The Predictive Performance of Depressive Symptoms in the Second Trimester of Gestation for Postnatal Depressive Symptoms in a Primary Care Setting.

Purpose: The aim of this study was to determine and quantify the predictive performance of depressive symptoms in the second trimester for postnatal depressive symptoms and to raise awareness of psychosocial problems. Methods: This was a prospective longitudinal study. The experimental group comprised Chinese women who completed the Edinburgh Postnatal Depression Scale (EPDS) two times (once during the second trimester and once at 6-8 weeks postdelivery) at Fong Son Tong Health Center (CSSL), Macau. Descriptive statistics were used to analyze the collected data. The predictive performance was determined using paired t-tests and receiver operating characteristic curves. The control group was a pre-existing group that had only completed the EPDS at 6-8 weeks postdelivery. Finally, postnatal depressive symptoms (EPDS score ≥12) were compared between the experimental and control groups. Results: In the experimental group, a total of 160 women completed the EPDS during the second trimester, and 137 (85.6%) completed the EPDS at 6-8 weeks postdelivery. The EPDS score in the second trimester was positively correlated with the score at 6-8 weeks postdelivery. The optimal threshold value of the EPDS score in the second trimester is ≥7. Compared with the control group, there was statistical significance in the detection of postnatal depressive symptoms in the experimental group. Conclusions: Screening for possible depressive symptoms in the second trimester and actively following up with at-risk women in the postnatal period may be an effective strategy for improving postnatal mental health outcomes.

Effectiveness of an audit programme for dyslipidaemia management in a primary care setting in Macau: a quality improvement study.

Objective: The objective of this study was to test the effectiveness of an audit programme for dyslipidaemia management in a primary care setting in Macau. Design: A quality improvement study based on an evaluation of a before-after intervention trial was conducted in 2017-2018. Interventions comprising feedback from an audit, general practitioner (GP) training via interactive workshops and one-on-one case discussions were implemented. The primary outcome measure was the proportion of patients with reasonable management of dyslipidaemia, and the secondary outcome measure was the proportion of patients with low-density lipoprotein cholesterol (LDL-C) meeting the target recommended by the Adult Treatment Panel III guidelines. Setting: This study was conducted at the Sao Lourenco Health Center, one of the health centres in the Macau primary care system; this centre provides primary care services to one-tenth of the residents of Macau. Participants: All GPs who worked in the Sao Lourenco Health Center participated in the study. We systematically reviewed 100 patient records from each participating physician's patient list. In total, 1200 and 1100 patient records were reviewed before and after the intervention, respectively. Results: At baseline, 390 (43.5%) patients were eligible for statin therapy, while 411 (47.7%) patients were eligible for statin therapy in the reaudit group (p=0.08). After intervention, the proportion of patients with reasonable management of dyslipidaemia increased from 83.9% to 88.5% (p=0.005), and the proportion of eligible patients with LDL-C levels meeting the target increased from 55.1% to 65% (p=0.004). Conclusions: The audits and feedback significantly improved dyslipidaemia management in the Macau primary care setting.

Study of type 2 diabetes management among patients in a Macau primary care setting.

BACKGROUND: In the primary care setting in Macau, type 2 diabetes mellitus (T2DM) is the seventh most common reason for consultation. Inadequate glycaemic control constitutes a major public health problem and is associated with premature death and disability and decreased quality of life. Moreover, this condition substantially increases healthcare expenditures. OBJECTIVE: The primary objective was to assess the successful glycaemic control rates, blood pressure (BP) and cholesterol control rates in patients with T2DM in a Macau primary care setting. The secondary objective of this study was to assess the delay of insulin initiation in the Sao Lourence Health Center. METHODS: Patients were stratified according to age (<65 years vs ≥65 years) and sex. Successful glycaemic control was defined as glycated haemoglobin (HbA1c) <7%. Successful cholesterol control was defined as a low-density lipoprotein cholesterol (LDL-C) level <2.6 mmol/L, and BP control was defined as BP <140/90 mm Hg. RESULTS: Among the 2157 participants included in this study, 1046 (48.5%) patients had HbA1c <7%, 1209 (56.1%) patients had BP <140/90 mm Hg and 1244 (57.7%) patients had LDL-C <2.6 mmol/L. In conclusion, only 403 (18.7%) patients met the targets for all three measures. Of the 235 patients who were on insulin therapy, the mean (±SD) duration from T2DM diagnosis to insulin initiation was 7.47±6.52 years, the mean (±SD) duration from HbA1c not meeting the target (HbA1c ≥7% over 1 year and persistently) to insulin initiation was 3.34±3.66 years and the mean baseline HbA1c was 9.13%. Compared with patients with a longer duration (≥5 years) of HbA1c not meeting the target before insulin initiation, those who started insulin within 1 year of HbA1c not meeting the target had a better glycaemic control rate (40.7% vs 13%). CONCLUSIONS: Nearly half of the patients at Sao Lourence Health Center, a primary care centre in Macau, met the glycaemic control target, but less than one-fifth of patients met all three targets for T2DM control. Moreover, there was a delay in insulin initiation for people with T2DM.

The Performance of the Neck Circumference for a Difficult Laryngoscopy in Obese Patients.

BACKGROUND AND OBJECTIVE: There is conflicting evidence as to whether neck circumference (NC) is related to a difficult laryngoscopy in obese patients. The objectives of this study were to determine the performance of the NC in defining a difficult laryngoscopy, and to identify factors predicting a difficult laryngoscopy among those obese patients. MATERIAL AND METHOD: This prospective study was conducted in adult patients with a body mass index (BM) of greater or equal to 30 kg/m² who underwent conventional endotracheal intubation. Preoperative NC, the modified Mallampati test (MMT), the thyromental distance (TM) and the sternomental distance (SM) were measured. A difficult laryngoscopy was defined as a Cormack-Lehane laryngoscopic view of grade III or IV. RESULTS: Five hundred patients (366 females; 134 males), with a mean BMI of 34.3 ± 4.6 kg/m² (minimum = 30.0 kg/m², and maximum = 68.4 kg/m²) and who had elective surgery planned, were enrolled. The incidence of a difficult laryngoscopy was 7.2%. The overall performance of the NC using the area under the receiver operating characteristic curves of a difficult laryngoscopy was 0.574, with a 95% confidence interval (CI) of 0.53 to 0.618. The optimal cutoff point of the NC for a difficult laryngoscopy was 37.1 centimeters. It provided sensitivity and specificity of 75.5% (95% CI 57.8, 87.9) and 42.5% (95% CI 37.9, 47.2). The positive and negative predictive values were 9.2% and 95.6%. After multivariate analysis, factors affecting a difficult laryngoscopy were high grades of MMT (odds ratio (OR) 2.23, 95% CI 1.10, 4.50) and NC/TM (OR 1.78, 95% CI 1.15, 2.74). CONCLUSION: The NC per se was not a good predictor of a difficult laryngoscopy. However the ratio of the NC to the TM and the MMT were factors predicting a difficult laryngoscopy in obese patients.

Formononetin attenuates osteoclastogenesis via suppressing the RANKL-induced activation of NF-κB, c-Fos, and nuclear factor of activated T-cells cytoplasmic 1 signaling pathway.

Formononetin (1), a plant-derived phytoestrogen, possesses bone protective properties. To address the potential therapeutic efficacy and mechanism of action of 1, we investigated its antiosteoclastogenic activity and its effect on nuclear factor-kappaB ligand (RANKL)-induced bone-marrow-derived macrophages (BMMs). Compound 1 markedly inhibited RANKL-induced osteoclast differentiation in the absence of cytotoxicity, by regulating the expression of osteoprotegerin (OPG) and RANKL in BMMs and in cocultured osteoblasts. Compound 1 significantly inhibited RANKL-induced tumor necrosis factor (TNF)-α, interleukin (IL)-1ß, IL-6, monocyte chemoattractant protein-1 (MCP-1), regulated on activation normal T cell expressed and secreted (RANTES), and macrophage inflammatory protein-1α (MIP-1α) in a concentration-dependent manner. These effects were accompanied by a decrease in RANKL-induced activation of the NF-κB p65 subunit, degradation of inhibitor κBα (IκBα), induction of NF-κB, and phosphorylation of AKT, extracellular-signal regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and p38 mitogen-activated protein kinase (p38 MAPK). NF-κB siRNA suppressed AKT, ERK, JNK, and p38 MAPK phosphorylation. Furthermore, 1 significantly suppressed c-Fos and nuclear factor of activated T-cells cytoplasmic 1 (NFATc1), key transcription factors during osteoclastogenesis. SP600125, a specific inhibitor of JNK, reduced RANKL-induced expression of phospho-c-Jun, c-Fos, and NFATc1 and inhibited osteoclast formation. These results suggested that 1 acted as an antiresorption agent by blocking osteoclast activation.

Construction of a chondrocyte cell sheet using temperature-responsive poly(N-isopropylacrylamide)-co-acrylamide.

In this study, a novel temperature-responsive poly(N-isopropylacrylamide)-co-acrylamide was used to prepare a chondrocyte cell sheet. Chondrocytes were isolated from human articular cartilage and plated on the copolymer film grafted tissue culture plates. The cell attachment on the copolymer film was shown to be similar to that of the ungrafted surface. To harvest a cell sheet, the incubation temperature was reduced to 10°C for 30 minutes to allow the polymer chain to fully extend, changing the copolymer's phase from hydrophobicity to hydrophilicity. Additional incubation at 20°C for 60 minutes was necessary to activate the cellular metabolism required for cytoskeletal organization and cell detachment. A complete cell sheet recovery was achieved when a PVDF membrane was used as a cell sheet carrier. Unfortunately, the shrinkage of the cell sheet was observed. Nonetheless, the harvested cell sheet was shown to be viable and healthy.