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Hou X, Luo W, Wu L, Chen Y, Li G, Zhang R, Zhang H, Wu J, Sun Y, Xu L, Xu P, Yu Y, Huang D, Hao C, Sun B. Associations of Four sensitization patterns revealed by Latent Class Analysis with Clinical symptoms: A multi-center study of China. EClinicalMedicine 2022; 46:101349. [PMID: 35330802 PMCID: PMC8938883 DOI: 10.1016/j.eclinm.2022.101349] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Because of the significant regional differences in the distribution of allergens, the relationship between anaphylaxis and allergic sensitization is complex in China. Using this large-scale epidemiologic survey, we explore the potential patterns of sensitization to common allergens in mainland China and investigate their relationship with various clinical symptoms. METHOD The participants were recruited from 13 medical centers in mainland China from October 2019 to June 2021. Skin prick test (SPT) results that cover 18 common allergens were utilized to diagnose atopic sensitization. The demographic characteristics and clinical information were collected through questionnaires during routine medical follow-up. Latent class analysis (LCA) was conducted to determine the optimal sensitization patterns. The logistic regression was used to assess the associations of different sensitization patterns with allergy symptoms. FINDINGS A total of 1089 patients who had a positive SPT to at least one of 18 allergens were included for formal analysis. An optimal LCA model with 4 classes was obtained in this study, and the corresponding labels were as follows: Class1, house dust mite sensitization; Class2, low pollen sensitization; Class3, middle pollen sensitization; Class4, high pollen sensitization. The prevalence of different classes varied widely in geographical distribution, which was characterized by Class1 being very common in south and east as well as Class2 in north and west of China. Compared with patients in Class1, those in middle and high pollen sensitization clusters had the higher odds ratios (ORs) of allergic rhinitis and allergic conjunctivitis when controlling for other confounders. However, there was no significant difference between low pollen sensitization and house dust mite sensitization groups in the risks for various clinical performances except dermatitis. Additionally, the adjusted ORs (95% confidence interval) of allergic conjunctivitis and dermatitis for participants in pollen sensitization clusters (Class2, 3 and 4) were 1.56 (1.18, 2.06) and 1.43 (1.09, 1.88) respectively compared with those in Class1. INTERPRETATION In this study, we identified four sensitization clusters with specific risks of various clinical symptoms using common allergens by adopting LCA. Our findings may contribute to improved diagnosis and potential immunotherapy approaches to allergy in mainland China. FUNDING This study was supported by the National Natural Science Foundation of China (81802076 and 81871736), the Guangzhou Science and Technology Foundation (202102010327), the Foundation of SKLRD (MS-2019-06 and Z-2022-09), and the Foundation of GYYY (ZH201904) and ZNSA-2020012.
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Key Words
- 95% CI, 95% confidence interval
- AIC, Akaike Information Criterion
- AR, allergic rhinitis
- AS, asthma
- BIC, Bayesian Information Criterion
- CAIC, the “consistent AIC”
- CRD, component-resolved diagnosis
- IgE, Immunoglobulin E
- LCA, latent class analysis
- SPT, skin prick test
- SSA-BIC, the adjusted BIC using Rissanen's sample size adjustment
- clinical symptoms
- latent class analysis
- sIgE, specific IgE
- sensitization patterns
- skin prick test
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Affiliation(s)
- Xiangqing Hou
- Faculty of Health Sciences, University of Macau 999078, Macau, China
| | - Wenting Luo
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, Guangdong, China
| | - Liting Wu
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, Guangdong, China
| | - Yuemin Chen
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, Guangdong, China
| | - Guoping Li
- Department of Pulmonary and Critical Care Medicine, Laboratory of Allergy and Precision Medicine, Chengdu Institute of Respiratory Health, the Third People's Hospital of Chengdu, Branch of National Clinical, 610000, Chengdu, China
| | - Rongfang Zhang
- Department of Pediatrics, Gansu Provincial Maternity and Child Care Hospital 730400, Gansu, China
| | - Hong Zhang
- Department of Pediatrics, Gansu Provincial Hospital 730400, Gansu, China
| | - Jing Wu
- Department of Allergy and Clinical Immunology, Inner Mongolia Cancer Hospital 021000, Inner Mongolia, China
| | - Yun Sun
- Department of Pediatrics, Yinchuan Maternal and Child Health Care Hospital 750001, Yinchuan, China
| | - Lina Xu
- Department of Respirology, Children's Hospital, Soochow University 215025, Suzhou, China
| | - Peiru Xu
- Department of Pediatrics, First Affiliated Hospital of Xinjiang Medical University 830000, China
| | - Yongmei Yu
- Department of Pediatrics, First Affiliated Hospital of Kunming Medical University 650000, Kunming, China
| | - Dongming Huang
- Department of Pediatrics, Bo'ai Hospital of Zhongshan City 511462, Zhongshan, China
| | - Chuangli Hao
- Department of Respirology, Children's Hospital, Soochow University 215025, Suzhou, China
- Chuangli Hao, Department of Respirology, Children's Hospital, Soochow University, Suzhou 215025, Jiangsu, China. Tel: +86-51280693588; Fax: +86-512-80696309.
| | - Baoqing Sun
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, Guangdong, China
- Corresponding author: Baoqing Sun, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou 510120, Guangdong, China. Tel: +86 20 8306 2865; Fax: +86 20 8306 2729.
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Riberholt CG, Gluud C, Jakobsen JC, Ovesen C, Mehlsen J, Møller K. Statistical analysis plan: Early mobilization by head-up tilt with stepping versus standard care after severe traumatic brain injury. Contemp Clin Trials Commun 2021; 24:100856. [PMID: 34877432 DOI: 10.1016/j.conctc.2021.100856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 09/12/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022] Open
Abstract
Background Early mobilization on a tilt table with stepping versus standard care may be beneficial for patients with severe brain injury, but data from randomized clinical trials are lacking. This detailed statistical analysis plan describes the analyses of data collected in a randomized clinical feasibility trial for early mobilization by head-up tilt with stepping versus standard care after severe traumatic brain injury. Methods Primary feasibility outcomes are the proportion of included participants who were randomized out of all screened patients; the proportion of participants allocated to the experimental intervention who received at least 60% of the planned exercise sessions; and safety outcomes such as adverse events and reactions and serious adverse events and reactions. Exploratory clinical outcomes are suspected unexpected serious adverse reactions; and functional outcomes as assessed by the Coma Recovery Scale-Revised at four weeks; Early Functional Ability Scale and Functional Independence Measure at three months. The description includes the statistical analysis plan, including the use of multiple imputations and Trial Sequential Analysis.
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Key Words
- 95% CI, 95% confidence interval
- AE, adverse event
- AR, adverse reaction
- CG, Control group
- CRS-R, Coma Recovery Scale-Revised
- EFA, Early Functional Ability
- EOE, Early orthostatic exercise
- Early mobilization
- FIM, Functional Independence Measure
- GCS, Glasgow coma scale
- ICU, Intensive care unit
- SAE, serious adverse event
- SAR, serious adverse reaction
- SD, standard deviation
- SUSAR, suspected unexpected adverse reaction
- Statistical analysis plan
- Traumatic brain injury
- Trial sequential analysis
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Chen CH, Wu MS, Yang YW, Liu YT, Chiu YF, Hsu CC, Chuang SC, Chung TC, Tsai TL, Huang WH, Huang WL, Juan CC, Lien LM, Hsiung CA, Wu IC. Longitudinal changes in physical and mental health of older adults with chronic hepatitis B infection: Trajectories and predictors. Prev Med Rep 2021; 23:101432. [PMID: 34150482 PMCID: PMC8193133 DOI: 10.1016/j.pmedr.2021.101432] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/14/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
Despite the increasing health burden of chronic hepatitis B (CHB) in aging populations, little is known about the course of health-related quality of life (HRQoL) changes. We aimed to assess individual-level longitudinal HRQoL changes in elderly patients with CHB and to examine their correlates. A prospective 5.1 years-cohort study was conducted in community-dwelling adults aged 55 years with hepatitis B surface antigen-positive. Participants underwent serial measurement of HRQoL using the short-form (12) health survey version 2. Of 503 participants, 82.7% remained in good physical health throughout the study period, whereas 9.1% had declining physical health and 8.2% were in poor physical health. We likewise identified three trajectories of mental health changes ("good mental health" [86.9%], "declining mental health" [6.8%], and "poor mental health" [6.4%]). Three baseline characteristics were independently associated with a lower likelihood of remaining physically or mentally healthy: sarcopenic obesity (odds ratio [OR] with 95% confidence interval [95% CI] of 7.5 [2.8-20.5] for poor physical health, 3.1 [1.1-8.4] for declining physical health, 4.3 [1.4-13.0] for poor mental health), a higher number of metabolic abnormalities (OR [95% CI] of 3.6 [1.6-8.0] for poor physical health) and depressed mood (OR [95% CI] of 21.7 [5.8-81.0] for poor physical health, 5.3 [1.4-19.9] for declining physical health, 83.1 [19.7-350.2] for poor mental health, 13.6 [2.9-64.8] for declining mental health). In conclusion, in a cohort of elderly patients with CHB, we demonstrated the heterogeneity and nonlinearity of HRQoL changes and their associations with variations in specific extrahepatic organs/systems.
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Key Words
- 95% CI, 95% confidence interval
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- Aging
- BIC, Bayesian information criterion
- BMI, body mass index
- BP, blood pressure
- CES-D, Center for Epidemiological Studies Depression
- CHB, chronic hepatitis B
- CV, coefficient of variation
- FIB-4, Fibrosis-4 Index for Liver Fibrosis
- Geriatric assessment
- Group-based trajectory modeling
- HALST, Healthy Aging Longitudinal Study in Taiwan
- HBV, hepatitis B virus
- HBsAg, hepatitis B surface antigen
- HOMA-IR, Homeostasis Model Assessment of Insulin Resistance
- HRQoL, health-related quality of life
- Health-related quality of life
- Healthy Aging Longitudinal Study in Taiwan (HALST)
- MCS, Mental Component Summary
- MMSE, Mini-Mental State Examination
- OR, odds ratio
- PCS, Physical Component Summary
- SF-12v2, the Short Form (12) Health Survey version 2
- hsCRP, high-sensitivity C-reactive protein
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Affiliation(s)
- Chang-Hua Chen
- Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan
- Center for Aging and Health, Changhua Christian Hospital, Changhua City, Taiwan
| | - Ming-Shiang Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Yu-Wen Yang
- Center for Aging and Health, Changhua Christian Hospital, Changhua City, Taiwan
- Department of Family Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Yen-Tze Liu
- Center for Aging and Health, Changhua Christian Hospital, Changhua City, Taiwan
- Department of Family Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Yen-Feng Chiu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Shu-Chun Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | | | - Tsung-Lung Tsai
- Puzi Hospital, Ministry of Health and Welfare, Chiayi County, Taiwan
| | | | | | | | - Li-Ming Lien
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chao A. Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - I-Chien Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
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Ziebart C, Bobos P, Furtado R, MacDermid JC, Bryant D, Szekeres M, Suh N. The Efficacy of Fall Hazards Identification on Fall Outcomes: A Systematic Review With Meta-analysis. Arch Rehabil Res Clin Transl 2021; 2:100065. [PMID: 33543091 PMCID: PMC7853376 DOI: 10.1016/j.arrct.2020.100065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/26/2022] Open
Abstract
Objective To investigate the efficacy of fall hazards identification programs when compared to no intervention or other fall prevention programs on number of falls, falls incidence, and identifying fall hazards in community-dwelling adults. Data Sources CINAHL, PubMed, EMBASE, Scopus, and PsychINFO were used to identify articles. Study Selection Studies were selected to compare fall hazards identification programs to a control group. Studies were eligible if they were randomized controlled trials and enrolled adults older than 50 years with the incidence rate of falls as an outcome. Data Extraction Study or authors, year, sample characteristics, intervention or comparison groups, number of falls, and number of hazards identified in the intervention and control groups, and follow-up were extracted. The risk of bias assessment was performed using the Cochrane Risk of Bias tool. Quality was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach per outcome. Data Synthesis A total of 8 studies (N=8) and 5177 participants were included. There was a high risk of bias across the studies mostly due to improper blinding of personnel of the outcome assessor. Pooled estimate effects from 5 studies assessing the incidence rate of falls from 3019 individuals indicated no difference between fall hazards identification programs and control (incidence rate ratio=0.98; 95% confidence interval, 0.87-1.10). Conclusions The current study suggests that there may be a benefit for fall hazards programs in reducing incident falls. However, because of a moderate GRADE rating, more large-scale studies with a higher number of falls events and more consistent control groups are required to determine the true effect.
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Affiliation(s)
- Christina Ziebart
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Pavlos Bobos
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada.,Dalla Lana School of Public Health, Institute of Health Policy Management and Evaluation, Department of Clinical Epidemiology and Health Care Research, University of Toronto, Toronto, ON, Canada
| | - Rochelle Furtado
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Dianne Bryant
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
| | - Mike Szekeres
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Nina Suh
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
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Abstract
Objective To identify patient characteristics on admission and daily events during hospitalization that could influence older medical inpatients walking activity during hospitalization. Design A cohort study. Setting Acute hospitalized care. Participants Premorbidly mobile, nonsurgical, nonelective inpatients (50% women) aged ≥65 years (N=154), with an anticipated ≥3-day inpatient stay were recruited consecutively within 48 hours of hospital admission. Of the 227 patients screened, 69 did not meet study criteria and 4 refused. Interventions Not applicable. Main Outcome Measures Age, comorbidities (Cumulative Illness Rating Scale), cognitive status (6-item Cognitive Impairment Test), falls history and efficacy (Falls Efficacy Scale-International), physical performance (short physical performance battery), and medications were recorded within 2 days of admission. Walking activity (step count) was recorded for 7 days or until discharge. Daily events (procedures, falls, fear of falling, ordered bedrest, devices or treatments that hindered walking [eg, intravenous fluids, wall-mounted oxygen therapy], patient- and nurse-reported medial status, fatigue, sleep quality, physiotherapy, or occupational therapy intervention) were measured on concurrent weekdays. Their associations with daily (log) step count were estimated using linear mixed-effects models, adjusted for patient-characteristics measured at admission. Results Approximately half of the variability in step count was described at the within-patient level. Multivariable models suggested positive associations with Wednesdays (+25% in step count; 95% confidence interval, 4-53), admission physical performance (+15%, 8-22), improving medical status (+33%, 7-64), negative associations with devices or treatments that hinder walking (−29%, −9 to −44), and instructed bedrest (−69%, −55 to −79). Conclusion Day-to-day step count fluctuated, suggesting considerable scope for intervention. Devices or treatments that hinder walking should be reviewed daily and walking activity should become a clinical priority. Admission physical performance may identify vulnerable patients.
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Affiliation(s)
- Ruth McCullagh
- Centre for Gerontology and Rehabilitation, St Finbarr's Hospital, College of Medicine and Health, University College Cork, Cork
| | - Dahly Darren
- School of Public Health, College of Medicine and Health, University College Cork, Cork.,Clinical Research Facility Cork, University College Cork, Cork
| | - N Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, St Finbarr's Hospital, College of Medicine and Health, University College Cork, Cork
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Zoch-Lesniak B, Dobberke J, Schlitt A, Bongarth C, Glatz J, Spörl-Dönch S, Koran I, Völler H, Salzwedel A. Performance Measures for Short-Term Cardiac Rehabilitation in Patients of Working Age: Results of the Prospective Observational Multicenter Registry OutCaRe. Arch Rehabil Res Clin Transl 2020; 2:100043. [PMID: 33543072 DOI: 10.1016/j.arrct.2020.100043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective To determine immediate performance measures for short-term, multicomponent cardiac rehabilitation (CR) in clinical routine in patients of working age, taking into account cardiovascular risk factors, physical performance, social medicine, and subjective health parameters and to explore the underlying dimensionality. Design Prospective observational multicenter register study in 12 rehabilitation centers throughout Germany. Setting Comprehensive 3-week CR. Participants Patients (N=1586) ≤65 years of age (mean 53.8±7.3y, 77.1% men) in CR (May 2017-May 2018). Interventions Not applicable. Main Outcome Measures Feasibility, defined by data availability for ≥85% of patients (CR admission and discharge), and modifiability based on pre-post comparison (statistical significance, with P value<.01; standardized effect size≥.35; change by ≥5% points in categorical variables). In addition, latent factors were identified using an exploratory factor analysis (EFA). Results Based on feasibility and modifiability criteria, smoking behavior, lifestyle change behavior, blood pressure, endurance training load, depression in Patient Health Questionnaire-9 (PHQ-9), the 5-item World Health Organization Well-Being Index (WHO-5), physical and mental health and pain scale of the indicators of rehabilitation status-24 (IRES-24), and self-assessed health prognosis proved to be suitable performance measures. As a result of the EFA, 2 solid factors were identified: (1) subjective mental health including PHQ-9, WHO-5, mental health (IRES-24), mental quality of life, and anxiety and (2) physical health including physical quality of life, physical health and pain scale of IRES-24, and self-assessed occupational prognosis. A third factor represents the blood pressure. Conclusions We provide a small set of performance measures, that are essentially based on 3 latent factors (subjective mental health, physical health, blood pressure). These performance measures can represent immediate success of comprehensive CR and be applied easily in clinical practice.
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Key Words
- 6MWD, 6-minute walking distance
- 95% CI, 95% confidence interval
- ACS, acute coronary syndrome
- BMI, body mass index
- CR, cardiac rehabilitation
- Cardiac rehabilitation
- Cardiovascular diseases
- EDC, electronic data capture
- HAF-17, Herzangstfragebogen (German version of the Cardiac Anxiety Questionnaire)
- IRES-24, indicators of rehabilitation status-24
- KMO, Kaiser-Meyer-Olkin
- LDL, low-density lipoprotein
- OutCaRe, Outcome of Cardiac Rehabilitation
- Outcome measures
- PAD, peripheral artery disease
- PCS, physical component summary
- PHQ-9, Patient Health Questionnaire-9
- Quality indicators
- Rehabilitation
- Rehabilitation outcome
- SES, standardized effect size
- SF-12, Medical Outcomes Study 12-Item Short-Form Health Survey
- Secondary prevention
- WHO-5, 5-item World Health Organization Well-Being Index
- health care
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Nordentoft M, Rod NH, Bonde JP, Bjorner JB, Cleal B, Madsen IEH, Magnusson Hanson LL, Nexo MA, Sterud T, Rugulies R. Changes in effort-reward imbalance at work and risk of onset of sleep disturbances in a population-based cohort of workers in Denmark. Sleep Med X 2020; 2:100021. [PMID: 33870174 PMCID: PMC8041122 DOI: 10.1016/j.sleepx.2020.100021] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/02/2020] [Accepted: 08/03/2020] [Indexed: 10/26/2022] Open
Abstract
Objective/background Associations between exposure to effort-reward imbalance at work (eg, high time pressure/low appreciation) and risk of sleep disturbances have been reported, but the direction of the effect is unclear. The present study investigated changes in effort-reward imbalance and risk of concomitant and subsequent onset of sleep disturbances. Methods Participants with sleep disturbances at baseline were excluded. We included participants from a population-based cohort in Denmark (n = 8,464, 53.6% women, mean age = 46.6 years), with three repeated measurements (2012 (T0); 2014 (T1); 2016 (T2)). Changes in effort-reward imbalance (T0-T1) were categorized into 'increase', 'decrease' and 'no change'. Self-reported sleep disturbances (difficulties initiating or maintaining sleep, non-restorative sleep, daytime tiredness) were dichotomized (presence versus absence). We regressed concomitant (T1) and subsequent (T2) sleep disturbances on changes in effort-reward imbalance (T0-T1) and calculated odds ratios (OR) and 95% confidence intervals, adjusted for sex, age, education and cohabitation. Results At follow-up, 8.4% (T1) and 12.5% (T2) reported onset of sleep disturbances. Increased effort-reward imbalance was associated with concomitant sleep disturbances (T1) (OR = 3.16, 2.56-3.81), whereas decreased effort-reward imbalance was not (OR = 1.22, 0.91-1.63). There was no association between increased effort-reward imbalance and subsequent sleep disturbances (T2) (OR = 1.00, 0.74-1.37). Results were similar for men and women. Conclusions Increased effort-reward imbalance was associated with a three-fold higher risk of concomitant onset of sleep disturbances at two-year follow-up, but not subsequent onset of sleep disturbances at four-year follow-up, indicating that changes in effort-reward imbalance have immediate rather than delayed effects on sleep impairment. It is possible that the results from the two-year follow-up were to some extent affected by reverse causality.
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Affiliation(s)
- Mads Nordentoft
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Naja H Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jens Peter Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Jakob B Bjorner
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Optum Patient Insights, Lincoln, RI, USA.,Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bryan Cleal
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Ida E H Madsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Mette A Nexo
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Tom Sterud
- The National Institute of Occupational Health, Oslo, Norway
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Ikuta F, Yoneta K, Miyaji T, Kidera K, Yonekura A, Osaki M, Gamada K. Association between stages of medial compartment osteoarthritis and three-dimensional knee alignment in the supine position: A cross-sectional study. J Clin Orthop Trauma 2020; 11:S130-S136. [PMID: 31992933 PMCID: PMC6978193 DOI: 10.1016/j.jcot.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/24/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) of the knee causes changes in knee alignment. A detailed knowledge of knee alignment is needed for correct assessment of the extent of disease progression, determination of treatment strategy, and confirmation of treatment effectiveness. However, deterioration of knee alignment during progression of OA has not been adequately characterized. The aims of this study were to clarify the changes in three-dimensional static knee alignment as knee OA stage progressed and to lay a foundation for an optimal treatment strategy to prevent knee malalignment. METHODS A total of 106 knees of 81 patients ((men/women) 45/36; mean age 48.4 ± 19.9 years; body mass index (BMI) 25.7 ± 4.4 kg/m2) were enrolled in this cross-sectional study, comprising 34 (33/1) in Kellgren-Lawrence (KL) grade 0, 17 (8/9) in KL grade 1, 26 (5/21) in KL grade 2, 19 (4/15) in KL grade 3, and 10 (1/9) in KL grade 4. In all cases, computed tomography images were obtained with the subject in a reclined and relaxed position with the knee straight. Three-dimensional bone models were created from the images and knee alignment was calculated with six degrees-of-freedom. Then, 40 knees were selected consisting of 10 sex- and BMI-matched knees from each KL grade group: KL grade 1 (mean age 54.6 ± 8.4 years; BMI 23.3 ± 3.5 kg/m2), grade 2 (64.7 ± 10.9 years; 27.3 ± 3.2 kg/m2), grade 3 (69.2 ± 11.4 years; 27.1 ± 4.3 kg/m2), and grade 4 (71.9 ± 9.2 years; 27.2 ± 3.6 kg/m2). The Mann-Whitney U test with Bonferroni correction for multiple comparisons was used to analyze static alignment (α < 0.05/6). RESULTS Alignment of the knee in flexion was -4.0 [95% confidence interval (CI): -6.4, -1.5] degrees, -3.4 [-8.0, 1.3] degrees, -0.1 [-3.7, 3.5] degrees, and 0.4 [-0.9, 1.6] degrees in the order of KL grade 1 to 4. There were significant differences between KL grade 1 and 4 (p = 0.0081). Anterior tibial translation was 6.6 [4.6, 8.6] mm, 5.8 [1.9, 9.7] mm, 1.0 [-2.5, 4.5] mm, and 1.3 [-2.4, 5.1] mm in the order of grade 1 to 4. There were significant differences between KL grade 1 and 4 (p = 0.0081). There were no significant differences in lateral tibial translation nor tibial rotation. CONCLUSIONS The severely osteoarthritic knee joint was flexed and the tibia was displaced posteriorly with respect to the femur. Preventing these changes in alignment would assist in the prevention and treatment of knee OA.
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Affiliation(s)
- Futoshi Ikuta
- Department of Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, 555-36 Kurosegakuendai, Higashihiroshima City, Hiroshima, 739-2695, Japan,Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo, 140-0002, Japan,Corresponding author. Department Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, 555-36 Kurosegakuendai, Higashihiroshima City, Hiroshima, 739-2695, Japan.
| | - Kei Yoneta
- Department of Rehabilitation, Kobayashi Hospital, Kita 3 Jo Nishi 4, Kitami City, Hokkaido, 090-0043, Japan
| | - Takeshi Miyaji
- Department of Orthopaedic Surgery, Aino Memorial Hospital, 3838-1 Ainocho, Unzen City, Nagasaki, 854-0301, Japan
| | - Kenichi Kidera
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Akihiko Yonekura
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Makoto Osaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Kazuyoshi Gamada
- Department of Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, 555-36 Kurosegakuendai, Higashihiroshima City, Hiroshima, 739-2695, Japan
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9
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Holm-Jensen A, Kjaer P, Schiøttz-Christensen B, Ziegler DS, Andersen S, Myburgh C. The Interexaminer Reproducibility and Prevalence of Lumbar and Gluteal Myofascial Trigger Points in Patients With Radiating Low Back Pain. Arch Rehabil Res Clin Transl 2020; 2:100044. [PMID: 33543073 PMCID: PMC7853331 DOI: 10.1016/j.arrct.2020.100044] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective To determine the interexaminer reproducibility for judging the presence, number, and location of leg-pain referring myofascial trigger points, and their prevalence in patients with low back pain with and without concomitant leg pain referral. Design An interexaminer reproducibility study. Setting An outpatient public Hospital Spine Centre in Southern Denmark. Participants Examiners: experienced examiners (N=2), a chiropractor and a physiotherapist, respectively. Subjects: a case mix of patients with low back pain (N=32) with and without leg pain referral. Interventions A standardized palpation examination protocol of 4 bilateral lumbosacral muscles performed by each examiner. Main Outcome Measures Reproducibility on presence (measured in Cohen’s κ), number (difference and limits of agreement), location (distance between matching marks placed by examiners), and prevalence of myofascial trigger points. Results Kappa values of the examined muscles were as follows: quadratus lumborum (κ=0.42), gluteus medius (κ=0.83), gluteus minimus (κ=0.74), and piriformis (κ=0.62), with a mean of all examined muscles of kappa=0.66, assessed as substantial agreement. The mean difference in number of trigger points was 0.8, with limits of agreement ranging from −6.4 to 4.9. Mean distance between trigger point locations was 12.9 mm, with 57% only being identified by a single examiner. The prevalence of trigger points was 82.7%, highest in the gluteal region of the painful side. Conclusions Inadequate standardization and multiple trigger point sites complicate interexaminer reproducibility on location and number of patients with low back pain and leg pain referral. Nevertheless, substantial interexaminer reproducibility for the trigger point presence appears achievable. Implemented routinely, this relatively simple clinical evaluation procedure could meaningfully enhance diagnostic triage and eventual management.
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Affiliation(s)
- Aske Holm-Jensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Berit Schiøttz-Christensen
- Medical Research Department, Spine Centre of Southern Denmark, Hospital Lillebælt, Middelfart, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Dorthe Schøler Ziegler
- Medical Research Department, Spine Centre of Southern Denmark, Hospital Lillebælt, Middelfart, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark.,Spine Surgery and Research, Spine Center of Southern Denmark-part of Lillebaelt Hospital, Middelfart, Denmark
| | - Stina Andersen
- Medical Research Department, Spine Centre of Southern Denmark, Hospital Lillebælt, Middelfart, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Corrie Myburgh
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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10
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Harvey PR, Baldwin S, Mytton J, Dosanjh A, Evison F, Patel P, Trudgill NJ. Higher volume providers are associated with improved outcomes following ERCP for the palliation of malignant biliary obstruction. EClinicalMedicine 2020; 18:100212. [PMID: 31922117 PMCID: PMC6948226 DOI: 10.1016/j.eclinm.2019.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Received: 06/13/2019] [Revised: 11/05/2019] [Accepted: 11/11/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Relieving malignant biliary obstruction improves quality of life and permits chemotherapy. Outcomes of endoscopic retrograde cholangio-pancratography(ERCP) in inoperable malignant biliary obstruction have been examined in a national cohort to establish factors associated with poor outcomes. METHODS Hospital Episode Statistics include diagnostic and procedural data for all NHS hospital attendances in England. Patients from 2006 to 2017 with a Hepaticopancreaticobiliary (HPB) malignancy who had undergone ERCP were studied. Patients undergoing a potentially curative operation were excluded. Associations between demographics, co-morbidities, unit ERCP volume and mortality were examined by logistic regression. FINDINGS 39,702 patients were included; 49.4% were male; median age was 75 (IQR 66-88)years. Pancreatic cancer was the most common tumour (63.9%). Mortality was 4.1%, 9.7% and 19.1% for 7-day, in hospital and 30-day respectively. On multivariable analysis: men (OR 1.20(95%CI 1.14-1.26), p < 0.001); increasing age quintile 78-83(1.73(1.59-1.89), p < 0.001), >83(2.70(2.48-2.94),p < 0.001); most deprived quintile (1.21(1.11-1.32), p < 0.001); increasing co-morbidity score >20(3.36(2.94-3.84),p < 0.001); small bowel malignancy (1.45(1.22-1.72), p < 0.001), intrahepatic biliary malignancy(1.10(1.03-1.17), p = 0.005) and year of ERCP 2006/07 (1.37(1.22-1.55), p < 0.001) were associated with increased 30-day mortality. Extrahepatic biliary tree cancers (0.67(0.61-0.73), p<0.001), high volume providers of ERCP (>318 annually, 0.91(0.84-0.98), p = 0.01) and high volume of ERCP for malignant obstruction (>40 annually (0.91(0.85-0.98), p = 0.014) were negatively associated with 30-day mortality. Patients were less likely to require a second ERCP in high volume providers (>318, 8.0%) compared to low volume ((<204, 13.4%), p<0.001). INTERPRETATION Short term mortality in patients with malignant biliary obstruction following ERCP was high. 30-day mortality was positively associated with increasing age and co-morbidity, men, deprivation, and earlier year of ERCP and negatively with extrahepatic biliary tree cancer and high volume ERCP providers. FUNDING Internal funding only.
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Key Words
- 95% CI, 95% confidence interval
- Cancer
- Chemotherapy
- ERCP
- ERCP, Endoscopic retrograde cholangiopancreatogram
- HES, Hospital Episode Statistics
- ICD10, International Classification of Diseases version 10
- IMD, Index of Multiple Deprivations 2010
- IQR, Interquartile range, OR, Odds ratio
- Mortality
- ONS, Office of National Statistics
- OPCS4, Office of Population Census and Surveys Classification of Interventions and Procedures, version 4
- PTC, percutaneous transhepatic cholangiography
- SMR, Standardised mortality rate
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Affiliation(s)
- Philip R Harvey
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Baldwin
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jemma Mytton
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Amandip Dosanjh
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Felicity Evison
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Prashant Patel
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nigel J Trudgill
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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11
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Yang D, He Y, Wu B, Deng Y, Li M, Yang Q, Huang L, Cao Y, Liu Y. Drinking water and sanitation conditions are associated with the risk of malaria among children under five years old in sub-Saharan Africa: A logistic regression model analysis of national survey data. J Adv Res 2019; 21:1-13. [PMID: 31641533 PMCID: PMC6796660 DOI: 10.1016/j.jare.2019.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 07/11/2019] [Revised: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 01/10/2023] Open
Abstract
Drinking water and sanitation is a risk factor to malaria infection. Wealth brought mixed effects of the relationship between WS and malaria. The associations between WS and malaria were more pronounced among the non-poor children. This pooling multi-country data eliminates many bias seen in traditional meta-analysis. Improved drinking water and sanitation seemed to be promising in preventing malaria.
Current efforts for the prevention of malaria have resulted in notable reductions in the global malaria burden; however, they are not enough. Good hygiene is universally considered one of the most efficacious and straightforward measures to prevent disease transmission. This work analyzed whether improved drinking water and sanitation (WS) conditions were associated with a decreased risk of malaria infection. Data were acquired through surveys published between 2006 and 2018 from the Demographic and Health Program in sub-Saharan Africa (SSA). Multiple logistic regression was used for each national survey to identify the associations between WS conditions and malaria infection diagnosed by microscopy or a malaria rapid diagnostic test (RDT) among children (0–59 months), with adjustments for age, gender, indoor residual spraying (IRS), insecticide-treated net (ITN) use, house quality, and the mother’s highest educational level. Individual nationally representative survey odds ratios (ORs) were combined to obtain a summary OR using a random-effects meta-analysis. Among the 247,440 included children, 18.8% and 24.2% were positive for malaria infection based on microscopy and RDT results, respectively. Across all surveys, both unprotected water and no facility users were associated with increased malaria risks (unprotected water: aOR 1.17, 95% CI 1.07–1.27, P = 0.001; no facilities: aOR 1.35, 95% CI 1.24–1.47, P < 0.001; respectively), according to microscopy, whereas the odds of malaria infection were 48% and 49% less among piped water and flush-toilet users, respectively (piped water: aOR 0.52, 95% CI 0.45–0.59, P < 0.001; flush toilets: aOR 0.51, 95% CI 0.43–0.61, P < 0.001). The trends of individuals diagnosed by RDT were consistent with those of individuals diagnosed by microscopy. Risk associations were more pronounced among children with a “nonpoor” socioeconomic status who were unprotected water or no facility users. WS conditions are a vital risk factor for malarial infection among children (0–59 months) across SSA. Improved WS conditions should be considered a potential intervention for the prevention of malaria in the long term.
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Key Words
- 95% CI, 95% confidence interval
- Children
- DHS, Demographic and Health Survey
- Drinking water
- IRS, indoor residual spraying
- ITNs, insecticide treated nets
- LLINs, long-lasting insecticidal mosquito nets
- MIS, Malaria Indicator Surveys
- Malaria
- NTDs, neglected tropical diseases
- RDT, rapid diagnostic test
- Risk
- SDGs, sustainable development goals
- SSA, sub-Saharan Africa
- STHs, soil transmitted helminth diseases
- Sanitation
- Sub-Saharan Africa
- WASH, water, sanitation, and hygiene
- WHO, World Health Organization
- WS, drinking water and sanitation
- aOR, adjusted odds ratio
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Affiliation(s)
- Dan Yang
- Department of Environmental Health, School of Public Health, China Medical University, 77th, Puhe Road, Shenyang, 110122 Liaoning, China
| | - Yang He
- Department of Central Laboratory, The First Affiliated Hospital, China Medical University, 155th, Nanjing North Street, Shenyang, 110001 Liaoning, China
| | - Bo Wu
- Department of Anus & Intestine Surgery, The First Affiliated Hospital, China Medical University, 155th, Nanjing North Street, Shenyang, 110001 Liaoning, China
| | - Yan Deng
- Department of Environmental Health, School of Public Health, China Medical University, 77th, Puhe Road, Shenyang, 110122 Liaoning, China
| | - Menglin Li
- Department of Environmental Health, School of Public Health, China Medical University, 77th, Puhe Road, Shenyang, 110122 Liaoning, China
| | - Qian Yang
- Department of Environmental Health, School of Public Health, China Medical University, 77th, Puhe Road, Shenyang, 110122 Liaoning, China
| | - Liting Huang
- Department of Environmental Health, School of Public Health, China Medical University, 77th, Puhe Road, Shenyang, 110122 Liaoning, China
| | - Yaming Cao
- Department of Immunology, College of Basic Medical Science, China Medical University, 77th, Puhe Road, Shenyang, 110122 Liaoning, China
| | - Yang Liu
- Department of Environmental Health, School of Public Health, China Medical University, 77th, Puhe Road, Shenyang, 110122 Liaoning, China
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12
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Medina-Porqueres I, Torres-Fernandez M, Palenque-Lobato FJ, Poljakovic-Kovacev N, Bellido-Da-Conceiçao A, Feise RJ, Cantero-Tellez R. The Spanish Version of the Functional Rating Index in Patients With Low Back Pain: Preliminary Results of the Validation Study. Arch Rehabil Res Clin Transl 2019; 1:100008. [PMID: 33543048 PMCID: PMC7853338 DOI: 10.1016/j.arrct.2019.100008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/16/2022] Open
Abstract
Objective To assess the reliability, validity, and the psychometric properties of the Spanish version of the Functional Rating Index (Sp-FRI) in a preliminary cohort of patients with low back pain (LBP). Design Prospective observational multicenter study. Setting Outpatient physical therapy clinics and units from public and private settings. Participants Patients with LBP (N=22; 52.5±12.5y) entered the study. Interventions The translation and cross-cultural adaptation were performed following international guidelines through a 5-step procedure. Main Outcome Measures The Sp-FRI was administered along with the Spanish version of Roland-Morris Disability Questionnaire (Sp-RMDQ) and numeric pain rating scale (NPRS) index. Preliminary testing included readability, comprehensibility, ceiling and floor effects, reliability, and validity. Statistical analysis was based on the Fernandez-Huerta index, and the calculation of Cronbach alpha, intraclass correlation coefficient (ICC), and Spearmanś correlation coefficient, respectively. All patients completed the Sp-FRI again after 1-2 days to assess its test-retest reliability. Results None of the participants requested clarification of any of the items at the time of completion. The test-retest reliability of the FRI score was substantial (ICC 0.77). Cronbach alpha was 0.859. Spearman correlation coefficient between Sp-FRI and Sp-RMDQ was 0.66; P<.0001, and between Sp-FRI and NPRS was 0.66; P<.0001. No ceiling or floor effects were detected. Conclusions In light of these preliminary data, the Sp-FRI appears to be linguistically accurate and has been adapted to the Spanish-speaking population. It demonstrated reliability and validity and is suitable for clinical and research use among Spanish patients with LBP, with an acceptable degree of internal consistency and concurrent validity.
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Affiliation(s)
- Ivan Medina-Porqueres
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain
| | - Manuel Torres-Fernandez
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain
| | | | - Nina Poljakovic-Kovacev
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain
| | | | - Ronald J Feise
- Institute of Evidence-Based Chiropractic, Scottsdale, Arizona
| | - Raquel Cantero-Tellez
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain
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13
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Brun MM, Holloway L, Oleksy A, Dayton J, Estey MP, Goudreau BL, Füzéry AK. Analytical evaluation of the Radiometer AQT90 FLEX βhCG assay. Pract Lab Med 2019; 14:e00116. [PMID: 30733990 PMCID: PMC6357890 DOI: 10.1016/j.plabm.2019.e00116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 09/14/2018] [Revised: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 01/18/2023] Open
Abstract
Objectives Many hospitals cannot afford an hCG assay on a central lab analyzer and turn to point of care testing (POCT) solutions. The Radiometer AQT90 FLEX is a small benchtop immunoareement between the AQT90 and comparator methods for samples with hCG ssay analyzer for use in the laboratory or at the patient bedside. This study evaluated the analytical performance of the AQT90's βhCG assay. Methods Precision was assessed using whole blood patient samples and two levels of quality control. Linearity was assessed by dilution of a high hCG plasma sample. Carryover and hook effect were assessed using high and low hCG samples. Method comparisons were done against Abbott i-STAT Total βhCG, Beckman Coulter Total βhCG (5th IS), and Roche hCG+β. Sample concentrations ranged from<2 IU/L to 4,973 IU/L. Results Repeatability and within-laboratory precision passed most manufacturer's claims and allowable error criteria. Linearity was validated from<2 IU/L to 4,741 IU/L. Hook effect was not observed up to 2,446,448 IU/L. Carryover was<4.0 ppm. A linear relationship was observed with i-STAT, Beckman and Roche methods. At>20 IU/L, biases were apparent against all three comparator assays (i-STAT: +20%, Roche: +30%, Beckman: +5 to 15%). At ≤20 IU/L, the acceptability of agreement varied according to TAE specifications. Concordance between AQT90 and comparator assays using 5 IU/L as the medical decision level ranged from 69% to 81%. Conclusions Overall, the AQT90 hCG assay performed well and would be suitable for smaller suburban or rural hospitals. Some limitations have been noted and should be kept in mind during clinical testing. Analytical evaluation of the Radiometer AQT90 FLEX βhCG assay. Most of Radiometer's claims and TAE criteria met by the AQT90. Clinically significant differences with comparators at high concentrations. Clinically insignificant differences with comparators at low concentrations. Suitable for use at smaller suburban or rural hospitals for hCG testing.
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Affiliation(s)
- Miranda M Brun
- Department of Laboratory of Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Jan Dayton
- DynaLIFE Medical Labs, Edmonton, Alberta, Canada
| | - Mathew P Estey
- Department of Laboratory of Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.,DynaLIFE Medical Labs, Edmonton, Alberta, Canada
| | | | - Anna K Füzéry
- Department of Laboratory of Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.,Alberta Health Services, Edmonton, Alberta, Canada
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14
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Markwick A, Ansari Z, Clinch D, McNeil J. Perceived racism may partially explain the gap in health between Aboriginal and non-Aboriginal Victorians: A cross-sectional population based study. SSM Popul Health 2018; 7:010-10. [PMID: 30623008 PMCID: PMC6317510 DOI: 10.1016/j.ssmph.2018.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 05/10/2018] [Revised: 06/22/2018] [Accepted: 10/18/2018] [Indexed: 12/22/2022] Open
Abstract
Background There is a persistent gap in the health of Aboriginal Victorians compared with non-Aboriginal Victorians, where Aboriginal Victorians have poorer health. Currently, the most commonly touted explanation for this gap revolves around health behaviours known as ‘lifestyle risk factors’. Yet the gap in health is similarly matched by persistent gaps in social and economic outcomes that reflect past and ongoing discrimination of Aboriginal peoples across Australia. Perceived racism has been implicated as a key determinant of the gap in health between Indigenous and non-Indigenous peoples across the world. We sought to determine the contribution of perceived racism to the gap in health and how this compared with the contribution of lifestyle risk factors and other determinants of health such as socioeconomic status. Methods We combined data from 2011, 2012 and 2014 Victorian Population Health Surveys (VPHS) to obtain a sample size of 33,833 Victorian adults, including 387 Aboriginal adults. The VPHS is a population-representative, cross-sectional, computer-assisted telephone interview survey conducted annually. Using logistic regression, poor self-reported health status was the dependent variable and Aboriginal status was the primary independent variable of interest. Secondary independent variables included age, sex, perceived racism, socioeconomic status, and lifestyle risk factors. Results Aboriginal Victorians were almost twice as likely as non-Aboriginal Victorians to report poor health; OR=1.9 (95% confidence interval; 1.3–2.6). Perceived racism explained 34% of the gap in self-reported health status between Aboriginal and non-Aboriginal Victorians, followed by: smoking (32%), unhealthy bodyweight (20%), socioeconomic status (15%), excessive consumption of alcohol (13%), and abstinence from alcohol consumption (13%). In contrast, physical inactivity made no contribution. Together, perceived racism and smoking explained 58% of the gap, while all secondary independent variables explained 82% of the gap. Conclusions Perceived racism may be an independent health risk factor that explains more than a third of the health gap between Aboriginal and non-Aboriginal Victorians; equivalent in strength to smoking. The recognised failure of the Australian government’s Closing the Gap strategy may be due in part to the failure to consider other determinants of the health gap beyond the lifestyle risk factors, namely racism, which may act to damage health through multiple pathways at multiple points along the causal chain. Aboriginal Victorians have poorer health than their non-Aboriginal counterparts. Racism explained more than a third of the gap in self-reported health status. Racism may be a health risk factor that is equivalent in strength to smoking. Racism and smoking explained 58% of the gap in self-reported health status. The failure of policies to reduce the health gap may be due to not addressing racism.
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Affiliation(s)
- Alison Markwick
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004, Australia
| | - Zahid Ansari
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004, Australia
| | - Darren Clinch
- Aboriginal Health and Wellbeing Branch, Victorian Department of Health and Human Services, 50 Lonsdale Street, Melbourne, Victoria 3000, Australia
| | - John McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004, Australia
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15
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Foraker RE, Shoben AB, Kelley MM, Lai AM, Lopetegui MA, Jackson RD, Langan MA, Payne PR. Electronic health record-based assessment of cardiovascular health: The stroke prevention in healthcare delivery environments (SPHERE) study. Prev Med Rep 2016; 4:303-8. [PMID: 27486559 PMCID: PMC4959947 DOI: 10.1016/j.pmedr.2016.07.006] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/21/2016] [Accepted: 07/08/2016] [Indexed: 12/30/2022] Open
Abstract
< 3% of Americans have ideal cardiovascular health (CVH). The primary care encounter provides a setting in which to conduct patient-provider discussions of CVH. We implemented a CVH risk assessment, visualization, and decision-making tool that automatically populates with electronic health record (EHR) data during the encounter in order to encourage patient-centered CVH discussions among at-risk, yet under-treated, populations. We quantified five of the seven CVH behaviors and factors that were available in The Ohio State University Wexner Medical Center's EHR at baseline (May–July 2013) and compared values to those ascertained at one-year (May–July 2014) among intervention (n = 109) and control (n = 42) patients. The CVH of women in the intervention clinic improved relative to the metrics of body mass index (16% to 21% ideal) and diabetes (62% to 68% ideal), but not for smoking, total cholesterol, or blood pressure. Meanwhile, the CVH of women in the control clinic either held constant or worsened slightly as measured using those same metrics. Providers need easy-to-use tools at the point-of-care to help patients improve CVH. We demonstrated that the EHR could deliver such a tool using an existing American Heart Association framework, and we noted small improvements in CVH in our patient population. Future work is needed to assess how to best harness the potential of such tools in order to have the greatest impact on the CVH of a larger patient population. Use and adoption of health information technology advances quality in patient care. Healthcare systems need tools to enhance primary prevention at the point-of-care. Providers and patients have shared accountability for population health metrics.
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Key Words
- 95% CI, 95% confidence interval
- ACC, American College of Cardiology
- AHA, American Heart Association
- CDS, clinical decision support
- CVH, cardiovascular health
- Disease management
- EHR, electronic health record
- GEE, generalized estimation equation
- Health outcomes
- Medical informatics
- OSUWMC, Ohio State University Wexner Medical Center
- Prevention
- Primary care
- SD, standard deviation
- SPHERE, stroke prevention in healthcare delivery environments
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Affiliation(s)
- Randi E. Foraker
- The Ohio State University College of Public Health, Columbus, OH 43210, United States
- The Ohio State University College of Medicine, Columbus, OH 43210, United States
- Corresponding author at: The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210, United States.The Ohio State University College of Public Health1841 Neil AvenueColumbusOH43210United States
| | - Abigail B. Shoben
- The Ohio State University College of Public Health, Columbus, OH 43210, United States
| | - Marjorie M. Kelley
- The Ohio State University College of Medicine, Columbus, OH 43210, United States
| | - Albert M. Lai
- The Ohio State University College of Medicine, Columbus, OH 43210, United States
| | - Marcelo A. Lopetegui
- The Ohio State University College of Medicine, Columbus, OH 43210, United States
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Rebecca D. Jackson
- The Ohio State University College of Medicine, Columbus, OH 43210, United States
| | - Michael A. Langan
- The Ohio State University College of Medicine, Columbus, OH 43210, United States
| | - Philip R.O. Payne
- The Ohio State University College of Public Health, Columbus, OH 43210, United States
- The Ohio State University College of Medicine, Columbus, OH 43210, United States
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Zhang SF, Wang XY, Fu ZQ, Peng QH, Zhang JY, Ye F, Fu YF, Zhou CY, Lu WG, Cheng XD, Xie X. TXNDC17 promotes paclitaxel resistance via inducing autophagy in ovarian cancer. Autophagy 2016; 11:225-38. [PMID: 25607466 DOI: 10.1080/15548627.2014.998931] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Paclitaxel is recommended as a first-line chemotherapeutic agent against ovarian cancer, but drug resistance becomes a major limitation of its success clinically. The key molecule or mechanism associated with paclitaxel resistance in ovarian cancer still remains unclear. Here, we showed that TXNDC17 screened from 356 differentially expressed proteins by LC-MS/MS label-free quantitative proteomics was more highly expressed in paclitaxel-resistant ovarian cancer cells and tissues, and the high expression of TXNDC17 was associated with poorer prognostic factors and exhibited shortened survival in 157 ovarian cancer patients. Moreover, paclitaxel exposure induced upregulation of TXNDC17 and BECN1 expression, increase of autophagosome formation, and autophagic flux that conferred cytoprotection for ovarian cancer cells from paclitaxel. TXNDC17 inhibition by siRNA or enforced overexpression by a pcDNA3.1(+)-TXNDC17 plasmid correspondingly decreased or increased the autophagy response and paclitaxel resistance. Additionally, the downregulation of BECN1 by siRNA attenuated the activation of autophagy and cytoprotection from paclitaxel induced by TXNDC17 overexpression in ovarian cancer cells. Thus, our findings suggest that TXNDC17, through participation of BECN1, induces autophagy and consequently results in paclitaxel resistance in ovarian cancer. TXNDC17 may be a potential predictor or target in ovarian cancer therapeutics.
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Key Words
- 95% CI, 95% confidence interval
- ALDOC, aldolase C, fructose-bisphosphate
- ATG5, autophagy-related 5
- BECN1
- BECN1, Beclin 1, autophagy-related
- BafA1, bafilomycin A1
- CNN3, calponin 3, acidic
- DAPI, 4', 6-diamidino-2-phenylindole
- FLNA, filamin A, α
- GO, gene ontology
- GenMAPP, gene microarray pathway profiler
- HBSS, Hank's balanced salt solution
- HR, hazard ratio
- KEGG, Kyoto encyclopedia of genes and genome
- LC-MS/MS, liquid chromatography-mass spectrometry/ mass spectrometry
- MAP1LC3B/LC3B, microtubule-associated protein 1 light chain 3 β
- OS, overall survival
- PFS, progression-free survival
- PGAM1, phosphoglycerate mutase 1 (brain)
- SQSTM1, sequestosome 1
- TNF, tumor necrosis factor
- TXN, thioredoxin
- TXNDC17
- TXNDC17, thioredoxin domain containing 17
- UTP23, small subunit (SSU) processome component, homolog (yeast)
- autophagy
- ovarian cancer
- paclitaxel resistance
- siRNA, short interfering RNA
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Affiliation(s)
- Song-Fa Zhang
- a Women's Reproductive Health Laboratory of Zhejiang Province; Women's Hospital; School of Medicine ; Zhejiang University ; Hangzhou , China
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Kinutani H, Shinke T, Nakayama K, Taniguchi Y, Otake H, Takaya T, Osue T, Konishi A, Emoto N, Hirata KI. High perfusion pressure as a predictor of reperfusion pulmonary injury after balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. Int J Cardiol Heart Vasc 2015; 11:1-6. [PMID: 28616517 PMCID: PMC5441330 DOI: 10.1016/j.ijcha.2015.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 09/11/2015] [Revised: 11/24/2015] [Accepted: 11/25/2015] [Indexed: 10/26/2022]
Abstract
BACKGROUND Clinical efficacy of balloon pulmonary angioplasty (BPA) to the patients with non-operable chronic thromboembolic pulmonary hypertension (CTEPH) for improving pulmonary hemodynamics and exercise tolerance has been reported in these several years. However, reperfusion pulmonary injury (RPI) remains to be a major complication of BPA to overcome. This study elucidated the local predictor of RPI. METHODS Twenty-eight consecutive patients with non-operable CTEPH underwent BPA for lesions in the segmental or sub-segmental vessels. Pre- and post-BPA pulmonary arterial pressures at proximal (Pp) and distal (Pd) to the stenosis were measured by a 0.014-in. pressure wire. Positive or negative RPI was evaluated by chest computed tomography in each re-perfused segment separately 4 h after BPA. RESULTS Pressure measurements pre- and post-BPA were obtained from 110 lesions, where Pd and pressure ratio (Pd/Pp) increased after BPA in all lesions. Among them, RPI was observed in 49 lesions (44.5%). In the RPI-positive lesions, post-BPA Pd and post-BPA Pd/Pp were higher compared with the RPI-negative lesions. Multivariate logistic analysis revealed that the post-BPA Pd was independently associated with RPI incidence. Receiver operating characteristic curve analysis demonstrated the best cut-off value of 19.5 mm Hg for post-BPA Pd to predict RPI. CONCLUSIONS High reperfusion pressure after BPA could be a predictor of RPI. Monitoring local pressure during BPA procedure may have a potential to reduce the incidence of RPI.
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Key Words
- 95% CI, 95% confidence interval
- BPA, balloon pulmonary angioplasty
- Balloon pulmonary angioplasty
- CI, cardiac index
- CO, cardiac output
- CT, computed tomography
- CTEPH, chronic thromboembolic pulmonary hypertension
- Chronic thromboembolic pulmonary hypertension
- Complication
- IVUS, intravascular ultrasound
- MLD, minimal lumen diameter
- NIPPV, non-invasive positive pressure ventilation
- PAG, pulmonary angiography
- PAP, pulmonary arterial pressure
- PCWP, pulmonary capillary wedge pressure
- PEA, pulmonary endarterectomy
- PVR, pulmonary vascular resistance
- Pd, mean pulmonary arterial pressure distal to the stenosis
- Pp, mean pulmonary arterial pressure proximal to the stenosis
- Predictor
- ROC, receiver-operating characteristic
- RPI, reperfusion pulmonary injury
- Reperfusion pulmonary injury
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Affiliation(s)
- Hiroto Kinutani
- Kobe University Graduate School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, Japan
| | - Toshiro Shinke
- Kobe University Graduate School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, Japan
| | - Kazuhiko Nakayama
- Kobe University Graduate School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, Japan
| | - Yu Taniguchi
- Kobe University Graduate School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, Japan
| | - Hiromasa Otake
- Kobe University Graduate School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, Japan
| | - Tomofumi Takaya
- Kobe University Graduate School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, Japan
| | - Tsuyoshi Osue
- Kobe University Graduate School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, Japan
| | - Akihide Konishi
- Kobe University Graduate School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, Japan
| | - Noriaki Emoto
- Kobe University Graduate School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Kobe University Graduate School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, Japan
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Liu T, Fang XC, Ding Z, Sun ZG, Sun LM, Wang YL. Pre-operative lymphocyte-to-monocyte ratio as a predictor of overall survival in patients suffering from osteosarcoma. FEBS Open Bio. 2015;5:682-687. [PMID: 26380812 PMCID: PMC4556728 DOI: 10.1016/j.fob.2015.08.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 02/08/2023] Open
Abstract
Inflammatory markers have been proposed to predict clinical outcomes in many types of cancers. The purpose of this study was to explore the influence of the lymphocyte-to-monocyte ratio (LMR) on clinical prognosis of patients with osteosarcoma. This study collected 327 patients who underwent surgical treatment for osteosarcoma during the period 2006-2010. LMR was calculated from pre-operative peripheral blood cells counts. The optimal cut-off value of LMR was determined based on receiver operating characteristic curve analysis. Overall survival (OS) and event free survival (EFS) was plotted using the Kaplan-Meier method and evaluated by the log-rank test. A predictive model was established to predict clinical prognosis for OS, and the predictive accuracy of this model was determined by concordance index (c-index). Our results showed that young age, elevated alkaline phosphatase, metastasis at diagnosis, chemotherapy, lymphocyte and monocyte counts were significantly associated with LMR. Low LMR was associated with shorter OS and EFS (P < 0.001), and was an independent predictor of both OS and EFS (HR = 1.72, 95% CI = 1.14-2.60, P = 0.010; HR = 1.89, 95% CI = 1.32-2.57, P = 0.009). The nomogram performed well in the prediction of overall survival in patients with osteosarcoma (c-index 0.630). In conclusion, low pre-operative LMR is associated with a poor prognosis in patients suffering from osteosarcoma. A prospective study is warranted for further validation of our results.
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Zhai Y, Zhao J, You H, Pang C, Yin L, Guo T, Feng T, Wang C, Gao K, Luo X, Zhang M, Wang J, Li L, Wang B, Ren Y, Shen Y, Zhu T, Hu D. Association of the rs11196218 polymorphism in TCF7L2 with type 2 diabetes mellitus in Asian population. Meta Gene 2014; 2:332-41. [PMID: 25606417 PMCID: PMC4287822 DOI: 10.1016/j.mgene.2014.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 12/10/2013] [Revised: 03/16/2014] [Accepted: 04/10/2014] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To clarify the association of rs11196218 polymorphism in transcription factor 7-like 2 (TCF7L2) and type 2 diabetes mellitus (T2DM) in Asian population by a case-control study and meta-analysis. METHODS In the case-control study, 1842 patients with T2DM and 7777 normal glucose-tolerant controls in the Henan province of China were genotyped for rs11196218 in TCF7L2 by PCR-ligase detection reaction. We used allele, co-dominant, dominant and recessive models to evaluate the risk association and performed a meta-analysis of the results of different genetic models in previous studies and the current study. RESULTS The AG genotype of rs11196218 was associated with risk of T2DM in the Henan population (odds ratio 1.37, 95% confidence interval 1.06-1.78), and dominant model showed marginal significant association (1.28, 0.99-1.67). Meta-analysis of 10 studies revealed the dominant model associated with T2DM in the overall population (1.20, 1.05-1.36). When stratified by region (southern and northern China and Japan), both the AG genotype and the dominant model were associated with risk of T2DM in southern Chinese (1.31, 1.03-1.66; 1.27, 1.01-1.60, respectively). CONCLUSION The rs11196218 polymorphism in TCF7L2 is associated with risk of T2DM in Asian population.
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Affiliation(s)
- Yujia Zhai
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, People's Republic of China
| | - Jingzhi Zhao
- Military Hospital of Henan Province, Zhengzhou 450003, People's Republic of China
| | - Haifei You
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, People's Republic of China
| | - Chao Pang
- Military Hospital of Henan Province, Zhengzhou 450003, People's Republic of China
| | - Lei Yin
- Military Hospital of Henan Province, Zhengzhou 450003, People's Republic of China
| | - Tan Guo
- Shenzhen University School of Medicine, Shenzhen 518060, People's Republic of China
| | - Tianping Feng
- Military Hospital of Henan Province, Zhengzhou 450003, People's Republic of China
| | - Chongjian Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, People's Republic of China
| | - Kaiping Gao
- Shenzhen University School of Medicine, Shenzhen 518060, People's Republic of China
| | - Xinping Luo
- Shenzhen University School of Medicine, Shenzhen 518060, People's Republic of China
| | - Ming Zhang
- Shenzhen University School of Medicine, Shenzhen 518060, People's Republic of China
| | - Jinjin Wang
- Department of Traditional Chinese Medicine Prevention, Preventive Medicine Research Evaluation Center, Henan University of Traditional Chinese Medicine, Zhengzhou 450008, People's Republic of China
| | - Linlin Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, People's Republic of China
| | - Bingyuan Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, People's Republic of China
| | - Yongcheng Ren
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, People's Republic of China
| | - Yanxia Shen
- Shenzhen University School of Medicine, Shenzhen 518060, People's Republic of China
| | - Tian Zhu
- Shenzhen University School of Medicine, Shenzhen 518060, People's Republic of China
| | - Dongsheng Hu
- Shenzhen University School of Medicine, Shenzhen 518060, People's Republic of China
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