Objective To study the relationship between dyslipidemia and outcome in patients with acute ischemic stroke. Methods Data about 2 568 patients with acute ischemic stroke were collected from 4 hospitals in Shandong Pro...Objective To study the relationship between dyslipidemia and outcome in patients with acute ischemic stroke. Methods Data about 2 568 patients with acute ischemic stroke were collected from 4 hospitals in Shandong Province from January 2006 to December 2008. National Institute of Health Stroke Scale （NIHSS） 〉10 at discharge or death was defined as the outcome. Effect of dyslipidemia on outcome in patients with acute ischemic stroke was analyzed by multivariate logistic regression analysis and propensity score-adjusted analysis, respectively. Results The serum levels of TC, LDL-C, and HDL-C were significantly associated with the outcome in patients with acute ischemic stroke. Multivariate logistic regression analysis and propensity score-adjusted analysis showed that the ORs and 95% CIs were 3.013 （1.259, 7.214）/2.655 （1.298, 5.43）, 3.157 （1.306, 7.631）/3.405 （1.621, 7.154）, and 0.482 （0.245, 0.946）/0.51 （0.282, O.921）, respectively, for patients with acute ischemic stroke. Hosmer-Lemeshow goodness-of-fit test showed no significant difference in observed and predicted risk in patients with acute ischemic stroke （chi-square=8.235, P=0.411）. Conclusion Serum levels of TC, LDL-C, and HDL-C are positively related with the outcome in patients with acute ischemic stroke.展开更多
Previous discussion about the factors of the expanding trend of abandoned cultivation had focused only on universal factors and lacked evaluation of the regionality of the phenomenon. This paper demonstrated the Toraj...Previous discussion about the factors of the expanding trend of abandoned cultivation had focused only on universal factors and lacked evaluation of the regionality of the phenomenon. This paper demonstrated the Toraja’s regional characteristics and the influence of cultural endemism on decision-making about abandoning cultivation by an observation-oriented approach. Based on a causal framework constructed by field observation and geospatial data generation, an adjustment for overt covariates using the multivariate logistic regression model to draw the causal effect from hidden covariates was examined in two rice terraces with different water systems, i.e. irrigated field and rain-fed field. The result of sub-group analysis revealed that decisions about abandoning cultivation in Toraja were greatly associated with disadvantageous factors for intensive farming, i.e. “number of adjacent fields” and “soil erosion” rather than advantageous factors, i.e. “area of field” and “distance to roads”. Moreover, the result of interaction analysis which controlled the effect of topography revealed the powerful effect of particular decision factors only in rain-fed rice terrace: the “distance to roads” factor’s fairly negative contribution on abandoning cultivation (Odds ratio = 9.94E - 01, P value = 2.03E - 11), as well as the “number of adjacent field” factor’s positive contribution on abandoning cultivation (Odds ratio = 1.13E+00, P value = 3.65E - 04). Given the evidence from the explanation of these results by customary laws and land inheritance system for each site, therefore, it could be concluded that the screening and detection of cultural endemism’s influence was achieved using the algorithm this paper proposes.展开更多
Objective To investigate the endoscopic and pathological features and the independent risk factors for early esophageal cancer combined with multiple primary cancer.Methods Endoscopic and pathological features of 324 ...Objective To investigate the endoscopic and pathological features and the independent risk factors for early esophageal cancer combined with multiple primary cancer.Methods Endoscopic and pathological features of 324 patients diagnosed as having early esophageal cancer from January 2013 to January 2022 in Beijing FriendshipHospital wereretrospectivelycollected.Independent risk factors for early esophageal cancer combined with multiple primary cancer were selected by multivariate logistic regression analysis.Results Among the 324 patients with early esophageal cancer,47(14.51%)patients(29 metachronous and 18 synchronous)had multiple primary cancer.Multivariate logistic regression analysis showed that alcohol drinking≥5 standard drinks/day(OR=6.23,95%CI:2.49-15.57,P<0.001),submucosal layer invasion(0R=2.80,95%Cl:1.07-7.30,P=0.036),lesion location at lower esophagus(0R=4.18,95%CI:1.98-8.97,P<0.001)and multiple lesions in esophagus(0R=3.30,95%CI:1.57-6.92,P=0.002)were independent risk factors for early esophageal cancer combined with multiple primary cancer.Conclusion Alcohol drinking≥5 standard drinks/day,submucosal layer invasion,lower lesions location,and multiple lesions in the esophagus are independent risk factors that are more likely to develop multiple primary cancer in patients with early esophageal cancer.It is recommended to prioritize monitoring patients with these factors,and enhance endoscopic follow-up and assessment.展开更多
Objective To develop a nomogram based on the monocyte-to-lymphocyte ratio(MLR)for predicting the risk of aortic-related adverse events within 30 days in patients with acute uncomplicated type B aortic intramural hemat...Objective To develop a nomogram based on the monocyte-to-lymphocyte ratio(MLR)for predicting the risk of aortic-related adverse events within 30 days in patients with acute uncomplicated type B aortic intramural hematoma.Methods This single-center retrospective cohort study screened consecutive patients with acute uncomplicated type B aortic intramural hematoma treated at the EmergencyyandCardiovascular Medicine Departments of the General Hospital of the Northern Theater Command from April 2018 to April 2024.Patients were divided into two groups based on the optimal MLR cut-off value for predicting aortic-related adverse events:low MLR and high MLR group.MLR was defined as the ratio of monocytes to lymphocytes.Aortic-related adverse events were defined as a composite of aortic-related death or aortic intramural hematoma progression(including aortic dissection and penetrating aortic ulcers)within 30 days.The receiver operating characteristic(ROC)curve identified the optimal MLR cut-off value.Multivariate logistic regression was used to identify independent predictors of aortic-related adverse events within 30 days,based on which nomogram models were constructed:the clinical characteristics model and the clinical characteristics-MLR model.The DeLong test was used to evaluate the diagnostic performance of different risk models.The additional predictive value of MLR was assessed using the net reclassification index(NRI)and integrated discrimination improvement(IDI).Results A total of 332 patients were included,of whom 217 were male(65.4%),with an average age of(64.3±9.4)years.A total of 107 aortic-related adverse events occurred during the 30-day follow-up period.The optimal cut-off value for MLR was 0.529.There were 189 cases in the low MLR group(MLR<0.529)and 143 cases in the high MLR group(MLR≥0.529).The rate of aortic-related adverse events was higher in the high MLR group compared to.the low MLR group(44.1%(63/143)vs.23.3%(44/189),P<0.001),mainly due to a higher rate of progression to aortic dissection(9.8%(14/143)vs.1.1%(2/189),P<0.001)and penetrating aortic ulcers(31.5%(45/143)vs.20.6%(39/189),P=0.025).Multivariate analysis identified diabetes(OR=0.25,95%CI 0.08-0.78,P=0.017),anemia(0R=3.45,95%CI 1.28-9.27,P=0.014),maximum descending aorta diameter(0R=1.08,95%CI 1.02-1.15,P=0.007),ulcerlike projections(OR=4.04,95%CI 2.26-7.24,P<0.001),and MLR(0R=6.61,95%CI 2.50-17.46,P<0.001)as independent predictors of aortic-related adverse events during the 30-day follow-up period.The clinical characteristics model includes diabetes,anemia,ulcer-like projections and maximum diameter of the descending aorta,and the clinical characteristics-MLR model includes the above clinical characteristics and MLR.The results of the DeLong test showed that the clinical characteristic-MLR model demonstrated a higher area under the ROC curve compared to the clinical characteristic model alone(0.784(95%CI 0.736-0.841)vs.0.742(95%CI0.691-0.788),P=0.031).The continuous NRI was 0.461(95%CI 0.237-0.685,P<0.001)and the IDI was 0.077(95%CI 0.043-0.112,P<0.001),indicating that the inclusion of the MLR in the model significantly improved the predictive accuracy.Conclusion The integration of MLR with other clinical characteristics improves the early identification ofhigh-risk patients with acute uncomplicated type B aortic intramural hematoma,optimizing clinical decisions and improving patient outcomes.展开更多
Introduction:The Global Activity Limitation Indicator(GALI)offers a simpler and more efficient approach to measuring disability compared to traditional instruments.While GALI’s reliability has been validated across d...Introduction:The Global Activity Limitation Indicator(GALI)offers a simpler and more efficient approach to measuring disability compared to traditional instruments.While GALI’s reliability has been validated across different regions,its effectiveness is influenced by cultural differences.This study aims to assess GALI’s applicability in China and examine the relationships between GALI and mortality rates,as well as health human resources.Methods:We analyzed data from the Resident Health and Health Service Monitoring survey,a nationally representative cross-sectional survey conducted annually from 2019−2022.Multivariate and multinomial logistic regression models were employed to estimate odds ratios and activity limitation probabilities.Mixed effect models were used to explore county-level associations.Results:GALI demonstrated high response rates and reliability throughout the survey period.Significant associations were observed between GALI and traditional disability instruments,as well as disease prevalence.At the county level,GALI showed positive associations with mortality rates and negative associations with the number of physicians per thousand residents.Conclusions:GALI represents a reliable measure of disability for the Chinese mainland population and could serve as a potential predictor for cardiovascular diseases,respiratory system diseases,and unintentional injuries.Our findings suggest that increasing the number of physicians per thousand residents may be associated with reduced activity limitation,though additional research is needed to validate this relationship.展开更多
Objective To observe the long-term efficacy of qibenefiting and yin-nourishing Chinese patent medicines(QYP)for IgA nephropathy(IgAN).Methods Two thousand patients with primary IgAN diagnosed by renal biopsy at three ...Objective To observe the long-term efficacy of qibenefiting and yin-nourishing Chinese patent medicines(QYP)for IgA nephropathy(IgAN).Methods Two thousand patients with primary IgAN diagnosed by renal biopsy at three hospitals were included in this study.Patients were assigned to a treatment group and a control group based on the administration of QYP.Demographic data,pathological outcomes,and differences in Chinese medicine syndromes between the two groups were compared.To control for confounding factors,a 1:1 propensity score matching method was used to match patients,and a multivariate Logistic regression analysis was conducted to explore the factors influencing the efficacy of QYP.Results Among 2000 patients with primary IgAN,491 patients were treated with QYP,while 1509 cases served as the control group..After matching propensity scores between groups,228 cases were included in each group.The median age of patients in the treatment group was 35.5 years(interquartile range:28.0,44.0),urine protein quantification was 1.2(0.7,1.9)g/d,and the eGFR was 84.6(61.2,107.0)mL/min/1.73 m^(2),the fllow-up period was was 32.0(12.0,62.0)months,a total of 21 patients(9.2%)experienced deterioration in renal function after treatment.In the control group,the median age was 34.0(27.0,43.0)years,urine protein quantification was 1.2(0.7,2.1)g/d,and eGFR was 84.8(56.2,112.2)mL/min/1.73 m^(2),the follow-up period was 30.5(12.0,54.8)months,a total of 35 patients(15.4%)experienced deterioration in renal function after treatment.The difference in the rate of renal function deterioration between the two groupswas statistically significant(P<0.05).Multivariable Logistic regression analysis showed that patients with qi and yin deficiency syndrome(OR 1.972,95%CI:1.162-3.346),damp-heat syndrome(OR 1.862,95%Cl:1.093-3.172)and those with crescent formation(0R 1.067,95%Cl:1.020-1.115)were more likely to achieve clinical remission with the use of QYP.Conclusion QYP delays the deterioration of renal function.Treatment with the application of QYP,particularly for patients with damp-heat syndrome and crescentic formation,can facilitate clinical remission in IgAN patients.展开更多
Background Infected pancreatic necrosis(IPN)exacerbates complications in patients with acute pancreatitis(AP),increasing mortality rates if not treated promptly.We aimed to evaluate the predictive value of clinical ch...Background Infected pancreatic necrosis(IPN)exacerbates complications in patients with acute pancreatitis(AP),increasing mortality rates if not treated promptly.We aimed to evaluate the predictive value of clinical characteristics within 24 hours of admission for IPN prediction.Methods We conducted a retrospective,multicentre cohort study including 3005 patients with AP from eight hospitals in China.Clinical variables collected within 24 hours after admission were analysed using least absolute shrinkage and selection operator regression(10 cross-validations)for variable selection,followed by multivariate logistic regression to develop an IPN prediction model.Internal cross-validation of the development set and validation of the validation set were performed to ensure robustness.Decision curve analysis was used to evaluate its clinical utility.Results IPN occurred in 176 patients(176/3005,5.9%).The final model included temperature,respiratory rate,plasma calcium ion concentration,serum urea nitrogen and serum glucose.The area under the receiver operating characteristics curve(AUC)was 0.85(95%CI 0.81 to 0.89),outperforming widely used severity scoring systems.The model demonstrated robust performance on the internal validation cohort(mean AUC:0.84)and external validation cohort(AUC:0.82,95%CI 0.77 to 0.87).Conclusion We developed a simple and robust model for predicting IPN in patients with AP,demonstrating strong predictive performance and clinical utility.展开更多
Background Hemodynamically significant patent ductus arteriosus(hsPDA)is associated with increased comorbidities in neonates.Early evaluation of hsPDA risk is critical to implement individualized intervention.The aim ...Background Hemodynamically significant patent ductus arteriosus(hsPDA)is associated with increased comorbidities in neonates.Early evaluation of hsPDA risk is critical to implement individualized intervention.The aim of the study was to provide a powerful reference for the early identification of high-risk hsPDA population and early treatment decisions.Methods We enrolled infants who were diagnosed with PDA and performed exome sequencing.The collapsing analyses were used to find the risk gene set(RGS)of hsPDA for model construction.The credibility of RGS was proven by RNA sequencing.Multivariate logistic regression was performed to establish models combining clinical and genetic features.The models were evaluated by area under the receiver operating curve(AUC)and decision curve analysis(DCA).Results In this retrospective cohort study of 2199 PDA patients,549(25.0%)infants were diagnosed with hsPDA.The model[all clinical characteristics selected by least absolute shrinkage and selection operator regression(all CCs)]based on six clinical variables was acquired within three days of life,including gestational age(GA),respiratory distress syndrome(RDS),the lowest platelet count,invasive mechanical ventilation,and positive inotropic and vasoactive drugs.It has an AUC of 0.790[95%confidence interval(CI)=0.749–0.832],while the simplified model(basic clinical characteristic model)including GA and RDS has an AUC of 0.753(95%CI=0.706–0.799).There was a certain consistency between RGS and differentially expressed genes of the ductus arteriosus in mice.The AUC of the models was improved by RGS,and the improvement was significant(all CCs vs.all CCs+RGS:0.790 vs.0.817,P<0.001).DCA demonstrated that all models were clinically useful.Conclusions Models based on clinical factors were developed to accurately stratify the risk of hsPDA in the first three days of life.Genetic features might further improve the model performance.展开更多
Background:Diarrhoeal diseases remain an important cause of mortality and morbidity among children,particularly in low-and middle-income countries.In Senegal,diarrhoea is responsible for 15%of all deaths in children u...Background:Diarrhoeal diseases remain an important cause of mortality and morbidity among children,particularly in low-and middle-income countries.In Senegal,diarrhoea is responsible for 15%of all deaths in children under the age of five and is the third leading cause of childhood deaths.For targeted planning and implementation of prevention strategies,a context-specific understanding of the determinants of diarrhoeal diseases is needed.The aim of this study was to identify risk factors of diarrhoeal diseases in children under the age of five in Mbour,Senegal.Methods:Between February and March 2014,a cross-sectional survey was conducted in four zones of Mbour to estimate the burden of diarrhoeal diseases(i.e.diarrhoea episodes in the 2 weeks preceding the survey)and associated risk factors.The zones covered urban central,peri-central,north peripheral and south peripheral areas.Overall,596 households were surveyed by a questionnaire,yielding information on sociodemographic,environmental and hygiene behavioural factors.Univariable and multivariable logistic regression analyses were used to identify risk factors associated with the occurrence of diarrhoea.Results:The reported prevalence of diarrhoea among children under the age of five during the 2 weeks preceding the survey was 26%.Without adjustment,the highest diarrhoea prevalence rates were observed in the peri-central(44.8%)and urban central zones(36.3%).Multivariable regression revealed significant associations between diarrhoeal diseases and unemployment of mothers(adjusted odds ratio[aOR]=1.62,95%confidence interval[CI]:1.18-2.23),use of open bags for storing household waste(aOR=1.75,95%CI:1.00-3.02),evacuation of household waste in public streets(aOR=2.07,95%CI:1.20-3.55),no treatment of stored drinking water(aOR=1.69,95%CI:1.11-2.56)and use of shared toilets(aOR=1.69,95%CI:1.11-2.56).Conclusion:We found a high prevalence of diarrhoea in children under the age of five in Mbour,with the highest prevalence occurring in the central and peri-central areas.These findings underscore the need for public health interventions to alleviate the burden of diarrhoea among vulnerable groups.Promotion of solid waste disposal and reduction of wastewater exposure should be implemented without delay.展开更多
基金supported by the National Natural Science Foundation of China(Grant No.81172761)a Project of the Priority Academic Program Development of Jiangsu Higher Education Institutions
文摘Objective To study the relationship between dyslipidemia and outcome in patients with acute ischemic stroke. Methods Data about 2 568 patients with acute ischemic stroke were collected from 4 hospitals in Shandong Province from January 2006 to December 2008. National Institute of Health Stroke Scale （NIHSS） 〉10 at discharge or death was defined as the outcome. Effect of dyslipidemia on outcome in patients with acute ischemic stroke was analyzed by multivariate logistic regression analysis and propensity score-adjusted analysis, respectively. Results The serum levels of TC, LDL-C, and HDL-C were significantly associated with the outcome in patients with acute ischemic stroke. Multivariate logistic regression analysis and propensity score-adjusted analysis showed that the ORs and 95% CIs were 3.013 （1.259, 7.214）/2.655 （1.298, 5.43）, 3.157 （1.306, 7.631）/3.405 （1.621, 7.154）, and 0.482 （0.245, 0.946）/0.51 （0.282, O.921）, respectively, for patients with acute ischemic stroke. Hosmer-Lemeshow goodness-of-fit test showed no significant difference in observed and predicted risk in patients with acute ischemic stroke （chi-square=8.235, P=0.411）. Conclusion Serum levels of TC, LDL-C, and HDL-C are positively related with the outcome in patients with acute ischemic stroke.
文摘Previous discussion about the factors of the expanding trend of abandoned cultivation had focused only on universal factors and lacked evaluation of the regionality of the phenomenon. This paper demonstrated the Toraja’s regional characteristics and the influence of cultural endemism on decision-making about abandoning cultivation by an observation-oriented approach. Based on a causal framework constructed by field observation and geospatial data generation, an adjustment for overt covariates using the multivariate logistic regression model to draw the causal effect from hidden covariates was examined in two rice terraces with different water systems, i.e. irrigated field and rain-fed field. The result of sub-group analysis revealed that decisions about abandoning cultivation in Toraja were greatly associated with disadvantageous factors for intensive farming, i.e. “number of adjacent fields” and “soil erosion” rather than advantageous factors, i.e. “area of field” and “distance to roads”. Moreover, the result of interaction analysis which controlled the effect of topography revealed the powerful effect of particular decision factors only in rain-fed rice terrace: the “distance to roads” factor’s fairly negative contribution on abandoning cultivation (Odds ratio = 9.94E - 01, P value = 2.03E - 11), as well as the “number of adjacent field” factor’s positive contribution on abandoning cultivation (Odds ratio = 1.13E+00, P value = 3.65E - 04). Given the evidence from the explanation of these results by customary laws and land inheritance system for each site, therefore, it could be concluded that the screening and detection of cultural endemism’s influence was achieved using the algorithm this paper proposes.
文摘Objective To investigate the endoscopic and pathological features and the independent risk factors for early esophageal cancer combined with multiple primary cancer.Methods Endoscopic and pathological features of 324 patients diagnosed as having early esophageal cancer from January 2013 to January 2022 in Beijing FriendshipHospital wereretrospectivelycollected.Independent risk factors for early esophageal cancer combined with multiple primary cancer were selected by multivariate logistic regression analysis.Results Among the 324 patients with early esophageal cancer,47(14.51%)patients(29 metachronous and 18 synchronous)had multiple primary cancer.Multivariate logistic regression analysis showed that alcohol drinking≥5 standard drinks/day(OR=6.23,95%CI:2.49-15.57,P<0.001),submucosal layer invasion(0R=2.80,95%Cl:1.07-7.30,P=0.036),lesion location at lower esophagus(0R=4.18,95%CI:1.98-8.97,P<0.001)and multiple lesions in esophagus(0R=3.30,95%CI:1.57-6.92,P=0.002)were independent risk factors for early esophageal cancer combined with multiple primary cancer.Conclusion Alcohol drinking≥5 standard drinks/day,submucosal layer invasion,lower lesions location,and multiple lesions in the esophagus are independent risk factors that are more likely to develop multiple primary cancer in patients with early esophageal cancer.It is recommended to prioritize monitoring patients with these factors,and enhance endoscopic follow-up and assessment.
文摘Objective To develop a nomogram based on the monocyte-to-lymphocyte ratio(MLR)for predicting the risk of aortic-related adverse events within 30 days in patients with acute uncomplicated type B aortic intramural hematoma.Methods This single-center retrospective cohort study screened consecutive patients with acute uncomplicated type B aortic intramural hematoma treated at the EmergencyyandCardiovascular Medicine Departments of the General Hospital of the Northern Theater Command from April 2018 to April 2024.Patients were divided into two groups based on the optimal MLR cut-off value for predicting aortic-related adverse events:low MLR and high MLR group.MLR was defined as the ratio of monocytes to lymphocytes.Aortic-related adverse events were defined as a composite of aortic-related death or aortic intramural hematoma progression(including aortic dissection and penetrating aortic ulcers)within 30 days.The receiver operating characteristic(ROC)curve identified the optimal MLR cut-off value.Multivariate logistic regression was used to identify independent predictors of aortic-related adverse events within 30 days,based on which nomogram models were constructed:the clinical characteristics model and the clinical characteristics-MLR model.The DeLong test was used to evaluate the diagnostic performance of different risk models.The additional predictive value of MLR was assessed using the net reclassification index(NRI)and integrated discrimination improvement(IDI).Results A total of 332 patients were included,of whom 217 were male(65.4%),with an average age of(64.3±9.4)years.A total of 107 aortic-related adverse events occurred during the 30-day follow-up period.The optimal cut-off value for MLR was 0.529.There were 189 cases in the low MLR group(MLR<0.529)and 143 cases in the high MLR group(MLR≥0.529).The rate of aortic-related adverse events was higher in the high MLR group compared to.the low MLR group(44.1%(63/143)vs.23.3%(44/189),P<0.001),mainly due to a higher rate of progression to aortic dissection(9.8%(14/143)vs.1.1%(2/189),P<0.001)and penetrating aortic ulcers(31.5%(45/143)vs.20.6%(39/189),P=0.025).Multivariate analysis identified diabetes(OR=0.25,95%CI 0.08-0.78,P=0.017),anemia(0R=3.45,95%CI 1.28-9.27,P=0.014),maximum descending aorta diameter(0R=1.08,95%CI 1.02-1.15,P=0.007),ulcerlike projections(OR=4.04,95%CI 2.26-7.24,P<0.001),and MLR(0R=6.61,95%CI 2.50-17.46,P<0.001)as independent predictors of aortic-related adverse events during the 30-day follow-up period.The clinical characteristics model includes diabetes,anemia,ulcer-like projections and maximum diameter of the descending aorta,and the clinical characteristics-MLR model includes the above clinical characteristics and MLR.The results of the DeLong test showed that the clinical characteristic-MLR model demonstrated a higher area under the ROC curve compared to the clinical characteristic model alone(0.784(95%CI 0.736-0.841)vs.0.742(95%CI0.691-0.788),P=0.031).The continuous NRI was 0.461(95%CI 0.237-0.685,P<0.001)and the IDI was 0.077(95%CI 0.043-0.112,P<0.001),indicating that the inclusion of the MLR in the model significantly improved the predictive accuracy.Conclusion The integration of MLR with other clinical characteristics improves the early identification ofhigh-risk patients with acute uncomplicated type B aortic intramural hematoma,optimizing clinical decisions and improving patient outcomes.
基金The National Key Research and Development Plan of China(2022YFC3600800)The National Office for Philosophy and Social Sciences(21&ZD186).
文摘Introduction:The Global Activity Limitation Indicator(GALI)offers a simpler and more efficient approach to measuring disability compared to traditional instruments.While GALI’s reliability has been validated across different regions,its effectiveness is influenced by cultural differences.This study aims to assess GALI’s applicability in China and examine the relationships between GALI and mortality rates,as well as health human resources.Methods:We analyzed data from the Resident Health and Health Service Monitoring survey,a nationally representative cross-sectional survey conducted annually from 2019−2022.Multivariate and multinomial logistic regression models were employed to estimate odds ratios and activity limitation probabilities.Mixed effect models were used to explore county-level associations.Results:GALI demonstrated high response rates and reliability throughout the survey period.Significant associations were observed between GALI and traditional disability instruments,as well as disease prevalence.At the county level,GALI showed positive associations with mortality rates and negative associations with the number of physicians per thousand residents.Conclusions:GALI represents a reliable measure of disability for the Chinese mainland population and could serve as a potential predictor for cardiovascular diseases,respiratory system diseases,and unintentional injuries.Our findings suggest that increasing the number of physicians per thousand residents may be associated with reduced activity limitation,though additional research is needed to validate this relationship.
文摘Objective To observe the long-term efficacy of qibenefiting and yin-nourishing Chinese patent medicines(QYP)for IgA nephropathy(IgAN).Methods Two thousand patients with primary IgAN diagnosed by renal biopsy at three hospitals were included in this study.Patients were assigned to a treatment group and a control group based on the administration of QYP.Demographic data,pathological outcomes,and differences in Chinese medicine syndromes between the two groups were compared.To control for confounding factors,a 1:1 propensity score matching method was used to match patients,and a multivariate Logistic regression analysis was conducted to explore the factors influencing the efficacy of QYP.Results Among 2000 patients with primary IgAN,491 patients were treated with QYP,while 1509 cases served as the control group..After matching propensity scores between groups,228 cases were included in each group.The median age of patients in the treatment group was 35.5 years(interquartile range:28.0,44.0),urine protein quantification was 1.2(0.7,1.9)g/d,and the eGFR was 84.6(61.2,107.0)mL/min/1.73 m^(2),the fllow-up period was was 32.0(12.0,62.0)months,a total of 21 patients(9.2%)experienced deterioration in renal function after treatment.In the control group,the median age was 34.0(27.0,43.0)years,urine protein quantification was 1.2(0.7,2.1)g/d,and eGFR was 84.8(56.2,112.2)mL/min/1.73 m^(2),the follow-up period was 30.5(12.0,54.8)months,a total of 35 patients(15.4%)experienced deterioration in renal function after treatment.The difference in the rate of renal function deterioration between the two groupswas statistically significant(P<0.05).Multivariable Logistic regression analysis showed that patients with qi and yin deficiency syndrome(OR 1.972,95%CI:1.162-3.346),damp-heat syndrome(OR 1.862,95%Cl:1.093-3.172)and those with crescent formation(0R 1.067,95%Cl:1.020-1.115)were more likely to achieve clinical remission with the use of QYP.Conclusion QYP delays the deterioration of renal function.Treatment with the application of QYP,particularly for patients with damp-heat syndrome and crescentic formation,can facilitate clinical remission in IgAN patients.
基金supported by National High Level Hospital Clinical Research Funding(grant number 2022-PUMCH-B-023)National Key Clinical Specialty Construction Project(grant number ZK108000)+1 种基金Chinese Natural Science Foundation(grant number 32170788)the Beijing Natural Science Foundation(grant number 7232123).
文摘Background Infected pancreatic necrosis(IPN)exacerbates complications in patients with acute pancreatitis(AP),increasing mortality rates if not treated promptly.We aimed to evaluate the predictive value of clinical characteristics within 24 hours of admission for IPN prediction.Methods We conducted a retrospective,multicentre cohort study including 3005 patients with AP from eight hospitals in China.Clinical variables collected within 24 hours after admission were analysed using least absolute shrinkage and selection operator regression(10 cross-validations)for variable selection,followed by multivariate logistic regression to develop an IPN prediction model.Internal cross-validation of the development set and validation of the validation set were performed to ensure robustness.Decision curve analysis was used to evaluate its clinical utility.Results IPN occurred in 176 patients(176/3005,5.9%).The final model included temperature,respiratory rate,plasma calcium ion concentration,serum urea nitrogen and serum glucose.The area under the receiver operating characteristics curve(AUC)was 0.85(95%CI 0.81 to 0.89),outperforming widely used severity scoring systems.The model demonstrated robust performance on the internal validation cohort(mean AUC:0.84)and external validation cohort(AUC:0.82,95%CI 0.77 to 0.87).Conclusion We developed a simple and robust model for predicting IPN in patients with AP,demonstrating strong predictive performance and clinical utility.
基金funded by the Cohort Project of Specialized Disease,Clinical Research Center,Children's Hospital of Fudan University(2020ZBDL14)National Key R&D Program of China(2022ZD0116003).
文摘Background Hemodynamically significant patent ductus arteriosus(hsPDA)is associated with increased comorbidities in neonates.Early evaluation of hsPDA risk is critical to implement individualized intervention.The aim of the study was to provide a powerful reference for the early identification of high-risk hsPDA population and early treatment decisions.Methods We enrolled infants who were diagnosed with PDA and performed exome sequencing.The collapsing analyses were used to find the risk gene set(RGS)of hsPDA for model construction.The credibility of RGS was proven by RNA sequencing.Multivariate logistic regression was performed to establish models combining clinical and genetic features.The models were evaluated by area under the receiver operating curve(AUC)and decision curve analysis(DCA).Results In this retrospective cohort study of 2199 PDA patients,549(25.0%)infants were diagnosed with hsPDA.The model[all clinical characteristics selected by least absolute shrinkage and selection operator regression(all CCs)]based on six clinical variables was acquired within three days of life,including gestational age(GA),respiratory distress syndrome(RDS),the lowest platelet count,invasive mechanical ventilation,and positive inotropic and vasoactive drugs.It has an AUC of 0.790[95%confidence interval(CI)=0.749–0.832],while the simplified model(basic clinical characteristic model)including GA and RDS has an AUC of 0.753(95%CI=0.706–0.799).There was a certain consistency between RGS and differentially expressed genes of the ductus arteriosus in mice.The AUC of the models was improved by RGS,and the improvement was significant(all CCs vs.all CCs+RGS:0.790 vs.0.817,P<0.001).DCA demonstrated that all models were clinically useful.Conclusions Models based on clinical factors were developed to accurately stratify the risk of hsPDA in the first three days of life.Genetic features might further improve the model performance.
基金This study received financial support from l’Agence Universitaire de la Francophonie and from the Swiss government,through the Swiss Government Excellence Scholarships for Foreign Scholars(ESKAS scholarship)research training at the Swiss Tropical and Public Health Institute,an associated institute of the University of Basel.The funders had a supporting role in the data collection,analysis and preparation of the manuscript.
文摘Background:Diarrhoeal diseases remain an important cause of mortality and morbidity among children,particularly in low-and middle-income countries.In Senegal,diarrhoea is responsible for 15%of all deaths in children under the age of five and is the third leading cause of childhood deaths.For targeted planning and implementation of prevention strategies,a context-specific understanding of the determinants of diarrhoeal diseases is needed.The aim of this study was to identify risk factors of diarrhoeal diseases in children under the age of five in Mbour,Senegal.Methods:Between February and March 2014,a cross-sectional survey was conducted in four zones of Mbour to estimate the burden of diarrhoeal diseases(i.e.diarrhoea episodes in the 2 weeks preceding the survey)and associated risk factors.The zones covered urban central,peri-central,north peripheral and south peripheral areas.Overall,596 households were surveyed by a questionnaire,yielding information on sociodemographic,environmental and hygiene behavioural factors.Univariable and multivariable logistic regression analyses were used to identify risk factors associated with the occurrence of diarrhoea.Results:The reported prevalence of diarrhoea among children under the age of five during the 2 weeks preceding the survey was 26%.Without adjustment,the highest diarrhoea prevalence rates were observed in the peri-central(44.8%)and urban central zones(36.3%).Multivariable regression revealed significant associations between diarrhoeal diseases and unemployment of mothers(adjusted odds ratio[aOR]=1.62,95%confidence interval[CI]:1.18-2.23),use of open bags for storing household waste(aOR=1.75,95%CI:1.00-3.02),evacuation of household waste in public streets(aOR=2.07,95%CI:1.20-3.55),no treatment of stored drinking water(aOR=1.69,95%CI:1.11-2.56)and use of shared toilets(aOR=1.69,95%CI:1.11-2.56).Conclusion:We found a high prevalence of diarrhoea in children under the age of five in Mbour,with the highest prevalence occurring in the central and peri-central areas.These findings underscore the need for public health interventions to alleviate the burden of diarrhoea among vulnerable groups.Promotion of solid waste disposal and reduction of wastewater exposure should be implemented without delay.
