Correlation between X-ray cross-complementing group 1 polymorphisms and the onset risk of glioma A meta-analysis

OBJECTIVE： To evaluate the association of X-ray cross-complementing group 1 （XRCC1） Arg399GIn, Arg194Trp and Arg280His polymorphisms with the risk of glioma. DATA SOURCES： A systematic literature search of papers published from January 2000 to August 2012 in PubMed, Embase, China National Knowledge Infrastructure database, and Wanfang da- tabase was performed. The key words used were ＂glioma＂, ＂polymorphism＂, and ＂XRCC1 or X-ray repair cross-complementing group 1＂. References cited in the retrieved articles were screened manually to identify additional eligible studies. STUDY SELECTION： Studies were identified according to the following inclusion criteria： case-control design was based on unrelated individuals; and genotype frequency was available to estimate an odds ratio （OR） and 95% confidence interval （CI）. Meta-analysis was performed for the selected studies after strict screening. Dominant and recessive genetic models were used and the relationship between homozygous mutant genotype frequencies and mutant gene frequency and glioma incidence was investigated. We chose the fixed or random effect model according to the heterogeneity to calculate OR and 95%CI, and sensitivity analyses were conducted. Publication bias was examined using the inverted funnel plot and the Egger＇s test using Stata 12.0 software. MAIN OUTCOME MEASURES： Association of XRCC1 Arg399GIn, Arg194Trp, and Arg280His polymorphisms with the risk of glioma, and subgroup analyses were performed according to differ- ent ethnicities of the subjects.RESULTS： Twelve articles were included in the meta-analysis. Eleven of the articles were concerned with the Arg399GIn polymorphism and glioma onset risk. Significantly increased glioma risks were found only in the dominant model （Gin/Gin ＋ GIn/Arg versus Arg/Arg： OR = 1.26, 95%CI= 1.03-1.54, P = 0.02）. In the subgroup analysis by ethnicity, significantly increased risk was found in Asian subjects in the recessive （OR = 1.46, 95%CI= 1.04-2.45, P = 0.03） and dominant models （OR = 1.40, 95%CI= 1.10-1.78, P = 0.007）, and homozygote contrast （OR = 1.69, 95%CI= 1.17-2.45, P = 0.005）, but not in Caucasian sub- jects. For association of the Arg194Trp （eight studies） and Arg280His （four studies） polymorphisms with glioma risk, the meta-analysis did not reveal a significant effect in the allele contrast, the recessive genetic model, the dominant genetic model, or homozygote contrast. CONCLUSION： The XRCC1 Arg399GIn polymorphism may be a biomarker of glioma susceptibility, espe- cially in Asian populations. The Arg194Trp and Arg280His polymorphisms were not associated with overall glioma risk.

Old vs new: Risk factors predicting early onset colorectal cancer

BACKGROUND Colorectal cancer(CRC)is the second leading cause of all cancer related deaths in the United States and Europe.Although the incidence has been decreasing for individuals’≥50,it has been on the rise for individuals<50.AIM To identify potential risk factors for early-onset CRC.METHODS A population-based cohort analysis using a national database,Explorys,screened all patients with an active electronic medical record from January 2012 to December 2016 with a diagnosis of CRC.Subgroups were stratified based on age(25–49 years vs≥50 years).Demographics,comorbidities,and symptom profiles were recorded and compared between both age groups.Furthermore,the younger group was also compared with a control group consisting of individuals aged 25-49 years within the same timeframe without a diagnosis of CRC.Twentydata points for CRC related factors were analyzed to identify potential risk factors specific to early-onset CRC.RESULTS A total of 68860 patients were identified with CRC,of which 5710(8.3%)were younger than 50 years old,with 4140(73%)between 40-49 years of age.Multivariable analysis was reported using odds ratio(OR)with 95%CI and demonstrated that several factors were associated with an increased risk of CRC in the early-onset group versus the later-onset group.These factors included:African-American race(OR 1.18,95%CI:1.09-1.27,P<0.001),presenting symptoms of abdominal pain(OR 1.82,95%CI:1.72-1.92,P<0.001),rectal pain(OR 1.50,95%CI:1.28-1.77,P<0.001),altered bowel function(OR 1.12,95%CI:1.05-1.19,P=0.0005),having a family history of any cancer(OR 1.78,95%CI:1.67-1.90,P<0.001),gastrointestinal(GI)malignancy(OR 2.36,95%CI:2.18-2.55,P<0.001),polyps(OR 1.41,95%CI:1.08-1.20,P<0.001),and obesity(OR 1.14,95%CI:1.08-1.20,P<0.001).Comparing the early-onset cohort versus the control group,factors that were associated with an increased risk of CRC were:male gender(OR 1.34,95%CI:1.27-1.41),P<0.001),Caucasian(OR 1.48,95%CI:1.40-1.57,P<0.001)and African-American race(OR 1.25,95%CI:1.17-1.35,P<0.001),presenting symptoms of abdominal pain(OR 4.73,95%CI:4.49-4.98,P<0.001),rectal pain(OR 7.48,95%CI:6.42-8.72,P<0.001),altered bowel function(OR 5.51,95%CI:5.19-5.85,P<0.001),rectal bleeding(OR 9.83,95%CI:9.12-10.6,P<0.001),weight loss(OR 7.43,95%CI:6.77-8.15,P<0.001),having a family history of cancer(OR 11.66,95%CI:10.97-12.39,P<0.001),GI malignancy(OR 28.67,95%CI:26.64-30.86,P<0.001),polyps(OR 8.15,95%CI:6.31-10.52,P<0.001),tobacco use(OR 2.46,95%CI:2.33-2.59,P<0.001),alcohol use(OR 1.71,95%CI:1.62-1.80,P<0.001),presence of colitis(OR 4.10,95%CI:3.79-4.43,P<0.001),and obesity(OR 2.88,95%CI:2.74-3.04,P<0.001).CONCLUSION Pending further investigation,these potential risk factors should lower the threshold of suspicion for early CRC and potentially be used to optimize guidelines for early screening.

新生儿晚发型大肠埃希菌败血症的危险因素分析及风险预警模型的构建

目的探讨新生儿晚发型大肠埃希菌败血症的危险因素,并构建新生儿晚发型大肠埃希菌败血症的列线图模型。方法选取2021年1月至2023年7月安徽医科大学附属阜阳人民医院收治的226例新生儿作为模型组,另收集2021年8月至2023年10月同院收治的100例新生儿作为验证组。采用Logistic回归分析新生儿晚发型大肠埃希菌败血症的危险因素,采用R软件构建新生儿晚发型大肠埃希菌败血症的列线图模型,并进行模型验证。结果与无晚发型大肠埃希菌败血症组相比,晚发型大肠埃希菌败血症组胎龄较小、机械通气占比高、出生体重较低、肠外营养占比高、胎膜早破时间长、长时间抗生素暴露占比高,差异均有统计学意义(χ^(2)/t值介于6.089~11.605之间,P<0.05);Logistic回归分析结果显示,胎龄<37周、机械通气、低出生体重、肠外营养、胎膜早破时间较长及长时间抗生素暴露等是新生儿晚发型大肠埃希菌败血症的危险因素,其OR值及95%CI分别为4.031(1.492~10.982)、3.064(1.306~7.188)、3.262(1.200~8.873)、2.852(1.092~7.450)、1.517(1.275~1.806)、2.947(1.216~7.140),P<0.05;模型组和验证组的校正曲线均显示预测值与实际值基本吻合;模型组的受试者工作特征(ROC)曲线下面积是0.856(0.820~0.892),验证组的曲线下面积是0.846(0.800~0.893);模型组及验证组的决策曲线显示阈值概率分别是1%~100%、1%~98%时,列线图预测新生儿晚发型大肠埃希菌败血症的净获益值较高。结论胎龄<37周、机械通气、低出生体重、肠外营养、胎膜早破时间较长及长时间抗生素暴露等是新生儿晚发型大肠埃希菌败血症的危险因素,新生儿晚发型大肠埃希菌败血症的列线图模型具有较高的准确性及临床应用价值。

新生儿早发型败血症并发的急性肾损伤危险因素分析

目的 分析新生儿早发型败血症(EOS)临床资料,探索影响新生儿早发型败血症并发急性肾损伤(AKI)的危险因素。方法 通过回顾分析2018年1月至2022年4月于新生儿科病房住院的EOS患儿的临床资料,将满足新生儿改良KDIGO AKI诊断标准的患儿设为AKI组,按照1∶2配对,纳入不合并AKI患儿设为NAKI组,比较临床资料,调查分析影响新生儿早发型败血症并发急性肾损伤(ESA-AKI)的危险因素。结果 研究期间共纳入AKI组70例,NAKI组140例。单因素条件logstic回归分析发现,入院日龄大、母孕期高血压、窒息、入院时血尿素氮和肌酐水平高,合并中重度贫血、肺出血、动脉导管未闭、感染性休克,小剂量多巴胺、美罗培南暴露以及手术是AKI发病的危险因素,AKI组死亡或放弃治疗率高(P<0.05)。结论 在早发型败血症群体中,对于入院日龄大、窒息、母孕期高血压,入院时血尿素氮和肌酐水平高,合并中重度贫血、肺出血、动脉导管未闭和感染性休克,使用多巴胺和美罗培南以及手术的EOS患儿,需警惕入院后AKI发生。

心电图ST-T段异常对缺血性脑卒中的预测效能

目的 探讨心电图ST-T段异常(STA)对缺血性脑卒中的预测价值。方法 采用前瞻性研究方法,对3 027名体检人员(受试者)进行心电图检查,并随访60个月~120个月(随访截止2022年6月,或研究对象发生缺血性脑卒中则停止随访)。根据随访结果进行分组,将发生缺血性脑卒中的94例受试者设为研究组,将其余2 933例受试者设为对照组,统计STA发生情况。对缺血性脑卒中的影响因素采用单因素分析及多因素非条件Logistic回归分析,绘制受试者工作特征(ROC)曲线分析STA对缺血性脑卒中的预测价值。结果 两组受试者性别、年龄、STA占比、左心室肥厚、脑卒中家族史比较,差异有统计学意义(P<0.01)。多因素非条件Logistic回归分析显示,年龄、STA、高血压、高血脂症、饮酒均是缺血性脑卒中的危险因素(P<0.05或0.01)。ROC曲线显示,STA预测缺血性脑卒中的曲线下面积为0.859,灵敏度为0.830,特异度为0.888,准确度为0.869;关联性检验显著(χ~2=138.706,P=0.000),优势性检验不显著(χ~2=0.432,P=0.511)。结论 STA可增加人群缺血性脑卒中的发病风险,对缺血性脑卒中的预测效能较高。

Timing of Elective Repeat Cesarean Delivery at 38 Weeks versus 39 Weeks: Rate of Spontaneous Onset of Labor before Planned Cesarean Section and Impact on Maternal Outcome: A Retrospective Cohort Study

Background: The timing of elective repeat cesarean delivery at 38 weeks versus 39 weeks is still a debatable subject, both regarding maternal and neonatal outcomes. In the Saudi context, there is lack of local data to aid decision-making regarding the timing of elective repeat cesarean delivery. Objectives: To estimate the rate of spontaneous onset of labor before the planned gestational age for repeat cesarean section in women who were booked at gestational age of (39 0/7 - 39 6/7) weeks (W39) versus (38 0/7 - 38 6/7) weeks (W38) and to compare the rate of maternal composite outcome between these groups. Design: Retrospective cohort. Setting: This study was conducted at King Abdulaziz Medical City, Jeddah, KSA. Method: Delivery registry books were reviewed to identify all deliveries from 1 January 2014 to 31 December 2016 (3 years). All low-risk pregnant women who had 2 or more cesarean deliveries and who met the inclusion criteria were included. Results: A total of 440 women were included of whom 318 (72.3%) were planned for elective cesarean section at W38 gestational age and 122 women at W39 gestational age. Mothers planned at W39 had higher rate of emergency cesarean deliveries versus those planned at W38 (18.0% versus 10.4%, p = 0.030;RR = 13.06), most frequently due to early onset of contractions (16.4% versus 8.2%, p = 0.012;RR = 12.17) or cervical dilatation (11.6% versus 5.4%, p = 0.024, RR = 16.15). No difference in the incidence of individual or composite maternal complications was noted between the two groups. Mother’s age (OR 0.93, p = 0.018) and schedule date at W39 (OR = 1.94, p = 0.028) were independently associated with spontaneous onset of labor before the scheduled gestational age, while no association was found with parity, previous number of spontaneous vaginal deliveries, number of previous cesarean deliveries or interval from last cesarean delivery. Conclusion: Elective cesarean section scheduled at 39 weeks of gestation or beyond carries a higher risk of emergency cesarean section, with no significant increase in maternal complications. The identification of factors associated with spontaneous onset of labor before the planned gestational age should be carefully identified to determine the optimal timing.

急性心肌梗死后新发心房颤动患者临床特征及危险因素

目的分析急性心肌梗死(AMI)后新发心房颤动(NOAF)患者的临床特征及危险因素。方法选取2021年5月至2022年2月孝感市中心医院收治的230例AMI患者作为研究对象,根据AMI后NOAF的发生情况,将患者分为研究组(NOAF组,25例)和对照组(无NOAF,205例)。收集两组患者的临床特征,如年龄、性别、吸烟史、高血压病史等;收集实验室检查结果,如肌钙蛋白I(CTNI)、脑钠肽(BNP)、C反应蛋白(CRP)、CRP与血清白蛋白的比值(CRA)等;收集影像学检查结果,如左房舒张末期内径(LAED)、左室舒张末期内径(LVEDD)等;采用多因素logistic回归分析AMI后NOAF的危险因素。结果单因素分析结果显示,NOAF组和对照组患者的高血压病史比例、BNP、KILLIP分级、CRP、CRA、LAED比较,差异有统计学意义(P<0.05);多因素分析结果提示,BNP(β=1.423,OR=4.148,95%CI:1.139~15.099)、KILLIP分级≥Ⅱ级(β=1.707,OR=5.515,95%CI:1.017~29.903)、CRP(β=2.096,OR=8.132,95%CI:1.541~42.895)、CRA(β=2.212,OR=9.136,95%CI:1.159~72.024)、LAED(β=2.472,OR=11.851,95%CI:2.571~54.619)是AMI后NOAF的危险因素(P<0.05,OR>1)。结论BNP、KILLIP分级≥Ⅱ级、CRP、CRA、LAED是AMI后NOAF的危险因素。

异基因造血干细胞移植后迟发型出血性膀胱炎的危险因素分析

目的:分析异基因造血干细胞移植(allo-HSCT)后并发迟发型出血性膀胱炎(LOHC)的危险因素、LOHC发展为重度LOHC的危险因素及LOHC对生存的影响。方法:对2015年1月-2021年12月在重庆医科大学附属第一医院行allo-HSCT的300例患者的临床资料进行回顾性研究,选择可能影响allo-HSCT后LOHC发生的相关临床参数进行单因素和多因素分析,同时分析组间的总生存期(OS)和无进展生存期(PFS)差异。结果:多因素分析结果显示,患者年龄≤45岁(P=0.039)、强化预处理方案中包含氟达拉滨/克拉屈滨+阿糖胞苷(P=0.002)、移植后d 30白蛋白≤30 g/L(P=0.007)、CMV-DNA+(P=0.028)、移植前有真菌感染(P=0.026)、Ⅱ-Ⅳ度a GVHD的发生(P=0.006)是发生LOHC的独立危险因素;在已发生LOHC的移植患者中,LOHC发生的时间在移植后32 d内(P=0.008)、移植后d 30的白蛋白≤30 g/L(P=0.032)是发展为重度LOHC的独立危险因素。重度LOHC组的OS率显著低于未发生LOHC组(P=0.041)。结论:对于年龄≤45岁、强化预处理或LOHC发生较早的移植患者,需要警惕发生LOHC或发展为重度LOHC,应早期做好防治;定期监测CMV-DNA、白蛋白水平,积极有效地抗病毒、抗真菌治疗及防治a GVHD是预防LOHC发生发展的有效措施。

基于Logistic回归和支持向量机的早发性结直肠癌风险预测模型

目的:通过Logis tic回归和支持向量机(SVM)探究早发性结直肠癌(EOCRC)和晚发性结直肠癌(LOCRC)的危险因素,建立针对不同年龄段人群的风险预测模型并比较预测效果。方法:选择2012—2022年诊断为结直肠癌患者,记录人口学特征、临床表现、既往史、家族史、生活方式、体格检查、实验室检查及病理诊断,分别建立风险预测模型,比较两模型的ROC曲线下面积(AUROC)、准确率、精确率、召回率、F1分数。结果:综合两模型结果,EOCRC风险与出现消化道出血、腹胀腹痛、大便习惯改变等临床表现、体重减轻、肿瘤标志物升高具有较强的正相关性,与婚姻状况、阑尾切除史、糖尿病史、血脂异常病史、结直肠癌家族史也存在较弱的正相关;LOCRC风险与婚姻状况、出现临床表现、体重减轻、血脂异常、肿瘤标志物升高具有较强的正相关性,与年龄、吸烟、阑尾切除史、结直肠癌家族史也存在一定的正相关性。两模型的AUROC、准确率、F1分数相差不大,但Logistic回归模型的精确率更高而SVM模型的召回率更高。结论:EOCRC和LOCRC的危险因素不完全相同,婚姻状况、吸烟、血脂异常、肿瘤家族史在EOCRC中的贡献低于在LOCRC中的贡献。相较Logistic回归,SVM能发现更多的结直肠癌危险因素,能尽可能多的找出结直肠癌的可能患者。

2000—2019年中国早发型癌症疾病负担及危险因素变化趋势

目的揭示2000—2019年中国早发型癌症疾病负担及危险因素的变化趋势。方法数据来自2019年全球疾病负担研究。采用发病、死亡和伤残调整寿命年(disability-adjusted life year,DALY)指标,分析中国15~49岁人群早发型癌症疾病负担情况;通过人群归因分值(population attributable fraction,PAF)估计早发型癌症DALY归因于可改变危险因素的比例。以年估计百分比(estimated annual percentage change,EAPC)及其95%CI估计2000—2019年疾病负担变化趋势。结果2019年中国早发型癌症发病率、死亡率和DALY率分别为109.0/10万、35.8/10万和1763.7/10万。新发病例数在所有早发型癌症中占比最高的癌种为乳腺癌、结直肠癌和胃癌;死亡例数占比最高的癌种为肺癌、肝癌和胃癌。35.8%的早发型癌症DALY可归因于可改变危险因素。烟草使用(PAF=16.0%)为我国早发型癌症首要危险因素,其次为膳食危险因素(6.1%)和酒精使用(5.9%)。2000—2019年,我国早发型癌症的发病率呈上升趋势(EAPC=2.0%,95%CI:1.6%~2.3%);死亡率(EAPC=-1.1%,95%CI:-1.4%~-0.7%)及DALY率(EAPC=-1.2%,95%CI:-1.5%~-0.8%)均呈下降趋势。早发型肝癌新发例数占所有早发型癌症新发病例的比例由2000年首位降至2019年第8位;早发型结直肠癌发病占比由2000年第6位升至2019年第2位。与2000年(32.0%)比较,2019年我国全人群早发型癌症DALY危险因素PAF增长11.9%。结论我国早发型癌症发病增加,死亡和伤残得到有效控制,不同癌种疾病负担构成的变化存在异质性。应加强对可改变危险因素的干预,降低早发型癌症负担。

极早产儿晚发型细菌感染败血症的危险因素及防治

【目的】分析极早产儿晚发型细菌感染败血症的临床特征及危险因素,提出可行的防治建议。【方法】选取2012年2月-2024年1月本院收治的94例晚发型细菌感染败血症的极早产儿作为研究对象,分析其围产期情况、临床症状、病原菌、危险因素及治疗等情况。【结果】极早产儿晚发型细菌感染败血症的发生率为8.40%(94/1119)。感染病原菌中以革兰阳性菌为主、占71.1%。Logistic回归分析提示:应用抗生素≥7 d、有创机械通气、留置中心静脉导管≥7 d及阴道分娩是极早产儿晚发型细菌感染败血症的主要危险因素,相对危险度(OR值)分别为2.787、4.243、3.033、2.174。【结论】极早产儿晚发型细菌感染败血症的病原菌以革兰阳性菌为主,长时间应用抗生素(≥7d)、有创机械通气、留置中心静脉导管(≥7d)及阴道分娩为极早产儿晚发型细菌感染败血症的高危因素。可通过采取加强围产期管理、缩短抗生素应用时间、减少有创操作的防治办法来降低极早产儿晚发型细菌感染败血症的发生率。

新生儿早发型败血症的早期识别指标

新生儿败血症是全球新生儿死亡的第三大原因,占新生儿总病死率的15%。早发型败血症(early-onset sepsis,EOS)大多系母体病原菌垂直传播,通常通过围产期高危因素、生后早期临床表现及实验室检查对患儿进行综合评估,然而围产期高危因素的非特异性、临床表现的不典型性及实验室检查的滞后性,导致早发型败血症的识别一直面临着巨大挑战。因此,本文查阅关于EOS早期识别的最新文献,并对相关指标进行综述,为临床早期识别EOS提供参考。

郑州儿童医院新生儿早发型败血症病原菌分布特点、发病的影响因素及耐药性分析

目的分析郑州儿童医院新生儿早发型败血症病原菌分布特点、发病的影响因素及耐药性。方法回顾性分析2020年2月至2023年2月郑州儿童医院收治的63例早发型败血症新生儿的临床资料,设为观察组。选取同期收治的非败血症新生儿临床资料设为对照组,共63例。分析早发型败血症新生儿病原菌分布情况。对早发型败血症发病的影响因素进行单因素和多因素分析。对早发型败血症新生儿感染的主要病原菌进行耐药性分析。结果观察组患儿共检出病原菌63株,其中表皮葡萄球菌和黄金色葡萄球菌在革兰阳性菌中所占比例较高,分别为22.22%和11.11%。大肠埃希菌和肺炎克雷伯菌在革兰阴性菌中占较高的比例,分别为26.98%和14.29%。观察组产妇胎膜早破、产妇产前发热、新生儿极低出生体重、新生儿脐部感染、新生儿肺部感染所占比例高于对照组(P<0.05)。产妇胎膜早破、产妇产前发热、新生儿极低出生体重、新生儿脐部感染、新生儿肺部感染是新生儿早发型败血症发病的独立危险因素(P<0.05)。早发型败血症新生儿感染病原菌中,表皮葡萄球菌对氨苄西林的耐药性为28.57%、青霉素的耐药为28.57%,占比最高。大肠埃希菌对氨苄西林和阿莫西林的耐药性均为29.41%,其后依次为克拉霉素的23.53%及头孢唑林的17.65%。结论早发型败血症治疗时应明确患儿感染病原菌类型并根据药敏结果给予适当的治疗方案。同时早发型败血症发病的影响因素较多,需及时进行针对性的预防,以减少该疾病的发生。

Statin use and risk of diabetes mellitus

The 3-hydroxy-methylglutaryl coenzyme A reductase inhibitors, statins, are widely used in the primary and secondary prevention of cardiovascular diseases to lower serum cholesterol levels. As type 2 diabetes mellitus is accompanied by dyslipidemia, statins have a major role in preventing the long term complications in diabetes and are recommended for diabetics with normal low density lipoprotein levels as well. In 2012, United States Food and Drug Administration released changes to statin safety label to include that statins have been found to increase glycosylated haemoglobin and fasting serum glucose levels. Many studies done on patients with cardiovascular risk factors have shown that statins have diabetogenic potential and the effect varies as per the dosage and type used. The various mechanisms for this effect have been proposed and one of them is downregulation of glucose transporters by the statins. The recommendations by the investigators are that though statins can have diabetogenic risk, they have more long term benefits which can outweigh the risk. In elderly patients and those with metabolic syndrome, as the risk of diabetes increase, the statins should be used cautiously. Other than a subset of population with risk for diabetes; statins still have long term survival benefits in most of the patients.

Risk factors in patients with type 2 diabetes in Bengaluru: A retrospective study

BACKGROUND Risk factors such as hereditary, ecological, and metabolic are interrelated and contribute to the development of type 2 diabetes mellitus. Family history(FH) of diabetes mellitus, age, obesity, and physical inactivity are some of the risk factors for the development of type 2 diabetes.AIM To study various aetiological determinants and risk factors for type 2 diabetes in Bangalore, India. This retrospective study examined questionnaire from patients attending the Diabetes Clinic.METHODS Data on various parameters were obtained through a questionnaire from 533 patients on the first visit to the diabetes clinic. Data regarding various aetiological determinants and risk factors viz.: Genetic risk factor and few modifiable risk factors were collected. Chi-squared test was used for statistical analysis.RESULTS A higher incidence of type 2 diabetes in males and younger population was observed in Bangalore, India. Obesity and FH were significant risk factors for not only type 2 diabetes but also early onset of diabetes. In addition, maternal history of type 2 diabetes and consanguinity increased incidence of early onset type 2 diabetes.CONCLUSION Risk factors such as obesity and FH(maternal history of type 2 diabetes) and consanguinity may play an important role in screening of family members of type 2 diabetes patients which may lead to early intervention and reduced risk of subsequent complications. Moreover, susceptible population can be counselled for the management of the type 2 diabetes including periodic investigation of blood glucose levels and lifestyle changes.

产妇泌乳启动延迟风险预测模型及评估工具的构建及验证

目的:构建并验证产妇泌乳启动延迟风险预测模型及评估工具,为早期识别泌乳启动延迟危险人群提供借鉴。方法:对产妇泌乳启动延迟的风险因素进行Meta分析,以各风险因素OR值的自然对数为模型的β系数,以产后72 h产妇泌乳启动延迟发生率与未发生率比值的自然对数为模型的a系数,建立预测模型及评估工具。收集420例产妇资料,分析模型及评估工具的预测性能。结果:产妇泌乳启动延迟发生率为29.76%,预测模型为Logit(P)=-0.859+0.174×高龄+0.148×初产+0.113×剖宫产+0.239×孕前超重或肥胖+0.182×孕期增重过多+0.166×妊娠期糖尿病+0.336×妊娠期高血压疾病+0.223×开奶时间晚+0.315×焦虑+0.285×抑郁,模型ROC曲线下面积为0.765,95%CI(0.717,0.812),敏感度为0.736,特异度为0.712。评估工具得分为0~20分,分值≥6分为高危人群,工具ROC曲线下面积为0.751,95%CI(0.702,0.799),敏感度为0.688,特异度为0.719。结论:基于Meta分析建立的产妇泌乳启动延迟风险预测模型和评估工具有较好的预测能力,可作为早期识别泌乳启动延迟高危人群的工具。

基于竞争风险模型的早发性结直肠癌患者预后影响因素分析

目的 探讨竞争风险时早发性结直肠癌患者的预后影响因素。方法 选取美国SEER数据库中2011年至2015年早发性结直肠癌患者4 226例。在考虑竞争风险的前提下,分别采用Gray检验和Fine-Gray模型进行单因素及多因素分析。结果 Gray检验结果显示,婚姻状况、参保情况、发病位置、肿瘤大小、组织学分级、T分期、N分期和M分期对早发性结直肠癌患者的预后有影响(均P <0.001),种族对早发性结直肠癌患者的预后也有影响(均P=0.001)。多因素竞争风险模型结果显示,组织学分级、婚姻状况、参保情况、T分期、N分期和M分期是影响早发性结直肠癌患者预后的重要因素。结论 竞争风险模型下,未参保,组织学分级越高,T分期、N分期和M分期高的早发性结直肠癌患者的预后更差。

A non-invasive,rapid method to genotype late-onset Alzheimer's disease-related apolipoprotein E gene polymorphisms

The apolipoprotein E gene ε4 allele is considered a negative factor for neural regeneration in late-onset Alzheimer＇s disease cases. The aim of this study was to establish a non-invasive, rapid method to genotype apolipoprotein E gene polymorphisms. Genomic DNA from mouth swab specimens was extracted using magnetic nanoparticles, and genotyping was performed by real-time PCR using TaqMan-BHQ probes. Genotyping accuracy was validated by DNA se- quencing. Our results demonstrate 100% correlation to DNA sequencing, indicating reliability of our protocol. Thus, the method we have developed for apolipoprotein E genotyping is accurate and reliable, and also suitable for genotyping large samples, which may help determine the role of the apolipoprotein E ε4 allele in neural regeneration in late-onset Alzheimer＇s disease cases.

环境气象因素对脂质异常型干眼发病的风险研究

目的:探讨我国东西部地区不同环境气象因素对脂质异常型干眼发病的影响。方法:多中心回顾性研究。选取2021-03-01/2022-02-28南京中医药大学附属南京中医院及新疆伊犁哈萨克自治州友谊医院眼科门诊就诊的干眼患者,统计整理一般资料(性别、年龄、就业情况、教育程度)及就诊当日室外环境气候数据(温度、湿度、空气质量指数、风力)。筛选出符合纳排的患者,应用单因素、多因素及非线性模型分析筛选出两地区脂质异常型干眼的环境相关因素。结果:南京与伊犁两地区各自不同季节脂质异常型干眼发病情况无明显差异,两地相比,伊犁地区脂质异常型干眼发病就诊人次四季均明显多于南京地区(P<0.001)。单因素研究结果显示,影响脂质异常型干眼发病的因素有:性别、就业情况、湿度、空气质量指数、风力。多因素Logistic回归分析显示:湿度、温度、空气质量指数三种环境因素有统计学意义,在调整年龄、性别、就业情况三种混杂因素后仍然有意义。非线性分析显示温度在低于10℃时,脂质异常型干眼的发生概率随温度的降低而上升;在10℃~15℃时,脂质异常型干眼的发生概率变化趋于平稳,当温度超过15℃后,脂质异常型干眼的发生概率随温度的升高而上升。湿度与脂质异常型干眼发病呈负相关,随湿度上升,脂质异常型干眼的发生概率下降。结论:伊犁地区脂质异常型干眼的发病风险四季均高于南京地区。湿度、温度、空气质量等环境气候因素均会影响脂质异常型干眼的发病情况。

预测极早产儿早发型败血症发生风险的列线图模型的构建

目的探讨极早产儿早发型败血症(early-onset sepsis,EOS)发生的危险因素,并构建预测EOS发生风险的列线图模型。方法回顾性选取2020年1月-2022年12月在郑州大学第一附属医院出生并入住新生儿科的344例极早产儿,按7∶3的比率随机分为训练集(241例)和验证集(103例)。训练集根据是否发生EOS分为EOS组(n=64)和非EOS组(n=177)。采用多因素logistic回归分析筛选极早产儿EOS发生的危险因素,利用R语言构建列线图,并由验证集进行验证。分别采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)、校准曲线和决策曲线分析评价模型的区分度、校准度和临床净收益。结果多因素logistic回归分析显示,胎龄、产房气管插管、羊水粪染、生后首日血清白蛋白水平和绒毛膜羊膜炎是极早产儿EOS发生的独立危险因素(P<0.05)。训练集ROC曲线的曲线下面积为0.925(95%CI:0.888~0.963),验证集ROC曲线的曲线下面积为0.796(95%CI:0.694~0.898),表明模型的区分度良好。Hosmer-Lemeshow拟合优度检验表明模型拟合度良好(P=0.621)。校准曲线分析和决策曲线分析提示模型的预测效能和临床应用价值较高。结论胎龄、产房气管插管、羊水粪染、生后首日血清白蛋白水平和绒毛膜羊膜炎与极早产儿EOS的发生独立相关;根据这些因素构建的极早产儿EOS发生风险的列线图模型有较高的预测效能和临床应用价值。