardin-related transcription factor--a signaling pathway.

Mesenchymal stem cells (MSCs) are pluripotent progenitors that can differentiate into a variety of cell types. Vascular endothelial growth factor (VEGF) is one of the major factors of initiating and regulating angiogenesis. It has been reported that VEGF can induce MSCs differentiated into endothelial cells (ECs). However, the mechanism that VEGF-induced MSC differentiation is not completely understood. Here, we showed that VEGF induced human and rat bone marrow-derived MSCs differentiation to ECs. Rho family plays an important role in VEGF-induced endothelial cell migration and angiogenesis. Our results indicated that in MSCs, VEGF activated Rho/ROCK signaling pathway and promoted nuclear translocation of myocardin-related transcription factor-A (MRTF-A), which is controlled by Rho/ROCK signaling. In addition, Rho inhibitor C3 transferase, ROCK inhibitor Y27632 or depletion of endogenous MRTF-A abolished the VEGF-induced differentiation of MSCs into ECs. Furthermore, VEGF also enhanced the expression levels of CYR61/CCN1, as a regulator of vascular development and angiogenesis, and knockdown of endogenous MRTF-A reduced VEGF-induced the upregulation of CYR61/CCN1. Report assays with site-direct mutation analysis of CYR61/CCN1 promoter demonstrated that MRTF-A transactivated CYR61/CCN1 promoter mainly depending on CArG box. In this study, we identify the Rho/MRTF-A signaling pathway as a main actor in controlling VEGF-induced differentiation of human and rat bone marrow-derived MSCs into endothelial cells.