Importance:Emicizumab(EMI)is efficacious and safe for hemophilia A(HA)prophylaxis.However,its high cost poses a challenge in China.Objective:To explore the possibility of using reduced-dosage EMI in Chinese HA childre...Importance:Emicizumab(EMI)is efficacious and safe for hemophilia A(HA)prophylaxis.However,its high cost poses a challenge in China.Objective:To explore the possibility of using reduced-dosage EMI in Chinese HA children.Methods:We conducted a retrospective study for HA children in our Comprehensive Care Center.Data were collected pre-and post-EMI treatment to evaluate bleeding rates.Laboratory analyses included factor VIII(FVIII)-like activity and EMI concentration measurements.Results:Thirty-four HA children receiving EMI prophylaxis for a median(range)24.5(2.5–47.9)months by June 2023.Of these,25(73.5%)were under 3 years of age,26(76.5%)had severe hemophilia and 12(35.3%)were minimally treated or previously untreated patients.Thirty-one(91.2%)of the 34 patients received reduced-dosage EMI for economic reasons.EMI concentration and FVIII-like activity measured showed a strong correlation.Overall,while on EMI,their annual treated bleeding rate(ATBR)and annual bleeding rate(ABR)decreased significantly(2–0)while their zero-bleeding rate(ZBR)increased significantly(11.5%–65.4%).After 6 months of EMI,there was no significant difference in ATBR and ABR among various maintenance dosages.However,ZBR was significantly lower in dosages under 4 mg/kg(P=0.0156).Receiver operator characteristic curves suggested the following cutoff values for zero bleeding:EMI 4-weekly maintenance dosage 3.8 mg/kg,EMI concentration 48.1µg/mL,and FVIII-like activity 15.4 IU/dL.Interpretation:We showed EMI effectively prevented bleeding even at reduced dosages.However,the bleeding risk may be higher with EMI 4-weekly maintenance dosage<3.8 mg/kg,EMI concentration<48.1µg/mL,and FVIII-like activity<15.4 IU/dL for zero bleeding.It is important that dosage reduction be done rationally.Dosage tailoring is possible.展开更多
Background and Objective Patients with glioma experience a high symptom burden and have diverse palliative care needs.However,the assessment scales used in palliative care remain non-standardized and highly heterogene...Background and Objective Patients with glioma experience a high symptom burden and have diverse palliative care needs.However,the assessment scales used in palliative care remain non-standardized and highly heterogeneous.To evaluate the application patterns of the current scales used in palliative care for glioma,we aim to identify gaps and assess the need for disease-specific scales in glioma palliative care.Methods We conducted a systematic search of five databases including PubMed,Web of Science,Medline,EMBASE,and CINAHL for quantitative studies that reported scale-based assessments in glioma palliative care.We extracted data on scale characteristics,domains,frequency,and psychometric properties.Quality assessments were performed using the Cochrane ROB 2.0 and ROBINS-I tools.Results Of the 3,405 records initially identified,72 studies were included.These studies contained 75 distinct scales that were used 193 times.Mood(21.7%),quality of life(24.4%),and supportive care needs(5.2%)assessments were the most frequently assessed items,exceeding half of all scale applications.Among the various assessment dimensions,the Distress Thermometer(DT)was the most frequently used tool for assessing mood,while the Short Form-36 Health Survey Questionnaire(SF-36)was the most frequently used tool for assessing quality of life.The Mini Mental Status Examination(MMSE)was the most common tool for cognitive assessment.Performance status(5.2%)and social support(6.8%)were underrepresented.Only three brain tumor-specific scales were identified.Caregiver-focused scales were limited and predominantly burden-oriented.Conclusions There are significant heterogeneity,domain imbalances,and validation gaps in the current use of assessment scales for patients with glioma receiving palliative care.The scale selected for use should be comprehensive and user-friendly.展开更多
Objective To explore and quantify the association of hot night exposure during the sperm development period(0–90 lag days) with semen quality.Methods A total of 6,640 male sperm donors from 6 human sperm banks in Chi...Objective To explore and quantify the association of hot night exposure during the sperm development period(0–90 lag days) with semen quality.Methods A total of 6,640 male sperm donors from 6 human sperm banks in China during 2014–2020were recruited in this multicenter study.Two indices(i.e.,hot night excess [HNE] and hot night duration[HND]) were used to estimate the heat intensity and duration during nighttime.Linear mixed models were used to examine the association between hot nights and semen quality parameters.Results The exposure-response relationship revealed that HNE and HND during 0–90 days before semen collection had a significantly inverse association with sperm motility.Specifically,a 1 ℃ increase in HNE was associated with decreased sperm progressive motility of 0.0090(95% confidence interval[CI]:–0.0147,–0.0033) and decreased total motility of 0.0094(95% CI:–0.0160,–0.0029).HND was significantly associated with reduced sperm progressive motility and total motility of 0.0021(95% CI:–0.0040,–0.0003) and 0.0023(95% CI:–0.0043,–0.0002),respectively.Consistent results were observed at different temperature thresholds on hot nights.Conclusion Our findings highlight the need to mitigate nocturnal heat exposure during spermatogenesis to maintain optimal semen quality.展开更多
Objectives:To investigate the parenting stress,care burden,and coping styles in mothers of autistic children during the pandemic of COVID-19.The outbreak of COVID-19 and the closure of education and care centers for t...Objectives:To investigate the parenting stress,care burden,and coping styles in mothers of autistic children during the pandemic of COVID-19.The outbreak of COVID-19 and the closure of education and care centers for these children may affect stress,care burden,and adaptation of these mothers.Methods:This study was a cross-sectional research.A total of 110 mothers completed questionnaires.Data were analyzed by descriptive statistics(frequency,percentage,mean,and standard deviation),independent t-test,ANOVA,and multiple linear regressions.Results:Findings showed that parenting stress has a strong and direct correlation with caring burden(P<0.001,r=0.95),and a strong and indirect correlation with coping styles(P<0.001,r=−0.91).Variables of caring burden,coping strategies,mother’s age,mother’s job,mother’s education,number of autistic children,economic status,children’s age,and functional level of autism in children can predict 72.21%of the variance in parenting stress in these mothers.Conclusions:In the present study,parenting stress of mothers of autistic children was reported to be high during the COVID-19 pandemic.Based on the findings of this study,it can be concluded that pediatric nurses and health policymakers should provide a suitable educational and supportive environment for mothers of autistic children to enhance the coping level of these mothers and consequently reduce their parenting stress and care burden.展开更多
目的:基于Lasso回归构建癫痫患者认知功能障碍预测模型,并分析该模型的预测效能。方法:采用横断面研究,纳入美国国家健康与营养调查(National Health and Nutrition Examination Survey,NHANES)数据库的癫痫患者,依据数字符号替换测试(d...目的:基于Lasso回归构建癫痫患者认知功能障碍预测模型,并分析该模型的预测效能。方法:采用横断面研究,纳入美国国家健康与营养调查(National Health and Nutrition Examination Survey,NHANES)数据库的癫痫患者,依据数字符号替换测试(digit symbol substitution test,DSST)总分将参与者分为认知功能障碍组(DSST<34分)和认知功能正常组(DSST≥34分)。收集人口学资料、社会经济学特征、体力活动情况、疾病资料以及25-羟基维生素D[25-hydroxyvitamin D,25(OH)D]、神经丝轻链蛋白(neurofilament light chain,NfL)等实验室检测指标,应用Lasso回归筛选非0系数变量,构建多因素Logistic回归模型分析癫痫患者认知功能障碍的影响因素并构建列线图预测模型,应用受试者工作特征(receiver operating characteristic,ROC)曲线、Bootstrap校准曲线和Hosmer-Lemeshow拟合优度检验评价列线图模型对癫痫患者认知功能障碍的预测能力。结果:共纳入282例研究对象,癫痫患者认知功能障碍发生率为32.62%。经Lasso降维处理和Logistic回归共筛选得到血尿酸、NfL、血清25(OH)D和教育程度等癫痫患者认知功能障碍的影响因素。基于上述影响因素构建列线图预测模型,ROC曲线显示模型的曲线下面积为0.833(95%CI:0.780~0.886),特异度为0.804,灵敏度为0.781。Bootstrap校准曲线显示实测概率与列线图预测概率之间具有较高的一致性;Hosmer-Lemeshow拟合优度检验结果也表明列线图模型的拟合程度较好(χ^(2)=7.781,P=0.455)。结论:癫痫患者认知功能障碍的发生受到血尿酸、NfL、血清25(OH)D和教育程度等因素的影响,基于Lasso回归构建的癫痫患者认知功能障碍预测模型显示出良好的预测效能,为临床评估和干预提供了重要依据,有助于提高癫痫患者的预后管理效果。展开更多
基金National Natural Science Foundation of China,Grant/Award Number:82270133
文摘Importance:Emicizumab(EMI)is efficacious and safe for hemophilia A(HA)prophylaxis.However,its high cost poses a challenge in China.Objective:To explore the possibility of using reduced-dosage EMI in Chinese HA children.Methods:We conducted a retrospective study for HA children in our Comprehensive Care Center.Data were collected pre-and post-EMI treatment to evaluate bleeding rates.Laboratory analyses included factor VIII(FVIII)-like activity and EMI concentration measurements.Results:Thirty-four HA children receiving EMI prophylaxis for a median(range)24.5(2.5–47.9)months by June 2023.Of these,25(73.5%)were under 3 years of age,26(76.5%)had severe hemophilia and 12(35.3%)were minimally treated or previously untreated patients.Thirty-one(91.2%)of the 34 patients received reduced-dosage EMI for economic reasons.EMI concentration and FVIII-like activity measured showed a strong correlation.Overall,while on EMI,their annual treated bleeding rate(ATBR)and annual bleeding rate(ABR)decreased significantly(2–0)while their zero-bleeding rate(ZBR)increased significantly(11.5%–65.4%).After 6 months of EMI,there was no significant difference in ATBR and ABR among various maintenance dosages.However,ZBR was significantly lower in dosages under 4 mg/kg(P=0.0156).Receiver operator characteristic curves suggested the following cutoff values for zero bleeding:EMI 4-weekly maintenance dosage 3.8 mg/kg,EMI concentration 48.1µg/mL,and FVIII-like activity 15.4 IU/dL.Interpretation:We showed EMI effectively prevented bleeding even at reduced dosages.However,the bleeding risk may be higher with EMI 4-weekly maintenance dosage<3.8 mg/kg,EMI concentration<48.1µg/mL,and FVIII-like activity<15.4 IU/dL for zero bleeding.It is important that dosage reduction be done rationally.Dosage tailoring is possible.
文摘Background and Objective Patients with glioma experience a high symptom burden and have diverse palliative care needs.However,the assessment scales used in palliative care remain non-standardized and highly heterogeneous.To evaluate the application patterns of the current scales used in palliative care for glioma,we aim to identify gaps and assess the need for disease-specific scales in glioma palliative care.Methods We conducted a systematic search of five databases including PubMed,Web of Science,Medline,EMBASE,and CINAHL for quantitative studies that reported scale-based assessments in glioma palliative care.We extracted data on scale characteristics,domains,frequency,and psychometric properties.Quality assessments were performed using the Cochrane ROB 2.0 and ROBINS-I tools.Results Of the 3,405 records initially identified,72 studies were included.These studies contained 75 distinct scales that were used 193 times.Mood(21.7%),quality of life(24.4%),and supportive care needs(5.2%)assessments were the most frequently assessed items,exceeding half of all scale applications.Among the various assessment dimensions,the Distress Thermometer(DT)was the most frequently used tool for assessing mood,while the Short Form-36 Health Survey Questionnaire(SF-36)was the most frequently used tool for assessing quality of life.The Mini Mental Status Examination(MMSE)was the most common tool for cognitive assessment.Performance status(5.2%)and social support(6.8%)were underrepresented.Only three brain tumor-specific scales were identified.Caregiver-focused scales were limited and predominantly burden-oriented.Conclusions There are significant heterogeneity,domain imbalances,and validation gaps in the current use of assessment scales for patients with glioma receiving palliative care.The scale selected for use should be comprehensive and user-friendly.
基金funded by the Guangdong Provincial Natural Science Foundation of China(No.2022A1515011517).
文摘Objective To explore and quantify the association of hot night exposure during the sperm development period(0–90 lag days) with semen quality.Methods A total of 6,640 male sperm donors from 6 human sperm banks in China during 2014–2020were recruited in this multicenter study.Two indices(i.e.,hot night excess [HNE] and hot night duration[HND]) were used to estimate the heat intensity and duration during nighttime.Linear mixed models were used to examine the association between hot nights and semen quality parameters.Results The exposure-response relationship revealed that HNE and HND during 0–90 days before semen collection had a significantly inverse association with sperm motility.Specifically,a 1 ℃ increase in HNE was associated with decreased sperm progressive motility of 0.0090(95% confidence interval[CI]:–0.0147,–0.0033) and decreased total motility of 0.0094(95% CI:–0.0160,–0.0029).HND was significantly associated with reduced sperm progressive motility and total motility of 0.0021(95% CI:–0.0040,–0.0003) and 0.0023(95% CI:–0.0043,–0.0002),respectively.Consistent results were observed at different temperature thresholds on hot nights.Conclusion Our findings highlight the need to mitigate nocturnal heat exposure during spermatogenesis to maintain optimal semen quality.
基金supported by Hamadan University of Medical Sciences supported financially this research(No.140005123994).
文摘Objectives:To investigate the parenting stress,care burden,and coping styles in mothers of autistic children during the pandemic of COVID-19.The outbreak of COVID-19 and the closure of education and care centers for these children may affect stress,care burden,and adaptation of these mothers.Methods:This study was a cross-sectional research.A total of 110 mothers completed questionnaires.Data were analyzed by descriptive statistics(frequency,percentage,mean,and standard deviation),independent t-test,ANOVA,and multiple linear regressions.Results:Findings showed that parenting stress has a strong and direct correlation with caring burden(P<0.001,r=0.95),and a strong and indirect correlation with coping styles(P<0.001,r=−0.91).Variables of caring burden,coping strategies,mother’s age,mother’s job,mother’s education,number of autistic children,economic status,children’s age,and functional level of autism in children can predict 72.21%of the variance in parenting stress in these mothers.Conclusions:In the present study,parenting stress of mothers of autistic children was reported to be high during the COVID-19 pandemic.Based on the findings of this study,it can be concluded that pediatric nurses and health policymakers should provide a suitable educational and supportive environment for mothers of autistic children to enhance the coping level of these mothers and consequently reduce their parenting stress and care burden.
文摘目的:基于Lasso回归构建癫痫患者认知功能障碍预测模型,并分析该模型的预测效能。方法:采用横断面研究,纳入美国国家健康与营养调查(National Health and Nutrition Examination Survey,NHANES)数据库的癫痫患者,依据数字符号替换测试(digit symbol substitution test,DSST)总分将参与者分为认知功能障碍组(DSST<34分)和认知功能正常组(DSST≥34分)。收集人口学资料、社会经济学特征、体力活动情况、疾病资料以及25-羟基维生素D[25-hydroxyvitamin D,25(OH)D]、神经丝轻链蛋白(neurofilament light chain,NfL)等实验室检测指标,应用Lasso回归筛选非0系数变量,构建多因素Logistic回归模型分析癫痫患者认知功能障碍的影响因素并构建列线图预测模型,应用受试者工作特征(receiver operating characteristic,ROC)曲线、Bootstrap校准曲线和Hosmer-Lemeshow拟合优度检验评价列线图模型对癫痫患者认知功能障碍的预测能力。结果:共纳入282例研究对象,癫痫患者认知功能障碍发生率为32.62%。经Lasso降维处理和Logistic回归共筛选得到血尿酸、NfL、血清25(OH)D和教育程度等癫痫患者认知功能障碍的影响因素。基于上述影响因素构建列线图预测模型,ROC曲线显示模型的曲线下面积为0.833(95%CI:0.780~0.886),特异度为0.804,灵敏度为0.781。Bootstrap校准曲线显示实测概率与列线图预测概率之间具有较高的一致性;Hosmer-Lemeshow拟合优度检验结果也表明列线图模型的拟合程度较好(χ^(2)=7.781,P=0.455)。结论:癫痫患者认知功能障碍的发生受到血尿酸、NfL、血清25(OH)D和教育程度等因素的影响,基于Lasso回归构建的癫痫患者认知功能障碍预测模型显示出良好的预测效能,为临床评估和干预提供了重要依据,有助于提高癫痫患者的预后管理效果。
