Risk factors for hepatocellular carcinoma in cirrhosis:A comprehensive analysis from a decade-long study

BACKGROUND Cirrhosis is a significant risk factor for the development of hepatocellular carcinoma(HCC).Variability in HCC risk among patients with cirrhosis is notable,particularly when considering the diverse etiologies of cirrhosis.AIM To identify specific risk factors contributing to HCC development in patients with cirrhosis.METHODS This retrospective study analyzed data from cirrhotic patients at Beijing Youan Hospital from January 1,2012 to September 30,2022 with at least 6 mo of followup.Patient demographics,medical histories,etiologies,and clinical characteristics were examined.Cox regression analysis was used to analyze correlations of the above parameters with hepatocarcinogenesis,while competing risk regression was used to estimate their adjusted hazard ratios accounting for death.The cumulative incidence was plotted over time.RESULTS Overall,5417 patients with cirrhosis(median age:54 years;65.8%males)were analyzed.Hepatitis B virus(HBV)was the most common etiology(23.3%),with 25%(n=1352)developing HCC over a 2.9-year follow-up period.Patients with multiple etiologies had the HCC highest incidence(30.3%),followed by those with HBV-related cirrhosis(29.5%).Significant risk factors included male sex,advanced age,hepatitis C virus(HCV)infection,elevated blood ammonia,and low platelet count.Men had a higher 5-year HCC risk than women(37.0%vs 31.5%).HBV,HCV,and HBV/HCV co-infected patients had 5-year risks of HCC of 45.8%,42.9%,and 48.1%,respectively,compared to 29.5%in nonviral hepatitis cases,highlighting the significant HCC risk from viral hepatitis,especially HBV,and underscores the importance of monitoring these high-risk groups.CONCLUSION In conclusion,HBV-related cirrhosis strongly correlates with HCC,with male sex,older age,viral hepatitis,elevated blood ammonia,and lower albumin and platelet levels increasing the risk of HCC.

Risk factors and survival prediction model establishment for prognosis in patients with radical resection of gallbladder cancer

BACKGROUND Gallbladder cancer(GBC)is the most common malignant tumor of the biliary system,and is often undetected until advanced stages,making curative surgery unfeasible for many patients.Curative surgery remains the only option for long-term survival.Accurate postsurgical prognosis is crucial for effective treatment planning.tumor-node-metastasis staging,which focuses on tumor infiltration,lymph node metastasis,and distant metastasis,limits the accuracy of prognosis.Nomograms offer a more comprehensive and personalized approach by visually analyzing a broader range of prognostic factors,enhancing the precision of treatment planning for patients with GBC.AIM A retrospective study analyzed the clinical and pathological data of 93 patients who underwent radical surgery for GBC at Peking University People's Hospital from January 2015 to December 2020.Kaplan-Meier analysis was used to calculate the 1-,2-and 3-year survival rates.The log-rank test was used to evaluate factors impacting prognosis,with survival curves plotted for significant variables.Single-factor analysis revealed statistically significant differences,and multivariate Cox regression identified independent prognostic factors.A nomogram was developed and validated with receiver operating characteristic curves and calibration curves.Among 93 patients who underwent radical surgery for GBC,30 patients survived,accounting for 32.26%of the sample,with a median survival time of 38 months.The 1-year,2-year,and 3-year survival rates were 83.87%,68.82%,and 53.57%,respectively.Univariate analysis revealed that carbohydrate antigen 19-9 expre-ssion,T stage,lymph node metastasis,histological differentiation,surgical margins,and invasion of the liver,ex-trahepatic bile duct,nerves,and vessels(P≤0.001)significantly impacted patient prognosis after curative surgery.Multivariate Cox regression identified lymph node metastasis(P=0.03),histological differentiation(P<0.05),nerve invasion(P=0.036),and extrahepatic bile duct invasion(P=0.014)as independent risk factors.A nomogram model with a concordance index of 0.838 was developed.Internal validation confirmed the model's consistency in predicting the 1-year,2-year,and 3-year survival rates.CONCLUSION Lymph node metastasis,tumor differentiation,extrahepatic bile duct invasion,and perineural invasion are independent risk factors.A nomogram based on these factors can be used to personalize and improve treatment strategies.

Analysis of the Current Situation and Risk Factors of Lower Respiratory Tract Infection among ICU Patients in Guizhou,China During 2019-2022

Objective:This study aims to explore the prevalence,features,and risk factors of lower respiratory tract infections(LRTIs)in the intensive care unit(ICU)of a newly established hospital in Zunyi City.The goal is to devise strategies for preventing LRTIs in the ICU of new hospitals,thereby mitigating the incidence of nosocomial LRTIs in ICU patients.Methods:A case-control study was conducted from March 2019 to December 2022 to investigate the incidence rate of LRTIs in the ICU of a newly constructed hospital in Zunyi City.Patients with LRTIs constituted the case group,while those without LRTIs constituted the control group,where a 1:1 matching principle was adhered to.A single-factor chi-square(χ2)test was employed to analyze the risk factors,with independent risk factors being explored using a multivariate logistic regression analysis.Results:A total of 169 strains of pathogenic bacteria were isolated,comprising 66.28%gram-negative bacteria,17.75%gram-positive bacteria,and 15.97%fungi.The most prevalent pathogens included Acinetobacter baumannii(43.20%),Candida albicans(10.65%),and Pseudomonas aeruginosa(8.88%).Of the 82 strains infected by multidrug-resistant bacteria in patients with LRTIs,81.7%were carbapenem-resistant Acinetobacter baumannii,9.8%were multidrug-resistant Pseudomonas aeruginosa,and 6.1%were carbapenem-resistant Escherichia coli.Identified risk factors included smoking history,total hospitalization days,ICU stay length,hypoproteinemia,indwelling gastric tube,intubation type,duration of mechanical ventilation,usage of antibacterial drugs,and administration of protein drugs(P<0.05).Multivariate logistic regression analysis demonstrated that these factors were independent risk factors for nosocomial LRTIs in ICU patients(P<0.05).Conclusion:ICU patients in our hospital were mainly infected by carbapenem-resistant Acinetobacter baumannii.To prevent LRTIs in patients,tailored preventive measures should be developed and the rational use of antibacterial drugs should be promoted.

Spatial Heterogeneity and Risk Factors of Dental Caries in 12-Year-Old Children in Shanxi Province,China

Objective This study aimed to explore the spatial heterogeneity and risk factors for dental caries in 12-year-old children in Shanxi province,China.Methods The data encompassed 3,721 participants from the two most recent oral health surveys conducted across 16 districts in Shanxi Province in 2015 and 2018.Eighteen specific variables were analyzed to examine the interplay between socioeconomic factors,medical resources and environmental conditions.The Geo-detector model was employed to assess the impacts and interactions of these ecological factors.Results Socioeconomic factors(Q=0.30,P<0.05)exhibited a more substantial impact compared to environmental(Q=0.19,P<0.05)and medical resource factors(Q=0.25,P<0.05).Notably,the urban population percentage(UPP)demonstrated the most significant explanatory power for the spatial heterogeneity in caries prevalence,as denoted by its highest q-value(q=0.51,P<0.05).Additionally,the spatial distribution’s heterogeneity of caries was significantly affected by SO2 concentration(q=0.39,P<0.05)and water fluoride levels(q=0.27,P<0.05)among environmental factors.Conclusion The prevalence of caries exhibited spatial heterogeneity,escalating from North to South in Shanxi Province,China,influenced by socioeconomic factors,medical resources,and environmental conditions to varying extents.

Analysis of risk factors for central venous port failure in cancer patients

AIM: To analyze the risk factors for central port failure in cancer patients administered chemotherapy, using univariate and multivariate analyses. METHODS: A total of 1348 totally implantable venous access devices (TIVADs) were implanted into 1280 cancer patients in this cohort study. A Cox proportional hazard model was applied to analyze risk factors for failure of TIVADs. Log-rank test was used to compare actuarial survival rates. Infection, thrombosis, and surgical complication rates (χ2 test or Fisher's exact test) were compared in relation to the risk factors. RESULTS: Increasing age, male gender and openended catheter use were signifi cant risk factors reducing survival of TIVADs as determined by univariate and multivariate analyses. Hematogenous malignancy decreased the survival time of TIVADs; this reduction was not statistically signifi cant by univariate analysis [hazard ratio (HR) = 1.336, 95% CI: 0.966-1.849, P = 0.080)]. However, it became a signifi cant risk factor by multivariate analysis (HR = 1.499, 95% CI: 1.079-2.083, P = 0.016) when correlated with variables of age, sex and catheter type. Close-ended (Groshong) catheters had a lower thrombosis rate than open-ended catheters (2.5% vs 5%, P = 0.015). Hematogenous malignancy had higher infection rates than solid malignancy (10.5% vs 2.5%, P < 0.001). CONCLUSION: Increasing age, male gender, openended catheters and hematogenous malignancy were risk factors for TIVAD failure. Close-ended catheters had lower thrombosis rates and hematogenous malignancy had higher infection rates.

Analysis of risk factors for epilepsy after stroke

Objective To explore the risk factors for epilepsy induced by stroke. Methods There were 179 patients with epilepsy caused by stroke,and 1 447 patients with cerebrovascular disorders without epilepsy after stroke. Multivariate noncondition stepwise logistic model analysis was made after single variable analysis.Results The following four factors were associated with epilepsy, i.e., large size of cerebral hemorrhage or cerebral infarction,subarachnoid hemorrhage, electrolyte disturbances and cortical lesions.Conclusion Epilepsy induced by stroke is mainly associated with the size of brain tissue necrosis.

Analysis of risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis

Objective To analyse the risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis. Methods From January 2001 to December 2008,2277 patients with rheumatic mitral stenosis underwent operations in our hospital. There were 737 males and 1540 females,the age ranged from 19 to 84 years [average (50.9 ±10.2) years]. Left atrial thrombosis group

Prognostic factors for lacrimal gland adenoid cystic carcinoma:a retrospective study in Chinese patients

AIM:To explore the prognostic factors for lacrimal gland adenoid cystic carcinoma(LGACC)in Chinese patients.METHODS:Clinical and histopathological data were reviewed in patients with pathologically confirmed LGACC.Local recurrence,metastasis,and disease-specific death were the main outcome measures.Univariate and multivariate analyses were performed by the Kaplan-Meier method and a Cox proportional hazard model.RESULTS:This retrospective cohort study included 45 patients with pathologically confirmed LGACC between January 2008 and June 2022.Tumor(T)classification(P=0.005),nodal metastasis(N)classification(P=0.018)and positive margin(P=0.008)were independent risk factors of recurrence;T(P=0.013)and N(P=0.003)classification and the basaloid tumor type(P=0.032)were independent risk factors for metastasis;T classification(P<0.001)was an independent factor of death of disease.In the further analysis,the durations from first surgery to radiotherapy is correlated with metastatic risk in LGACC patients with basaloid component(P=0.022).CONCLUSION:Histological subtype should be emphasized when evaluating prognosis and guiding treatment.Timely radiotherapy may reduce the risk of metastasis in patients with basaloid component.

Association of education with cholelithiasis and mediating effects of cardiometabolic factors:A Mendelian randomization study

BACKGROUND Education,cognition,and intelligence are associated with cholelithiasis occurrence,yet which one has a prominent effect on cholelithiasis and which cardiometabolic risk factors mediate the causal relationship remain unelucidated.AIM To explore the causal associations between education,cognition,and intelligence and cholelithiasis,and the cardiometabolic risk factors that mediate the associations.METHODS Applying genome-wide association study summary statistics of primarily European individuals,we utilized two-sample multivariable Mendelian randomization to estimate the independent effects of education,intelligence,and cognition on cholelithiasis and cholecystitis(FinnGen study,37041 and 11632 patients,respectively;n=486484 participants)and performed two-step Mendelian randomization to evaluate 21 potential mediators and their mediating effects on the relationships between each exposure and cholelithiasis.RESULTS Inverse variance weighted Mendelian randomization results from the FinnGen consortium showed that genetically higher education,cognition,or intelligence were not independently associated with cholelithiasis and cholecystitis;when adjusted for cholelithiasis,higher education still presented an inverse effect on cholecystitis[odds ratio:0.292(95%CI:0.171-0.501)],which could not be induced by cognition or intelligence.Five out of 21 cardiometabolic risk factors were perceived as mediators of the association between education and cholelithiasis,including body mass index(20.84%),body fat percentage(40.3%),waist circumference(44.4%),waist-to-hip ratio(32.9%),and time spent watching television(41.6%),while time spent watching television was also a mediator from cognition(20.4%)and intelligence to cholelithiasis(28.4%).All results were robust to sensitivity analyses.CONCLUSION Education,cognition,and intelligence all play crucial roles in the development of cholelithiasis,and several cardiometabolic mediators have been identified for prevention of cholelithiasis due to defects in each exposure.

Development and validation of a predictive model for acute-onchronic liver failure after transjugular intrahepatic portosystemic shunt

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a cause of acute-onchronic liver failure(ACLF).AIM To investigate the risk factors of ACLF within 1 year after TIPS in patients with cirrhosis and construct a prediction model.METHODS In total,379 patients with decompensated cirrhosis treated with TIPS at Nanjing Drum Tower Hospital from 2017 to 2020 were selected as the training cohort,and 123 patients from Nanfang Hospital were included in the external validation cohort.Univariate and multivariate logistic regression analyses were performed to identify independent predictors.The prediction model was established based on the Akaike information criterion.Internal and external validation were conducted to assess the performance of the model.RESULTS Age and total bilirubin(TBil)were independent risk factors for the incidence of ACLF within 1 year after TIPS.We developed a prediction model comprising age,TBil,and serum sodium,which demonstrated good discrimination and calibration in both the training cohort and the external validation cohort.CONCLUSION Age and TBil are independent risk factors for the incidence of ACLF within 1 year after TIPS in patients with decompensated cirrhosis.Our model showed satisfying predictive value.

Risk factors and care of early surgical site infection after primary posterior lumbar interbody fusion

Objectives:To explore the risk factors and nursing measures of early surgical site infection(SSI)after posterior lumbar interbody fusion(PLIF).Methods:A total of 468 patients who received PLIF in our hospital from January 2017 to June 2020 were enrolled into this study.According to the occurrence of early SSI,the patients were divided into two groups,and the general data were analyzed by univariate analysis.Multivariate logistic regression analysis was conducted with the dichotomous variable of whether early SSI occurred and other factors as independent variables to identify the risk factors of early SSI and put forward targeted prevention and nursing measures.Results:Among 468 patients with PLIF,18 patients developed early SSI(3.85%).The proportion of female,age,diabetes mellitus and urinary tract infection(UTI),operation segment,operation time,post-operative drainage volume,and drainage time were significantly higher than those in the uninfected group,with statistical significance(P<0.05),whereas the preoperative albumin and hemoglobin in the infected group were significantly lower than those in the uninfected group,with statistical significance(P<0.05).There was no significant difference between the two groups in the American Society of Anesthesiologists(ASA)grading,body mass index(BMI),complications including cardiovascular and cerebrovascular diseases or hypertension(P>0.05).Logistic regression analysis showed that preoperative diabetes mellitus(OR=2.109,P=0.012)/UTI(OR=1.526,P=0.035),prolonged drainage time(OR=1.639,P=0.029)were risk factors for early SSI.Men(OR=0.736,P=0.027)and albumin level(OR=0.526,P=0.004)were protective factors in reducing early SSI.Conclusions:Women,preoperative diabetes/UTI,hypoproteinemia,and prolonged drainage time are risk factors for early SSI after PLIF.Clinical effective preventive measures should be taken in combination with targeted nursing intervention to reduce the risk of early SSI.

Quality of life of hospitalized patients after lung cancer operation and analysis of influencing factors

Objective:To explore the current status and influencing factors of quality of life in patients with lung cancer after surgery in a tertiary hospital in Hainan province.Methods:To investigate the influencing factors of quality of life of lung cancer patients after surgery in a tertiary hospital in Hainan province by cross‑sectional survey method.Results:The scores of insomnia,appetite loss,constipation and pain in 186 lung cancer patients after surgery in a tertiary hospital in Hainan Province were significantly higher than the reference value.Multiple linear regression analysis showed that older patients(>60 years)had lower scores in physical function domain(β=-0.193),and female patients had more appetite loss symptoms(β=0.245).Compared with other minority ethnic groups,Han ethnic group had lower scores in role function domain(β=0.179),more severe fatigue symptoms(β=-0.162),and higher general health level(β=0.166).Patients with employee medical insurance had lower scores of emotional function(β=0.194),cognitive function(β=0.281),the lowest score in social function(β=0.188),and severe pain in other parts(β=-0.227).Smokers had less cough symptoms(β=0.175)and more arm and shoulder pain symptoms(β=-0.21)than non‑smokers.Patients with secondhand smoke exposure had lower cognitive function scores(β=-0.158)and more obvious symptoms of oral ulcer(β=0.185).Patients who drank alcohol frequently(drinking frequency>1 time/day)had more severe cough symptoms(β=0.27).Patients with small number of children(0‑1)had milder cough symptoms(β=0.178).Patients who did not understand the disease had obvious symptoms of arm and shoulder pain(β=0.151).Patients with early pathological stage(stageⅠ‑Ⅱ)had more severe shortness of breath(β=-0.159)and pain(β=-0.181).The symptoms of appetite loss were more obvious in patients living in cities(β=0.192).The symptoms of peripheral neuropathy were more obvious(β=0.174).Patients who often consumed pickulated food had severe pain symptoms(β=-0.219),and pain in other parts was obvious(β=-0.149).Male patients had obvious alopecia symptoms(β=-0.306).Conclusion:Age,ethnicity,residence,type of medical insurance,number of children,pathological stage of lung cancer,smoking,second‑hand smoke exposure,alcohol consumption,and frequent consumption of pickled food were related to the quality of life of lung cancer patients in hospital after surgery.Medical staff and family members should pay attention to the emotional communication of patients during the treatment of lung cancer patients in hospital after surgery.Patients should avoid exposure to smoking,alcohol and second‑hand smoke,and reduce consumption of pickled food.

Risk factors for progressive ischemic stroke: A retrospective analysis

BACKGROUND： Progressive ischemic stroke has higher fatality rate and disability rate than common cerebral infarction, thus it is very significant to investigate the early predicting factors related to the occurrence of progressive ischemic stroke, the potential pathological mechanism and the risk factors of early intervention for preventing the occurrence of progressive ischemic stroke and ameliorating its outcome. OBJECTIVE： To analyze the possible related risk factors in patients with progressive ishcemic stroke, so as to provide reference for the prevention and treatment of progressive ishcemic stroke. DESIGN： A retrospective analysis. SETTING： Department of Neurology, General Hospital of Beijing Coal Mining Group. PARTICIPANTS： Totally 280 patients with progressive ischemic stroke were selected from the Department of Neurology, General Hospital of Beijing Coal Mining Group from March 2002 to June 2006, including 192 males and 88 females, with a mean age of （62±7） years old. They were all accorded with the diagnostic standards for cerebral infarction set by the Fourth National Academic Meeting for Cerebrovascular Disease in 1995, and confired by CT or MRI, admitted within 24 hours after attack, and the neurological defect progressed gradually or aggravated in gradients within 72 hours after attack, and the aggravation of neurological defect was defined as the neurological deficit score decreased by more than 2 points. Meanwhile, 200 inpatients with non-progressive ischemic stroke （135 males and 65 females） were selected as the control group. METHODS： After admission, a univariate analysis of variance was conducted using the factors of blood pressure, history of diabetes mellitus, fever, leukocytosis, levels of blood lipids, fibrinogen, blood glucose and plasma homocysteine, cerebral arterial stenosis, and CT symptoms of early infarction, and the significant factors were involved in the multivariate non-conditional Logistic regression analysis. MAIN OUTCOME MEASURES： Results of the univariate analysis of variance of the factors related to progressive ischemic stroke; Results of the multivariate regression analysis. RESULTS： All the 480 patients were involved in the analysis of results. ① Results of the univariate analysis variance： There were significantly more patients with fever, leukocytosis, history of diabetes mellitus, cerebral arterial stenosis and CT symptoms of early infarction in the progressive ischemic stroke group than in the control group （P 〈 0.01）; The levels of blood glucose and fibrinogen in the progressive ischemic stroke group were significantly higher than those in the control group, while the level of blood pressure was significantly lower than that in the control group （P 〈 0.05 - 0.01）. ② Results of the multivariate Logistic regression analysis： The independent predicting factors for progressive ischemic stroke were history of diabetes mellitus, fever, leukocytosis, cerebral arterial stenosis, CT symptoms of early infarction, blood glucose and blood pressure （OR =2.61,2.96, 3.79, 1.03, 3.57, 2.68, 95% CI 0.92 - 3.59, P 〈 0.05 - 0.01）. CONCLUSION： History of diabetes mellitus, fever, leukocytosis, levels of blood pressure, blood glucose, cerebral arterial stenosis and CT symptoms of early infarction are the risk factors for progress ischemic stroke

Analysis on Nutritional Risk Screening and Influencing Factors of Hospitalized Patients in Central Urban Area

Rational nutritional support shall be based on nutritional screening and nutritional assessment. This study is aimed to explore nutritional risk screening and its influencing factors of hospitalized patients in central urban area. It is helpful for the early detection of problems in nutritional supports, nutrition management and the implementation of intervention measures, which will contribute a lot to improving the patient＇s poor clinical outcome. A total of three tertiary medical institutions were enrolled in this study. From October 2015 to June 2016, 1202 hospitalized patients aged ≥18 years were enrolled in Nutrition Risk Screening 2002（NRS2002） for nutritional risk screening, including 8 cases who refused to participate, 5 cases of same-day surgery and 5 cases of coma. A single-factor chi-square test was performed on 312 patients with nutritional risk and 872 hospitalized patients without nutritional risk. Logistic regression analysis was performed with univariate analysis（P〈0.05）, to investigate the incidence of nutritional risk and influencing factors. The incidence of nutritional risk was 26.35% in the inpatients, 25.90% in male and 26.84% in female, respectively. The single-factor analysis showed that the age ≥60, sleeping disorder, fasting, intraoperative bleeding, the surgery in recent month, digestive diseases, metabolic diseases and endocrine system diseases had significant effects on nutritional risk（P〈0.05）. Having considered the above-mentioned factors as independent variables and nutritional risk（Y=1, N=0） as dependent variable, logistic regression analysis revealed that the age ≥60, fasting, sleeping disorders, the surgery in recent month and digestive diseases are hazardous factors for nutritional risk. Nutritional risk exists in hospitalized patients in central urban areas. Nutritional risk screening should be conducted for inpatients. Nutritional intervention programs should be formulated in consideration of those influencing factors, which enable to reduce the nutritional risk and to promote the rehabilitation of inpatients.

Factors Predicting Progression to Severe COVID-19: A Competing Risk Survival Analysis of 1753 Patients in Community Isolation in Wuhan, China

Most studies of coronavirus disease 2019(COVID-19)progression have focused on the transfer of patients within secondary or tertiary care hospitals from regular wards to intensive care units.Little is known about the risk factors predicting the progression to severe COVID-19 among patients in community iso-lation,who are either asymptomatic or suffer from only mild to moderate symptoms.Using a multivari-able competing risk survival analysis,we identify several important predictors of progression to severe COVID-19—rather than to recovery—among patients in the largest community isolation center in Wuhan,China from 6 February 2020(when the center opened)to 9 March 2020(when it closed).All patients in community isolation in Wuhan were either asymptomatic or suffered from mild to moderate COVID-19 symptoms.We performed competing risk survival analysis on time-to-event data from a cohort study of all COVID-19 patients(n=1753)in the isolation center.The potential predictors we inves-tigated were the routine patient data collected upon admission to the isolation center:age,sex,respira-tory symptoms,gastrointestinal symptoms,general symptoms,and computed tomography(CT)scan signs.The main outcomes were time to severe COVID-19 or recovery.The factors predicting progression to severe COVID-19 were:male sex(hazard ratio(HR)=1.29,95%confidence interval(CI)1.04–1.58,p=0.018),young and old age,dyspnea(HR=1.58,95%CI 1.24–2.01,p<0.001),and CT signs of ground-glass opacity(HR=1.39,95%CI 1.04–1.86,p=0.024)and infiltrating shadows(HR=1.84,95%CI 1.22–2.78,p=0.004).The risk of progression was found to be lower among patients with nausea or vomiting(HR=0.53,95%CI 0.30–0.96,p=0.036)and headaches(HR=0.54,95%CI 0.29–0.99,p=0.046).Our results suggest that several factors that can be easily measured even in resource-poor set-tings(dyspnea,sex,and age)can be used to identify mild COVID-19 patients who are at increased risk of disease progression.Looking for CT signs of ground-glass opacity and infiltrating shadows may be an affordable option to support triage decisions in resource-rich settings.Common and unspecific symptoms(headaches,nausea,and vomiting)are likely to have led to the identification and subsequent community isolation of COVID-19 patients who were relatively unlikely to deteriorate.Future public health and clinical guidelines should build on this evidence to improve the screening,triage,and monitoring of COVID-19 patients who are asymtomatic or suffer from mild to moderate symptoms.

Risk factors analysis of prognosis of adult acute severe myocarditis

BACKGROUND Adult severe myocarditis is primarily caused by infection with any number of a variety of viruses.It arises quickly,progresses rapidly,and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock with a high hospital mortality rate.AIM To analyze the risk factors affecting the short-term prognosis of adult acute severe myocarditis(ASM).METHODS Adult patients with ASM(ASM group,n=218)and acute nonsevere myocarditis(ANSM group,n=80)who came to our department from January 2014 to January 2020 were enrolled in this study.Patients with ASM were divided into the ASM survival group(n=185)and ASM nonsurvival group(n=33)according to the treatment results during hospitalization.The clinical symptoms,laboratory examinations,treatment methods,complications,and the relationship between the treatment results of the two groups were retrospectively compared and discussed.The risk factors for death in patients with severe myocarditis were analyzed by binary logistic regression.A follow-up to 5.5 years was conducted on patients in the ASM survival group and ANSM group after discharge,and the readmission rate and incidence rate of dilated cardiomyopathy were analyzed.RESULTS Compared with the ASM survival group,the ASM nonsurvival group had longer QRS complex,higher incidence of cardiogenic shock,higher serum creatinine(SCr,235μmol/L vs 89μmol/L,P<0.05),higher sensitive cardiac troponin I(cTnI,4.45μg/L vs 1.66μg/L,P<0.05)and brain natriuretic peptide(BNP,1756 pg/mL vs 401 pg/mL,P<0.05).The binary logistic regression revealed that there were statistical differences between the two groups in SCr,cTnI,and BNP values(all P<0.05).After discharging from the hospital,patients in the ASM group and ANSM group had no significant differences in the readmission rate and incidencerate of dilated cardiomyopathy.CONCLUSION Elevated SCr,cTnI,and BNP are independent predictors for poor prognosis in patients with ASM.The long-term prognosis of patients in the ASM survival group is good.

Predictive Factors of Multiple Hospitalizations for Acute Exacerbations of COPD

Background: Multiple hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with considerable morbidity and mortality. Objectives: To identify predictive factors of multiples hospitalizations for AECOPD. Methods: This is a retrospective single center study of consecutive patients with COPD hospitalized at the Department of Respiratory Medicine between January 1990 and December 2015. We calculated for each patient the mean number of hospitalizations for AECOPD/year (H/y). We distinguished 2 groups (G) of patients. G1: <2 H/y and G2: ≥2 H/y. Predictors of multiple admissions identified by univariate analysis were included in the multivariate analysis. Results: The study included 1167 COPD patients (mean age 67 ± 10 years, 97% males). Three hundred six (26%) COPD patients had a mean number of hospitalizations per year ≥ 2. Multivariate logistic regression analysis demonstrated that an mMRC ≥ 2 (Odd ratio [OR] 1.8, 95% confidence interval [CI] 1.08 - 2.99, p = 0.022), a low PaO2 (PaO2 OR 0.97, 95% CI 0.95 - 0.99, p = 0.007) and frequent exacerbations (OR 2.95, 95% CI 2.56 - 3.39, p < 0.001) are independent factors associated with multiple admissions for AECOPD. Conclusions: An mMRC ≥ 2, a low PaO2 and frequent exacerbations are independently associated with multiple hospitalizations for AECOPD. The identification of these high risk COPD patients will be helpful in the decision of intervention strategies.

Risk Factors for Hospitalization Due to Hypoglycemia in Diabetic Patients in Northeast Thailand

Background: Hypoglycemia among diabetic patients is a major complication, which results in high morbidity and mortality. Hospitalization provides the inadequate patient care and management. Objective: The aim of this study was to determine the potential risk factors for hospitalization due to hypoglycemia among diabetic patients. Method: In a case-control study, the cases were diabetic patients admitted due to hypoglycemia. Controls were diabetic patients admitted for other reasons. The cases and control subjects were recruited from the inpatient department of the middle level hospital in Northeast Thailand. The total sample size was 360 patients who met the criteria and had been hospitalized. The number of case was 90, and the number of controls was 270. The data were analyzed by determining the adjusted odds ratio, and 95% confidence interval of the ORs using multiple logistic regression models. Results: Using a multivariate logistic regression model, five variables were significantly associated with hospitalization due to hypoglycemia among diabetic patients: 1) patients who received insulin injections (AOR = 20.75;95% CI: 4.7 - 91.41;p = 0.001);2) patients who did not carry sugar candy or a dessert with them at all times (AOR = 13.89;95% CI: 1.92 - 100.31;p = 0.01);3) patients with an occurrence of hypoglycemia at least once a week at home(AOR = 8.83;95% CI: 2.58 - 30.20;p = 0.001);4) patients who were adjusted for doses of medication on their own (AOR = 6.62;95% CI: 1.30 - 33.70;p = 0.02);and 5) patients who lacked knowledge did not understand the causes and symptoms of low blood sugar (AOR = 7.97;95% CI: 1.97 - 32.22;p = 0.001). Conclusion: Receiving insulin injection and poor knowledge and self-care of hypoglycemia prevention were the best predictors of hospitalization due to hypoglycemia among diabetic patients. These factors need to be adequately addressed in order to provide better care and management to prevent hospitalization among diabetic patients.

Analysis of Cardiovascular Risk Factors in Newly Defined Stage 1 Hypertension among Chinese on the Basis of the 2017 ACC/AHA Hypertension Guidelines

In 2017,American College of Cardiology(ACC)/American Heart Association(AHA)et al.jointly released the latest guidelines for adult hypertension,exactly including prevention,diagnosis,assess and treatment,in which blood pressure levels greater than 130/80 mm Hg were defined as hypertension[1].Based on these modified guidelines,the morbidity of hypertension in US increased from 32%to 46%.

Risk factors for new onset diabetes mellitus after liver transplantation: A meta-analysis

AIM: To determine the risk factors for new-onset diabetes mellitus(NODM) after liver transplantation by conducting a systematic review and meta-analysis.METHODS: We electronically searched the databases of MEDLINE, EMBASE and the Cochrane Library from January 1980 to December 2013 to identify relevant studies reporting risk factors for NODM after liver transplantation. Two authors independently assessed the trials for inclusion and extracted the data. Discrepancies were resolved in consultation with a third reviewer. All statistical analyses were performed with the Rev Man5.0 software(The Cochrane Collaboration, Oxford, United Kingdom). Pooled odds ratios(OR) or weighted mean differences(WMD) with 95% confidence intervals(CIs) were calculated using either a fixed effects or a random effects model, based on the presence(I2 < 50%) or absence(I2 > 50%) of significant heterogeneity. RESULTS: Twenty studies with 4580 patients were included in the meta-analysis, all of which were retrospective. The meta-analysis identified the following significant risk factors: hepatitis C virus(HCV) infection(OR = 2.68; 95%CI: 1.92-3.72); a family history of diabetes(OR = 1.69, 95%CI: 1.09-2.63, P < 0.00001); male gender(OR = 1.53; 95%CI: 1.24-1.90; P < 0.0001); impaired fasting glucose(IFG; OR = 3.27; 95%CI: 1.84-5.81; P < 0.0001); a family history of diabetes(OR = 1.69; 95%CI: 1.09-2.63; P = 0.02); use of tacrolimus(OR = 1.34; 95%CI: 1.03-1.76; P = 0.03) and body mass index(BMI)(WMD = 1.19, 95%CI: 0.69-1.68, P < 0.00001). Other factors, such as hepatitis B virus infection and alcoholism, were not found to be associated with the incidence of NODM.CONCLUSION: The study showed that HCV infection, IFG, a family history of diabetes, male gender, tacrolimus and BMI are risk factors for NODM after liver transplantation.