Prevalence and impact of diabetes in patients with COVID-19 in China

BACKGROUND Coronavirus disease 2019(COVID-19)is an emerging infectious disease that has spread rapidly around the world.Previous studies have indicated that COVID-19 patients with diabetes are prone to having poor clinical outcomes.AIM To systematically evaluate the prevalence of diabetes among COVID-19 patients in China and its impact on clinical outcomes,including ICU admission,progression to severe cases,or death.METHODS We searched studies published in PubMed,Web of Science,and EMBASE from December 1,2019 to March 31,2020 to identify relevant observational study that investigated the prevalence of diabetes among COVID-19 patients or its impact on clinical outcomes.We used a random-effects or fixed-effects model to estimate the pooled prevalence of diabetes and risk ratio(RR)and its 95%confidence interval(CI)of diabetes on outcomes.Funnel plots were used to evaluate the publication bias and the heterogeneity was evaluated by I2 statistic.RESULTS Twenty-three eligible articles including 49564 COVID-19 patients(1573 with and 47991 without diabetes)were finally included.The pooled prevalence of diabetes was 10%(95%CI:7%-15%)in COVID-19 patients.In the subgroup analyses,the pooled prevalence of diabetes was higher in studies with patients aged>50 years(13%;95%CI:11%-16%)than in studies with patients aged≤50 years(7%;95%CI:6%-8%),in severe patients(17%;95%CI:14%-20%)than in non-severe patients(6%;95%CI:5%-8%),and in dead patients(30%;95%CI:13%-46%)than in survivors(8%;95%CI:2%-15%)(P<0.05 for all).Compared with patients without diabetes,the risk of severe cases was higher(RR=2.13,95%CI:1.76-2.56,I2=49%)in COVID-19 patients with diabetes.The risk of death was also higher in COVID-19 patients with diabetes(RR=3.16,95%CI:2.64-3.78,I2=34%).However,diabetes was not found to be significantly associated with admission to ICU(RR=1.16,95%CI:0.15-9.11).CONCLUSION Nearly one in ten COVID-19 patients have diabetes in China.Diabetes is associated with a higher risk of severe illness and death.The present study suggested that targeted early intervention is needed in COVID-19 patients with diabetes.

Features of gastric cancer by anatomic subsite in northern China: A multi-center Health Science Report database study

BACKGROUND The features of gastric cancer based on the anatomic site remain unknown in northern China patients.AIM To analyze gastric cancer features and associated trends based on the anatomical site in northern China patients.METHODS This cross-sectional study used incident gastric cancer case data from 10 Peking University-affiliated hospitals(2014 to 2018).The clinical and prevailing local features were analyzed.RESULTS A total of 10709 patients were enrolled,including antral(42.97%),cardia(34.30%),and stomach body(18.41%)gastric cancer cases.Cancer in the cardia had the highest male:female ratio,proportion of elderly patients,and patients with complications,including hypertension,diabetes,cerebrovascular,and coronary diseases(P<0.001).gastric cancer involving the antrum showed the lowest proportion of patients from rural areas and accounted for the highest hospitalization rate and cost(each P<0.001).The proportion of patients with cancer involving the cardia increased with an increase in the number of gastroesophageal reflux disease cases during the same period(P<0.001).Multivariate analysis revealed that tumor location in the cardia increased the risk of inhospital mortality(P=0.046).Anatomical subsite was not linked to postoperative complications.CONCLUSION The features of gastric cancer based on the anatomical site differ between northern China and other regions,both globally and within the country.Social factors may account for these differences and should affect policy-making and clinical practice.

Tinnitus assessment:Chinese version of the Tinnitus Primary Function Questionnaire

Objective:The aim of this study is to evaluate the Chinese Version of the Tinnitus Primary Function Questionnaire(TPFQ).Methods:One hundred and sixteen patients who had been suffering from tinnitus for over 3 months were included in this study.Those tinnitus patients were administered the TPFQ,the Tinnitus Handicap Inventory(THI),the Beck Anxiety Inventory(BAI),the Beck Depression Inventory(BDI),and the Pittsburgh Sleep Quality Index(PSQI).Additionally,the magnitude estimate of tinnitus loudness,pure tone audiogram,and tinnitus matching was obtained.The factor structure was measured using the Kaiser–Meyer–Olkin test.The internal consistency was examined using Cronbach'sαcoefficient.The relationships between the TPFQ scores and other measurements were compared using Spearman's rank correlation coefficient.Results:The Cronbach'sαof the 20-item version of TPFQ was 0.94,and that of the 12-item version of TPFQ was 0.92.Both the 20-and 12-item versions of TPFQ were significantly correlated with magnitude estimation of tinnitus loudness,THI,PSQI,BDI,and BAI.The average pure tone hearing threshold was significantly correlated with the hearing subscale.Conclusion:The 20-and 12-item Chinese versions of TPFQ are reliable and valid measures of tinnitus.The TPFQ can be applied to the assessment and management of tinnitus among the Chinese-speaking population.

The survival and prognostic factors of primary testicular lymphoma- two-decade single-center experience

This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma （PTL） patients. We retrospectively reviewed the clinical records of 32 patients from 1993 to 2017 diagnosed with PTL and included 22 patients for analysis. The Kaplan-Meier method, Log-rank test, and multivariate Cox proportional hazard regression analysis were applied to evaluate progression-free survival （PFS）, overall survival （OS）, and determine prognosis predictors. The median follow-up time was 30 months. Median OS and PFS were 96 months and 49 months, respectively. In univariate analysis, advanced Ann Arbor stage （Ill/IV） （P 〈 0.001）, B symptoms （P 〈 0.001）, and extranodal involvement other than testis （P = 0.001） were significantly associated with shorter OS and PFS. In multivariate analysis, Ann Arbor stage was significantly associated with OS （OR = 11.58, P = 0.049）, whereas B symptom was significantly associated with PFS （OR = 11.79, P = 0.049）. In the 10 patients with the systemic usage of rituximab, bilateral intervention could improve median OS from 16 to 96 months （P = 0.032）. The study provides preliminary evidence on bilateral intervention in testes in the rituximab era and validates common prognostic factors for Chinese PTL patients.

Efficacy of Different Treatment Regimens for Antiphospholipid Syndrome-related Recurrent Spontaneous Abortion

Background： Antiphospholipid syndrome （APS）-related immune factors are considered as an important cause of recurrent spontaneous abortion （RSA）. Anticoagulant and anti-inflammatory treatments are believed to effectively improve adverse pregnancy outcomes by affecting the abnormal autoimmune response of the maternal-fetal interface. The aim of this study was to observe the clinical characteristics and treatment outcomes of anticoagulant regimens and anti-inflammatory plus anticoagulation regimens for APS-related RSA. Methods： APS-related RSA cases from September 2011 to September 2016 at Peking University Third Hospital were retrospectively analyzed. The patients were assigned to study group （anti-inflammation plus anticoagulation） and control group （simple anticoagulation）, The incidence of repeat abortion, the incidence of placental dysfunction, the gestational weeks of pregnancy, and the mean weight of the fetus were observed. Results： The pregnancy and neonatal outcome indicators of the repeat pregnancy loss rate （ 11. 11% vs. 22.70%）, placental dysfunction-related diseases （6.35% vs. 15.60%）, the mean birth weight of infants born after 24 weeks gestation （3152.4 ± 844.67 g vs. 2765.76 ± 816.40 g）, full-ternl delivery weight （3456.28 ±419.79 g vs. 3076.18±518.79 g）, the proportions of low birth weight infants （ 12.70% vs. 21.98%）, and small for gestational age （6.35% vs. 14.18%） differed significantly between the study and control groups （all P 〈 0.05）. The incidence of preterm delivery, term delivery, and stillbirth was not significantly different between the two groups, and there was no significant difference between the study and control groups in gestational age at birth （37.6 ± 3.3 weeks vs. 36.9 ± 3.2 weeks： P 〉 0.05）. Conclusion： The anti-inflammatory and anticoagulation regimen is more effective than the simple anticoagulation regimen in the treatlnent of APS recurrent abortion.

Evaluation of blood pressure lowering effect by generic and brand-name antihypertensive drugs treatment:a multicenter prospective study in China

Background:Generic drugs are bioequivalent to their brand-name counterparts;however,concerns still exist regarding the effectiveness and safety of generic drugs because of small sample sizes and short follow-up time in most studies.The purpose of this study was to evaluate the long-term antihypertensive efficacy,cost-effectiveness and cardiovascular outcomes of generic drugs compared with brand-name drugs.Methods:In a multicenter,community-based study including 7955 hypertensive patients who were prospectively followed up for an average of 2.5 years,we used the propensity-score-matching method to match the patients using brand-name drugs to those using generic drugs in a ratio of 1:2,2176 patients using brand-name drugs and 4352 patients using generic drugs.Results:There were no significant differences between generic drugs and brand-name drugs in blood pressure(BP)-lowering efficacy,BP control rate,and cardiovascular outcomes including coronary heart disease and stroke.The adjusted mean(95%confidence interval[CI])of systolic BP(SBP)-lowering was-7.9 mmHg(95%CI,-9.9 to-5.9)in the brand-name drug group and-7.1 mmHg(95%CI,-9.1 to-5.1)in the generic drug group after adjusting for age,sex,body mass index,number of antihypertensive drugs and traditionally cardiovascular risk factors.Among patients aged<60 years,brand-name drugs had a higher BP control rate(47%vs.41%;P=0.02)and a greater effect in lowering SBP compared with generic drugs,with the between-group difference of 1.5 mmHg(95%CI,0.2-2.8;P=0.03).BP control rate was higher in male patients using brand-name drugs compared with those using generic drugs(46%vs.40%;P=0.01).Generic drugs treatment yielded an average annual incremental cost-effectiveness ratio of$315.4 per patient per mmHg decrease in SBP compared with brand-name drugs treatment.Conclusions:Our data suggested that generic drugs are suitable and cost-effective in improving hypertension management and facilitating public health benefits,especially in low-and middle-income areas.

Comparison of Vaginal Gel and Intramuscular Progesterone for In vitro Fertilization and Embryo Transfer with Gonadotropin-Releasing Hormone Antagonist Protocol

Background： Luteal support is a key to patients undergoing in vitro fertilization and embryo transfer （IVF-ET） with gonadotropin-releasing hormone （GnRH）-antagonist protocol. This study aimed to compare the effect between vaginal progesterone （VP） and intramuscular progesterone （IMP） with GnRH-antagonist protocol alter IVF-ET. Methods： A total of 1760 patients （18 years ≤ age ≤35 years） undergoing IVF-ET with GnRH-antagonist protocol were studied retrospectively between September 2014 and August 2015 in Peking University Third Hospital. In the patients, 1341 patients received VP （VP group） and 419 patients received IMP （IMP group） as luteal support. We compared clinical outcomes between these two groups. The primary objective of the study was the live birth rate. Measurement data between the two groups were conducted using independent samples t-test. The variables in line with non-normal distribution were expressed as median （p25 and p75） and were compared using nonparametric Mann. Whitney U-test. Results： Live birth rate in VP group was 38.55%, significantly higher than that in the IMP group, which was 30.79% （x^2 = 8.287, P= 0.004）. The clinical intrauterine pregnancy rate and implantation rate in VP group were also significantly higher than those in the IMP group （clinical intrauterine pregnancy rate 47.35% vs. 41.29%, x^2= 4.727, P = 0.030： implantation rate 30.99% vs. 25.26%, x^2=14.546, P 〈 0.001）. Any statistically significant differences in ectopic pregnancy and abortion rates between two groups were not observed. Conclusion： Luteal support with VP had better clinical outcomes for young women undergoing IVF-ET with GnRH-antagonist protocol.

Age-specific differences in non-cardiac comorbidities among elderly patients hospitalized with heart failure: a special focus on young-old, old-old, and oldest-old

Background:Despite the growing epidemic of heart failure(HF),there is limited data available to systematically compare noncardiac comorbidities in the young-old,old-old,and oldest-old patients hospitalized for HF.The precise differences will add valuable information for better management of HF in elderly patients.Methods:A total of 1053 patients aged 65 years or older hospitalized with HF were included in this study.Patients were compared among three age groups:(1)young-old:65 to 74 years,(2)old-old:75 to 84 years,and(3)oldest-old:≥85 years.Clinical details of presentation,comorbidities,and prescribed medications were recorded.Results:The mean age was 76.7 years and 12.7%were 85 years or older.Most elderly patients with HF(97.5%)had at least one of the non-cardiac comorbidities.The patterns of common non-cardiac comorbidities were different between the young-old and oldestold group.The three most common non-cardiac comorbidities were anemia(53.6%),hyperlipidemia(45.9%),and diabetes(42.4%)in the young-old group,while anemia(73.1%),infection(58.2%),and chronic kidney disease(44.0%)in the oldest-old group.Polypharmacy was observed in 93.0%elderly patients with HF.Additionally,29.2%patients were diagnosed with infection,and 67.0%patients were prescribed antibiotics.However,60.4%patients were diagnosed with anemia with only 8.9%of them receiving iron repletion.Conclusions:Non-cardiac comorbidities are nearly universal in three groups but obviously differ by age,and inappropriate medications are very common in elderly patients with HF.Further treatment strategies should be focused on providing optimal medications for age-specific non-cardiac conditions.

Comparison of Two Dose-response Relationship of Noise Exposure Evaluation Results with High Frequency Hearing Loss

Background:Complex noise and its relation to hearing loss are difficult to measure and evaluate.In complex noise measurement,individual exposure results may not accurately represent lifetime noise exposure.Thus,the mean LAeq,8 h values of individuals in the same workgroup were also used to represent LAeq,8h in our study.Our study aimed to explore whether the mean exposure levels of workers in the same workgroup represented real noise exposure better than individual exposure levels did.Methods:A cross-sectional study was conducted to establish a model for cumulative noise exposure (CNE) and hearing loss in 205 occupational noise-exposed workers who were recruited from two large automobile manufacturers in China.We used a personal noise dosimeter and a questionnaire to determine the workers' occupational noise exposure levels and exposure times,respectively.A qualified audiologist used standardized audiometric procedures to assess hearing acuity after at least 16 h of noise avoidance.Results:We observed that 88.3％ of workers were exposed to more than 85 dB(A) of occupational noise (mean:89.3 ± 4.2 dB(A)).The personal CNE (CNEp) and workgroup CNE (CNEg) were 100.5 ± 4.7 dB(A) and 100.5 ± 2.9 dB(A),respectively.In the binary logistic regression analysis,we established a regression model with high-frequency hearing loss as the dependent variable and CNE as the independent variable.The Wald value was 5.014 with CNEp as the independent variable and 8.653 with CNEg as the independent variable.Furthermore,we found that the figure for CNEg was more similar to the stationary noise reference than CNEp was.The CNEg model was better than the CNEp model.In this circumstance,we can measure some subjects instead of the whole workgroup and save manpower.Conclusions:In a complex noise environment,the measurements of average noise exposure level of the workgroup can improve the accuracy and save manpower.

Efficacy and safety of antifibrinolytic agents in spinal surgery: a network meta-analysis

Background: Significant blood loss is still one of the most frequent complications in spinal surgery, which often necessitates blood transfusion. Massive perioperative blood loss and blood transfusion can create additional risks. Aprotinin, tranexamic acid (TXA), and epsilon-aminocaproic acid (EACA) are antifibrinolytics currently offered as prophylactic agents to reduce surgery-ass oci a ted blood loss. The aim of this study was to evaluate the efficacy and safety of aprotinin, EACA, and low/high doses of TXA in spinal surgery, and assess the use of which agent is the most optimal intervention using the network meta-analysis (NMA) method. Methods: Five electronic databases were searched, including PubMed, Cochrane Library, ScienceDirect, Embase, and Web of Science, from the inception to March 1,2018. Trials that were randomized and compared results between TXA, EACA, and placebo were identified. The NMA was conducted with software R 3.3.2 and STATA 14.0. Results: Thirty randomized controlled trial (RCT) studies were analyzed. Aprotinin (standardized mean difference [SMD]=-0.65, 95% credibility intervals [CrI;-1.25,-0.06]), low-dose TXA (SMD=-0.58, 95% CrI [-0.92,-0.25]), and high-dose TXA (SMD =-0.70, 95% CrI [-1.04,-0.36]) were more effective than the respective placebos in reducing intraoperative blood loss. Low-dose TXA (SMD=-1.90, 95% CrI [-3.32,-0.48]) and high-dose TXA (SMD =-2.31, 95% CrI [-3.75,-0.87]) had less postoperative blood loss. Low-dose TXA (SMD=-1.07, 95% CrI [-1.82,-0.31]) and high-dose TXA (SMD =-1.07, 95% CrI[-1.82,-0.31]) significantly reduced total blood loss. However, only high-dose TXA (SMD =-2.07, 95% CrI [-3.26,-0.87]) was more effective in reducing the amount of transfusion, and was significantly superior to low-dose TXA in this regard (SMD =-1.67, 95% CrI [-3.20,-0.13]). Furthermore, aprotinin (odds ratio [OR]= 0.16, 95% CrI [0.05, 0.54]), EACA (OR = 0.46, 95% CrI [0.22, 0.97]) and high dose of TXA (OR = 0.34, 95% CrI [0.19, 0.58]) had a significant reduction in transfusion rates. Antifibrinolytics did not show a significantly increased risk of postoperative thrombosis. Results of ranking probabilities indicated that high-dose TXA had the greatest efficacy and a relatively high safety level. Conclusions: The antifibrinolytic agents are able to reduce perioperative blood loss and transfusion requirement during spine surgery. And the high-dose TXA administration might be used as the optimal treatment to reduce blood loss and transfusion.

Nomogram to predict pregnancy outcomes of emergency oocyte freeze-thaw cycles

Background:Existing clinical prediction models for in vitro fertilization are based on the fresh oocyte cycle,and there is no prediction model to evaluate the probability of successful thawing of cryopreserved mature oocytes.This research aims to identify and study the characteristics of pre-oocyte-retrieval patients that can affect the pregnancy outcomes of emergency oocyte freeze-thaw cycles.Methods:Data were collected from the Reproductive Center,Peking University Third Hospital of China.Multivariable logistic regression model was used to derive the nomogram.Nomogram model performance was assessed by examining the discrimination and calibration in the development and validation cohorts.Discriminatory ability was assessed using the area under the receiver operating characteristic curve(AUC),and calibration was assessed using the Hosmer–Lemeshow goodness-of-fit test and calibration plots.Results:The predictors in the model of“no transferable embryo cycles”are female age(odds ratio[OR]=1.099,95%confidence interval[CI]=1.003–1.205,P=0.0440),duration of infertility(OR=1.140,95%CI=1.018–1.276,P=0.0240),basal follicle-stimulating hormone(FSH)level(OR=1.205,95%CI=1.051–1.382,P=0.0084),basal estradiol(E2)level(OR=1.006,95%CI=1.001–1.010,P=0.0120),and sperm from microdissection testicular sperm extraction(MESA)(OR=7.741,95%CI=2.905–20.632,P<0.0010).Upon assessing predictive ability,the AUC for the“no transferable embryo cycles”model was 0.799(95%CI:0.722–0.875,P<0.0010).The Hosmer–Lemeshow test(P=0.7210)and calibration curve showed good calibration for the prediction of no transferable embryo cycles.The predictors in the cumulative live birth were the number of follicles on the day of human chorionic gonadotropin(hCG)administration(OR=1.088,95%CI=1.030–1.149,P=0.0020)and endometriosis(OR=0.172,95%CI=0.035–0.853,P=0.0310).The AUC for the“cumulative live birth”model was 0.724(95%CI:0.647–0.801,P<0.0010).The Hosmer–Lemeshow test(P=0.5620)and calibration curve showed good calibration for the prediction of cumulative live birth.Conclusions:The predictors in the final multivariate logistic regression models found to be significantly associated with poor pregnancy outcomes were increasing female age,duration of infertility,high basal FSH and E2 level,endometriosis,sperm from MESA,and low number of follicles with a diameter>10 mm on the day of hCG administration.