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Yang R, Long JM, Wang X, Wang CJ, Chen Y. [Progress in epidemiological characteristics and surveillance and early warning of dengue fever in China]. Zhonghua Liu Xing Bing Xue Za Zhi 2024; 45:305-312. [PMID: 38413073 DOI: 10.3760/cma.j.cn112338-20230811-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Dengue fever is an acute mosquito-borne infectious disease caused by dengue virus and widely spread worldwide. Many factors, such as pathogens, vector organisms, climate, and social environment, affect its transmission and prevalence. The local dengue fever epidemic caused by imported cases in China shows a trend of increasing epidemic latitude and more widespread epidemic areas. However, the traditional monitoring and early warning models of dengue fever mainly focus on researching a single factor and a single area. Establishing a multi-factor forecast and early warning system is urgent to strengthen the early warning capability for the dengue fever epidemic. This paper mainly discusses the epidemic characteristics, the influencing factors, and the surveillance and early warning models of dengue fever in China to provide a reference for the effective prevention and control of dengue fever in China.
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Affiliation(s)
- R Yang
- Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing 100071, China School of Public Health, China Medical University, Shenyang 110122, China
| | - J M Long
- Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing 100071, China School of Public Health, China Medical University, Shenyang 110122, China
| | - X Wang
- Shaanxi Normal University, Xi'an 710119, China
| | - C J Wang
- Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing 100071, China
| | - Y Chen
- Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing 100071, China
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Yang GG, Wang CJ, Liu ZY, He PJ, Wang D, Ji CH, Yuan YM, Xiao SM, Zhang N, Ying T. [Epidemiological investigation of constipation in urban areas of Hangzhou, China]. Zhonghua Wei Chang Wai Ke Za Zhi 2023; 26:1147-1153. [PMID: 38110276 DOI: 10.3760/cma.j.cn441530-20230811-00046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Objective: To determine the prevalence and risk factors of constipation in Hangzhou urban areas by analyzing data from a recent epidemiological survey. Methods: From August 2022 to June 2023, a cross-sectional survey was conducted on 43 communities on eight streets in suburbs of Hangzhou, including Wangjiang, Sijiqing, Puyan, Changhe, Ziyang, Xiaoshanchengxiang, Zhuantang, and Banshan. Written questionnaires were filled out face to face by community doctors. The prevalence of constipation was investigated using a combination of the Bristol stool typing method and the Rome IV criteria. The risk factors for constipation were analyzed using multivariate logistic regression analysis. Results: The study cohort comprised 10,479 participants, 5551 of whom were male (53.0%) and 4928 female (47.0%). The overall prevalence of constipation was 10.6% (1107/10,479). The prevalence was 11.0% (613/5551) for male and 10.0% (494/4928) for female participants; this difference is not statistically significant (P>0.05).There were no significant differences in the prevalence of constipation between different categories of body mass index (P>0.05). The prevalence of constipation was highest in individuals aged 70 years and above, accounting for 15.4% (264/1717) of all cases. There were significant differences in the prevalence of constipation between different occupations, marital statuses, and educational levels (P<0.001). Patients with hypertension or diabetes mellitus had a higher prevalence of constipation than those without these conditions, those who had been taking long-term medication had a higher prevalence of constipation than those who did not, parents of children with constipation had a higher prevalence of constipation than those with children who did not have constipation, and there were other significant differences in various variables (P<0.001). Multivariate logistic regression analysis of modifiable factors revealed that eating less fruit (OR=1.284, 95%CI: 1.061-1.553, P=0.010), liking spicy and salty food (OR=1.234, 95%CI: 1.039-1.466, P=0.016), sleeping for too long (OR=1.644, 95%CI: 1.260-2.144, P<0.001), irregular sleep patterns (OR=1.370, 95%CI: 1.127-1.665, P=0.002) and minimal exercise (OR=1.388, 95% CI: 1.168-1.649, P<0.001) were all risk factors for constipation; whereas mix diets (OR=0.709,95%CI:0.608-0.826, P<0.001), meat diets (OR=0.604,95%CI: 0.495-0.736, P<0.001), moderate alcohol consumption (OR=0.659, 95% CI: 0.534-0.812, P<0.001), less or no drinking (OR=0.523, 95% CI: 0.428-0.638, P<0.001), and non-smoking (OR=0.819, 95%CI:0.674-0.995, P<0.001) protected against constipation. We found no association between dietary preferences and the risk of constipation (refined grains: OR=1.147, 95%CI:0.944-1.393, P=0.167; no specific preference: OR=0.935, 95%CI:0.783-1.117, P=0.459). The rate of agreement between self-evaluation of constipation by the respondents and objective criteria was higher for negatives (95.8%) than for positives (38.0%). Conclusion: The prevalence of constipation is relatively high in the urban population of Hangzhou. A good lifestyle and diet can significantly reduce its incidence. There should be more emphasis on preventive education, promotion of prevention of constipation, and advocacy for a healthy lifestyle.
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Affiliation(s)
- G G Yang
- Department of Anal-Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou 310009, China
| | - C J Wang
- Department of Anal-Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou 310009, China
| | - Z Y Liu
- Department of Anal-Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou 310009, China
| | - P J He
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - D Wang
- Department of Anal-Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou 310009, China
| | - C H Ji
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Y M Yuan
- Department of Anal-Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou 310009, China
| | - S M Xiao
- Department of Anal-Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou 310009, China
| | - N Zhang
- Department of Anal-Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou 310009, China
| | - T Ying
- Department of Anal-Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou 310009, China
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Li N, Hu DX, Qin X, Zhu YP, Zhou M, He L, Chang LX, Xu XJ, Dai Y, Cao XY, Chen K, Wang HM, Wang CJ, He YL, Qian XW, Xu LP, Chen J. [Diagnosis status and genetic characteristics analysis of Fanconi anemia in China]. Zhonghua Er Ke Za Zhi 2023; 61:889-895. [PMID: 37803855 DOI: 10.3760/cma.j.cn112140-20230606-00383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Objective: To analyze the clinical and molecular diagnostic status of Fanconi anemia (FA) in China. Methods: The General situation, clinical manifestations and chromosome breakage test and genetic test results of 107 pediatric FA cases registered in the Chinese Blood and Marrow Transplantation Registry Group (CBMTRG) and the Chinese Children Blood and Marrow Transplantation Registry Group (CCBMTRG) from August 2009 to January 2022 were analyzed retrospectively. Children with FANCA gene variants were divided into mild and severe groups based on the type of variant, and Wilcoxon-test was used to compare the phenotypic differences between groups. Results: Of the 176 registered FA patients, 69 (39.2%) cases were excluded due to lack of definitive genetic diagnosis results, and the remaining 107 children from 15 hospitals were included in the study, including 70 males and 37 females. The age at transplantation treatment were 6 (4, 9) years. The enrolled children were involved in 10 pathogenic genes, including 89 cases of FANCA gene, 7 cases of FANCG gene, 3 cases of FANCB gene, 2 cases of FANCE gene and 1 case each of FANCC, FANCD1, FANCD2, FANCF, FANCJ, and FANCN gene. Compound heterozygous or homozygous of loss-of-function variants account for 69.2% (72/104). Loss-of-function variants account for 79.2% (141/178) in FANCA gene variants, and 20.8% (37/178) were large exon deletions. Fifty-five children (51.4%) had chromosome breakage test records, with a positive rate of 81.8% (45/55). There were 172 congenital malformations in 80 children.Café-au-Lait spots (16.3%, 28/172), thumb deformities (16.3%,28/172), polydactyly (13.9%, 24/172), and short stature (12.2%, 21/172) were the most common congenital malformations in Chinese children with FA. No significant difference was found in the number of congenital malformations between children with severe (50 cases) and mild FANCA variants (26 cases) (Z=-1.33, P=0.185). Conclusions: FANCA gene is the main pathogenic gene in children with FA, where the detection of its exon deletion should be strengthened clinically. There were no phenotypic differences among children with different types of FANCA variants. Chromosome break test is helpful to determine the pathogenicity of variants, but its accuracy needs to be improved.
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Affiliation(s)
- N Li
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - D X Hu
- Department of Hematology, Children's Hospital of Soochow University,Suzhou 215000, China
| | - X Qin
- Department of Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Y P Zhu
- Department of Pediatrics, West China Second University Hospital of Sichuan University, Chengdu 610041, China
| | - M Zhou
- Department of Hematology, Guangzhou First People's Hospital, Guangzhou 510030, China
| | - L He
- Nanfang-Chunfu Children's Institute of Hematology & Oncology, Dongguan 523000, China
| | - L X Chang
- Department of Pediatrics, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjing 300020, China
| | - X J Xu
- Department of Hematology and Oncology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Y Dai
- Department of Pediatrics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - X Y Cao
- Department of Transplantation, Hebei Yanda Ludaopei Hospital, Langfang, 065201, China
| | - K Chen
- Department of Hematology and Oncology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200040, China
| | - H M Wang
- Department of Pediatrics, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
| | - C J Wang
- Department of Hematology, Shenzhen Children's Hospital, Shenzhen 518028, China
| | - Y L He
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - X W Qian
- Department of Hematology, Children's Hospital of Fudan University, Shanghai 201102, China
| | - L P Xu
- Department of Hematology, Peking University People's Hospital, Beijing 100044, China
| | - J Chen
- Department of Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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Gu HQ, Wang CJ, Yang X, Zhao XQ, Wang YL, Liu LP, Jiang Y, Li H, Wang YJ, Li ZX. Clinical characteristics, in-hospital management, and outcomes of patients with in-hospital vs. community-onset ischaemic stroke: a hospital-based cohort study. Lancet Reg Health West Pac 2023; 38:100890. [PMID: 37790077 PMCID: PMC10544278 DOI: 10.1016/j.lanwpc.2023.100890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/25/2023] [Accepted: 08/15/2023] [Indexed: 10/05/2023]
Abstract
Background Lack of high-quality national-level data on in-hospital ischaemic stroke hinders the development of tailored strategies for this subgroup's identification, treatment, and management. Methods We analyzed and compared clinical characteristics, in-hospital management measures, and outcomes, including death or discharge against medical advice (DAMA), major adverse cardiovascular events (MACEs), disability at discharge, and in-hospital complications between in-hospital and community-onset ischaemic stroke enrolled in the Chinese Stroke Center Association registry from August 2015 to December 2022. Findings The cohort comprised 14,948 in-hospital and 1,366,898 community-onset ischaemic stroke patients. In-hospital ischaemic stroke exhibited greater stroke severity, higher prevalence of comorbidities, more pre-admission medications, and had suboptimal management measures, for example, the onset-to-needle time within 4.5 h (83.3% vs. 93.1%; difference, -9.8% [-11.4% to -8.3%]), and antithrombotics at discharge (78.6% vs. 90.0%; difference, -11.4% [95% CI, -12.1% to -10.7%]). After adjusting for covariates, in-hospital ischaemic stroke remains associated with higher risks of unfavorable outcomes, including in-hospital death/DAMA (13.9% vs. 8.6%; adjusted risk difference [aRD], 2.2% [95% CI, 1.8%-2.7%]; adjusted odds ratio [aOR], 1.35 [95% CI, 1.25-1.45]), MACE (12.6% vs. 6.5%; aRD, 4.1% [95% CI, 3.5%-4.7%]; aOR, 1.68 [95% CI, 1.52-1.85]), and complications (23.7% vs. 12.1%; aRD, 6.5% [95% CI, 5.1%-7.9%]; aOR, 1.72 [95% CI, 1.64-1.80]), except for disability at discharge (41.1% vs. 33.1%; aRD, 0.4% [95% CI, -1.7% to 2.5%]; aOR, 0.99 [95% CI, 0.88-1.11]). Interpretation In-hospital ischaemic stroke demonstrated more severe strokes, worse vascular risk profiles, suboptimal management measures, and worse outcomes compared to community-onset ischaemic stroke. This emphasizes the urgent need for improved hospital systems of care and targeted quality improvement initiatives for better outcomes in in-hospital ischaemic stroke. Funding National Key R&D Programme of China and Beijing Hospitals Authority.
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Affiliation(s)
- Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
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Wang CJ, Gu HQ, Zong LX, Zhang XM, Zhou Q, Jiang Y, Li H, Meng X, Yang X, Wang M, Huo XC, Wangqin RQ, Bei YZ, Qi XH, Liu XY, Hu SQ, Wang ZM, Zhao XQ, Wang YL, Liu LP, Ma XD, Morgan L, Xian Y, Schwamm LH, Wang YJ, Li ZX. Effectiveness of a Quality Improvement Intervention on Reperfusion Treatment for Patients With Acute Ischemic Stroke: A Stepped-Wedge Cluster Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2316465. [PMID: 37266940 DOI: 10.1001/jamanetworkopen.2023.16465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Importance Reperfusion therapy is the most effective treatment for acute ischemic stroke but remains underused in China. Objective To evaluate the effect of a problem-oriented, culturally adapted, targeted quality improvement intervention on reperfusion therapy for patients with acute ischemic stroke in China. Design, Setting, and Participants In this stepped-wedge cluster randomized clinical trial, patients from 16 secondary and 33 tertiary hospitals in China with acute ischemic stroke within 6 hours of symptom onset were consecutively recruited between July 1, 2018, and June 30, 2020. Interventions Hospitals were randomly assigned to 1 of 3 sequences to receive the targeted quality improvement intervention (n = 5689), in which workflow reconstruction was promoted to reduce in-hospital reperfusion treatment delays, or usual care (n = 6443), in which conventional stroke care was left to the discretion of the stroke team. Main Outcomes and Measures The primary outcome was the reperfusion therapy rate, a composite outcome of intravenous recombinant tissue plasminogen activator (IV rtPA) or endovascular thrombectomy (EVT) for eligible patients who arrived within 3.5 or 4.5 hours of symptom onset. Secondary outcomes were the IV rtPA administration rate among eligible patients who arrived within 3.5 hours of symptom onset, the EVT rate among eligible participants who arrived within 4.5 hours of symptom onset, the proportion of patients with door-to-needle time within 60 minutes, the proportion of patients with door-to-puncture time within 90 minutes, in-hospital mortality, and 3-month disability as measured by a modified Rankin Scale score greater than 2. Results All 12 132 eligible patients (mean [SD] age, 66 [12.1] years; 7759 male [64.0%]) completed the trial. The reperfusion rate was 53.5% (3046 of 5689) for the eligible patients in the intervention period and 43.9% (2830 of 6443) in the control period. No significant improvement in primary outcomes was found for the intervention after adjusting for cluster, period, and imbalanced baseline covariates (adjusted risk difference [ARD], 5.5%; 95% CI, -8.0% to 19.0%; adjusted odds ratio [AOR], 1.26; 95% CI, 0.72-2.21) or for the secondary outcomes. However, significant improvements were found in secondary hospitals for reperfusion therapy (1081 of 1870 patients [57.8%] vs 945 of 2022 patients [42.9%]; ARD, 19.0%; 95% CI, 6.4%-31.6%; AOR, 2.24; 95% CI, 1.29-3.88), IV rtPA administration (1062 of 1826 patients [58.2%] vs 916 of 2170 patients [42.2%]; ARD, 20.3%; 95% CI, 7.4%-33.1%; AOR, 2.37; 95% CI, 1.34-4.19), and EVT (51 of 231 patients [22.1%] vs 37 of 259 patients [14.3%]; ARD, 13.6%; 95% CI, 1.0%-26.3%; AOR, 3.03; 95% CI, 1.11-8.25) in subgroup analyses. Conclusions and Relevance In this stepped-wedge cluster randomized clinical trial of patients with acute ischemic stroke in China, the use of a targeted quality improvement intervention compared with usual care did not improve the reperfusion therapy rate. However, the intervention may be effective in secondary hospitals. Trial Registration ClinicalTrials.gov Identifier: NCT03578107.
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Affiliation(s)
- Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Xia Zong
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin-Miao Zhang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qi Zhou
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Meng Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Chuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China
| | - Run-Qi Wangqin
- Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Yu-Zhang Bei
- Department of Neurology, Liuyang Jili Hospital, Hunan, China
| | - Xiu-Hui Qi
- Department of Neurology, Jilin Electric Power Hospital, Jilin, China
| | - Xiao-Yun Liu
- Department of Neurology, the Second Hospital of Hebei Medical University, Hebei, China
| | - Shi-Qiang Hu
- Department of Neurology, Zhengzhou Zhongkang Hospital, Henan, China
| | - Zhi-Min Wang
- Department of Neurology, Taizhou First People's Hospital, Zhejiang, China
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi-Long Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu-Dong Ma
- Bureau of Medical Administration of National Health Commission, Beijing, China
| | - Louise Morgan
- International Quality Improvement Department, American Heart Association, Dallas, Texas
| | - Ying Xian
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
- Clinical Center for Precision Medicine in Stroke, Capital Medical University, Beijing, China
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Clinical Center for Precision Medicine in Stroke, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
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Chen ZM, Gu HQ, Mo JL, Yang KX, Jiang YY, Yang X, Wang CJ, Xu J, Meng X, Jiang Y, Li H, Liu LP, Wang YL, Zhao XQ, Li ZX, Wang YJ. U-shaped association between low-density lipoprotein cholesterol levels and risk of all-cause mortality mediated by post-stroke infection in acute ischemic stroke. Sci Bull (Beijing) 2023:S2095-9273(23)00347-X. [PMID: 37270342 DOI: 10.1016/j.scib.2023.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/19/2023] [Accepted: 05/22/2023] [Indexed: 06/05/2023]
Abstract
During the acute stage of ischemic stroke, it remains unclear how to interpret the low low-density lipoprotein cholesterol (LDL-C) level. We aimed to evaluate the association between LDL-C levels, post-stroke infection, and all-cause mortality. 804,855 ischemic stroke patients were included. Associations between LDL-C levels, infection, and mortality risk were estimated by multivariate logistic regression models and displayed by restricted cubic spline curves. Mediation analysis was performed under counterfactual framework to elucidate the mediation effect of post-stroke infection. The association between LDL-C and mortality risk was U-shaped. The nadir in LDL-C level with the lowest mortality risk was 2.67 mmol/L. Compared with the group with LDL-C = 2.50-2.99 mmol/L, the multivariable-adjusted odds ratio for mortality was 2.22 (95% confidence intervals (CI): 1.77-2.79) for LDL-C <1.0 mmol/L and 1.22 (95% CI: 0.98-1.50) for LDL-C ≥5.0 mmol/L. The association between LDL-C and all-cause mortality was 38.20% (95% CI: 5.96-70.45, P = 0.020) mediated by infection. After stepwise excluding patients with increasing numbers of cardiovascular risk factors, the U-shaped association between LDL-C and all-cause mortality and the mediation effects of infection remained consistent with the primary analysis, but the LDL-C interval with the lowest mortality risk increased progressively. The mediation effects of infection were largely consistent with the primary analysis in subgroups of age ≥65 years, female, body mass index <25 kg/m2, and National Institutes of Health Stroke Scale ≥16. During the acute stage of ischemic stroke, there is a U-shaped association between LDL-C level and all-cause mortality, where post-stroke infection is an important mediating mechanism.
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Affiliation(s)
- Zi-Mo Chen
- Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing 100071, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
| | - Jing-Lin Mo
- Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing 100071, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
| | - Kai-Xuan Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
| | - Ying-Yu Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
| | - Jie Xu
- Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing 100071, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
| | - Xia Meng
- Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing 100071, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100071, China; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing 100071, China; Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
| | - Hao Li
- Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing 100071, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100071, China; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing 100071, China; Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China
| | - Li-Ping Liu
- Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing 100071, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
| | - Yi-Long Wang
- Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing 100071, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
| | - Xing-Quan Zhao
- Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing 100071, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
| | - Zi-Xiao Li
- Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing 100071, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100071, China; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing 100071, China; Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China.
| | - Yong-Jun Wang
- Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing 100071, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100071, China; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing 100071, China; Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China.
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7
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Gu HQ, Wang CJ, Zhang XM, Jiang Y, Li H, Meng X, Yang X, Liu LP, Zhao XQ, Wang YL, Wang YJ, Li ZX. Ten-year trends in sex differences in cardiovascular risk factors, in-hospital management, and outcomes of ischemic stroke in China: Analyses of a nationwide serial cross-sectional survey from 2005 to 2015. Int J Stroke 2023:17474930231158226. [PMID: 36752578 DOI: 10.1177/17474930231158226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Women with stroke differ from men in terms of risk factors, treatment, and outcomes. However, previous inconsistent results in China hampered the development of tailored sex-specific strategies for ischemic stroke management. We performed a nationwide serial cross-sectional survey to obtain national-level estimates to assess the 10-year trends in sex differences in cardiovascular risk factors, in-hospital management, and outcomes in China from 2005 to 2015. METHODS We used a two-stage random sampling design, economic-geographical region-stratified random sampling for hospitals first and then systematic sampling for patients, to obtain a nationally representative sample of ischemic strokes in China in 2005, 2010, and 2015. We extracted data on clinical characteristics, management measures (diagnostic tests, interventions, and secondary prevention treatments), in-hospital outcomes (all-cause in-hospital mortality, discharge against medical advice [DAMA], and a composite outcome of in-hospital death and DAMA), and comorbidities. We applied weights proportional to the inverse sampling fraction of hospitals within each stratum and the inverse sampling fraction of patients within each hospital. RESULTS A total of 26,900 ischemic stroke admissions were analyzed. Compared to men, women had a much lower prevalence of current smokers and a slightly higher prevalence of hypertension, diabetes, dyslipidemia, and atrial fibrillation at admission. Prevalence differences between sex in these cardiovascular risk factors were stable except for atrial fibrillation (decreased from 3.7% [95% CI: 1.8% to 5.7%] to 1.3% [95% CI: 0.5% to 2.0%]) and current smoker (increased from -18.0 [95% CI: -20.2% to -15.9%] to -25.6% [95% CI: -26.6% to -24.6%]). From 2005 to 2015, in-hospital management and outcomes were improved both for women and men, and sex differences in cerebrovascular assessment, cervical vessels assessment, and transthoracic echocardiography/transesophageal echocardiography were improved as well. However, women increased more slowly than men in the administration of clopidogrel (from 0.3% [95% CI: -0.9% to 1.4%) to -7.3% [95% CI: -8.7% to -6.0%]) and aspirin plus clopidogrel (0.3% [95% CI: -5.0% to 1.1%] to -5.0% [95% CI: -6.2% to -3.9%]). CONCLUSION Compared to men, women patients with ischemic stroke had a steadily higher prevalence of cardiovascular risk factors, a slower increase rate in the administration of key secondary prevention drugs, and comparable in-hospital outcomes. More effort should be paid to the treatment and control of cardiovascular risk factors and also to the prescription of antiplatelets at discharge for women.
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Affiliation(s)
- Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin-Miao Zhang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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8
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Wang M, Han Y, Wang CJ, Xue T, Gu HQ, Yang KX, Liu HY, Cao M, Meng X, Jiang Y, Yang X, Zhang J, Xiong YY, Zhao XQ, Liu LP, Wang YL, Guan TJ, Li ZX, Wang YJ. Short-term effect of PM2.5 on stroke in susceptible populations: A case-crossover study. Int J Stroke 2023; 18:312-321. [PMID: 35722790 DOI: 10.1177/17474930221110024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fine particulate matter (PM2.5) is a risk factor for stroke, and patients with pre-existing diseases appear to be particularly susceptible. We conducted a case-crossover study to examine the association between short-term exposure to fine particulate matter (PM2.5) and hospital admission for stroke in individuals with atrial fibrillation (AF), hypertension, diabetes, or hyperlipidemia. METHODS Patients diagnosed with acute ischemic stroke (AIS) were recruited from 2015 to 2017 in Chinese Stroke Center Alliances. We estimated daily PM2.5 average exposures with a spatial resolution of 0.1° using a data assimilation approach combining satellite measurements, air model simulations, and monitoring values. Conditional logistic regression was used to assess PM2.5-related stroke risk in patients with pre-existing medical co-morbidities. RESULTS A total of 155,616 patients diagnosed with AIS were admitted. Patients with a history of AF (n = 15,430), hypertension (n = 138,220), diabetes (n = 43,737), or hyperlipidemia (n = 16,855) were assessed separately. A 10 µg/m3 increase in daily PM2.5 was associated with a significant increase in AIS for individuals with AF at lag 4 (odds ratio (OR), 1.008; 95% confidence interval (CI), 1.002-1.014), and with hypertension (OR, 1.008; 95% CI, 1.006-1.010), diabetes (OR, 1.006; 95% CI, 1.003-1.010), and hyperlipidemia (OR, 1.007; 95% CI, 1.001-1.012) at lags 0-7. Elderly (⩾ 65 years old) and female patients with AF had significantly higher associations at lag 5 (OR, 1.009; 95% CI, 1.002-1.015) and lag 5 (OR, 1.010; 95% CI, 1.002-1.018), respectively. CONCLUSION Short-term exposure to PM2.5 is significantly associated with hospital admission for stroke in individuals with pre-existing medical histories, especially in older or female patients with AF. Preventive measures to reduce PM2.5 concentrations are particularly important in individuals with other medical co-morbidities.
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Affiliation(s)
- Meng Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Ying Han
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Tao Xue
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Kai-Xuan Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Heng-Yi Liu
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Man Cao
- Department of Health Policy and Management, School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xia Meng
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Jing Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Yun-Yun Xiong
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tian-Jia Guan
- Department of Health Policy and Management, School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zi-Xiao Li
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
| | - Yong-Jun Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.,Chinese Institute for Brain Research, Beijing, China.,Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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9
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Wang CJ, Gu HQ, Zhang XM, Jiang Y, Li H, Bettger JP, Meng X, Dong KH, Wangqin RQ, Yang X, Wang M, Liu C, Liu LP, Tang BS, Li GZ, Xu YM, He ZY, Yang Y, Yip W, Fonarow GC, Schwamm LH, Xian Y, Zhao XQ, Wang YL, Wang Y, Li Z. Temporal trends and rural-urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional survey. Stroke Vasc Neurol 2023; 8:34-50. [PMID: 35985768 PMCID: PMC9985802 DOI: 10.1136/svn-2022-001552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/27/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Stroke is the leading cause of mortality in China, with limited evidence of in-hospital burden obtained from nationwide surveys. We aimed to monitor and track the temporal trends and rural-urban disparities in cerebrovascular risk factors, management and outcomes from 2005 to 2015. METHODS We used a two-stage random sampling survey to create a nationally representative sample of patients admitted for ischaemic stroke in 2005, 2010 and 2015. We sampled participating hospitals with an economic-geographical region-stratified random-sampling approach first and then obtained patients with a systematic sampling approach. We weighed our survey data to estimate the national-level results and assess changes from 2005 to 2015. RESULTS We analysed 28 277 ischaemic stroke admissions from 189 participating hospitals. From 2005 to 2015, the estimated national hospital admission rate for ischaemic stroke per 100 000 people increased (from 75.9 to 402.7, Ptrend<0.001), and the prevalence of risk factors, including hypertension, diabetes, dyslipidaemia and current smoking, increased. The composite score of diagnostic tests for stroke aetiology assessment (from 0.22 to 0.36, Ptrend<0.001) and secondary prevention treatments (from 0.46 to 0.70, Ptrend<0.001) were improved. A temporal decrease was found in discharge against medical advice (DAMA) (from 15.2% (95% CI 13.7% to 16.7%) to 8.6% (8.1% to 9.0%); adjusted Ptrend=0.046), and decreases in in-hospital mortality (0.7% in 2015 vs 1.8% in 2005; adjusted OR (aOR) 0.52; 95% CI 0.32 to 0.85) and the composite outcome of in-hospital mortality or DAMA (8.4% in 2015 vs 13.9% in 2005; aOR 0.65; 95% CI 0.47 to 0.89) were observed. Disparities between rural and urban hospitals narrowed; however, disparities persisted in in-hospital management (brain MRI: rural-urban difference from -14.4% to -11.2%; cerebrovascular assessment: from -20.3% to -16.7%; clopidogrel: from -2.1% to -10.3%; anticoagulant for atrial fibrillation: from -10.9% to -8.2%) and in-hospital outcomes (DAMA: from 2.7% to 5.0%; composite outcome of in-hospital mortality or DAMA: from 2.4% to 4.6%). CONCLUSIONS From 2005 to 2015, improvements in hospital admission and in-hospital management for ischaemic stroke in China were found. A temporal improvement in DAMA and improvements in in-hospital mortality and the composite outcome of in-hospital mortality or DAMA were observed. Disparities between rural and urban hospitals generally narrowed but persisted.
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Affiliation(s)
- Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijng, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin-Miao Zhang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Janet Prvu Bettger
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ke-Hui Dong
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China
| | - Run-Qi Wangqin
- Department of Neurology, Duke Univeristy Medical Center, Durham, North Carolina, USA
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Meng Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chelsea Liu
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Li-Ping Liu
- Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bei-Sha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guo-Zhong Li
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yu-Ming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Key Laboratory of Cerebrovascular Disease Prevention and Treatment, National Health Commission (Province and Ministry Co-constructed), Zhengzhou, Henan, China
| | - Zhi-Yi He
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yi Yang
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Winnie Yip
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ying Xian
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijng, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi-Long Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijng, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijng, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Zixiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
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10
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Sun Y, Wang B, Zhang GF, Zhang X, Wang CJ, Wang DY, Li YX, Zhang J. [Clinical characteristics of convalescent children infected with SARS-CoV-2 Omicron variant in Tianjin]. Zhonghua Er Ke Za Zhi 2022; 60:1054-1058. [PMID: 36207853 DOI: 10.3760/cma.j.cn112140-20220711-00631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To analyze the clinical characteristics of SARS-CoV-2 Omicron variant infected children in convalescence in Tianjin. Methods: A total of 104 pediatric patients infected by SARS-CoV-2 Omicron variant Tianjin First Central Hospital (designated hospital for SARS-CoV-2 infection in Tianjin) for convalescent treatment from January 22nd, 2022 to February 24th were included for a retrospective study.Clinical data including clinical typing, SARS-CoV-2 IgG and IgM test and 2019-nCoV nucleic acid test were collected.The cases were divided into 2-dose group and zero-dose group based on the doses of inactivated SARS-CoV-2 vaccine. The children were divided into repositive group and negative group, according to the nucleic acid test during hospitalization. Chi-square test was used for the comparison between the groups. Results: The age of these 104 children was 10.0 (0.3, 14.0) years on admission, 53 children were males and 51 were females, 92 cases (88.5%) had mild symptoms, 12 cases (11.5%) had common symptoms.The age and SARS-CoV-2 IgG level of zero-dose group was lower (2.0 (0.3, 10.2) vs. 10.0 (3.2, 14.0) years, 10 (2, 17) vs. 193 (157, 215), χ²=-5.57, Z=-48.76,both P<0.001) than that of 2-dose group. The zero-dose group had a high rate of transmission among family members and a high level of SARS-CoV-2 IgM level (13/14 vs. 62.2% (56/90), 0.4 (0.2, 0.8) vs. 0.4 (0.2, 1.1),χ²=5.09, Z=-48.95, both P<0.05) than the 2-dose group. Repositive group had a high rate of underlying diseases and SARS-CoV-2 IgM level was higher (2/13) vs. 1.1% (1/91), (0.6 (0.2, 1.0) vs. 0.3 (0.2, 0.7), χ²=8.29, Z=2.70, both P<0.05) than negative group. The SARS-CoV-2 IgG level of repositive group was lower than that of negative group (160 (78, 197) vs. 213 (186, 231), χ²=-3.20, P<0.05). Conclusions: Children infected with SARS-CoV-2 Omicron variant in Tianjin were mainly transmitted by family members, and most of them had mild symptoms. Two-dose group had higher IgG levels and lower IgM levels than zero-dose group.The probability of SARS-CoV-2 nucleic acid test repositivity increased in children with underlying diseases and lower IgG levels.
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Affiliation(s)
- Y Sun
- Department of Surgical Intensive Care Unit, Tianjin First Central Hospital, Tianjin 300192, China
| | - B Wang
- Department of Surgical Intensive Care Unit, Tianjin First Central Hospital, Tianjin 300192, China
| | - G F Zhang
- Tianjin Key Laboratory of Organ Transplantation, Tianjin 300192, China
| | - X Zhang
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin 300192, China
| | - C J Wang
- Tianjin Key Laboratory of Organ Transplantation, Tianjin 300192, China
| | - D Y Wang
- Department of Surgical Intensive Care Unit, Tianjin First Central Hospital, Tianjin 300192, China
| | - Y X Li
- Department of Surgical Intensive Care Unit, Tianjin First Central Hospital, Tianjin 300192, China
| | - Jingxiao Zhang
- Department of Surgical Intensive Care Unit, Tianjin First Central Hospital, Tianjin 300192, China
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11
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Liu XT, Tu RQ, He YL, Dong XK, Li RY, Hou J, Li YQ, Wang CJ. [Mendelian randomization analysis: the causal relationship between the DNA methylation levels of JAK2 and obesity]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:1315-1320. [PMID: 35981996 DOI: 10.3760/cma.j.cn112338-20220318-00200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Based on the Mendelian randomization analysis, to assess the causal relationship between DNA methylation levels of Janus kinase 2 (JAK2) and obesity. Methods: A case-control study was carried out, including 1 021 individuals [obesity (visceral fat index ≥10) vs. no obesity (visceral fat index <10) was 440 vs. 581] from the Henan Rural Cohort Study. MethylTargetTM target region methylation sequencing technology was used for testing the DNA methylation level of JAK2. logistic regression models were used to assess the association between the DNA methylation level of JAK2 and obesity. With SNP as the instrumental variable, the association between the DNA methylation level of JAK2 and obesity was explored by using the Mendelian randomization analysis method. Results: There was a positive association between Chr9:4984943 (one DNA methylation site in the promoter of JAK2) and obesity, and the OR (95%CI) was 1.22(1.04-1.42). Methylation level of five sites in the exon of JAK2 (Chr9:4985378, Chr9:4985404, Chr9:4985407, Chr9:4985409 and Chr9:4985435) were negatively associated with obesity, the corresponding OR (95%CI) were 0.53 (0.29-0.95), 0.58(0.36-0.93), 0.69 (0.49-0.97), 0.72 (0.53-0.99) and 0.58 (0.35-0.98) , respectively. Mendelian randomization analysis showed that there was a causal relationship between the DNA methylation levels of JAK2 and obesity, and the corresponding β (95%CI) were -1.985 (-3.520 - -0.450),-3.547 (-6.301 - -0.792) and -3.900 (-6.328 - -1.472) for Mendelian randomization method of inverse variance weighted, Mendelian randomization method of median based and Maximum-likelihood method, respectively. Conclusion: This study supported there was a causal relationship between the DNA methylation level of JAK2 and obesity.
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Affiliation(s)
- X T Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - R Q Tu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Y L He
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - X K Dong
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - R Y Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - J Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Y Q Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - C J Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
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12
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Weng JX, Gu HQ, Wang S, Yang KX, Yang X, Wang CJ, Meng X, Zhao XQ, Wang YJ, Li ZX. External validation of ABCD series scores for predicting early stroke events following transient ischemic attack in a large nationwide registry. Eur Stroke J 2022; 7:439-446. [DOI: 10.1177/23969873221113145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: In the context of modern guideline-based strategies, new validations of prognostic scores for predicting early stroke risk are needed. We aimed to compare the validity of the ABCD series scores and assess the incremental values of risk components for predicting in-hospital stroke events in patients with transient ischemic attack (TIA). Patients and methods: We abstracted data from the Chinese Stroke Center Alliance (CSCA), a nationwide registry with 68,433 TIA patients admitted within 7 days of symptom onset from 1476 hospitals. TIA was defined by time-based criteria according to the World Health Organization (WHO). The discrimination of ABCD, ABCD2, ABCD2-I, and ABCD3 scores for predicting in-hospital stroke events was assessed by the area under the receiver-operating characteristics curves (AUC). The incremental predictive values of added risk predictor were determined by net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results: A total of 29,286 TIA patients were included, of whom 1466 (5.0%) had in-hospital stroke events. Compared with ABCD2-I score (AUC 0.79, 95% confidence interval [CI] 0.77–0.80), ABCD (AUC 0.58, 95% CI 0.57–0.60), ABCD2 (AUC 0.58, 95% CI 0.56–0.59), and ABCD3 (AUC 0.58, 95% CI 0.56–0.60) had lower predictive utility. An incremental value was observed when adding infarction on DWI (IDI = 0.0597, NRI = 1.1036) into ABCD2 score to be ABCD2-I. Conclusion: The traditional scales utilizing medical history (ABCD, ABCD2, and ABCD3 scores) show fair ability for predicting in-hospital stroke events after TIA, but the ABCD2-I score, which adds infarction on DWI, improves the predictive ability.
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Affiliation(s)
- Jia-Xu Weng
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shang Wang
- Neurocardiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai-Xuan Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center for Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Yong-Jun Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center for Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Zi-Xiao Li
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center for Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
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13
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Wang HY, Gu HQ, Zhou Q, Jiang YY, Yang X, Wang CJ, Zhao XQ, Wang YL, Liu LP, Meng X, Li H, Liu C, Li ZX, Wang YJ, Jiang Y. Thrombolysis, time-to-treatment and in-hospital outcomes among young adults with ischaemic stroke in China: findings from a nationwide registry study in China. BMJ Open 2022; 12:e055055. [PMID: 35750455 PMCID: PMC9234794 DOI: 10.1136/bmjopen-2021-055055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE We aimed to determine whether young adults (<50 years) with acute ischaemic stroke (AIS) are more likely to receive intravenous tissue plasminogen activator (IV tPA) and have shorter time to treatment than older patients with stroke. METHODS We analysed data from the Chinese Stroke Center Alliance registry for patients with AIS hospitalised between August 2015 and July 2019. Patients were classified into two groups according to age: young adults (<50 years of age) and older adults (≥50 years of age). RESULTS Of 793 175 patients with AIS admitted to 1471 hospitals, 9.1% (71 860) were young adults. Compared with older adults, a higher proportion of young adults received IV tPA among patients without contraindicaitons (7.2% vs 6.1%, adjusted OR (aOR) 1.13, 95% CI 1.10 to 1.17) and among patients without contraindications and with onset-to-door time ≤3.5 hours (23.6% vs 19.3%, aOR 1.20, 95% CI 1.15 to 1.24). We did not observe differences in onset-to-needle time (median hours 2.7 hours) or door-to-needle time (DNT) (median minutes 60 min) between young and older adults. The proportion of DNT ≤30 min, DNT ≤45 min and DNT ≤60 min in young and older IV tPA-treated patients were 16.9% vs 18.8%, 30.2% vs 32.8% and 50.2% vs 54.2%, respectively. Compared with older adults, young adults treated with IV tPA had lower odds of in-hospital mortality (0.5% vs 1.3%, aOR 0.54, 95% CI 0.35 to 0.82) and higher odds of independent ambulation at discharge (61.0% vs 53.6%, aOR 1.15, 95% CI 1.08 to 1.22), and the associations may be partly explained by stroke severity measured by the National Institutes of Health Stroke Scale score. CONCLUSION Young adults with AIS were more likely to receive IV tPA than older adults, although there was no difference between the two groups in time to treatment. Compared with older adults, young adults may had better in-hospital outcomes.
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Affiliation(s)
- Hai-Yan Wang
- Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qi Zhou
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying-Yu Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi-Long Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chelsea Liu
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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14
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Wu MR, Chen YT, Li ZX, Gu HQ, Yang KX, Xiong YY, Wang YJ, Wang CJ. Dysphagia screening and pneumonia after subarachnoid hemorrhage: Findings from the Chinese stroke center alliance. CNS Neurosci Ther 2022; 28:913-921. [PMID: 35233938 PMCID: PMC9062548 DOI: 10.1111/cns.13822] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/15/2021] [Accepted: 02/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Dysphagia is common and is associated with aspiration pneumonia. However, little is known about the prevalence of and factors influencing dysphagia screening (DS) and pneumonia after subarachnoid hemorrhage (SAH). METHODS We used data on SAH patients admitted to 1476 hospitals from the China Stroke Center Alliance (CSCA) from August 2015 to July 2019 to analyze the rates of DS and pneumonia. We then conducted univariate and multivariable analyses to examine the relationship between DS and pneumonia. RESULTS Among 4877 SAH patients who were eligible for DS and had complete data on pneumonia status, 3527 (72.3%) underwent DS, and 1006 (20.6%) developed pneumonia. Compared with patients without pneumonia, patients with pneumonia were older (mean: 63.4 vs. 57.8 years of age), had lower Glasgow Coma Scale (GCS) scores at admission (mean: 13.5 vs. 14.3), were more likely to have dysphagia (15.2% vs. 3.3%), and were more likely to have undergone aneurysm isolation (19.1% vs. 10.0%). In multivariable analyses, factors independently associated with a higher risk of pneumonia were dysphagia [odds ratio (OR), 3.77; 95% confidence interval (CI), 2.85-4.98], age (OR, 1.50 per 10-year increase; 95% CI, 1.40-1.60), male sex (OR, 1.23; 95% CI, 1.02-1.49), arrival at the hospital by emergency medical services (OR, 1.36; 95% CI, 1.16-1.58), nimodipine treatment (OR, 1.42; 95% CI, 1.11-1.81), endovascular embolization of aneurysms (OR, 1.23; 95% CI, 1.03-1.47), cerebral ventricular shunt placement (OR, 2.24; 95% CI, 1.41-3.54), and treatment at a higher grade hospital (OR, 1.44; 95% CI, 1.21-1.71). CONCLUSION More than a quarter of patients with SAH did not have documented DS, while one-fifth developed pneumonia. DS performance was associated with a lower risk of pneumonia. Randomized controlled trials may be needed to determine the effectiveness of DS.
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Affiliation(s)
- Mei-Ru Wu
- Nursing Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Tong Chen
- Nursing Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zi-Xiao Li
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Kai-Xuan Yang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yun-Yun Xiong
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong-Jun Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Chun-Juan Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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15
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Wang YJ, Li ZX, Gu HQ, Zhai Y, Zhou Q, Jiang Y, Zhao XQ, Wang YL, Yang X, Wang CJ, Meng X, Li H, Liu LP, Jing J, Wu J, Xu AD, Dong Q, Wang D, Wang WZ, Ma XD, Zhao JZ. China Stroke Statistics: an update on the 2019 report from the National Center for Healthcare Quality Management in Neurological Diseases, China National Clinical Research Center for Neurological Diseases, the Chinese Stroke Association, National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention and Institute for Global Neuroscience and Stroke Collaborations. Stroke Vasc Neurol 2022; 7:415-450. [PMID: 35443985 PMCID: PMC9614174 DOI: 10.1136/svn-2021-001374] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 02/05/2022] [Indexed: 12/25/2022] Open
Abstract
China faces the greatest challenge from stroke in the world. According to results from the Global Burden of Disease Study 2019, there were 3.94 million new stroke cases, 28.76 million prevalent cases and 2.19 million deaths due to stroke in China in 2019. Furthermore, stroke is also the leading cause of disability-adjusted life-year (DALY) in China, the number of DALYs reached 45.9 million in 2019. Several recent large-scale epidemiological surveys have updated the data on pre-existing conditions contributed to stroke. The age-adjusted prevalence of overweight among Chinese adults aged 18–69 years was 34.4%, and the prevalence of obesity was 16.8% in 2018. 50.9% of Chinese adults ≥18 years of age without history of hypertension had prehypertension in 2018. The weighted prevalence of hypertension in adults was 27.5% in 2018. The weighted prevalence of total diabetes and pre-diabetes diagnosed by the American Diabetes Association criteria were 12.8% and 35.2%, respectively, among Chinese adults ≥18 years of age in 2017. The weighted atrial fibrillation prevalence was 1.8% among Chinese adults ≥45 years of age and equates to being present in an estimated 7.9 million people in China. Data from 1672 tertiary public hospitals in the Hospital Quality Monitoring System (HQMS) showed that 3 411 168 stroke cases were admitted during 2019. Of those, 2 818 875 (82.6%) were ischaemic strokes (ISs), 485 474 (14.2%) were intracerebral haemorrhages (ICHs), 106 819 (3.1%) were subarachnoid haemorrhages (SAHs). The average age was 66 years old, and 59.6% were male. A total of 1379 (<0.1%), 2604 (0.5%), 1250 (1.2%) paediatric strokes (age <18 years) were identified among IS, ICH and SAH, respectively. Over one-third (1 231 519 (36.1%)) of the stroke cases were covered by urban resident basic medical insurance, followed by urban employee basic medical insurance (891 103 (26.1%)) and new rural cooperative medical schema (543 108 (15.9%)). The leading risk factor was hypertension (57.3% for IS, 69.9% for ICH and 44.1% for SAH), and the leading comorbidity was pneumonia or pulmonary infection (10.4% for IS, 34.6% for ICH and 29.7% for SAH). In-hospital death/discharge against medical advice rate was 8.5%, ranging from 6.0% for IS to 20.6% for SAH. The median and IQR of length of stay was 9.0 (6.0–13.0) days, ranging from 10.0 (7.0–13.0) in IS to 14.0 (8.0–22.0) in ICH. Similar data from 2847 secondary public hospitals or private hospitals in the HQMS were also reported. Data from HQMS showed that higher proportions of interprovincial admission to other provinces were seen in Inner Mongolia, Anhui, Tibet and Beijing. Higher proportions of interprovincial admission from other provinces were seen in Beijng, Tianjin, Shanghai and Ningxia. Data from 323 601 strokes from 1337 hospitals in the Chinese Stroke Center Alliance during 2019 demonstrated that the composite scores of guideline-recommended key performance indicators for patients with IS, ICH and SAH were 0.78±0.20, 0.69±0.27 and 0.60±0.31, respectively.
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Affiliation(s)
- Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Zhai
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qi Zhou
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Jing
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Wu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - An-Ding Xu
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - David Wang
- Neurovascular Division, Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Wen-Zhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xu-Dong Ma
- Bureau of Medical Administration, National Health Commission of the People's Republic of China, Beijing, China
| | - Ji-Zong Zhao
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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16
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Yang CL, Wang XD, Zhou XH, Wang CJ, Zhang XL, Li Y, Yu Y, Liu SX. [Clinical characteristics and risk factors of pericardial effusion after hematopoietic stem cell transplantation in children with thalassemia major]. Zhonghua Er Ke Za Zhi 2022; 60:323-328. [PMID: 35385938 DOI: 10.3760/cma.j.cn112140-20210809-00659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To investigate the characteristics, risk factors and outcomes of thalassemia major (TM) children with pericardial effusion (PE) after allo-geneic hematopoietic stem cell transplantation (allo-HSCT). Methods: Clinical data of 446 TM children received allo-HSCT at Shenzhen Children's Hospital between January 2012 and December 2020 were analyzed retrospectively. Patients were divided into PE and non-PE group according to the occurrence of PE. Chi-square tests were used to investigate the risk factors that were associated with the development of PE. Kaplan-Meier method was used for survival analysis of the 2 groups. Results: Twenty-five out of 446 patients (5.6%) developed PE at a time of 75.0 (66.5, 112.5) days after allo-HSCT. Among these patients, 22 cases (88.0%) had PE within 6 months after allo-HSCT and 19 patients (76.0%) had PE within 100 days after allo-HSCT. The diagnoses of PE were confirmed using echocardiography. Pericardial tamponade was observed in only 1 patient, who later undergone emergency pericardiocentesis. The rest of patients received conservative managements alone. PE disappeared in all patients after treatment. Risk factors that were associated with the development of PE after allo-HSCT included the gender of patients, the type of transplantation, the number of mononuclear cells (MNC) infuse, pulmonary infection after HSCT and transplantation associated thrombotic microangiopathy (TA-TMA) (χ²=3.99, 10.20, 14.18, 36.24, 15.03, all P<0.05). In 239 patients that received haploidentical HSCT, the development of PE was associated with the gender of patients, pulmonary infection after HSCT and TA-TMA (χ²=4.48, 20.89, 12.70, all P<0.05). The overall survival rates of PE and non-PE groups were 96.0% (24/25) and 98.6% (415/421). The development of PE was not associated with the overall survival of TM children after allo-HSCT (χ²=1.73, P=0.188). Conclusions: PE mainly develop within 100 days after allo-HSCT in pediatric TM recipients. Haploidentical grafts, female gender, pulmonary infection after HSCT and TA-TMA are the main risk factors associated with PE development after transplant. However, the presence of PE don't have a significant impact on the outcomes of pediatric TM patients after allo-HSCT.
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Affiliation(s)
- C L Yang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen 518000, China
| | - X D Wang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen 518000, China
| | - X H Zhou
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen 518000, China
| | - C J Wang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen 518000, China
| | - X L Zhang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen 518000, China
| | - Y Li
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen 518000, China
| | - Y Yu
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen 518000, China
| | - S X Liu
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen 518000, China
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17
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Lin Y, Xu Y, Cao X, Zhou XT, Zhou YD, Mao F, Wang CJ, Xu YL, Sun Q. [Comprehensive treatment options and influencing factors in elderly patients with breast cancer]. Zhonghua Yi Xue Za Zhi 2022; 102:428-434. [PMID: 35144343 DOI: 10.3760/cma.j.cn112137-20210929-02186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To investigate the treatment options for breast cancer patients aged 65 and over, and analyze the influencing factors. Methods: The clinical data of 521 elderly patients aged 65 years or older,who underwent surgery in Peking Union Medical College Hospital from January 2009 to December 2015, were collected. They were all female and 65-98 years old. The patients were divided into 65-74 years old group (n=353) and ≥ 75 years old group (n=168). The differences of variables including age, functional status, treatment methods, pathological characteristics, comorbidities and survival time between the two groups were compared, and the differences of comprehensive treatment methods and their impact on clinical efficacy were analyzed. Results: The main operation methods of the two groups were modified radical mastectomy [39.1% (138/353) and 33.9% (57/168), respectively], breast conserving surgery [56.9% (201/353) and 61.3% (103/353), respectively]. Among the patients choosing adjuvant therapy, there was no significant difference between the two groups except chemotherapy (all P>0.05). Univariate analysis showed that the choice of chemotherapy was related to age, surgical methods, pathological types, tumor burden, molecular typing, functional status and comorbidities (all P<0.05). The Eastern Cooperative Oncology Group (ECOG) score and the number of comorbidities were independent factors affecting the choice of chemotherapy for breast cancer in the elderly: [ECOG score: adjusted OR=0.45 (95CI: 0.26-0.75), number of comorbidities: adjusted OR = 0.63 (95CI:0.41-0.98); all P<0.05]. The 5-year disease-free survival rate of 521 elderly patients with breast cancer was 86.3%, 5-year overall survival rate was 88.8%, and the breast cancer specific survival rate was 94.3%. Conclusions: The comprehensive treatment of breast cancer patients aged 65 and above is not affected by age, but is associated with tumor burden, pathological type, molecular typing, comorbidities and ECOG score. Among them, ECOG score and the number of comorbidities are the independent factors influencing the choice of adjuvant chemotherapy.
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Affiliation(s)
- Y Lin
- Department of Breast Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - Y Xu
- Department of Breast Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - X Cao
- Department of Breast Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - X T Zhou
- Department of Breast Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - Y D Zhou
- Department of Breast Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - F Mao
- Department of Breast Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - C J Wang
- Department of Breast Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - Y L Xu
- Department of Breast Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - Q Sun
- Department of Breast Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
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18
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Liu JX, Wang CJ, Dai JH, Zhang MX, Lyu B, Jiang B. [Fibrinogen gamma-chain mutation, p.Ile171His, leads to hereditary hypofibrinogenemia]. Zhonghua Nei Ke Za Zhi 2022; 61:172-176. [PMID: 35090252 DOI: 10.3760/cma.j.cn112138-20210305-00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To explore the clinical phenotype and genotype of a family with hereditary hypofibrinogenemia. Methods: Activated partial thrombin time (APTT), prothrombin time (PT),thrombin time (TT) and thrombelastogram (TEG) were tested in all family members. Fibrinogen activity and antigen were detected by Clauss method and immunoturbidimetric method respectively. All exons and flanking sequences of fibrinogen FGA,FGB,FGG genes were analyzed by PCR, and the products were subjected to Sanger sequencing. Results: The proband represented prolonged PT and TT, low Fg activity and antigen, elevated K value and decreased Angle value in TEG. Other family members reported similar changes including proband's father,daughter and son, and his elder brother and his niece. Exon 5 c.510_512 of FGG gene in the proband revealed a minor deletion mutation. Conclusion: The novel heterozygous missense mutation of exon 5 c.510_512del (Gln170_Ile171 del ins His) of FGG gene is the molecular mechanism that leads to hereditary hypofibrinogenemia in this family.
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Affiliation(s)
- J X Liu
- Department of Hematology, Peking University International Hospital, Beijing 102206, China
| | - C J Wang
- Department of Hematology, Peking University International Hospital, Beijing 102206, China
| | - J H Dai
- Department of Clinical Laboratory, Peking University International Hospital, Beijing 102206, China
| | - M X Zhang
- Department of Hematology, Peking University International Hospital, Beijing 102206, China
| | - B Lyu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - Bin Jiang
- Department of Hematology, Peking University International Hospital, Beijing 102206, China
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19
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Liu C, Gu HQ, Yang X, Wang CJ, Meng X, Yang KX, Xiong YY, Zhao XQ, Wang YL, Liu LP, Wang YJ, Li ZX. Pre-stroke dementia and in-hospital outcomes in the Chinese Stroke Center Alliance. Ann Transl Med 2022; 10:1050. [PMID: 36330395 PMCID: PMC9622475 DOI: 10.21037/atm-22-723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022]
Abstract
Background Little is known about the impact of prevalent dementia on in-hospital outcomes of patients with incident stroke in China. Using data from the Chinese Stroke Center Alliance (CSCA), we aim to quantify the prevalence of pre-stroke dementia and whether this group is at higher risk of adverse in-hospital outcomes compared to those without pre-stroke dementia. Methods We used multivariable logistic regression models to assess the associations between pre-stroke dementia and ambulation by day 2, in-hospital mortality, in-hospital complications, and being discharged home. Covariates included age, sex, comorbidities [dyslipidemia, atrial fibrillation, peripheral vascular disease (PVD), smoking, and alcohol use], medication history (antiplatelet drugs or lipid-lowering drugs), stroke severity [measured by the National Institute of Health Stroke Scale (NIHSS)], administration of intravenous tissue plasminogen activator (IV tPA) within 4.5 hours of stroke onset, and receipt of deep vein thrombosis (DVT) prophylaxis if indicated. Results In the final analytic sample of 559,070 ischemic stroke patients with no prior stroke history enrolled across 1,476 hospitals, those with pre-stroke dementia (n=1,511; 0.3%) were older and more likely to be female. Despite having received similar treatment, patients with pre-stroke dementia had lower odds of ambulating by day 2 [odds ratio (OR) =0.69; 95% confidence interval (CI): 0.62–0.78], higher odds of in-hospital mortality (OR =2.01; 95% CI: 1.35–2.99) or complications (OR =2.17; 95% CI: 1.93–2.44), and lower odds of being discharged home compared to those without pre-stroke dementia (OR =0.71; 95% CI: 0.62–0.83). Conclusions Worse in-hospital outcomes among patients with pre-stroke dementia may be explained by pre-existing cognitive impairment that limited their ability to advocate for care needs. Further research is needed to determine whether a different care pathway or additional attention from clinicians is necessary for patients with pre-stroke dementia.
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Affiliation(s)
- Chelsea Liu
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai-Xuan Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yun-Yun Xiong
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- Neuro-Intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
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20
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Zhang MX, Shi WZ, Liu JX, Wang CJ, Li Y, Wang W, Jiang B. [Clinical characteristics and prognosis of MLL-AF6 positive patients with acute myeloid leukemia]. Beijing Da Xue Xue Bao Yi Xue Ban 2021; 53:915-920. [PMID: 34650294 PMCID: PMC8517675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE To investigate the clinical features and prognosis of acute myeloid leukemia (AML) patients with the mixed lineage leukemia (MLL) gene rearrangements AF6 (MLL-AF6) positive. METHODS In the study, 11 patients who were newly diagnosed with MLL-AF6 positive AML were analyzed retrospectively, related literature was reviewed to clarify the clinical features and prognosis of MLL-AF6 positive patients. RESULTS Among the 11 patients, there were 6 males and 5 females, with a median age of 36 years. Six patients were diagnosed with AML M5 and five with M4 according to FAB classification (French-American-British classification systems). Gingival swelling and pain occurred in 6 cases and fever occurred in 5 cases. At first diagnosis, the median white blood cells were 55.5×109/L. Immunotype showed the expression of myeloid/monocyte and early stem cell series antigens. The expression level of MLL-AF6 fusion gene (real-time quantitative PCR) was 14.2%-214.5%, and 6/11 cases (54.5%) were associated with high EVI1 gene expression. Mutations of KRAS, TET2, ASXL1, TP53, DNMT3A, and FLT3-ITD were detected by next generation sequencing (NGS) in 4 patients. Chromosome G banding examination showed that 2 cases were t(6;11)(q27, q23) with complex karyotype abnormality, 4 cases with +8 abnormality and 2 cases with normal karyotype. Hematological complete remission (CR) was achieved in 8/11 patients (72.7%) after conventional induction chemotherapy, and primary drug resistance was observed in 3 patients. Two of the eight patients with CR were negative for minimal residual disease (MRD), with a median CR duration of 4.5 months. Two patients with positive MRD and three patients with refractory recurrence underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT), but all died due to leukemia progression. At the end of follow-up on December 1, 2019, 2 patients were alive and 9 died, with median survival time of 9 months. CONCLUSION The AML patients with MLL-AF6 positive were mostly young, the majority of FAB types were M4 and M5, and most of the patients often had fever as the first symptom, with increased white blood cells, accompanied by organ infiltration, and high EVI1 gene expression. The hematological remission rate of routine chemotherapy is not low, but it is difficult to achieve molecular remission, most of which have early recurrence. Early allo-HSCT in a molecular negative state may prolong the CR duration.
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Affiliation(s)
- M X Zhang
- Department of Hematology, Peking University International Hospital, Beijing 102206, China
| | - W Z Shi
- Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi, China
| | - J X Liu
- Department of Hematology, Peking University International Hospital, Beijing 102206, China
| | - C J Wang
- Department of Hematology, Peking University International Hospital, Beijing 102206, China
| | - Y Li
- Department of Hematology, Peking University International Hospital, Beijing 102206, China
| | - W Wang
- Department of Hematology, Peking University International Hospital, Beijing 102206, China
| | - B Jiang
- Department of Hematology, Peking University International Hospital, Beijing 102206, China
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21
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Gu HQ, Wang CJ, Yang X, Liu C, Wang X, Zhao XQ, Wang YL, Liu LP, Meng X, Jiang Y, Li H, Wang YJ, Li ZX. Sex differences in vascular risk factors, in-hospital management, and outcomes of patients with acute ischemic stroke in China. Eur J Neurol 2021; 29:188-198. [PMID: 34564908 DOI: 10.1111/ene.15124] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/19/2021] [Accepted: 09/21/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Previous assessments of sex differences for patients with acute ischemic stroke were limited in a specific region or population, narrow scope, or small sample size. METHODS Patients with acute ischemic stroke hospitalized in the China Stroke Center Alliance hospitals were analyzed. Absolute standardized differences (ASDs) were used to assess sex differences in vascular risk factors, guideline-recommended in-hospital management measures and outcomes, including stroke severity (National Institutes of Health Stroke Scale≥16), death/discharge against medical advice, major adverse cardiovascular events, pneumonia, and disability (modified Rankin Scale≥3). RESULTS Of 838,229 patients analyzed, 524351 (62.6%) were men and 313,878 (37.4%) were women. Compared with men, women were older (68.6 vs. 64.7 years), had higher prevalence of hypertension (67.7% vs. 62.4%), diabetes (24.7% vs. 19.5%), and atrial fibrillation (7.1% vs. 4.3%), but lower prevalence of smoking (4.5% vs. 56.6%) and drinking (2.6% vs 35.8%) (ASDs >10%). No sex differences were seen in guideline-directed management measures, indicated by risk-adjusted individual measures and the all-or-null summary measure (34.5% vs 34.9%, ASD = 1.0%). Compared to men, women tended to have strokes that were more severe at presentation (6.5% vs. 4.5%, ASD = 8.8%) and more disabilities at discharge (34.9% vs 30.5%, ASD =9.4%). However, all sex-related differences in outcomes were attenuated to null after risk adjustments (ASDs<2%). CONCLUSIONS Compared to male patients, female patients had more vascular risk factors and received similar in-hospital care. They had strokes that were more severe at presentation and more disabilities at discharge, both of which may be explained by worse vascular risk profiles.
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Affiliation(s)
- Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chelsea Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xia Wang
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
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22
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Gu HQ, Yang KX, Yang X, Wang CJ, Lyu TJ, Zhao XQ, Wang YL, Liu LP, Liu C, Li H, Jiang Y, Wang YJ, Li ZX. Guideline-directed low-density lipoprotein management in high-risk ischemic stroke or transient ischemic attack admissions in China from 2015 to 2019. Ann Transl Med 2021; 9:1224. [PMID: 34532361 PMCID: PMC8421930 DOI: 10.21037/atm-21-1467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022]
Abstract
Background Lowering low-density lipoprotein cholesterol (LDL-C) is crucial for secondary stroke prevention in stroke patients with preexisting cardiovascular diseases (CVD) or cerebrovascular diseases (CeVD). However, data on attainment of guideline-recommended LDL-C levels are lacking. Methods We analyzed data from the Chinese Stroke Center Alliance (CSCA) program for patients with ischemic stroke and transient ischemic attack (TIA) hospitalized between August 2015 and July 2019. Participants were classified into different disease groups according to preexisting CeVD (stroke/TIA) or CVD [coronary heart disease (CHD) or myocardial infarction (MI)]. Results Of 858,509 patients presenting with an acute stroke/TIA, 251,176 (29.3%) had a preexisting CeVD, 44,158 (5.1%) had preexisting CVD, 33,070 (3.9%) had concomitant preexisting CeVD and CVD, and 530,105 (61.7%) had no documented history of CeVD/CVD. Overall, only 397,596 (46.3%) met the target for LDL-C <2.6 mmol/L, 128,177 (14.9%) for LDL-C <1.8 mmol/L and 55,275 (6.4%) for LDL-C <1.4 mmol/L, and patients with concomitant CeVD and CVD had higher attainment rates than other disease groups (P<0.001). Despite improvements over time in the proportion of patients who attain LDL-C targets (P for trend <0.05), it remains suboptimal. Younger age, women, having a history of hypertension or dyslipidemia, current smoking or drinking, and being admitted to hospitals located in eastern China were associated with lower odds of meeting the LDL-C goals. Conclusions Overall attainment of guideline LDL-C targets in a population of stroke/TIA patients is low and indicates the need for better management of dyslipidemia, particularly for high-risk stroke patients with pre-existing CeVD or CVD.
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Affiliation(s)
- Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai-Xuan Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tian-Jie Lyu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chelsea Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
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23
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Chen JL, Jin ML, Wang X, Yang XJ, Zhang N, Liu FN, Liu R, Guo JP, Chen Y, Wang CJ. [Fitting and predicting trend of COVID-19 by SVEPIUHDR dynamic model]. Zhonghua Liu Xing Bing Xue Za Zhi 2021; 42:1341-1346. [PMID: 34814551 DOI: 10.3760/cma.j.cn112338-20210225-00147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: To fit and predict the trend of COVID-19 epidemics in the United States (USA) and the United Kingdom (UK), and analyze the effect of vaccination. Methods: Based on the SEIR dynamic model, considering the presymptomatic infections, isolation measures, vaccine vaccination coverage, etc., we developed a SEIR with vaccine inoculation, Presymptomatic infectious, unconfirmed infectious, hospital isolation and domiciliary isolation dynamics model. The publicly released incidence data of COVID-19 from November 6, 2020 to January 31, 2021 in USA and from November 23, 2020 to January 31, 2021 in UK were used to fit the model and the publicly released incidence data of COVID-19 from February 1, 2021 to April 1 were used to evaluate the predicting power of the model by software R 4.0.3 and predict changes in the daily new cases in the context of different vaccination coverage. Results: According to the cumulative confirmed cases, the fitting bias and the predicting bias of the SVEPIUHDR model for USA and UK were less than 5%, respectively. From the model prediction results, the cumulative cases after COVID-19 vaccination in USA in early April reached 31 864 970. If there had not had such vaccination, the cumulative cases of COVID-19 would have reached to 35 317 082, with a gap of more than 3.4 million cases. In UK, the cumulative cases of COVID-19 after the vaccination was estimated to be 4 195 538 in early April, compared with 4 268 786 cases if no COVID-19 vaccination had been provided, there would have heen a gap of more than 70 000 cases. Conclusion: SVEPIUHDR model shows a good prediction effect on the epidemic of COVID-19 in both USA and UK.
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Affiliation(s)
- J L Chen
- School of Public Health, China Medical University, Shenyang 110122, China
| | - M L Jin
- School of Public Health, China Medical University, Shenyang 110122, China
| | - X Wang
- Shaanxi Normal University, Xi'an 710119, China
| | - X J Yang
- School of Public Health, China Medical University, Shenyang 110122, China
| | - N Zhang
- School of Public Health, China Medical University, Shenyang 110122, China
| | - F N Liu
- School of Public Health, China Medical University, Shenyang 110122, China
| | - R Liu
- School of Public Health, China Medical University, Shenyang 110122, China
| | - J P Guo
- Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing 100071, China
| | - Y Chen
- Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing 100071, China
| | - C J Wang
- Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing 100071, China
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24
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Gu HQ, Yang X, Wang CJ, Zhao XQ, Wang YL, Liu LP, Meng X, Jiang Y, Li H, Liu C, Wangqin R, Fonarow GC, Schwamm LH, Xian Y, Li ZX, Wang YJ. Clinical Characteristics, Management, and In-Hospital Outcomes in Patients With Stroke or Transient Ischemic Attack in China. JAMA Netw Open 2021; 4:e2120745. [PMID: 34387677 PMCID: PMC8363916 DOI: 10.1001/jamanetworkopen.2021.20745] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Stroke represents a significant burden on the health care system of China. The Chinese Stroke Center Alliance was launched in 2015 to monitor and improve care quality and outcomes for patients with acute stroke and transient ischemic attack (TIA). OBJECTIVE To evaluate the clinical characteristics, management, and in-hospital clinical outcomes and complications among patients with stroke or TIA in China. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study assessed stroke or TIA admissions to 1476 participating hospitals in the Chinese Stroke Center Alliance between August 1, 2015, and July 31, 2019. EXPOSURES Stroke types and calendar year. MAIN OUTCOMES AND MEASURES Eleven guideline-based admission or discharge management measures and 2 summary measures: an all-or-none binary outcome and a composite score (range, 0 [nonadherence] to 1 [perfect adherence]) for adherence to evidence-based stroke and TIA care and in-hospital clinical outcomes, including death or discharge against medical advice (DAMA), major adverse cardiovascular events (MACEs), including ischemic stroke, hemorrhagic stroke, TIA, or myocardial infarction; and in-hospital complications. RESULTS Of 1 006 798 patients with stroke or TIA (mean [SD] age, 65.7 [12.2] years; 383 500 [38.1%] female), 838 229 (83.3%) had an ischemic stroke, 64 929 (6.4%) had TIA, 85 705 (8.5%) had intracerebral hemorrhage (ICH), and 11 241 (1.1%) had subarachnoid hemorrhage (SAH). Management measures varied by cerebrovascular event type, with the mean (SD) composite score ranging from 0.57 (0.31) in SAH to 0.83 (0.24) in TIA. Poor outcomes and complications were highest among patients with SAH (21.9%; 95% CI, 21.0%-22.8% in-hospital death or DAMA; 9.6%; 95% CI, 9.1%-10.2% MACEs; and 31.4%; 95% CI, 30.6%-32.3% in-hospital complications) and patients with ICH (17.2%; 95% CI, 16.9%-17.5% in-hospital death or DAMA; 9.3%; 95% CI, 9.1%-9.5% MACEs; and 31.3%; 95% CI, 31.0%-31.6% in-hospital complications), followed by patients with ischemic stroke (6.1%; 95% CI, 6.0%-6.1% in-hospital death or DAMA; 6.3%; 95% CI, 6.3%-6.4% MACEs; and 12.8%; 95% CI, 12.7%-12.9% in-hospital complications), and lowest in patients with TIA (5.0%; 95% CI, 4.8%-5.2% in-hospital death or DAMA; 2.4%; 95% CI, 2.3%-2.5% MACEs; and 0.8%; 95% CI, 0.7%-0.8% in-hospital complications). Temporal improvements in management measures were observed from 2015 to 2019, especially in administration of intravenous recombinant tissue plasminogen activator (+60.3% relatively; 95% CI, 52.9%-70.5%), dysphagia screening (+14.7% relatively; 95% CI, 14.0%-15.6%), and use of anticoagulants for atrial fibrillation (+31.4% relatively; 95% CI, 25.7%-37.3%). Temporal improvements in in-hospital death or DAMA (-9.7% relatively; 95% CI, -9.6% to -8.5%) and complications (-27.1% relatively; 95% CI, -28.6% to -25.3) were also observed. CONCLUSIONS AND RELEVANCE In this quality improvement study, performance measure adherence and poor outcomes and complications varied by cerebrovascular event type; although there were substantial improvements over time, these results suggest that support for the use of evidence-based practices is needed.
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Affiliation(s)
- Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chelsea Liu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Runqi Wangqin
- Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan–UCLA Medical Center, Los Angeles, California
- Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology
| | - Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ying Xian
- Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
| | - Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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25
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Gu HQ, Yang X, Wang CJ, Zhao XQ, Wang YL, Liu LP, Meng X, Jiang Y, Li H, Liu C, Xiong YY, Fonarow GC, Wang D, Xian Y, Li ZX, Wang YJ. Assessment of Trends in Guideline-Based Oral Anticoagulant Prescription for Patients With Ischemic Stroke and Atrial Fibrillation in China. JAMA Netw Open 2021; 4:e2118816. [PMID: 34323982 PMCID: PMC8322995 DOI: 10.1001/jamanetworkopen.2021.18816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Adherence to oral anticoagulants (OACs) per guideline recommendations is crucial in reducing ischemic stroke and systemic thromboembolism in high-risk patients with ischemic stroke and atrial fibrillation. However, data on OAC use are underreported in China. OBJECTIVE To assess adherence to the Chinese Stroke Association or the American Heart Association/American Stroke Association's clinical management guideline-recommended prescription of OACs, the temporal improvement in adherence, and the risk factors associated with OAC prescriptions. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study was conducted at 1430 participating hospitals in the Chinese Stroke Center Alliance (CSCA) among patients with ischemic stroke and atrial fibrillation enrolled in the CSCA between August 1, 2015, and July 31, 2019. EXPOSURE Calendar year. MAIN OUTCOMES AND MEASURES Adherence to the Chinese Stroke Association or the American Heart Association/American Stroke Association's clinical management guideline-recommended prescribing of OACs (warfarin and non-vitamin K OACs, including dabigatran, rivaroxaban, apixaban, and edoxaban) at discharge. RESULTS Among 35 767 patients (18 785 women [52.5%]; mean [SD] age, 75.5 [9.2] years) with previous atrial fibrillation at admission, the median CHA2DS2-VASc (cardiac failure or dysfunction, hypertension, age 65-74 [1 point] or ≥75 years [2 points], diabetes, and stroke, transient ischemic attack or thromboembolism [2 points]-vascular disease, and sex category [female]) score was 4.0 (interquartile range, 3.0-5.0); 6303 (17.6%) were taking OACs prior to hospitalization for stroke, a rate that increased from 14.3% (20 of 140) in the third quarter of 2015 to 21.1% (118 of 560) in the third quarter of 2019 (P < .001 for trend). Of 49 531 eligible patients (26 028 men [52.5%]; mean [SD] age, 73.4 [10.4] years), 20 390 (41.2%) had an OAC prescription at discharge, an increase from 23.2% (36 of 155) in the third quarter of 2015 to 47.1% (403 of 856) in the third quarter of 2019 (P < .001 for trend). Warfarin was the most commonly prescribed OAC (11 956 [24.2%]) and had the largest temporal increase (from 5.8% [9 of 155] to 20.7% [177 of 856]). Older age (adjusted odds ratio [aOR] per 5 year increase, 0.89;95% CI, 0.89-0.90), lower levels of education (aOR for below elementary school, 0.84; 95% CI, 0.74-0.95 ), lower income (aOR for ≤¥1000 [$154], 0.66; 95% CI, 0.59-0.73), having new rural cooperative medical scheme insurance (aOR, 0.92; 95% CI, 0.87-0.96), prior antiplatelet use (aOR, 0.70; 95% CI, 0.66-0.74), having several cardiovascular comorbid conditions (including stroke or transient ischemic attack [aOR, 0.78; 95% CI, 0.75-0.82], hypertension [aOR, 0.84; 95% CI, 0.80-0.89], diabetes [aOR, 0.91; 95% CI, 0.83-0.99], dyslipidemia [aOR, 0.87; 95% CI, 0.80-0.94], carotid stenosis [aOR, 0.83; 95% CI, 0.69-0.98], and peripheral vascular disease [aOR, 0.80; 95% CI, 0.71-0.90]), and admission to secondary hospitals (aOR, 0.71; 95% CI, 0.68-0.74) or hospitals located in the central region of China (aOR, 0.80; 95% CI, 0.75-0.84) were associated with not being prescribed an OAC at discharge. CONCLUSIONS AND RELEVANCE This quality improvement study suggests that, despite significant improvement over time, OAC prescriptions remained low. Efforts to increase OAC prescriptions, especially non-vitamin K OACs, are needed for vulnerable subgroups by age, socioeconomic status, and presence of comorbid conditions.
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Affiliation(s)
- Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chelsea Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Yun-Yun Xiong
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California
| | - David Wang
- Neurovascular Division, Department of Neurology, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Ying Xian
- Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
| | - Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Wang M, Wang CJ, Gu HQ, Yang X, Yang KX, Li ZX, Wang YJ. Abstract P236: Impact of Covid-19 Outbreak on the Quality of Care and Outcomes for In-Hospital Patients With Acute Ischemic Stroke in China. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
It is unclear the impact of the COVID-19 pandemic on the health care and outcomes for in-hospital patients with acute ischemic stroke (AIS). We aimed to evaluate the influence of COVID-19 on the quality of care for in-hospital patients with AIS.
Methods:
This is an observational registry study between November 23rd, 2019 and March 22nd, 2020. 408 hospital from 29 provinces in China were enrolled from Chinese Stroke Center Alliance (CSCA). Patients with AIS were extracted with demographic, clinical and previous history information. We focus on the time period before and after January 23rd, 2020, when the public health interventions were carried out in China. The primary outcome was adherence to 11 performance measures, with co-primary outcomes of a composite of percentage of performance measures adhered to. Secondary outcomes included were time measures and in-hospital outcomes.
Results:
42056 patients with AIS was enrolled (mean age 66.5±12.1, male 61.3%). The overall in-hospital patients decreased slightly from 14323 to 14204 before the COVID-19 outbreak and went down sharply by 31.4% and 61.1% after the outbreak and the public conducted interventions in China. A remarkable reduction was shown in patients with NIHSS score ≤ 3 from 57.7% to 55.7% after the outbreak (p<.001). Adherence to performance kept steady and grew slightly overall, for the composite measure (0.78±0.19 vs. 0.79±0.18, p<.001) increased after the COVID-19 outbreak. Discharged against medical advice increased from 5.9% to 7.3% after the outbreak (p<.001). The length of stay fell as expected after the public health interventions (10.0 (7.0-13.0) vs. 9.0 (7.0-13.0), p<.001).
Conclusions:
The admission number of patients with AIS declined significantly after the COVID-19 outbreak, but the quality of care and outcomes kept stable. Hospitals should admit AIS patients to the fullest extent of ability and provide tailored treatment strategies under the premise of no the cross-infection of COVID-19.
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Affiliation(s)
- Meng Wang
- Beijing Tian Hosp, Capital Med Univ, Beijing, China
| | | | - Hong-Qiu Gu
- Beijing Tian Hosp, Capital Med Univ, Beijing, China
| | - Xin Yang
- Beijing Tian Hosp, Capital Med Univ, Beijing, China
| | | | - Zi-Xiao Li
- Beijing Tian Hosp, Capital Med Univ, Beijing, China
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Wang CJ, Shen Z, Yu YY, Xiao SM, Feng J, Ge XH, Zheng HQ, Yang GG. [A new method to improve the quality of bowel preparation before colonoscopy]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 23:1203-1206. [PMID: 33353278 DOI: 10.3760/cma.j.cn.441530-20191230-00531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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28
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Huang ZX, Gu HQ, Yang X, Wang CJ, Wang YJ, Li ZX. Risk factors for in-hospital mortality among acute ischemic stroke patients in China: a nationwide prospective study. Neurol Res 2020; 43:387-395. [PMID: 33357098 DOI: 10.1080/01616412.2020.1866356] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: We aimed to investigate factors related to in-hospital mortality (IHM) in acute ischemic stroke (AIS) patients.Methods: We prospectively investigated 827,314 patients who were admitted within 7 days of AIS between August 2015 and July 2019. Demographic characteristics, risk factors, and clinical and laboratory characteristics of patients were assessed. Univariate and multivariate logistic regression analyses were performed to identify predictors associated with IHM.Results: The IHM rate in this study was 0.5% in women and 0.3% in men. Factors associated with IHM in AIS included diabetes (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.03-1.43), female (OR 0.84, 95%CI 0.74-0.96), hypertension (OR 1.16, 95%CI 1.01-1.34), atrial fib/flutter (OR 1.51, 95%CI 1.29-1.77), other heart disease (OR1.43, 95%CI 1.23-1.67), prior myocardial infarction (OR 2.00, 95%CI 1.54-2.60), antiplatelet therapies (OR 0.71, 95%CI 0.60-0.84), gastrointestinal bleeding (OR 3.54, 95%CI 2.83-4.44), pulmonary embolism (OR 2.53, 95%CI1.41-4.53), dysphagia(OR7.32, 95%CI6.23-8.61), glycosylated hemoglobin (OR1.05, 95%CI 1.02-1.09), serum creatinine (OR 1.001, 95%CI 1.001-1.002), urea nitrogen (OR 1.10, 95%CI 1.08-1.12), National Institutes of Health Stroke Scale (NIHSS) score (4-5 vs. 0-4: OR 3.58; ≥15 vs. 0-4: OR 8.78), stroke rehabilitation (OR 0.27, 95%CI 0.23-0.30), age (third IQR vs. first IQR: OR 1.57; fourth IQR vs. first IQR: OR 2.23), and in-hospital stroke/TIArecurrence (OR 2.38, 95%CI 2.03-2.78).Conclusions: The findings from this study may help clinicians control the risk of IHM better for patients with AIS.
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Affiliation(s)
- Zhi-Xin Huang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China.,Department of Neurology, The Second Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, China
| | - Hong-Qiu Gu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xin Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chun-Juan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong-Jun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zi-Xiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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Liu C, Gu HQ, Yang X, Wang CJ, Yang KX, Li ZX, Wang YJ. Pre-stroke dementia and in-hospital outcomes in the Chinese Stroke Center Alliance. Innov Aging 2020. [PMCID: PMC7743400 DOI: 10.1093/geroni/igaa057.3250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Little is known about the prevalence of pre-stroke dementia in China and whether this group is at higher risk of adverse in-hospital outcomes. We aimed to understand this association using data from the Chinese Stroke Center Alliance. Multivariable logistic regressions were conducted to assess the association between pre-stroke dementia status and ambulation at day 2, in-hospital mortality, and in-hospital complications. Covariates included age, sex, medical history, history of smoking, history of alcohol use, medication history (antiplatelet drugs, lipid-lowering drugs), stroke severity (measured by the National Institute of Health Stroke Scale), whether IV tPA was administered within 4.5 hours, and whether the patient received deep vein thrombosis prophylaxis as needed. Odds ratios and 95% confidence intervals were presented for the adjusted models. In the final analytic sample of 559,070 ischemic stroke patients with no prior stroke history enrolled across 1476 hospitals, 1511 (0.3%) had pre-stroke dementia, and they were older and more likely to be female. Patients with pre-stroke dementia had lower odds of ambulating at day 2, higher odds of having any complications and higher odds of in-hospital mortality compared to those without pre-stroke dementia, despite little difference in treatment received. Our findings may be explained by communication barriers experienced by patients with pre-stroke dementia that limited their ability to advocate for their own care needs. Further research is needed to determine whether a different care pathway or additional attention from clinicians is necessary for patients with pre-stroke dementia.
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Affiliation(s)
- Chelsea Liu
- Harvard School of Public Health, Boston, Massachusetts, United States
| | | | - Xin Yang
- Beijing Tiantan Hospital, Beijing, China
| | | | | | - Zi-Xiao Li
- Beijing Tiantan Hospital, Beijing, China
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30
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Zhang TT, Liu XM, Shi BY, Wang CJ, Mo ZH, Liu Y, Shan ZY, Yang WY, Li QM, Lyu XF, Yang JK, Xue YM, Zhu DL, Shi YQ, Huang Q, Zhou ZG, Wang Q, Ji QH, Li YB, Gao X, Lu JM, Zhang JQ, Guo XH. [ Efficacy and safety of Changsulin® compared with Lantus® in type 2 diabetes: a phase Ⅲ multicenter, randomized, open-label, parallel, controlled clinical trial]. Zhonghua Nei Ke Za Zhi 2020; 59:960-967. [PMID: 33256337 DOI: 10.3760/cma.j.cn112138-20200423-00417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objective: To compare the efficacy and safety of Changsulin® with Lantus® in treating patients with type 2 diabetes mellitus (T2DM). Methods: This was a phase Ⅲ, multicenter, randomized, open-label, parallel-group, active-controlled clinical trial. A total of 578 participants with T2DM inadequately controlled on oral hypoglycemic agents were randomized 3∶1 to Changsulin® or Lantus® treatment for 24 weeks. The efficacy measures included changes in glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2h postprandial plasma glucose (2hPG), 8-point self-monitoring of blood glucose (SMBG) profiles from baseline, and proportions of subjects achieving targets of HbA1c and FPG. The safety outcomes included rates of hypoglycemia, adverse events (AEs) and anti-insulin glargine antibody. Results: After 24 weeks of treatment, mean HbAlc decreased 1.16% and 1.25%, FPG decreased 3.05 mmol/L and 2.90 mmol/L, 2hPG decreased 2.49 mmol/L and 2.38 mmol/L in Changsulin® and in Lantus®, respectively. No significant differences could be viewed in above parameters between the two groups (all P>0.05). There were also no significant differences between Changsulin® and Lantus® in 8-point SMBG profiles from baseline and proportions of subjects achieving the targets of HbA1c and FPG (all P>0.05). The rates of total hypoglycemia (38.00% and 39.01% for Changsulin® and Lantus®, respectively) and nocturnal hypoglycemia (17.25% and 16.31% for Changsulin® and Lantus®, respectively) were similar between the two groups (all P>0.05). Most of the hypoglycemia events were asymptomatic, and no severe hypoglycemia were found in both groups. No differences were observed in rates of AEs (61.77% vs.52.48%) and anti-insulin glargine antibody (after 24 weeks of treatment, 6.91% vs.3.65%) between the two groups (all P>0.05). Conclusions: Changsulin® shows similar efficacy and safety profiles compared with Lantus® and Changsulin® treatment was well tolerated in patients with T2DM.
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Affiliation(s)
- T T Zhang
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
| | - X M Liu
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - B Y Shi
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, China
| | - C J Wang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Z H Mo
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Y Liu
- Department of Endocrinology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Z Y Shan
- Department of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - W Y Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Q M Li
- Department of Endocrinology, PLA Rocket Force General Hospital, Beijing 100088, China
| | - X F Lyu
- Department of Endocrinology, PLA Army General Hospital, Beijing 100700, China
| | - J K Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Y M Xue
- Department of Endocrinology, Nanfang Hospital of Nanfang Medical University, Guangzhou 510515, China
| | - D L Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Y Q Shi
- Department of Endocrinology, Shanghai Changzheng Hospital, Shanghai 200003, China
| | - Q Huang
- Department of Endocrinology, Shanghai Changhai Hospital, Shanghai 200433, China
| | - Z G Zhou
- Department of Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Q Wang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Q H Ji
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Y B Li
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - X Gao
- Department of Endocrinology, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - J M Lu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - J Q Zhang
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
| | - X H Guo
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
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Sun RJ, Ma J, Duan LZ, Zhu JY, Yu SC, Huang H, Zhang YL, Zhou GY, Wang CJ, Ba Y. [Threshold effects of body mass index on the bone mineral density of Chinese rural women in fluorosis area]. Zhonghua Yu Fang Yi Xue Za Zhi 2020; 54:1295-1299. [PMID: 33147932 DOI: 10.3760/cma.j.cn112150-20200825-01150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To explore the threshold effect of body mass index (BMI) on bone mineral density (BMD) in Chinese women living in the fluorosis area, we conducted a cross-sectional study and recruited 722 women in rural areas in Henan Province, China. After detection and analyses, we found that compared with the normal BMI group, the risk of osteoporosis in the overweight and obese groups were reduced by 32% and 69%, respectively. Threshold effect analysis showed that BMD was positively correlated with BMI when BMI was 16.8-31.2 kg/m2; while when BMI was greater than 31.2 kg/m2, the correlation reached saturation. The correlation observed between low-to-moderate fluoride exposure and BMD in rural women was not significant.
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Affiliation(s)
- R J Sun
- Department of Environmental Health, Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - J Ma
- Department of Endemic Diseases, Kaifeng Municipal Center for Disease Control and Prevention, Kaifeng 475000, China
| | - L Z Duan
- Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450001, China
| | - J Y Zhu
- Department of Environmental Health, Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - S C Yu
- Department of Nutrition and Food Hygiene, School of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - H Huang
- Department of Environmental Health, Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Y L Zhang
- Department of Environmental Health, Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - G Y Zhou
- Department of Environmental Health, Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - C J Wang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Y Ba
- Department of Environmental Health, Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou 450001, China
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Wang CJ, Zeng ZL, Zhang FS, Guo SG. Clinical features of adult anti-N-methyl-d-aspartate receptor encephalitis after Japanese encephalitis. J Neurol Sci 2020; 417:117080. [PMID: 32777576 DOI: 10.1016/j.jns.2020.117080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 07/16/2020] [Accepted: 07/31/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Chun-Juan Wang
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Zi-Ling Zeng
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Fu-Sheng Zhang
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Shou-Gang Guo
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong 250021, China.
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Abstract
When wars, major disasters, or epidemics of the infectious diseases occur, existing medical facilities are usually unable to implement timely and effective treatment for patients, or the reception capacity is difficult to meet the surge in demand for health care. The makeshift emergency hospitals are built for patient reception, treatment and even isolation for infectious disease control. The makeshift hospitals have developed and improved in modern times, including mobile field hospitals, field tent hospitals and navy hospital ships equipped with advanced equipment and commonly used for military purposes, or temporary hospitals built in large public buildings and newly built hospitals in support of disaster relief and humanitarian operation. Makeshift hospitals have played an important role in response to many disasters and epidemics globally. This paper briefly summarizes the history, types, and applications of makeshift hospitals in disasters and epidemic responses.
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Affiliation(s)
- J Lyu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - H X Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Y Chen
- Department of Emergency Response, Chinese PLA Center for Disease Control and Prevention, Beijing 100071, China
| | - C J Wang
- Department of Health Service, Chinese PLA Center for Disease Control and Prevention, Beijing 100071, China
| | - L M Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
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Chiang L, Wang CJ, Chiang TL. Determinants of child resilience in poverty: findings from the Taiwan Birth Cohort Study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Poverty has adverse effects on child health. While children in poverty face greater health challenges, some still achieve positive health outcomes. This is in part due to their resilience when facing adversity. Identifying the factors that foster child resilience can aid in developing strategies to promote child resilience and reduce the harmful effects of child poverty. This study aims to identify the biological and social factors of resilience among children in poverty from birth to age 12.
Methods
Data for the analysis came from the Taiwan Birth Cohort Study, a nationally representative sample of 17,354 children who completed six waves of interview surveys between 2005 and 2017. Our sample included 4,570 children who experienced poverty from birth to age 12. The primary outcome variable was child resilience, defined as impoverished children who maintained good health outcomes over the 12-year survey period. Multiple logistic regression was used to examine the factors of child resilience.
Results
Of the 4,570 children, 36.1% always had good health despite experiencing poverty before the age of 12. An easy temperament (OR = 2.5, 95% CI: 1.9-3.0), female (OR = 1.1, 95% CI: 1.0-1.3), a birth weight greater than 2,500 grams (OR = 1.6, 95% CI: 1.2-2.1), having a foreign-born mother (OR = 1.5, 95% CI: 1.2-1.7), receiving breast milk after birth (OR = 1.3, 95% CI: 1.1-1.5), and good parent-child interaction at 3 years of age (OR = 1.4, 95% CI: 1.2-1.7) were associated with child resilience. Early parent-child interactions can moderate the effect of children's birth weight on later resilience.
Conclusions
Our findings indicated the factors associated with child resilience in the context of poverty, suggesting that supporting breastfeeding and nurturing parent-child relationships are effective public health actions to foster child resilience. Future research is needed to unravel the underlying mechanisms of biological factors associated with child resilience.
Key messages
Breastfeeding after birth and high-quality parent-child interaction can lead to positive adaptations to child poverty. Children with difficult temperaments, boys and those born at low birthweight are more vulnerable to poverty and should be targeted for building resilience against poverty.
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Affiliation(s)
- L Chiang
- Center for Policy, Outcomes and Prevention, Stanford University, Stanford, USA
| | - C J Wang
- Center for Policy, Outcomes and Prevention, Stanford University, Stanford, USA
| | - T L Chiang
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
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Wang YJ, Li ZX, Gu HQ, Zhai Y, Jiang Y, Zhao XQ, Wang YL, Yang X, Wang CJ, Meng X, Li H, Liu LP, Jing J, Wu J, Xu AD, Dong Q, Wang D, Zhao JZ. China Stroke Statistics 2019: A Report From the National Center for Healthcare Quality Management in Neurological Diseases, China National Clinical Research Center for Neurological Diseases, the Chinese Stroke Association, National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention and Institute for Global Neuroscience and Stroke Collaborations. Stroke Vasc Neurol 2020; 5:211-239. [PMID: 32826385 PMCID: PMC7548521 DOI: 10.1136/svn-2020-000457] [Citation(s) in RCA: 270] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023] Open
Abstract
China faces the greatest challenge from stroke in the world. The death rate for cerebrovascular diseases in China was 149.49 per 100 000, accounting for 1.57 million deaths in 2018. It ranked third among the leading causes of death behind malignant tumours and heart disease. The age-standardised prevalence and incidence of stroke in 2013 were 1114.8 per 100 000 population and 246.8 per 100 000 person-years, respectively. According to the Global Burden of Disease Study 2017, the years of life lost (YLLs) per 100 000 population for stroke increased by 14.6%; YLLs due to stroke rose from third highest among all causes in 1990 to the highest in 2017. The absolute numbers and rates per 100 000 population for all-age disability-adjusted life years (DALYs) for stroke increased substantially between 1990 and 2017, and stroke was the leading cause of all-age DALYs in 2017. The main contributors to cerebrovascular diseases include behavioural risk factors (smoking and alcohol use) and pre-existing conditions (hypertension, diabetes mellitus, dyslipidaemia and atrial fibrillation (AF)). The most prevalent risk factors among stroke survivors were hypertension (63.0%-84.2%) and smoking (31.7%-47.6%). The least prevalent was AF (2.7%-7.4%). The prevalences for major risk factors for stroke are high and most have increased over time. Based on the latest national epidemiological data, 26.6% of adults aged ≥15 years (307.6 million adults) smoked tobacco products. For those aged ≥18 years, age-adjusted prevalence of hypertension was 25.2%; adjusted prevalence of hypercholesterolaemia was 5.8%; and the standardised prevalence of diabetes was 10.9%. For those aged ≥40 years, the standardised prevalence of AF was 2.31%. Data from the Hospital Quality Monitoring System showed that 3 010 204 inpatients with stroke were admitted to 1853 tertiary care hospitals during 2018. Of those, 2 466 785 (81.9%) were ischaemic strokes (ISs); 447 609 (14.9%) were intracerebral haemorrhages (ICHs); and 95 810 (3.2%) were subarachnoid haemorrhages (SAHs). The average age of patients admitted was 66 years old, and nearly 60% were male. A total of 1555 (0.1%), 2774 (0.6%) and 1347 (1.4%) paediatric strokes (age <18 years) were identified among IS, ICH and SAH, respectively. Over one-third (1 063 892 (35.3%)) of the patients were covered by urban resident basic medical insurance, followed by urban employee basic medical insurance (699 513 (23.2%)) and new rural cooperative medical schema (489 361 (16.3%)). The leading risk factor was hypertension (67.4% for IS, 77.2% for ICH and 49.1% for SAH), and the leading comorbidity was pneumonia or pulmonary infection (10.1% for IS, 31.4% for ICH and 25.2% for SAH). In-hospital death/discharge against medical advice rate was 8.3% for stroke inpatients, ranging from 5.8% for IS to 19.5% for ICH. The median and IQR of length of stay was 10.0 (7.0-14.0) days, ranging from 10.0 (7.0-13.0) in IS to 14.0 (8.0-22.0) in SAH. Data from the Chinese Stroke Center Alliance demonstrated that the composite scores of guideline-recommended key performance indicators for patients with IS, ICH and SAH were 0.77±0.21, 0.72±0.28 and 0.59±0.32, respectively.
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Affiliation(s)
- Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Zhai
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Jing
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Wu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - An-Ding Xu
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital,Fudan University, Shanghai, China
| | - David Wang
- Neurovascular Division, Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ji-Zong Zhao
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Wang M, Li ZX, Wang CJ, Yang X, Wang YJ. Abstract 331: Area Specific Differences for Quality of Care and Outcomes in Ischemic Stroke in China. Circ Cardiovasc Qual Outcomes 2020. [DOI: 10.1161/hcq.13.suppl_1.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Former studies suggest differences in stroke care associated with race, age or gender. We sought to find whether such disparities existed in different areas in patients hospitalized with stroke among hospitals participating in the China Stroke Center Association.
Methods:
In-hospital mortality and 4 stroke performance measures among 660,225 patients admitted with ischemic stroke in the Eastern, Central and Western regions of China in the China Stroke Center Association between 2015 and 2019.
Results:
After adjustment for both demographics and diseases history variables, western patients had lower odds relative of receiving intravenous thrombolysis (Eastern: OR, 1.78; 95%CI, 1.72 to 1.84; Central: OR, 1.55; 95%CI, 1.50 to 1.60), early antithrombotics (Eastern: OR, 1.95; 95%CI, 1.90 to 1.99; Central: OR, 1.86; 95%CI, 1.81 to 1.90), dysphagia screening (Eastern: OR, 1.03; 95%CI, 1.01 to 1.04; Central: OR, 0.83; 95%CI, 0.81 to 0.84) and NIHSS (Eastern: OR, 1.18; 95%CI, 1.16 to 1.20; Central: OR, 1.50; 95%CI, 1.48 to 1.53). However, the in-hospital death was higher in eastern and central regions (Eastern: OR, 0.48; 95%CI, 0.43 to 0.54; Central: OR, 0.51; 95%CI, 0.45 to 0.57).
Conclusions:
Western patients with stroke received fewer evidence-based care processes than central or eastern patients. Quality of care improvement in stroke should be focused on the west. The high mortality of the east and central probably resulted in that better hospitals in these areas received more severe patients substantially.
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Affiliation(s)
| | | | | | - Xin Yang
- Beijing Tian Hosp, Beijing, China
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Lv J, Li HX, Chen Y, Wang CJ, Li LM. [Development and applications of makeshift emergency hospitals]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41:E044. [PMID: 32312020 DOI: 10.3760/cma.j.cn 112338-20200403-00510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
When wars, major disasters, or epidemics of the infectious diseases occur, existing medical facilities are usually unable to implement timely and effective treatment for patients, or the reception capacity is difficult to meet the surge in demand for health care. The makeshift emergency hospitals are built for patient reception, treatment, and even isolation for infectious disease control. The makeshift hospitals have developed and improved in modern times, including mobile field hospitals, field tent hospitals, and navy hospital ships equipped with advanced equipment and commonly used for military purposes or in support of disaster relief and humanitarian operation, and temporary hospitals built in large public buildings, and newly built hospitals. Makeshift hospitals have played an important role in response to many disasters and epidemics globally. This paper briefly summarizes the history, types, and applications of makeshift hospitals in disaster and epidemic response.
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Affiliation(s)
- J Lv
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - H X Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Y Chen
- Department of Emergency Response, Chinese PLA Center for Disease Control and Prevention, Beijing 100071, China
| | - C J Wang
- Department of Health Service, Chinese PLA Center for Disease Control and Prevention, Beijing 100071, China
| | - L M Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
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Yang XM, Rao ZZ, Gu HQ, Zhao XQ, Wang CJ, Liu LP, Liu C, Wang YL, Li ZX, Xiao RP, Wang YJ. Atrial Fibrillation Known Before or Detected After Stroke Share Similar Risk of Ischemic Stroke Recurrence and Death. Stroke 2020; 50:1124-1129. [PMID: 31009353 DOI: 10.1161/strokeaha.118.024176] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background and Purpose- We aim to compare the risk of 1-year ischemic stroke recurrence and death for atrial fibrillation diagnosed after stroke (AFDAS), atrial fibrillation known before stroke (KAF), and sinus rhythm (SR). Methods- From June 2012 to January 2013, 19 604 patients with acute ischemic stroke were admitted to 219 urban hospitals in the China National Stroke Registry II. Based on heart rhythm assessed during admission, we classified patients as AFDAS, KAF, or SR. We explored the relationship between heart rhythm groups and 1-year ischemic stroke recurrence or death by using Cox regression adjusted for multiple covariates. Considering that death is a competing risk for stroke recurrence, we used the competing risks analysis of Fine and Gray and subdistribution Cox proportional hazards to test the association between heart rhythm and 1-year outcomes. Results- Among 19 604 ischemic stroke patients, 17 727 had SR, 495 AFDAS, and 1382 KAF. At 1 year, 54 (10.9%) patients with AFDAS, 182 (13.2%) with KAF, and 1008 (5.7%) with SR had recurrent ischemic strokes ( P<0.0001). Mortality was 22.0% in patients with AFDAS, 22.1% in patients with KAF, and 7.0% in patients with SR ( P<0.0001). AFDAS-related ischemic stroke recurrence adjusted risk was higher than that of SR (adjusted subdistribution hazard ratios, 1.61; 95% CI, 1.29-2.01) but not different from that of KAF (adjusted subdistribution hazard ratio, 1.12; 95% CI, 0.87-1.45]). The adjusted risk of 1-year death for AFDAS was also higher than that of SR (hazard ratio, 1.70; 95% CI, 1.37-2.12) and not different from that of KAF (hazard ratio, 1.10; 95% CI, 0.86-1.41). Conclusions- This study showed that AFDAS had similar risk of 1-year ischemic stroke recurrence and mortality when compared with KAF and higher risk when compared with SR. The potential risk of AFDAS should be given more emphasis, and appropriate treatment is needed to achieve reduction in the incidence of stroke recurrence and mortality.
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Affiliation(s)
- Xiao-Meng Yang
- From the Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.-M.Y., X.-Q.Z., Y.-L.W., Z.-X.L., Y.-J.W.)
| | - Zhen-Zhen Rao
- Institute of Molecular Medicine, Yingjie Center, Peking University, Beijing, China (Z.-Z.R., R.-P.X.)
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing (H.-Q.G., X.-Q.Z., C.-J.W., Y.-L.W., Z.-X.L., Y.-J.W.)
| | - Xing-Quan Zhao
- From the Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.-M.Y., X.-Q.Z., Y.-L.W., Z.-X.L., Y.-J.W.).,China National Clinical Research Center for Neurological Diseases, Beijing (H.-Q.G., X.-Q.Z., C.-J.W., Y.-L.W., Z.-X.L., Y.-J.W.).,Center of Stroke, Beijing Institute for Brain Disorders, China (X.-Q.Z., C.-J.W., Y.-L.W., Y.-J.W.)
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing (H.-Q.G., X.-Q.Z., C.-J.W., Y.-L.W., Z.-X.L., Y.-J.W.).,Center of Stroke, Beijing Institute for Brain Disorders, China (X.-Q.Z., C.-J.W., Y.-L.W., Y.-J.W.)
| | - Li-Ping Liu
- Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (L.-P.L.)
| | - Chelsea Liu
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (C.L.)
| | - Yi-Long Wang
- From the Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.-M.Y., X.-Q.Z., Y.-L.W., Z.-X.L., Y.-J.W.).,China National Clinical Research Center for Neurological Diseases, Beijing (H.-Q.G., X.-Q.Z., C.-J.W., Y.-L.W., Z.-X.L., Y.-J.W.).,Center of Stroke, Beijing Institute for Brain Disorders, China (X.-Q.Z., C.-J.W., Y.-L.W., Y.-J.W.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Y.-L.W., Y.-J.W.)
| | - Zi-Xiao Li
- From the Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.-M.Y., X.-Q.Z., Y.-L.W., Z.-X.L., Y.-J.W.).,China National Clinical Research Center for Neurological Diseases, Beijing (H.-Q.G., X.-Q.Z., C.-J.W., Y.-L.W., Z.-X.L., Y.-J.W.)
| | - Rui-Ping Xiao
- Institute of Molecular Medicine, Yingjie Center, Peking University, Beijing, China (Z.-Z.R., R.-P.X.)
| | - Yong-Jun Wang
- From the Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.-M.Y., X.-Q.Z., Y.-L.W., Z.-X.L., Y.-J.W.).,China National Clinical Research Center for Neurological Diseases, Beijing (H.-Q.G., X.-Q.Z., C.-J.W., Y.-L.W., Z.-X.L., Y.-J.W.).,Center of Stroke, Beijing Institute for Brain Disorders, China (X.-Q.Z., C.-J.W., Y.-L.W., Y.-J.W.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Y.-L.W., Y.-J.W.)
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Gu HQ, Rao ZZ, Yang X, Wang CJ, Zhao XQ, Wang YL, Liu LP, Wang CY, Liu C, Li H, Li ZX, Xiao RP, Wang YJ. Use of Emergency Medical Services and Timely Treatment Among Ischemic Stroke. Stroke 2020; 50:1013-1016. [PMID: 30841820 DOI: 10.1161/strokeaha.118.024232] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Emergency medical services (EMSs) are critical for early treatment of patients with ischemic stroke, yet data on EMS utilization and its association with timely treatment in China are still limited. Methods- We examined data from the Chinese Stroke Center Alliance for patients with ischemic stroke from June 2015 to June 2018. Absolute standardized difference was used for covariates' balance assessments. We used multivariable logistic models with the generalized estimating equations to account for intrahospital clustering in identifying demographic and clinical factors associated with EMS use as well as in evaluating the association of EMS use with timely treatment. Results- Of the 560 447 patients with ischemic stroke analyzed, only 69 841 (12.5%) were transported by EMS. Multivariable-adjusted results indicated that those with younger age, lower levels of education, less insurance coverage, lower income, lower stroke severity, hypertension, diabetes mellitus, and peripheral vascular disease were less likely to use EMS. However, a history of cardiovascular diseases was associated with increased EMS usage. Compared with self-transport, EMS transport was associated with significantly shorter onset-to-door time, door-to-needle time (if prenotification was sent), earlier arrival (adjusted odds ratio [95% CIs] were 2.07 [1.95-2.20] for onset-to-door time ≤2 hours, 2.32 [2.18-2.47] for onset-to-door time ≤3.5 hours), and more rapid treatment (2.96 [2.88-3.05] for IV-tPA [intravenous recombinant tissue-type plasminogen activator] in eligible patients, 1.70 [1.62-1.77] for treatment with IV-tPA by 3 hours if onset-to-door time ≤2 hours, and 1.76 [1.70-1.83] for treatment with IV-tPA by 4.5 hours if onset-to-door time ≤3.5 hours). Conclusions- Although EMS transportation is associated with substantial reductions in prehospital delay and improved likelihood of early arrival and timely treatment, rate of utilization is currently low among Chinese patients with ischemic stroke. Developing an efficient EMS system and promoting culture-adapted education efforts are necessary for improving EMS activation.
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Affiliation(s)
- Hong-Qiu Gu
- From the China National Clinical Research Center for Neurological Diseases (H.-Q.G., X.Y., C.-J.W., Y.-L.W., C.-Y.W., H.L., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.,National Center for Healthcare Quality Management in Neurological Diseases (H.-Q.G., X.Y., C.-J.W., C.-Y.W., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Zhen-Zhen Rao
- Institute of Molecular Medicine, Yingjie Center, Peking University, Beijing, China (Z.-Z.R., R.-P.X.)
| | - Xin Yang
- From the China National Clinical Research Center for Neurological Diseases (H.-Q.G., X.Y., C.-J.W., Y.-L.W., C.-Y.W., H.L., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.,National Center for Healthcare Quality Management in Neurological Diseases (H.-Q.G., X.Y., C.-J.W., C.-Y.W., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Chun-Juan Wang
- From the China National Clinical Research Center for Neurological Diseases (H.-Q.G., X.Y., C.-J.W., Y.-L.W., C.-Y.W., H.L., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.,Vascular Neurology, Department of Neurology (C.-J.W., X.-Q.Z., Y.-L.W., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.,National Center for Healthcare Quality Management in Neurological Diseases (H.-Q.G., X.Y., C.-J.W., C.-Y.W., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (C.-J.W., Y.-L.W., Y.-J.W.).,Center for Stroke, Beijing Institute for Brain Disorders, China (C.-J.W., X.-Q.Z., Y.-L.W., Z.-X.L., Y.-J.W.)
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology (C.-J.W., X.-Q.Z., Y.-L.W., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.,Center for Stroke, Beijing Institute for Brain Disorders, China (C.-J.W., X.-Q.Z., Y.-L.W., Z.-X.L., Y.-J.W.)
| | - Yi-Long Wang
- From the China National Clinical Research Center for Neurological Diseases (H.-Q.G., X.Y., C.-J.W., Y.-L.W., C.-Y.W., H.L., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.,Vascular Neurology, Department of Neurology (C.-J.W., X.-Q.Z., Y.-L.W., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (C.-J.W., Y.-L.W., Y.-J.W.).,Center for Stroke, Beijing Institute for Brain Disorders, China (C.-J.W., X.-Q.Z., Y.-L.W., Z.-X.L., Y.-J.W.)
| | - Li-Ping Liu
- Neuro-Intensive Care Unit, Department of Neurology (L.-P.L.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Cai-Yun Wang
- From the China National Clinical Research Center for Neurological Diseases (H.-Q.G., X.Y., C.-J.W., Y.-L.W., C.-Y.W., H.L., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.,National Center for Healthcare Quality Management in Neurological Diseases (H.-Q.G., X.Y., C.-J.W., C.-Y.W., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Chelsea Liu
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (C.L.)
| | - Hao Li
- From the China National Clinical Research Center for Neurological Diseases (H.-Q.G., X.Y., C.-J.W., Y.-L.W., C.-Y.W., H.L., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Zi-Xiao Li
- From the China National Clinical Research Center for Neurological Diseases (H.-Q.G., X.Y., C.-J.W., Y.-L.W., C.-Y.W., H.L., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.,Vascular Neurology, Department of Neurology (C.-J.W., X.-Q.Z., Y.-L.W., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.,National Center for Healthcare Quality Management in Neurological Diseases (H.-Q.G., X.Y., C.-J.W., C.-Y.W., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.,Center for Stroke, Beijing Institute for Brain Disorders, China (C.-J.W., X.-Q.Z., Y.-L.W., Z.-X.L., Y.-J.W.)
| | - Rui-Ping Xiao
- Institute of Molecular Medicine, Yingjie Center, Peking University, Beijing, China (Z.-Z.R., R.-P.X.)
| | - Yong-Jun Wang
- From the China National Clinical Research Center for Neurological Diseases (H.-Q.G., X.Y., C.-J.W., Y.-L.W., C.-Y.W., H.L., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.,Vascular Neurology, Department of Neurology (C.-J.W., X.-Q.Z., Y.-L.W., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.,National Center for Healthcare Quality Management in Neurological Diseases (H.-Q.G., X.Y., C.-J.W., C.-Y.W., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (C.-J.W., Y.-L.W., Y.-J.W.).,Center for Stroke, Beijing Institute for Brain Disorders, China (C.-J.W., X.-Q.Z., Y.-L.W., Z.-X.L., Y.-J.W.)
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Wang M, Qu LJ, Wang J, Chen TP, Li Y, Xu Z, Cheng J, Wang CJ, Gao S, Lu YJ. [A novel mutation of the LYST gene in a Chinese family with Chediak-Higashi syndrome]. Zhonghua Er Ke Za Zhi 2019; 57:963-965. [PMID: 31795567 DOI: 10.3760/cma.j.issn.0578-1310.2019.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- M Wang
- Department of Hematology, Anhui Provincial Children's Hospital, Hefei 230001, China
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Meng XH, Wang CJ, Wang C, Wang R, Ming Y, Zheng LL. [Three-dimensional finite element analysis on en-mass retraction of anterior teeth with clear aligner]. Zhonghua Kou Qiang Yi Xue Za Zhi 2019; 54:753-759. [PMID: 31683382 DOI: 10.3760/cma.j.issn.1002-0098.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the mechanical effects during en-mass retraction of maxillary anterior teeth with clear aligner using three-dimensional finite element method. Methods: Cone-beam CT (CBCT) was used to scan a female orthodontic patient (26 years old, from Department of Orthodontics, Stomatological Hospital of Chongqing Medical University) whose maxillary first premolars were extracted and maxillary dentition had been aligned and leveled. A finite element model including maxillary teeth-periodontal ligament (PDL)-alveolar bone-clear aligner was established by using Mimics 17.0, SolidWorks 2016 and Geomagic Studio 2015 software packages. The process of 0.2 mm en-mass retraction of anterior teeth using clear aligner was simulated by using non-linear contact method of Abaqus 6.14. The trend and displacement of maxillary teeth, the stress distribution of PDL and alveolar fossae, and the deformation trend of clear aligner were obtained and analyzed. Results: Under the experimental condition, lingual crown tipping and distal tipping movement of anterior teeth were observed, and all of them had the tendency of overbite increasing.The maximum displacement of the central incisor, lateral incisor and canine were 25.16, 50.34 and 24.98 μm, respectively. Meanwhile, the second premolar, first molar and second molar had the tendency of mesial tipping movement, and the maximum displacement of them were 33.04, 2.90 and 16.63 μm, respectively. The stress distribution both at the PDL and alveolar fossae were consistent with tooth movement pattern. It was noted that the stress in the PDL of the canine and second premolar were comparatively big, and the corresponding apical areas of alveolar fossae appeared stress concentration. Concurrently, it was found that the clear aligner showed stress concentration at the junction of adjacent teeth with a tendency of crown directional dislocation. Conclusions: During en-mass retraction of anterior teeth with clear aligner, attention should be paid to the overbite and torque in anterior teeth, and the anchorage protection of posterior teeth. At the same time, we should be careful of root resorption of the teeth on both sides of the extraction space.
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Affiliation(s)
- X H Meng
- Department of Orthodontics, Stomatological Hospital of Chongqing Medical University & Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences & Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
| | - C J Wang
- Department of Orthodontics, Stomatological Hospital of Chongqing Medical University & Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences & Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
| | - C Wang
- Department of Orthodontics, Stomatological Hospital of Chongqing Medical University & Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences & Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
| | - R Wang
- Department of Orthodontics, Stomatological Hospital of Chongqing Medical University & Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences & Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
| | - Y Ming
- Department of Orthodontics, Stomatological Hospital of Chongqing Medical University & Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences & Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
| | - L L Zheng
- Department of Orthodontics, Stomatological Hospital of Chongqing Medical University & Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences & Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
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Weng C, Chen LH, Chao AS, Wang CJ. 2363 Laparoscopic Management of Heterotopic Cornual Pregnancy - Tips & Tricks. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wang CJ, Huang XJ, Gong LZ, Jia JS, Liu XH, Wang Y, Yan CH, Chang YJ, Zhao XS, Shi HX, Lai YY, Jiang H. [Observation on the efficacy of consolidation chemotherapy combined with allogeneic natural killer cell infusion in the treatment of low and moderate risk acute myeloid leukemia]. Zhonghua Xue Ye Xue Za Zhi 2019; 40:812-817. [PMID: 31775478 PMCID: PMC7364980 DOI: 10.3760/cma.j.issn.0253-2727.2019.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Indexed: 01/10/2023]
Abstract
Objective: To evaluate the efficacy of consolidation chemotherapy combined with allogeneic natural killer (NK) cell infusion in the treatment of low or intermediate-risk (LIR) acute myeloid leukemia (AML) . Methods: A cohort of 23 LIR AML patients at hematologic complete remission (CR) received NK cell transfusion combined with consolidation chemotherapy after 3 consolidation courses from January 2014 to June 2019 were reviewed. Control group cases were concurrent patients from Department of Hematology, and their gender, age, diagnosis, risk stratification of prognosis, CR and the number of courses of consolidate chemotherapy before NK cell transfusion were matched with LIR AML patients. Results: A total of 45 times of NK cells were injected into 23 LIR AML patients during 4 to 7 courses of chemotherapy. The median NK cell infusion quantity was 7.5 (6.6-8.6) ×10(9)/L, and the median survival rate of NK cells was 95.4% (93.9%-96.9%) . Among them, the median CD3(-)CD56(+) cell number was 5.0 (1.4-6.4) ×10(9)/L, accounting for 76.8% (30.8%-82.9%) ; The number of CD3(+) CD56(+) cells was 0.55 (0.24-1.74) ×10(9)/L, accounting for 8.8% (4.9%-20.9%) . Before NK cell infusion, the number of patients with positive MRD in the treatment and control groups were 9/23 (39.1%) and 19/46 (41.3%) (χ(2)=0.030, P=0.862) respectively. After NK infusion, There was no significant difference in terms of MRD that went from negative to positive between the treatment and the control groups (14.3% vs 22.2%, χ(2)=0.037, P=0.847) . In the treatment group, 66.7% (6/9) of the MRD were converted from positive to negative, which was significantly higher than that in the control group (10.5%, 2/19) (χ(2)=6.811, P=0.009) . Morphological recurrence occurred in 1 case of MRD negative in the treatment group and 2 cases of MRD positive in the control group. By the end of follow-up, the median follow-up was 35 (10-59) months, the number of patients with morphological recurrence in the treatment group was 30.4% (7/23) , which was significantly lower than that in the control group (50.2%, 24/46) (χ(2)=2.929, P=0.087) , although there was no statistically significant difference between the two groups. There was no significant difference on MRD-negative between the treatment and the control groups (43.5% vs 43.5%, χ(2)=1.045, P=0.307) . The 3-year leukemia-free survival was better in the treatment group [ (65.1±11.1) %] than that in the control group [ (50.0±7.4) %] (P=0.047) . The 3-year overall survival in the treatment and control groups were (78.1±10.2) % and (65.8±8.0) % (P=0.212) , respectively. Conclusion: The consolidation of chemotherapy combined with allogeneic NK cell infusion contributed to the further remission of patients with LMR AML and the reduction of long-term recurrence.
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Affiliation(s)
- C J Wang
- Beijing University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China (Wang Chunjian is working on the Peking University International Hospital, Beijing 102206, China)
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Rao ZZ, Gu HQ, Wang XW, Xie XW, Yang X, Wang CJ, Zhao X, Xian Y, Wang YL, Li ZX, Xiao RP, Wang YJ. Renal Dysfunction and In-Hospital Outcomes in Patients With Acute Ischemic Stroke After Intravenous Thrombolytic Therapy. J Am Heart Assoc 2019; 8:e012052. [PMID: 31595836 PMCID: PMC6818031 DOI: 10.1161/jaha.119.012052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background The impact of estimated glomerular filtration rate (eGFR) on clinical short‐term outcomes after stroke thrombolysis with tissue plasminogen activator remains controversial. Methods and Results We analyzed 18 320 ischemic stroke patients who received intravenous tissue plasminogen activator at participating hospitals in the Chinese Stroke Center Alliance between June 2015 and November 2017. Multivariate logistic regression models were used to evaluate associations between eGFR (<45, 45–59, 60–89, and ≥90 mL/min per 1.73 m2) and in‐hospital mortality and symptomatic intracerebral hemorrhage, adjusting for patient and hospital characteristics and the hospital clustering effect. Of the 18 320 patients receiving tissue plasminogen activator, 601 (3.3%) had an eGFR <45, 625 (3.4%) had an eGFR 45 to 59, 3679 (20.1%) had an eGFR 60 to 89, and 13 415 (73.2%) had an eGFR ≥90. As compared with eGFR ≥90, eGFR values <45 (6.7% versus 0.9%, adjusted odds ratio, 3.59; 95% CI, 2.18–5.91), 45 to 59 (4.0% versus 0.9%, adjusted odds ratio, 2.00; 95% CI, 1.18–3.38), and 60 to 89 (2.5% versus 0.9%, adjusted odds ratio, 1.67; 95% CI, 1.20–2.34) were independently associated with increased odds of in‐hospital mortality. However, there was no statistically significant association between eGFR and symptomatic intracerebral hemorrhage. Conclusions eGFR was associated with an increased risk of in‐hospital mortality in acute ischemic stroke patients after treatment with tissue plasminogen activator. eGFR is an important predictor of poststroke short‐term death but not of symptomatic intracerebral hemorrhage.
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Affiliation(s)
- Zhen-Zhen Rao
- Institute of Molecular Medicine, Yingjie Center Peking University Beijing China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases Beijing China.,National Center for Healthcare Quality Management in Neurological Diseases Beijing China
| | - Xian-Wei Wang
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Xue-Wei Xie
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases Beijing China.,National Center for Healthcare Quality Management in Neurological Diseases Beijing China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases Beijing China.,National Center for Healthcare Quality Management in Neurological Diseases Beijing China.,Vascular Neurology Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China.,Center for Stroke Beijing Institute for Brain Disorders Beijing China
| | - Xingquan Zhao
- China National Clinical Research Center for Neurological Diseases Beijing China.,National Center for Healthcare Quality Management in Neurological Diseases Beijing China.,Vascular Neurology Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - Ying Xian
- Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Yi-Long Wang
- China National Clinical Research Center for Neurological Diseases Beijing China.,Vascular Neurology Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China.,Center for Stroke Beijing Institute for Brain Disorders Beijing China
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases Beijing China.,National Center for Healthcare Quality Management in Neurological Diseases Beijing China.,Vascular Neurology Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China.,Center for Stroke Beijing Institute for Brain Disorders Beijing China
| | - Rui-Ping Xiao
- Institute of Molecular Medicine, Yingjie Center Peking University Beijing China
| | - Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases Beijing China.,National Center for Healthcare Quality Management in Neurological Diseases Beijing China.,Vascular Neurology Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China.,Center for Stroke Beijing Institute for Brain Disorders Beijing China
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Gu HQ, Yang X, Rao ZZ, Wang CJ, Zhao XQ, Wang YL, Liu LP, Liu C, Li H, Li ZX, Wang YJ. Disparities in outcomes associated with rural-urban insurance status in China among inpatient women with stroke: a registry-based cohort study. Ann Transl Med 2019; 7:426. [PMID: 31700862 DOI: 10.21037/atm.2019.08.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Despite a few studies have demonstrated sex differences in stroke care and outcomes, limited research has explored insurance-related disparities in outcomes, particularly among women stroke patients. The aim was to determine whether rural-urban health insurance status affect the stroke treatment, process of care, and 1-year clinical outcomes for inpatient ischemic stroke in women. Methods Women patients with acute ischemic stroke (AIS) covered by New Rural Cooperative Medical Scheme (NRCMS) and urban resident/employee-based basic medical insurance scheme (URBMI/UEBMI) were abstracted from the China National Stroke Registry II (CNSR II). Shared frailty model in the Cox model or generalized estimating equation with consideration of the hospital's cluster effect were used to assess the associations between rural-urban insurance status and quality of care during hospitalization and 1-year stroke outcomes including all-cause death, 1-year recurrence, and 1-year disability. Results A total of 5,707 women patients enrolled from 219 hospitals in CNSR II were analyzed. Compared with 2,880 women patients covered by URBMI/UEBMI, 2,827 women patients covered by NRCMS were younger (65.7 versus 68.9 years), less likely to have vascular risk factors, awareness and treatment of hypertension and dyslipidemia prior to stroke. Women covered by NRCMS were more likely to receive early antithrombotics, discharge antithrombotics, lipid-lowering drugs, but less likely to receive antihypertensive medication than those covered by URBMI/UEBMI. One-year all-cause mortality and stroke recurrence were both significantly higher in women patients with NRCMS than those with URBMI/UEBMI [adjusted hazard ratio (95% confidence interval): 1.40 (1.06-1.84) and 1.38 (1.04-1.83), separately]. Conclusions AIS women patients with rural-urban insurance status demonstrated remarkable differences in age, stroke risk factors, awareness and treatment, the process of care, and 1-year stroke recurrence and mortality. Healthcare policymakers need to focus their attention on these disparities and take proper steps to improve primary healthcare service in rural areas.
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Affiliation(s)
- Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Zhen-Zhen Rao
- Institute of Molecular Medicine, Yingjie Center, Peking University, Beijing 100871, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing 100053, China.,Center for Stroke, Beijing Institute for Brain Disorders, Beijing 100068, China
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,Center for Stroke, Beijing Institute for Brain Disorders, Beijing 100068, China
| | - Yi-Long Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing 100053, China.,Center for Stroke, Beijing Institute for Brain Disorders, Beijing 100068, China
| | - Li-Ping Liu
- Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Chelsea Liu
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,Center for Stroke, Beijing Institute for Brain Disorders, Beijing 100068, China
| | - Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing 100053, China.,Center for Stroke, Beijing Institute for Brain Disorders, Beijing 100068, China
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Lin Y, Xu Y, Zhang XH, Wang CJ, Sun Q. [Comparative analysis of the correlation between axillary treatment and upper limb lymphedema]. Zhonghua Wai Ke Za Zhi 2019; 57:713-716. [PMID: 31474063 DOI: 10.3760/cma.j.issn.0529-5815.2019.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the surgical treatment of breast cancer, "de-escalating" is becoming more popular, especially in the treatment of axilla. Axillary sentinel lymph node biopsy has become a routine treatment for axillary-negative breast cancer patients because it can effectively reduce the occurrence of upper limb lymphedema, so that some patients with sentinel lymph node negative can be exempted from axillary lymph node dissection. However, in recent years, several international clinical studies, such as AMAROS trial, explored the use of radiotherapy instead of dissection when 1 to 2 sentinel lymph nodes were positive. The results showed that radiotherapy can reduce the incidence of upper limb edema by nearly 50% compared with dissection. How to interpret the results of such non-inferiority studies, and how to treat the impact of axillary dissection and axillary radiotherapy on the occurrence of lymphedema? Based on the review of literature in recent 10 years, the incidence and hazard ratio of edema related to the two axillary treatments were compared. The conclusion is the hazard ratios are close to each other, around 3 for both arms. The results of clinical studies such as radiotherapy instead of axillary dissection need to be carefully interpreted. At the same time, axillary dissection is still suitable for some patients at current stage, and the corresponding prevention of upper limb lymphedema still needs attention.
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Affiliation(s)
- Y Lin
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Affiliation(s)
- P H Deng
- Department of Dermatology, Keck School of Medicine of USC, Los Angeles, CA, U.S.A
| | - C J Wang
- Department of Dermatology, Keck School of Medicine of USC, Los Angeles, CA, U.S.A
| | - A W Armstrong
- Department of Dermatology, Keck School of Medicine of USC, Los Angeles, CA, U.S.A
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van Galen LS, Wang CJ, Nanayakkara PWB, Paranjape K, Kramer MHH, Car J. Telehealth requires expansion of physicians' communication competencies training. Med Teach 2019; 41:714-715. [PMID: 29944031 DOI: 10.1080/0142159x.2018.1481284] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We are in the midst of transformation of health systems where remote consulting (via video, telephone, email, and mobile messaging) is soon to become the dominant mode of consultation. Most of the literature on telehealth omits mentioning the need for telehealth communication competencies. Yet evidence base has been growing about how critical this training is - whether from clinical communication research or litigation claims analysis. In this article, we are calling for an urgent expansion of communication skills curricula to encompass these new telehealth domains from medical schools, specialty trainings to CMEs.
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Affiliation(s)
- L S van Galen
- a Centre for Population Health Sciences, Lee Kong Chian School of Medicine , Nanyang Technological University , Singapore
- b Department of Internal Medicine, Section of Acute Medicine , VU University Medical Centre , Amsterdam , The Netherlands
| | - C J Wang
- c Centre of Policy, Outcomes and Prevention, and Division of General Paediatrics , Stanford University , Stanford , CA , USA
| | - P W B Nanayakkara
- b Department of Internal Medicine, Section of Acute Medicine , VU University Medical Centre , Amsterdam , The Netherlands
| | | | - M H H Kramer
- b Department of Internal Medicine, Section of Acute Medicine , VU University Medical Centre , Amsterdam , The Netherlands
| | - J Car
- a Centre for Population Health Sciences, Lee Kong Chian School of Medicine , Nanyang Technological University , Singapore
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Wang YS, Zhao RR, Liu YB, Chen P, Zhao T, Sun X, Wang CJ, Zhang ZP, Shi ZQ, Qiu PF. [Discussion on the indications of internal mammary sentinel lymph node biopsy in breast cancer in the era of precision medicine]. Zhonghua Zhong Liu Za Zhi 2019; 41:251-256. [PMID: 31014049 DOI: 10.3760/cma.j.issn.0253-3766.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To determine the clinical benefits of internal mammary sentinel lymph node biopsy (IM-SLNB) acquired by breast cancer patients with clinically positive axillary lymph node (ALN), and further optimize the IM-SLNB indications. Methods: All primary breast cancer patients with clinically positive ALN from February 2014 to September 2017 were prospectively recruited in this study. IM-SLNB was performed under the guidance of the modified injection technique. The success rate and visualization rate of IM-SLNB, metastatic rate of internal mammary sentinel lymph node (IMSLN) and its related factors were analyzed, and the clinical benefits were accessed according to the current guidelines. Results: Among 126 patients, all of 94 patients (74.6%) who showed internal mammary drainage successfully underwent IM-SLNB. The incidence of internal mammary artery bleeding and pleural lesion were 4.3%(4/94) and 9.6%(9/94), respectively. The metastatic rate of IMSLN was 38.3% (36/94), which was significantly associated with the number of positive ALN (P<0.001) and tumor size (P=0.024). The lymph node staging of 94 patients who underwent IM-SLNB was more accurate. Among them, 36 cases with positive IMSLN underwent internal mammary radiotherapy (IMRT), while the other 58 cases with negative IMSLN avoided radiotherapy. Conclusions: IM-SLNB should be routinely performed in patients with positive ALN. IM-SLNB can provide more accurate staging and guide tailored IMRT to benefit more breast cancer patients.
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Affiliation(s)
- Y S Wang
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China
| | - R R Zhao
- Department of Medicine, Shandong Cancer Hospital and Institute, Jinan 250117, China
| | - Y B Liu
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China
| | - P Chen
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China
| | - T Zhao
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China
| | - X Sun
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China
| | - C J Wang
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China
| | - Z P Zhang
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China
| | - Z Q Shi
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China
| | - P F Qiu
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China
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Zhou C, Wang CJ. [Advances in the role of exosome-derived long non-coding RNAs in hepatocellular carcinoma]. Zhonghua Gan Zang Bing Za Zhi 2019; 27:77-81. [PMID: 30685932 DOI: 10.3760/cma.j.issn.1007-3418.2019.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Exosomes are one kind of microvesicles secreted by living cells. It contains some small non-coding RNAs (microRNA, lncRNA, circRNA, etc.) which play an important role in signal transduction. In addition, they transfer information through circulating small vesicles, regulate epithelial-mesenchymal transition, tumor microenvironment, promote microangiogenesis, regulate tumor immunity, chemoradiation resistance, and regulate cellular energy metabolism pathways, thereby promoting the occurrence, development and metastasis of hepatocellular carcinoma. This article reviews the mechanism of lncRNA in exogenous and in vivo in relation to the occurrence, development and metastasis of hepatocellular carcinoma.
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Affiliation(s)
- C Zhou
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - C J Wang
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatric Institute, Guangzhou 510080, China
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