Comparison of QT Correction Methods in the Pediatric Population of a Community Hospital: A Retrospective Study

Objective:Accurate measurement of QT interval,the ventricular action potential from depolarization to repolarization,is important for the early detection of Long QT syndrome.The most effective QT correction(QTc)formula has yet to be determined in the pediatric population,although it has intrinsically greater extremes in heart rate(HR)and is more susceptible to errors in measurement.The authors of this study compare six dif-ferent QTc methods(Bazett,Fridericia,Framingham,Hodges,Rautaharju,and a computer algorithm utilizing the Bazett formula)for consistency against variations in HR and RR interval.Methods:Descriptive Retrospective Study.We included participants from a pediatric cardiology practice of a community hospital who had an ECG performed in 2017.All participants were healthy patients with no past medical history and no regular med-ications.Results:ECGs from 95 participants from one month to 21 years of age(mean 9.7 years)were included with a mean HR of 91 beats per minute(bpm).The two-sample paired t-test or Wilcoxon signed-rank test assessed for any difference between QTc methods.A statistically significant difference was observed between every combination of two QTc formulae.The Spearman’s rank correlation analysis explored the QTc/HR and QTc/RR relationships for each formula.Fridericia method was most independent of HR and RR with the lowest absolute value of correlation coefficients.Bazett and Computer had moderate correlations,while Framingham and Rautaharju exhibited strong correlations.Correlations were positive for Bazett and Computer,reflecting results from prior studies demonstrating an over-correction of Bazett at higher HRs.In the linear QTc/HR regression analysis,Bazett had the slope closest to zero,although Computer,Hodges,and Fridericia had comparable values.Alternatively,Fridericia had the linear QTc/RR regression coefficient closest to zero.The Bland-Altman method assessed for bias and the limits of agreement between correction formulae.Bazett and Computer exhibited good agreement with minimal bias along with Framingham and Rautaharju.To account for a possible skewed distri-bution of QT,all the above analyses were also performed excluding the top and bottom 2%of data as sorted by heart rate ranges(N=90).Results from this data set were consistent with those derived from all participants(N=95).Conclusions:Overall,the Fridericia correction method provided the best rate correction in our pedia-tric study cohort.

Psychiatric comorbidities in epilepsy:population co-occurrence,genetic correlations and causal effects

Background Psychiatric comorbidities are common in patients with epilepsy.Reasons for the co-occurrence of psychiatric conditions and epilepsy remain poorly understood.Aim We aimed to triangulate the relationship between epilepsy and psychiatric conditions to determine the extent and possible origins of these conditions.Methods Using nationwide Swedish health registries,we quantified the lifetime prevalence of psychiatric disorders in patients with epilepsy.We then used summarydata from genome-wide association studies to investigate whether the identified observational associations could be attributed to a shared underlying genetic aetiology using cross-trait linkage disequilibrium score regression.Finally,we assessed the potential bidirectional relationships using two-sample Mendelian randomisation.Results In a cohort of 7628495 individuals,we found that almost half of the 94435 individuals diagnosed with epilepsy were also diagnosed with a psychiatric condition in their lifetime(adjusted lifetime prevalence,44.09%;95%confidence interval(Cl)43.78%to 44.39%).We found evidence for a genetic correlation between epilepsy and some neurodevelopmental and psychiatric conditions.For example,we observed a genetic correlation between epilepsy and attention-deficit/hyperactivity disorder(r,=0.18,95%Cl 0.09 to 0.27,p<0.001)—a correlation that was more pronounced in focal epilepsy(r=0.23,95%CI 0.09 to 0.36,p<0.001).Findings from Mendelian randomisation using common genetic variants did not support bidirectional effects between epilepsy and neurodevelopmental or psychiatric conditions.Conclusions Psychiatric comorbidities are common in patients with epilepsy.Genetic correlations may partially explain some comorbidities;however,there is little evidence of a bidirectional relationship between the genetic liability of epilepsy and psychiatric conditions.These findings highlight the need to understand the role of environmental factors or rare genetic variations in the origins of psychiatric comorbidities in epilepsy.

Temporal trends and cohort variations of gender-specific major depressive disorders incidence in China:analysis based on the age-period-cohortinteraction model

Background Major depressive disorders(MDDs)impose substantial burdens on individuals and society;however,further detailed analysis is still needed for its long-term trends.Aims This study aimed to analyse the gender-specific temporal trends and cohort variations of MDD incidence among Chinese residents over the past three decades.Methods Employing the age-period-cohort-interaction model and leveraging data from the Global Burden of Disease Study 2019,this research identified and analysed incidence trends of MDD among Chinese males and females aged 5-94 years from 1990 to 2019 across three dimensions,encompassing age,period and birth cohort.Results The analysis reveals age-related effects,indicating heightened MDD risk among adolescents and older adults.Specifically,individuals entering the older adulthood at the age of 65-69 significantly increased the risk of MDD by 64.9%.People aged 90-94 years witnesseda 105.4%increase in MDD risk for the overall population,with females and males in this age group experiencing a 75.1%and 103.4%increase,respectively.In terms of period effects,the risk of MDD displayed a decline from 1990 to 1994,followed by a rebound in 2008.Cohort effects demonstrated diverse generational patterns,with generationⅠand generationⅢmanifesting opposing‘age-as-level'trends.GenerationⅡand generationⅣexhibited'cumulative disadvantage'and'cumulative advantage'patterns,respectively.Age effects indicated an overall higher risk of MDD incidence in females,while cohort effects showed greater variations of MDD incidence among females.Conclusions The study underscores the substantial effects of age,period and cohort on MDD across genders in China.Priority interventions targeting vulnerable populations,including children,adolescents,older adults,females and the post-millennium birth cohort,are crucial to mitigate the impact of MDD.

Identification of county-level health factors associated with COVID-19 mortality in the United States

Many studies have investigated causes of COVID-19 and explored safety measures for preventing COVID-19 infections.Unfortunately,these studies fell short to address disparities in health status and resources among decentralized communities in the United States.In this study,we utilized an advanced modeling technique to examine complex associations of county-level health factors with COVID-19 mortality for all 3141 counties in the United States.Our results indicated that counties with more uninsured people,more housing problems,more urbanized areas,and longer commute are more likely to have higher COVID-19 mortality.Based on the nationwide population-based data,this study also echoed prior research that used local data,and confirmed that county-level sociodemographic factors,such as more Black,Hispanic,and older subpopulations,are attributed to high risk of COVID-19 mortality.We hope that these findings will help set up priorities on high risk communities and subpopulations in future for fighting the novel virus.

Mental health status in veterans residing in rural versus non-rural areas: results from the veterans’ health study

Background: The majority of Veterans Affair(VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status.Methods: Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including posttraumatic stress disorder(PTSD), major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors.Results: A total of 1730 subjects(55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information(n=38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores;they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors(e.g., age, gender, marital status and education).Conclusions: Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.

Why caution should be applied when interpreting and promoting findings from Mendelian randomisation studies

Introduction In their article entitled‘Investigating genetic causal relationships between blood pressure and anxiety,depressive symptoms,neuroticism and subjective well-being’,Cai and colleagues1 presented the results of a two-sample Mendelian randomisation2(MR)study examining associations between blood pressure traits(systolic,diastolic,hypertension and pulse pressure)and psychological traits(anxiety,depression,neuroticism and subjective well-being).After correction for multiple testing.

Narrative minireview of the spatial epidemiology of substance use disorder in the United States:Who is at risk and where?

Drug overdose is the leading cause of death by injury in the United States.The incidence of substance use disorder(SUD)in the United States has increased steadily over the past two decades,becoming a major public health problem for the country.The drivers of the SUD epidemic in the United States have changed over time,characterized by an initial heroin outbreak between 1970 and 1999,followed by a painkiller outbreak,and finally by an ongoing synthetic opioid outbreak.The nature and sources of these abused substances reveal striking differences in the socioeconomic and behavioral factors that shape the drug epidemic.Moreover,the geospatial distribution of the SUD epidemic is not homogeneous.The United States has specific locations where vulnerable communities at high risk of SUD are concentrated,reaffirming the multifactorial socioeconomic nature of this epidemic.A better understanding of the SUD epidemic under a spatial epidemiology framework is necessary to determine the factors that have shaped its spread and how these patterns can be used to predict new outbreaks and create effective mitigation policies.This narrative minireview summarizes the current records of the spatial distribution of the SUD epidemic in the United States across different periods,revealing some spatiotemporal patterns that have preceded the occurrence of outbreaks.By analyzing the epidemic of SUD-related deaths,we also describe the epidemic behavior in areas with high incidence of cases.Finally,we describe public health interventions that can be effective for demographic groups,and we discuss future challenges in the study and control of the SUD epidemic in the country.

新护士入职2年内护理能力水平差异及影响因素研究

目的:探究新护士入职2年内护理能力使用频率和水平现状及影响因素,为进一步制定新护士护理能力精准分级的提升策略提供参考。方法:于2020年9月,采用量性研究,便利抽样上海市13所三级甲等医院入职2年内的新护士为研究对象进行问卷调查。结果:工作第2年(2019年入职)的新护士护理能力得分为(77.54±13.05)分,较2020年入职的新护士高,护理能力使用频率为71.76%~78.68%,也明显高于2020年入职的新护士,自评使用频率越高的新护士护理能力水平也越高。经线性多元回归分析得出,护理能力使用频率和职业认同感对新护士的护理能力均有持续的促进作用(P<0.001),而组织支持感仅对2019年入职的新护士护理能力有正向显著影响(P=0.011)。结论:新护士护理能力总体中等偏上,工作时间的积累、护理能力的反复运用、职业认同、组织支持都是新护士护理能力提升的保护因子。护理管理者应重视工作时间不同的新护士护理能力评估,针对影响因素采取精准分级干预措施提高新护士的护理能力。

Barriers in the Transition of Care for Heart Failure Patients Attending Clinics in Mwanza City, Tanzania

Introduction: Transition of care strategies have shown to improve quality of lives of heart failure patients, but it has little implemented in clinical settings. Objective: To evaluate context-specific perceived barriers and experiences of heart failure patients during their admission and after they were discharged from hospital. Methods: A cross-sectional qualitative study was conducted among 13 heart failure patients at two large referral hospitals in northwestern Tanzania. In-depth interviews among heart failure patients, in line with the Consolidated Criteria for Reporting Qualitative research checklist, were used to collect data. Interviews were audio recorded, transcribed, and translated into English. Results: Three key barriers were identified, as well as possible solutions that could improve the transition of care for heart failure patients. These include strengthening healthcare provider communications, organizing medication management, and assisting with follow-up appointments. Conclusion: The barriers identified are real and challenging in clinical resource- limited settings. Findings suggest they can be overcome when realistic and tailor-made interventions are in place.

Baseline neutrophil-lymphocyte ratio and platelet-lymphocyte ratio appear predictive of immune treatment related toxicity in hepatocellular carcinoma

BACKGROUND A well-recognized class effect of immune checkpoint inhibitors(ICI)is immune-related adverse events(IrAEs)ranging from low grade toxicities to life-threatening end organ damage requiring permanent discontinuation of ICI.Deaths are reported in<5%of patients treated with ICI.There are,however,no reliable markers to predict the onset and severity of IrAEs.We tested the association between neutrophil-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR)at baseline with development of clinically significant IrAEs(grade≥2)in hepatocellular carcinoma(HCC)patients treated with ICI.AIM To test the association between NLR and PLR at baseline with development of clinically significant IrAEs(grade≥2)in HCC patients treated with ICI.METHODS Data was extracted from an international database from a consortium of 11 tertiary-care referral centers.NLR=absolute neutrophil count/absolute lymphocyte count(ALC)and PLR=platelet count/ALC.Cutoff of 5 was used for NLR and 300 for PLR based on literature.We also tested the association between RESULTS Data was collected from 361 patients treated between 2016-2020 across the United States(67%),Asia(14%)and Europe(19%).Most patients received Nivolumab(n=255,71%).One hundred sixty-seven(46%)patients developed at least one IrAE,highest grade 1 in 80(48%),grade≥2 in 87(52%)patients.In a univariable regression model PLR>300 was significantly associated with a lower incidence of grade≥2 IrAEs(OR=0.40;P=0.044).Similarly,a trend was observed between NLR>5 and lower incidence of grade≥2 IrAEs(OR=0.58;P=0.097).Multivariate analyses confirmed PLR>300 as an independent predictive marker of grade≥2 IrAEs(OR=0.26;P=0.011),in addition to treatment with programmed cell death ligand 1(PD-1)/cytotoxic T lymphocyte-associated protein-4(OR=2.57;P=0.037)and PD-1/tyrosine kinase inhibitor(OR=3.39;P=0.01)combinations.Antibiotic use was not associated with IrAE incidence(OR=1.02;P=0.954).Patients treated with steroids had a>2-fold higher incidence of grade≥2 IrAEs(OR=2.74;P<0.001),although 74%were prescribed steroids for the treatment of IrAEs.CONCLUSION Given that high baseline NLR and PLR are associated with a decreased incidence of IrAEs,lower baseline NLR and PLR may be predictive biomarkers for the appearance of IrAEs in HCC treated with ICI.This finding is in keeping with several studies in solid tumors that have shown that baseline NLR and PLR appear predictive of IrAEs.

由欧洲五维健康量表衡量的健康相关生活质量的决定:来自中国北京的数据

本文通过检验由欧洲五维健康量表(EQ5D)衡量的中国健康相关的生活质量(HealthRelatedQualityofLife,HRQoL)与深受改革进程影响的社会、经济和医疗系统指标之间的关系,考察了当前的经济转型对中国人健康状况的潜在效应。本文的数据取自2000年北京家庭健康调查,包括了2994名年龄12岁或以上的中国受访者。我们利用结合OLS模型和2SLS模型的健康生产函数分析估计了健康相关的生活质量指标和社会、经济及医疗系统指标之间的关系。本研究有如下三个主要发现。首先,就业状况和财产状况是中国人口健康相关的生活质量的主要潜在决定因素。其次,对于中年组(35岁至65岁)、男性和患有慢性疾病者而言,失业对健康相关的生活质量的潜在影响甚至还要更大。第三,尽管医疗保险覆盖状况是医疗服务利用的主要的潜在决定因素,但后者与总体人口健康相关的生活质量的联系却相当有限。

Spatial epidemiology of diabetes: Methods and insights

Diabetes mellitus(DM)is a growing epidemic with global proportions.It is estimated that in 2019,463 million adults aged 20-79 years were living with DM.The latest evidence shows that DM continues to be a significant global health challenge and is likely to continue to grow substantially in the next decades,which would have major implications for healthcare expenditures,particularly in developing countries.Hence,new conceptual and methodological approaches to tackle the epidemic are long overdue.Spatial epidemiology has been a successful approach to control infectious disease epidemics like malaria and human immunodeficiency virus.The implementation of this approach has been expanded to include the study of non-communicable diseases like cancer and cardiovascular diseases.In this review,we discussed the implementation and use of spatial epidemiology and Geographic Information Systems to the study of DM.We reviewed several spatial methods used to understand the spatial structure of the disease and identify the potential geographical drivers of the spatial distribution of DM.Finally,we discussed the use of spatial epidemiology on the design and implementation of geographically targeted prevention and treatment interventions against DM.

Prevalence and clinical characteristics associated with left atrial thrombus detection: Apixaban

BACKGROUND The prevalence of left atrial appendage(LAA) thrombus detection by transesophageal echocardiogram(TEE) in patients with non-valvular atrial fibrillation(AF) anticoagulated with apixaban is not well defined and identification of additional risk factors may help guide the selection process for pre-procedural TEE. The purpose of our study was to retrospectively analyze the prevalence of LAA thrombus detection by TEE in patients continuously anticoagulated with apixaban for ≥ 4 wk and evaluate for any cardiac risk factors or echocardiographic characteristics which may serve as predictors of thrombus formation.AIM To retrospectively analyze the prevalence of LAA thrombus detection by TEE in patients continuously anticoagulated with apixaban.METHODS Clinical and echocardiographic data for 820 consecutive patients with AF undergoing TEE at Augusta University Medical Center over a four-year period were retrospectively analyzed. All patients(apixaban: 226) with non-valvular AF and documented compliance with apixaban for ≥ 4 wk prior to index TEE were included.RESULTS Following ≥ 4 wk of continuous anticoagulation with apixaban, the prevalence ofLAA thrombus and LAA thrombus/dense spontaneous echocardiographic contrast was 3.1% and 6.6%, respectively. Persistent AF, left ventricular ejection fraction < 30%, severe LA dilation, and reduced LAA velocity were associated with thrombus formation. Following multivariate logistic regression, persistent AF(OR: 7.427; 95%CI: 1.02 to 53.92; P = 0.0474), and reduced LAA velocity(OR:1.086; 95%CI: 1.010 to 1.187; P = 0.0489) were identified as independent predictors of LAA thrombus. No Thrombi were detected in patients with a CHA2 DS2-VASc score ≤ 1.CONCLUSION Among patients with non-valvular AF and ≥ 4 wk of anticoagulation with apixaban, the prevalence of LAA thrombus detected by TEE was 3.1%. This suggests that continuous therapy with apixaban does not completely eliminate the risk of LAA thrombus and that TEE prior to cardioversion or catheter ablation may be of benefit in patients with multiple risk factors.

Assessing the Effect of Global Travel and Contact Restrictions on Mitigating the COVID-19 Pandemic

Travel restrictions and physical distancing have been implemented across the world to mitigate the coronavirus disease 2019(COVID-19)pandemic,but studies are needed to understand their effectiveness across regions and time.Based on the population mobility metrics derived from mobile phone geolocation data across 135 countries or territories during the first wave of the pandemic in 2020,we built a metapopulation epidemiological model to measure the effect of travel and contact restrictions on containing COVID-19 outbreaks across regions.We found that if these interventions had not been deployed,the cumulative number of cases could have shown a 97-fold(interquartile range 79–116)increase,as of May 31,2020.However,their effectiveness depended upon the timing,duration,and intensity of the interventions,with variations in case severity seen across populations,regions,and seasons.Additionally,before effective vaccines are widely available and herd immunity is achieved,our results emphasize that a certain degree of physical distancing at the relaxation of the intervention stage will likely be needed to avoid rapid resurgences and subsequent lockdowns.

Quality of life after surgical and endoscopic management of severe acute pancreatitis: A systematic review

BACKGROUND Treatment for severe acute severe pancreatitis(SAP)can significantly affect Health-related quality of life(HR-QoL).The effects of different treatment strategies such as endoscopic and surgical necrosectomy on HR-QoL in patients with SAP remain poorly investigated.AIM To critically appraise the available evidence on HR-QoL following surgical or endoscopic necrosectomy in patient with SAP.METHODS A literature search was performed on PubMed,Google^(TM) Scholar,the Cochrane Library,MEDLINE and Reference Citation Analysis databases for studies that investigated HR-QoL following surgical or endoscopic necrosectomy in patients with SAP.Data collected included patient characteristics,outcomes of interventions and HR-QoL-related details.RESULTS Eleven studies were found to have evaluated HR-QoL following treatment for severe acute pancreatitis including 756 patients.Three studies were randomized trials,four were prospective cohort studies and four were retrospective cohort studies with prospective follow-up.Four studies compared HR-QoL following surgical and endoscopic necrosectomy.Several metrics of HR-QoL were used including Short Form(SF)-36 and EuroQol.One randomized trial and one cohort study demonstrated significantly improved physical scores at three months in patients who underwent endoscopic necrosectomy compared to surgical necrosectomy.One prospective study that examined HR-QoL following surgical necrosectomy reported some deterioration in the functional status of the patients.On the other hand,a cohort study that assessed the long-term HR-QoL following sequential surgical necrosectomy stated that all patients had SF-36>60%.In the only study that examined patients following endoscopic necrosectomy,the HR-QoL was also very good.Three studies investigated the quality adjusted life years suggesting that endoscopic and surgical approaches to management of pancreatic necrosis were comparable in cost effectiveness.Finally,regarding HR-QoL between open necrosectomy and minimally invasive approaches,patients who underwent the later had a significantly better overall quality of life,vitality and mental health.CONCLUSION This review would suggest that the endoscopic approach might offer better HR-QoL compared to surgical necrosectomy.However,the available comparative literature was very limited.More randomized trials powered to detect differences in HR-QoL are required.

Surgical ampullectomy:A comprehensive review

Tumours of the ampulla of Vater are relatively uncommon lesions of the digestive system.They are typically diagnosed at an earlier stage than other types of tumours in this region,due to their tendency to invoke symptoms by obstructing the bile duct or pancreatic duct.Consequently,many are potentially curable by excision.Surgical ampullectomy(SA)(or transduodenal ampullectomy)for an ampullary tumour was first described in 1899,but was soon surpassed by pancreatoduodenectomy(PD),which offered a more extensive resection resulting in a lower risk of recurrence.Ongoing innovation in endoscopic techniques over recent decades has led to the popularization of endoscopic papillectomy(EP),particularly for adenomas and even early cancers.The vast majority of resectable ampullary tumours are now treated using either PD or EP.However,SA continues to play a role in specific circumstances.Many authors have suggested specific indications for SA based on their own data,practices,or interpretations of the literature.However,certain issues have attracted controversy,such as its use for early ampullary cancers.Consequently,there has been a lack of clarity regarding indications for SA,and no evidence-based consensus guidelines have been produced.All studies reporting SA have employed observational designs,and have been heterogeneous in their methodologies.Accordingly,characteristics of patients and their tumours have differed substantially across treatment groups.Therefore,meaningful comparisons of clinical outcomes between SA,PD and EP have been elusive.Nevertheless,it appears that suitably selected cases of ampullary tumours subjected to SA may benefit from favourable peri-operative and long-term outcomes with very low mortality and significantly long survival,hence its role in this setting warrants further clarification,while it can also be useful in the management of specific benign entities.Whilst the commissioning of a randomised controlled trial seems unlikely,well-designed observational studies incorporating adjustments for confounding variables may become the best available comparative evidence for SA,potentially informing the eventual development of consensus guidelines.In this comprehensive review,we explore the role of SA in the modern management of ampullary lesions.

Association of types of diabetes and insulin dependency on birth outcomes

BACKGROUND Diabetes rates among pregnant women in the United States have been increasing and are associated with adverse pregnancy outcomes.AIM To investigate differences in birth outcomes(preterm birth,macrosomia,and neonatal death)by diabetes status.METHODS Cross-sectional design,using linked Missouri birth and death certificates(singleton births only),2010 to 2012(n=204057).Exposure was diabetes non-diabetic,pre-pregnancy diabetes-insulin dependent(PD-I),pre-pregnancy diabetes-non-insulin dependent(PD-NI),gestational diabetes-insulin dependent(GD-I),and gestational diabetes-non-insulin dependent(GD-NI).Outcomes included preterm birth,macrosomia,and infant mortality.Confounders included demographic characteristics,adequacy of prenatal care,body mass index,smoking,hypertension,and previous preterm birth.Bivariate and multivariate logistic regression assessed differences in outcomes by diabetes status.RESULTS Women with PD-I,PD-NI,and GD-I remained at a significantly increased odds for preterm birth(aOR 2.87,aOR 1.77,and aOR 1.73,respectively)and having a very large baby[macrosomia](aOR 3.01,aOR 2.12,and aOR 1.96,respectively);in reference to non-diabetic women.Women with GDNI were at a significantly increased risk for macrosomia(aOR1.53),decreased risk for their baby to die before their first birthday(aOR 0.41)and no difference in risk for preterm birth in reference to non-diabetic women.CONCLUSION Diabetes is associated with the poor birth outcomes.Clinical management of diabetes during pregnancy and healthy lifestyle behaviors before pregnancy can reduce the risk for diabetes and poor birth outcomes.

Use of glycated albumin for the identification of diabetes in subjects from northeast China

BACKGROUND Metabolic memory is important for the diagnosis and treatment of diabetes in the early stage,and in maintaining blood glucose concentrations within the normal range.The clinical diagnosis of diabetes mellitus is currently made using fasting plasma glucose,2 h-plasma glucose(2h-PG)during a 75 g oral glucose tolerance test,and hemoglobin A1c(HbA1c)level.However,the fasting plasma glucose test requires fasting,which is a barrier to screening,and reproducibility of the 2h-PG level is poor.HbA1c is affected by a shortened red blood cell lifespan.In patients with anemia and hemoglobinopathies,the measured HbA1c levels may be inaccurate.Compared with HbA1c,glycated albumin(GA)is characterized by more rapid and greater changes,and can be used to diagnose new-onset diabetes especially if urgent early treatment is required,for example in gestational diabetes.In this study,we provided cutoff values for GA and evaluated its utility as a screening and diagnostic tool for diabetes in a large high-risk group study.AIM To evaluate the utility of GA in identifying subjects with diabetes in northeast China,and to assess the diagnostic accuracy of the proposed GA cutoff in the diagnosis of diabetes mellitus.METHODS This cross-sectional study included 1935 subjects,with suspected diabetes or in high-risk groups,from 2014 to 2015 in the Second Affiliated Hospital of Harbin Medical University(Harbin,China).The use of GA to identify diabetes was investigated using the area under the receiver operating characteristic curve(AUC).The GA cutoffs were derived from different 2h-PG values with hemoglobin A1c cutoffs used as a calibration curve.RESULTS The GA cutoff for the diagnosis of diabetes mellitus was 15.15%from the receiver operating characteristic(ROC)curve.ROC analysis demonstrated that GA was an efficient marker for detecting diabetes,with an AUC of 90.3%.CONCLUSION Our study supports the use of GA as a biomarker for the diagnosis of diabetes.

COVID-19 vaccine-associated myocarditis

Myocarditis is now recognized as a rare complication of coronavirus disease 2019(COVID-19)mRNA vaccination,particularly in adolescent and young adult males.Since the authorization of the Pfizer-BioNTech^(TM)and Moderna^(TM)mRNA vaccines targeting the severe acute respiratory syndrome coronavirus-2(SARSCoV-2)spike protein,the Centers for Disease Control and Prevention(CDC)has reported 1175 confirmed cases of myocarditis after COVID-19 vaccination in individuals ages 30 years and younger as of January 2022.According to CDC data in June 2021,the incidence of vaccine-mediated myocarditis in males ages 12-29 years old was estimated to be 40.6 cases per million second doses of COVID-19 mRNA vaccination administered.Individuals with cases of COVID-19 vaccinemediated myocarditis typically present with acute chest pain and elevated serum troponin levels,often within one week of receiving the second dose of mRNA COVID-19 vaccination.Most cases follow a benign clinical course with prompt resolution of symptoms.Proposed mechanisms of COVID-19 vaccine myocarditis include molecular mimicry between SARS-CoV-2 spike protein and self-antigens and the triggering of preexisting dysregulated immune pathways in predisposed individuals.The higher incidence of COVID-19 vaccine myocarditis in young males may be explained by testosterone and its role in modulating the immune response in myocarditis.There is limited data on long-term outcomes in these cases given the recency of their occurrence.The CDC continues to recommend COVID-19 vaccination for everyone 5 years of age and older given the greater risk of serious complications related to natural COVID-19 infection including hospitalization,multisystem organ dysfunction,and death.Further study is needed to better understand the immunopathology and long-term outcomes behind COVID-19 mRNA vaccine-mediated myocarditis.

On Sample Size Determination When Comparing Two Independent Spearman or Kendall Coefficients

One of the most commonly used statistical methods is bivariate correlation analysis. However, it is usually the case that little or no attention is given to power and sample size considerations when planning a study in which correlation will be the primary analysis. In fact, when we reviewed studies published in clinical research journals in 2014, we found that none of the 111 articles that presented results of correlation analyses included a sample size justification. It is sometimes of interest to compare two correlation coefficients between independent groups. For example, one may wish to compare diabetics and non-diabetics in terms of the correlation of systolic blood pressure with age. Tools for performing power and sample size calculations for the comparison of two independent Pearson correlation coefficients are widely available;however, we were unable to identify any easily accessible tools for power and sample size calculations when comparing two independent Spearman rank correlation coefficients or two independent Kendall coefficients of concordance. In this article, we provide formulas and charts that can be used to calculate the sample size that is needed when testing the hypothesis that two independent Spearman or Kendall coefficients are equal.