International Journal of Clinical Practice

Objective. Nonalcoholic fatty liver disease (NAFLD) is becoming more prevalent in the nonobese population. The aim of this study was to investigate the combined effects of metabolism-related mixtures on NAFLD subjects in nonobese populations using four statistical models. Study Design. This was a retrospective observational study. Methods. Our study included 904 nonobese patients who had taken part in the 2017-2018 National Health and Nutrition Examination Survey (NHANES). We used logistic regression models, Bayesian kernel machine regression (BKMR), and the weighted quantile sum (WQS) regression model to estimate the association between metabolism-related indicators and NAFLD in the nonobese population. Finally, we included several indicators to create nomograms to predict the risk of NAFLD occurrence in the nonobese population. Results. Among the 904 participants, 116 (12.83%) had NAFLD. The logistic regression model found that the waist-to-hip ratio (WHR), HDL-c, triglyceride (TG), and HbA1c were positively associated with the outcomes. The WQS regression model showed that the WQS index was significantly associated with the occurrence of NAFLD in the nonobese population (OR: 5.789, 95% CI: 3.933–8.520), and WHR, TC, and TG had the largest weight. The BKMR model’s WHR and TG increased from the 25th percentile to the 75th percentile (other metabolite exposure remained fixed at the 75th percentile) and the risk of developing NAFLD increased in the nonobese people. The significant predictors mentioned above were introduced to construct the nomogram. The calibration curve, DCA, and AUROC (0.796) (95% CI: 0.743–0.843) all indicated that the model had a good potential clinical performance. Conclusions. By comparing the results of the four models together, WHR and TG were identified as important factors associated with NAFLD in the nonobese population. Further research is warranted to investigate the risk factors and pathogeny of NAFLD in nonobese populations.

Background Aim. To compare the efficacy of omeprazole to other proton-pump inhibitors (PPIs) or placebo for the treatment of acid peptic disorders (APDs) using a comprehensive literature search including hard-to-access journals and non-English articles. Methods. PubMed, Google Scholar, and China National Knowledge Infrastructure were searched (from inception to March 2023) for trials comparing omeprazole to other types of PPIs or placebo for the treatment APD. Efficacy was analyzed separately for erosive diseases and nonerosive diseases. Primary outcomes included improvement of APD symptoms and frequency of ulcer or erosion healing. Secondary outcomes included adverse events, cost effectiveness, nocturnal acid breakthrough, and length of stay if hospitalized. Random and fixed-effects models were used to determine estimates of efficacy. Results. Thirty-one eligible trials (N = 10,539 participants) were analyzed, including 12 articles not typically included in previous reviews due to translation or journal access issues. Omeprazole significantly improved heartburn compared to placebo (RR = 2.47, 95% CI: 2.13 and 2.86, and ) and was equivalent to the other five types of PPI. Omeprazole had significantly fewer patients reporting adverse events versus placebo (11% versus 31%, respectively) and other PPIs. Omeprazole was the most cost-effective PPI compared to the other types of PPIs in India. Conclusions. Omeprazole continues to be an effective proton-pump inhibitor to treat patients with acid peptic disorders and was well tolerated. Omeprazole was significantly better than placebo and was equivalent with other PPIs for curing heartburn and was equivalent to other PPIs for the healing of ulcers or erosions in addition to being the most cost-effective.

Diseases related to cartilage abnormalities pose a serious threat to human health. Normal cartilage contains only one type of cell, chondrocytes. This study aims to investigate the impact of inositol polyphosphate-5-phosphatase E (INPP5E) on chondrocytes and its underlying mechanisms. Following transfection of small interfering RNA INPP5E into chondrocytes, real-time quantitative PCR (RT-PCR) and western blot (WB) assays were conducted to detect the expression of intraflagellar transport 88 (IFT88), Bcl-2-interacting protein 1 (Beclin1), microtubule-associated protein 1 light chain 3 alpha (MAP1LC3A), microtubule-associated protein 1 light chain 3 beta (MAP1LC3B), phosphoinositide 3-kinase (PI3K), protein kinase B (Akt), mammalian target of rapamycin (mTOR), collagen type II alpha 1 chain (COL2A1), and cyclin D1 (CCND1). Furthermore, immunofluorescence was used to detect the expression of acetylated α-tubulin and microtubule-associated protein 1 light chain 3 (LC3) II. RT-PCR, WB, and the dual luciferase assay demonstrated the regulation between SNHG12, hsa-miR-181a-5p, hsa-miR-138-5p, and INPP5E. Functional recovery experiments were used to observe the regulation of these factors on IFT88, Beclin1, LC3 I, LC3 II, p-PI3K, p-Akt, p-mTOR, collagen II, and cyclin D1 in chondrocytes. The results showed that silencing INPP5E inhibited the mRNA and protein expressions of the investigated factors in chondrocytes. SNHG12 promoted INPP5E expression by inhibiting hsa-miR-181a-5p or hsa-miR-138-5p, which resulted in regulation of the expression of various factors via the hsa-miR-181a-5p/hsa-miR-138-5p-INPP5E axis in chondrocytes. These findings provide a theoretical basis for the treatment of patients with cartilage-related abnormalities.

Background. The severe pregnancy complication hyperemesis gravidarum (HG) requires intravenous fluids, antiemetics, and nutrition to prevent maternal and fetal complications. Several guidelines exist for the treatment of HG within and across countries. The aim of this study was to investigate whether the guideline issued by the Norwegian Society for Obstetrics and Gynecology (NGF) was implemented in clinical practice by comparing department treatment protocols and assessing provided treatment. Methods. Department protocols for the treatment of HG were requested from all Norwegian gynecology departments and compared to the NGF guideline regarding the use of Pregnancy Unique Quantification of Emesis (PUQE-24) score, antiemetics, thiamine, and fluid and nutritional therapy. Additionally, we performed a retrospective chart review of provided treatment during 2017–2019 at four hospitals. Results. In all, 28 of 39 (72%) departments replied, of which 11 reported using the NGF guidelines unaltered. Of the 17 local department protocols in use, 16 closely resembled the NGF guidelines regarding the use of PUQE score, fluid therapy, nutritional treatment, and thiamine. Eight department protocols differed slightly from the NGF guidelines regarding the antiemetic medication treatment pathway, and two recommended antiemetic medication not supported by national or international guidelines. The retrospective chart review of 343 patients at four hospitals showed that the provided care aligned with the guidelines regarding intravenous fluids and the use of PUQE score, and the use of antiemetics mostly aligned with the treatment pathway provided in the NGF guideline. However, the proportion of patients receiving ondansetron varied between 32% and 79% and thiamine from 38 to 86% between hospitals. Overall, few patients were provided with nutritional treatment by partial peripheral nutrition (14%), enteral tube feeding (8%), or total parenteral nutrition (1.5%). Conclusion. The NGF guideline was used unaltered or largely integrated in department protocols. Treatment data suggest that the guideline was implemented in clinical practice, but differences in the provision of ondansetron and thiamine suggest geographical inequality of care. Infrequent use of nutritional treatment by parenteral nutrition or enteral feeding tube could suggest improvements in pharmacological symptom management or undertreatment of malnutrition.

Background. The activation of complement is involved in monocyte recruitment in tuberculous pleural effusion (TPE), while the role of the cleavage product of complement C3 in this process needs further research. Methods. The expression of complement components in pleural biopsy specimens of TPE patients was measured. The concentration of cleavage products of complement was tested in TPE by ELISA. Moreover, the colocalizations of C3b and CR1, C3d and CR3, and CXCL12 and CXCR4 in monocytes and pleural mesothelial cells (PMCs) isolated from TPE were determined by an immunofluorescent assay. Monocyte chemotaxis assay was analyzed via transwell chambers. Results. Three pathways of the complement system were activated in tuberculous pleurisy. In patients with TPE, C3 lysis was more active than peripheral blood in pleural cavity. Tuberculous protein Mpt64 and anaphylatoxin C3a could significantly promote CXCL12 production in human PMCs isolated from TPE. C3b-CR1, C3d-CR3, and CXCL12-CXCR4 were colocalized in PMCs and monocytes from TPE. The recruitment of monocytes into TPE mediated by PMCs could be inhibited by anti-CR1, anti-CR3, and anti-CXCL12 monoclonal antibodies (mAbs). Conclusions. Complement activates strongly in TPE, and PMCs induced monocytes to the pleural cavity through C3a, C3b, and C3d.

Background. Osteoporosis “OP” is classified as one of the most serious health conditions worldwide. OP increases the skeletal fracture risk by 35%, particularly at hip, spine, and wrist joints. Healthcare professionals should be aware of OP clinical signs and have good knowledge while managing all patients. Objectives. This study aims to investigate the current level of osteoporosis knowledge and awareness among physical therapy providers in Saudi Arabia. Methods. One hundred and sixty-eight physical therapy providers participated in this cross-sectional electronic survey from February to July of 2021. The participants completed the Osteoporosis Knowledge Assessment Tool questionnaire (OKAT). Descriptive analysis was utilized to assess the current level of osteoporosis knowledge among physical therapy providers. Results. Among the 168 participants, 55% (n = 92) were over 31 years old and 45% (n = 76) were 30 years old or under. The majority of participants 37% (n = 62) had more than 10 years of experience, 45% (n = 76) mainly treat orthopedic conditions, and 70% (n = 117) live in the western region. The results showed that 67.9% (n = 114) of participants had good knowledge about osteoporosis, while 19.6% (n = 33) had poor knowledge, and only 12.5% (n = 21) had excellent knowledge. Conclusion. Physical therapy providers in Saudi Arabia have a good knowledge of osteoporosis. The overall OP preventive measure knowledge questions were poor. It is crucial for physical therapy providers to act appropriately to prevent falls and mitigate any potential risks.