OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ej...OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ejection fraction(LVEF)level.METHODS We enrolled hospitalized HF patients with AF from China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study.COX proportional hazard regression models were employed to calculate hazard ratio of betablockers.The primary outcome was all-cause death.RESULTS Among 1762 HF patients with AF(756 women[41.4%]),1041(56%)received beta-blockers at discharge and 1272(72.2%)had an LVEF>40%.During one year follow up,all-cause death occurred in 305(17.3%),cardiovascular death occurred in203 patients(11.5%),and rehospitalizations for HF occurred in 622 patients(35.2%).After adjusting for demographic characteristics,social economic status,smoking status,medical history,anthropometric characteristics,and medications used at discharge,the use of beta-blockers at discharge was not associated with all-cause death[hazard ratio(HR):0.86;95%Confidence Interval(CI):0.65-1.12;P=0.256],cardiovascular death(HR:0.76,95%CI:0.52-1.11;P=0.160),or the composite outcome of all-cause death and HF rehospitalization(HR:0.97,95%CI:0.82-1.14;P=0.687)in the entire cohort.There were no significant interactions between use of beta-blockers at discharge and LVEF with respect to all-cause death,cardiovascular death,or composite outcome.In the adjusted models,the use of beta-blockers at discharge was not associated with all-cause death,cardiovascular death,or composite outcome across the different levels of LVEF:reduced(<40%),mid-range(40%-49%),or preserved LVEF(≥50%).CONCLUSION Among HF patients with AF,the use of beta-blockers at discharge was not associated with 1-year clinical outcomes,regardless of LVEF.展开更多
目的探讨原发性喉癌患者癌组织中微小核糖核酸-425-5p(miR-425-5p)/跨膜蛋白受体Patched1(PTCH1)轴分子与临床病理参数及预后的关系。方法前瞻性选取2018年7月至2021年6月新乡医学院第一附属医院收治的108例原发性喉癌患者作为研究对象...目的探讨原发性喉癌患者癌组织中微小核糖核酸-425-5p(miR-425-5p)/跨膜蛋白受体Patched1(PTCH1)轴分子与临床病理参数及预后的关系。方法前瞻性选取2018年7月至2021年6月新乡医学院第一附属医院收治的108例原发性喉癌患者作为研究对象。比较癌组织、癌旁组织及不同病理特征癌组织miR-425-5p、PTCH1 m RNA相对表达量,采用Spearman法分析miR-425-5p、PTCH1与临床病理特征的相关性,随访3年,统计所有患者的3年生存率,比较生存与死亡患者癌组织中的miR-425-5p、而PTCH1 m RNA相对表达量,并利用受试者工作特征(ROC)曲线获取miR-425-5p、PTCH1最佳截断值,采用KM曲线分析miR-425-5p、PTCH1与预后的关系。结果原发性喉癌患者癌组织中的miR-425-5p相对表达量为1.81±0.48,明显高于癌旁组织的1.08±0.23,PTCH1 m RNA相对表达量为1.21±0.36,明显低于癌旁组织的1.63±0.41,差异均有统计学意义(P<0.05);Ⅲ~Ⅳ期、淋巴结转移、低分化癌组织中的miR-425-5p相对表达量分别为1.97±0.46、2.09±0.42、2.14±0.46,明显高于Ⅰ~Ⅱ期、无淋巴结转移、中高分化癌组织的1.54±0.41、1.66±0.39、1.60±0.40,PTCH1 m RNA相对表达量分别为1.09±0.21、1.04±0.24、1.01±0.20,明显低于Ⅰ~Ⅱ期、无淋巴结转移、中高分化癌组织的1.42±0.25、1.30±0.27、1.34±0.23,差异均有统计学意义(P<0.05);Spearman法分析结果显示,miR-425-5p与临床分期、淋巴结转移呈正相关(r=0.663、0.702,P<0.05),与分化程度呈负相关(r=-0.681,P<0.05),PTCH1与临床分期、淋巴结转移呈负相关(r=-0.652、-0.711,P<0.05),与分化程度呈正相关(r=0.694,P<0.05);死亡患者癌组织中的miR-425-5p相对表达量为2.23±0.46,明显高于生存患者癌组织的1.67±0.38,而PTCH1 m RNA相对表达量为0.96±0.21,明显低于生存患者癌组织的1.30±0.34,差异均有统计学意义(P<0.05);ROC分析结果显示,miR-425-5p、PTCH1预测死亡的曲线下面积(AUC)分别为0.815(95%CI:0.727~0.884)、0.792(95%CI:0.702~0.865),最佳截断值分别为2.01、1.09;KM分析结果显示,miR-425-5p高表达、PTCH1低表达患者3年生存率均低于miR-425-5p低表达、PTCH1高表达患者,差异均有统计学意义(P<0.05)。结论miR-425-5p在原发性喉癌癌组织中表达上调,PTCH1表达下调,联合检测对预后具有一定预测价值,可作为临床评估病情、预测预后的辅助指标,以指导临床工作。展开更多
Background:Acute kidney injury(AKI)is primarily defined and classified according to the magnitude of theelevation of serum creatinine(Scr).We aimed to determine whether the duration of AKI adds prognostic valuein addi...Background:Acute kidney injury(AKI)is primarily defined and classified according to the magnitude of theelevation of serum creatinine(Scr).We aimed to determine whether the duration of AKI adds prognostic valuein addition to that obtained from the magnitude of injury alone.Methods:This retrospective study enrolled very elderly inpatients(≥75 years)in the Chinese PLA General Hospitalfrom January 2007 to December 2018.AKI was stratified by magnitude according to KDIGO stage(1,2,and 3)andduration(1–2 days,3–4 days,5–7 days,and>7 days).The primary outcome was the 1-year mortality after AKI.Multivariable Cox regression analysis was performed to identify covariates associated with the 1-year mortality.The probability of survival was estimated using the Kaplan–Meier method,and curves were compared using thelog-rank test.Results:In total,688 patients were enrolled,with the median age was 88(84–91)years,and the majority(652,94.8%)were male.According to the KDIGO criteria,317 patients(46.1%)had Stage 1 AKI,169(24.6%)hadStage 2 AKI,and 202(29.3%)had Stage 3 AKI.Of the 688 study subjects,61(8.9%)with a duration of AKIlasted 1–2 days,104(15.1%)with a duration of AKI lasted 3–4 days,140(20.3%)with a duration of AKI lasted5–7 days,and 383(55.7%)with a duration of AKI lasted>7 days.Within each stage,a longer duration of AKIwas slightly associated with a higher rate of 1-year mortality.However,within each of the duration categories,the stage of AKI was significantly associated with 1-year mortality.When considered separately in multivariateanalyses,both the duration of AKI(3–4 days:HR=3.184;95%CI:1.733–5.853;P<0.001,5–7 days:HR=1.915;95%CI:1.073–3.416;P=0.028;>7 days:HR=1.766;95%CI:1.017–3.065;P=0.043)and more advanced AKIstage(Stage 2:HR=3.063;95%CI:2.207–4.252;P<0.001;Stage 3:HR=7.333;95%CI:5.274–10.197;P<0.001)were independently associated with an increased risk of 1-year mortality.Conclusions:In very elderly AKI patients,both a higher stage and duration were independently associated withan increased risk of 1-year mortality.Hence,the duration of AKI adds additional information to predict long-termmortality.展开更多
目的探索神经重症康复病房患者住院期间营养风险评价指标与1年预后的关系。方法回顾性分析2020年12月至2022年8月首都医科大学附属北京康复医院神经重症康复病房276例患者的临床资料。记录患者入科时性别、年龄、主要诊断、格拉斯哥昏...目的探索神经重症康复病房患者住院期间营养风险评价指标与1年预后的关系。方法回顾性分析2020年12月至2022年8月首都医科大学附属北京康复医院神经重症康复病房276例患者的临床资料。记录患者入科时性别、年龄、主要诊断、格拉斯哥昏迷评分(Glasgow coma scale,GCS)、血红蛋白、血清白蛋白、营养风险筛查量表2002(NRS2002);出重症监护病房(ICU)时,记录患者ICU住院期间的最低血磷、最低前白蛋白、最高降钙素原(PCT)、病重当天24 h内(或住ICU期间最差)的急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、改良危重症营养风险评分(m-NUTRIC)及ICU住院时间;出院时,记录总住院时间。根据1年随访时患者是否死亡分为生存组(n=220)和死亡组(n=56)。采用多因素Logistic回归模型分析神经重症康复患者1年内死亡的危险因素。绘制受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC)及其95%置信区间(95%CI),评价各营养风险评价指标和最低血磷联合最低前白蛋白及最高PCT对神经重症康复患者1年死亡的预测价值。结果生存组和死亡组年龄,病种结构,入院血红蛋白和入院时NRS200,住院期间最低前白蛋白、最低血磷和最高PCT,住院期间最差APACHEⅡ、SOFA、m-NUTRIC评分和总住院时间差异有统计学意义(P值均<0.05)。以上指标为自变量,1年内死亡做因变量行多元Logistic回归分析显示,方程含有以上6个变量时,P=0.358>0.200,较好地拟合了原始数据。在校正了年龄、主要诊断及血红蛋白后,以上指标均为神经重症康复患者1年内死亡的独立危险因素。最低血磷、最低前白蛋白和最高PCT联合预测及NRS2002评分和m-NUTRIC评分预测神经重症康复1年预后的AUC(95%CI)分别为0.887(0.844~0.922)、0.679(0.595~0.763)和0.689(0.631~0.743),最佳截断值分别为联合预测值>0.252、NRS2002>4和m-NUTRIC>3,约登指数分别为0.658、0.321和0.326。结论神经重症康复患者在ICU期间的最低血磷联合最低前白蛋白和最高PCT可以更好地预测神经重症康复患者的1年预后。展开更多
Introduction: Infant and child mortality is a worldwide concern, but developing countries such as Mali are more affected. The aim of this study was to investigate morbidity and factors associated with mortality in chi...Introduction: Infant and child mortality is a worldwide concern, but developing countries such as Mali are more affected. The aim of this study was to investigate morbidity and factors associated with mortality in children aged 1 month to 15 years. Methodology: This was a cross-sectional study which took place from January 1 to December 31, 2020 covering children aged 1 month to 15 years hospitalized at the Kalaban-Coro CSRéf. Data were entered into Excel and analyzed using SPSS version 20 software. Results: Five hundred children aged 1 months to 15 years were included. The age range 1 to 5 years (53.6%) and male sex (58.2%) were the most represented. Malaria (72.2%), acute respiratory infections (6.2%) and diarrhea/dehydration (3%) were the main morbidities. Mortality was estimated at 10.6%, and the two main causes of death were malaria (56.6%) and acute respiratory infections (7.54%). Univariate analysis revealed a statistically significant association between the dependent variable (death) and age (p Conclusion: This study confirms the high rate of infant and child morbidity and mortality in our health facilities. Strengthening human resources and intensifying behavior-change communication can help reverse the trend.展开更多
基金supported by the National Key Research and Development Program from the Ministry of Science and Technology of China(grant number:2018YFC1312400)the CAMS Innovation Fund for Medical Science(grant number:2016-I2M-2-004,2017-I2M-2-002)+1 种基金the National Key Technology R&D Program from the Ministry of Science and Technology of China(grant number:2015BAI12B02)the 111 Project from the Ministry of Education of China(grant number:B16005)。
文摘OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ejection fraction(LVEF)level.METHODS We enrolled hospitalized HF patients with AF from China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study.COX proportional hazard regression models were employed to calculate hazard ratio of betablockers.The primary outcome was all-cause death.RESULTS Among 1762 HF patients with AF(756 women[41.4%]),1041(56%)received beta-blockers at discharge and 1272(72.2%)had an LVEF>40%.During one year follow up,all-cause death occurred in 305(17.3%),cardiovascular death occurred in203 patients(11.5%),and rehospitalizations for HF occurred in 622 patients(35.2%).After adjusting for demographic characteristics,social economic status,smoking status,medical history,anthropometric characteristics,and medications used at discharge,the use of beta-blockers at discharge was not associated with all-cause death[hazard ratio(HR):0.86;95%Confidence Interval(CI):0.65-1.12;P=0.256],cardiovascular death(HR:0.76,95%CI:0.52-1.11;P=0.160),or the composite outcome of all-cause death and HF rehospitalization(HR:0.97,95%CI:0.82-1.14;P=0.687)in the entire cohort.There were no significant interactions between use of beta-blockers at discharge and LVEF with respect to all-cause death,cardiovascular death,or composite outcome.In the adjusted models,the use of beta-blockers at discharge was not associated with all-cause death,cardiovascular death,or composite outcome across the different levels of LVEF:reduced(<40%),mid-range(40%-49%),or preserved LVEF(≥50%).CONCLUSION Among HF patients with AF,the use of beta-blockers at discharge was not associated with 1-year clinical outcomes,regardless of LVEF.
文摘目的探讨原发性喉癌患者癌组织中微小核糖核酸-425-5p(miR-425-5p)/跨膜蛋白受体Patched1(PTCH1)轴分子与临床病理参数及预后的关系。方法前瞻性选取2018年7月至2021年6月新乡医学院第一附属医院收治的108例原发性喉癌患者作为研究对象。比较癌组织、癌旁组织及不同病理特征癌组织miR-425-5p、PTCH1 m RNA相对表达量,采用Spearman法分析miR-425-5p、PTCH1与临床病理特征的相关性,随访3年,统计所有患者的3年生存率,比较生存与死亡患者癌组织中的miR-425-5p、而PTCH1 m RNA相对表达量,并利用受试者工作特征(ROC)曲线获取miR-425-5p、PTCH1最佳截断值,采用KM曲线分析miR-425-5p、PTCH1与预后的关系。结果原发性喉癌患者癌组织中的miR-425-5p相对表达量为1.81±0.48,明显高于癌旁组织的1.08±0.23,PTCH1 m RNA相对表达量为1.21±0.36,明显低于癌旁组织的1.63±0.41,差异均有统计学意义(P<0.05);Ⅲ~Ⅳ期、淋巴结转移、低分化癌组织中的miR-425-5p相对表达量分别为1.97±0.46、2.09±0.42、2.14±0.46,明显高于Ⅰ~Ⅱ期、无淋巴结转移、中高分化癌组织的1.54±0.41、1.66±0.39、1.60±0.40,PTCH1 m RNA相对表达量分别为1.09±0.21、1.04±0.24、1.01±0.20,明显低于Ⅰ~Ⅱ期、无淋巴结转移、中高分化癌组织的1.42±0.25、1.30±0.27、1.34±0.23,差异均有统计学意义(P<0.05);Spearman法分析结果显示,miR-425-5p与临床分期、淋巴结转移呈正相关(r=0.663、0.702,P<0.05),与分化程度呈负相关(r=-0.681,P<0.05),PTCH1与临床分期、淋巴结转移呈负相关(r=-0.652、-0.711,P<0.05),与分化程度呈正相关(r=0.694,P<0.05);死亡患者癌组织中的miR-425-5p相对表达量为2.23±0.46,明显高于生存患者癌组织的1.67±0.38,而PTCH1 m RNA相对表达量为0.96±0.21,明显低于生存患者癌组织的1.30±0.34,差异均有统计学意义(P<0.05);ROC分析结果显示,miR-425-5p、PTCH1预测死亡的曲线下面积(AUC)分别为0.815(95%CI:0.727~0.884)、0.792(95%CI:0.702~0.865),最佳截断值分别为2.01、1.09;KM分析结果显示,miR-425-5p高表达、PTCH1低表达患者3年生存率均低于miR-425-5p低表达、PTCH1高表达患者,差异均有统计学意义(P<0.05)。结论miR-425-5p在原发性喉癌癌组织中表达上调,PTCH1表达下调,联合检测对预后具有一定预测价值,可作为临床评估病情、预测预后的辅助指标,以指导临床工作。
基金This study was funded by grants from the Special Scientific Research Project of Military Health Care(grant number:20BJZ27 to Dr FHZ)Special Scientific Research Project ofMilitary Key Laboratory of Military Medical Engineering(grantnumber:2022SYSZZKY12 to Dr FHZ).
文摘Background:Acute kidney injury(AKI)is primarily defined and classified according to the magnitude of theelevation of serum creatinine(Scr).We aimed to determine whether the duration of AKI adds prognostic valuein addition to that obtained from the magnitude of injury alone.Methods:This retrospective study enrolled very elderly inpatients(≥75 years)in the Chinese PLA General Hospitalfrom January 2007 to December 2018.AKI was stratified by magnitude according to KDIGO stage(1,2,and 3)andduration(1–2 days,3–4 days,5–7 days,and>7 days).The primary outcome was the 1-year mortality after AKI.Multivariable Cox regression analysis was performed to identify covariates associated with the 1-year mortality.The probability of survival was estimated using the Kaplan–Meier method,and curves were compared using thelog-rank test.Results:In total,688 patients were enrolled,with the median age was 88(84–91)years,and the majority(652,94.8%)were male.According to the KDIGO criteria,317 patients(46.1%)had Stage 1 AKI,169(24.6%)hadStage 2 AKI,and 202(29.3%)had Stage 3 AKI.Of the 688 study subjects,61(8.9%)with a duration of AKIlasted 1–2 days,104(15.1%)with a duration of AKI lasted 3–4 days,140(20.3%)with a duration of AKI lasted5–7 days,and 383(55.7%)with a duration of AKI lasted>7 days.Within each stage,a longer duration of AKIwas slightly associated with a higher rate of 1-year mortality.However,within each of the duration categories,the stage of AKI was significantly associated with 1-year mortality.When considered separately in multivariateanalyses,both the duration of AKI(3–4 days:HR=3.184;95%CI:1.733–5.853;P<0.001,5–7 days:HR=1.915;95%CI:1.073–3.416;P=0.028;>7 days:HR=1.766;95%CI:1.017–3.065;P=0.043)and more advanced AKIstage(Stage 2:HR=3.063;95%CI:2.207–4.252;P<0.001;Stage 3:HR=7.333;95%CI:5.274–10.197;P<0.001)were independently associated with an increased risk of 1-year mortality.Conclusions:In very elderly AKI patients,both a higher stage and duration were independently associated withan increased risk of 1-year mortality.Hence,the duration of AKI adds additional information to predict long-termmortality.
文摘目的探索神经重症康复病房患者住院期间营养风险评价指标与1年预后的关系。方法回顾性分析2020年12月至2022年8月首都医科大学附属北京康复医院神经重症康复病房276例患者的临床资料。记录患者入科时性别、年龄、主要诊断、格拉斯哥昏迷评分(Glasgow coma scale,GCS)、血红蛋白、血清白蛋白、营养风险筛查量表2002(NRS2002);出重症监护病房(ICU)时,记录患者ICU住院期间的最低血磷、最低前白蛋白、最高降钙素原(PCT)、病重当天24 h内(或住ICU期间最差)的急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、改良危重症营养风险评分(m-NUTRIC)及ICU住院时间;出院时,记录总住院时间。根据1年随访时患者是否死亡分为生存组(n=220)和死亡组(n=56)。采用多因素Logistic回归模型分析神经重症康复患者1年内死亡的危险因素。绘制受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC)及其95%置信区间(95%CI),评价各营养风险评价指标和最低血磷联合最低前白蛋白及最高PCT对神经重症康复患者1年死亡的预测价值。结果生存组和死亡组年龄,病种结构,入院血红蛋白和入院时NRS200,住院期间最低前白蛋白、最低血磷和最高PCT,住院期间最差APACHEⅡ、SOFA、m-NUTRIC评分和总住院时间差异有统计学意义(P值均<0.05)。以上指标为自变量,1年内死亡做因变量行多元Logistic回归分析显示,方程含有以上6个变量时,P=0.358>0.200,较好地拟合了原始数据。在校正了年龄、主要诊断及血红蛋白后,以上指标均为神经重症康复患者1年内死亡的独立危险因素。最低血磷、最低前白蛋白和最高PCT联合预测及NRS2002评分和m-NUTRIC评分预测神经重症康复1年预后的AUC(95%CI)分别为0.887(0.844~0.922)、0.679(0.595~0.763)和0.689(0.631~0.743),最佳截断值分别为联合预测值>0.252、NRS2002>4和m-NUTRIC>3,约登指数分别为0.658、0.321和0.326。结论神经重症康复患者在ICU期间的最低血磷联合最低前白蛋白和最高PCT可以更好地预测神经重症康复患者的1年预后。
文摘Introduction: Infant and child mortality is a worldwide concern, but developing countries such as Mali are more affected. The aim of this study was to investigate morbidity and factors associated with mortality in children aged 1 month to 15 years. Methodology: This was a cross-sectional study which took place from January 1 to December 31, 2020 covering children aged 1 month to 15 years hospitalized at the Kalaban-Coro CSRéf. Data were entered into Excel and analyzed using SPSS version 20 software. Results: Five hundred children aged 1 months to 15 years were included. The age range 1 to 5 years (53.6%) and male sex (58.2%) were the most represented. Malaria (72.2%), acute respiratory infections (6.2%) and diarrhea/dehydration (3%) were the main morbidities. Mortality was estimated at 10.6%, and the two main causes of death were malaria (56.6%) and acute respiratory infections (7.54%). Univariate analysis revealed a statistically significant association between the dependent variable (death) and age (p Conclusion: This study confirms the high rate of infant and child morbidity and mortality in our health facilities. Strengthening human resources and intensifying behavior-change communication can help reverse the trend.
