Dyslipidemia and Outcome in Patients with Acute Ischemic Stroke

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.

Observation-Oriented Causal Discovery for Cultivation Abandonment of Rice Terraces: Focusing on an Effect of Cultural Endemism on Decision-Making in Toraja, Indonesia

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.

Risk stratification of hemodynamically significant patent ductus arteriosus by clinical and genetic factors

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.

Prevalence of diarrhoea and risk factors among children under five years old in Mbour,Senegal:a cross-sectional study

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.