Increase in nonhepatic diagnoses among persons with hepatitis C hospitalized for any cause,United States, 2004–2011

Although persons with hepatitis C virus (HCV) infection may experience nonhepatic illnesses, little is known about the frequency of and trends in such conditions in a population‐based sample of HCV‐infected persons. Using hospitalization data collected during 2004–2011 from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, we examined trends in comorbidities among all hospitalizations that included either a principal or secondary HCV diagnostic code (i.e., HCV was not necessarily the cause for hospitalization). We also compared comorbidities among all persons aged 45–64 years hospitalized with and without principal or secondary HCV diagnostic codes. The estimated number of hospitalizations among persons with HCV infection increased from 850 490 in 2004–2005 to 1 178 633 in 2010–2011; mean age at hospitalization was 50 years in 2004–2005 and 52.5 years in 2010–2011. There were significant increases in the prevalence of most medical and psychiatric comorbidities; the largest were for lipid disorders, chronic kidney disease and obesity. Among HCV‐infected aged 45–64 persons hospitalized for any cause, the prevalence of alcohol /substance abuse, mental disorders, chronic kidney disease, pneumonia, hepatitis B virus infection and HIV infection were significantly higher than those aged 45–64 persons hospitalized without HCV infection (P < 0.001 for all). The prevalence of cryoglobulinaemia, vasculitis, nephrotic syndrome or membranoproliferative glomerulonephritis and porphyria cutanea tarda among hospitalizations with HCV infection was consistently low during the study period (i.e., <0.5%). The increase we observed in nonhepatic comorbidities associated with a high risk of HCV‐related complications has important implications for the current HCV treatment recommendations in a greatly expanded treatment population.     

Pulse pressure measured at the level of the femoral artery,but not at the level of the aorta,carotid and brachial arteries,is associated with the incidence of coronary heart disease events in a population with a high prevalence of type 2 diabetes and impaired glucose metabolism – The Hoorn study

IntroductionCentral (aortic or carotid) pulse pressure (PP) is more strongly associated with local organ damage and possibly mortality than brachial PP.AimTo investigate for the first time the association of femoral (f) PP with all-cause mortality, and incident cardiovascular disease (CVD), coronary heart disease (CHD) and cerebrovascular disease (CerVD) events, as well as with markers of renal function (estimated glomerular filtration rate, eGFR, and microalbuminuria).MethodsWe used data from a population-based study, by design including 50% type 2 diabetes and impaired glucose metabolism (IGM). The baseline examination included non-invasive PP assessment at the brachial, aorta (Sphygmocor device), carotid and femoral (ultrasound distention waves calibrated by brachial mean and diastolic pressure) arteries.ResultsAfter 7.8 years of follow-up (n = 449, age: 68.9 ± 6.0 males: 52%), 66 participants had died, 102 had a CVD event, 45 a CHD event, and 31 a CerVD event. PP at all sites was associated with incident all-cause mortality and CVD events. Only fPP was, however, associated with incident CHD events, even after adjustment for CVD risk factors (HRs 1.31 [1.07–1.61 95% CIs]). No association between PP and incident CerVD events was found – possibly due to the small number of events. fPP was associated with renal function but this was similar to other PP indices. No interaction between each any local PP index and glucose metabolism status or renal function was present.ConclusionBeyond anatomical topography, local fPP provide important information related to CVD events. This possibility and the underlying mechanisms should be further investigated.     

A novel non-invasive score for the prediction of advanced fibrosis in patients with chronic hepatitis B

Introduction and objectivesEvaluation of liver fibrosis is important for treatment decisions, complications and to predict prognosis in patients with chronic hepatitis B (CHB). Our aim was to develop a new non-invasive fibrosis scoring method and prove its accuracy in the differentiation of no/low grade and advanced fibrosis in patients with CHB.Patients and methodsOur study included 273 chronic hepatitis B patients who underwent liver biopsy from February, 2007 to February, 2019 with medical records retrospectively reviewed. Preparations of these patients were divided into two groups as ≤ 3 no-low grade fibrosis (n=236) and ≥ 4 advanced fibrosis (n=37) according to histological ISHAK fibrosis scoring system.ResultsThe newly developed AGAP score and other non-invasive fibrosis scores; Fibrosis-4 index, Aspartate aminotransferase to platelets ratio, Gamma glutamyl transpeptidase to platelet ratio, Goteborg University Cirrhosis Index, King's score, Albumin-bilirubin index, Fibrosis cirrhosis index, Fibrosis index, Fibrosis quotient, Lok score and mean and/or median values of Fibroindex were significantly higher in the advanced fibrosis group compared to the no/low grade fibrosis group (p<0.001). However, there was no significant difference in AAR score among the groups (p=0.265). With cut-off value of 4.038, AUROC value of 0.803, sensitivity of 75.7%, specificity of 73.7% and accuracy of 0.740, AGAP score showed the best performance in advanced fibrosis differentiation compared to 12 other non-invasive fibrosis scoring methods.ConclusionsThe newly developed AGAP score showed better performance in patients with CHB compared to 12 other non-invasive fibrosis scores in differentiation of no/low grade fibrosis and advanced fibrosis.     

手术室优质护理应用马斯洛需要层次论对患者心理状态及手术配合度影响

目的 探究手术室优质护理应用马斯洛需要层次论对患者心理状态及手术配合度的影响.方法 回顾性分析2012年1月-2014年12月该院诊治的110例行手术治疗患者的临床资料,按照不同护理方式分为二组,每组55例,对照组给予常规护理,观察组给予马斯洛需要层次论的优质护理,观察并比较二组护理情况.结果 二组护理后心理状态均得到显著改善,但是观察组改善程度更大,并且SAS、HA-MA、SDS及HAMD的各项评分均显著优于对照组,组内比较及组间比较差异均具有统计学意义(P＜0.05或P＜0.01);观察组手术配合度、护理满意度均分别为94.55％与92.73％,均显著高于对照组的76.36％与74.55％,同时护理有效性情况也均优于对照组,差异均有统计学意义(P＜0.05或P＜0.01).结论 手术室优质护理应用马斯洛需要层次论对患者心理状态及手术配合度具有积极影响,同时提高护理满意度,增强护理质量,值得临床推广及应用.     

From the Cover: Brief Report: Excess mortality in the United States in the 21st century

We use three indexes to identify how age-specific mortality rates in the United States compare to those in a composite of five large European countries since 2000. First, we examine the ratio of age-specific death rates in the United States to those in Europe. These show a sharp deterioration in the US position since 2000. Applying European age-specific death rates in 2017 to the US population, we then show that adverse mortality conditions in the United States resulted in 400,700 excess deaths that year. Finally, we show that these excess deaths entailed a loss of 13.0 My of life. In 2017, excess deaths and years of life lost in the United States represent a larger annual loss of life than that associated with the COVID-19 epidemic in 2020.     

基于专利合作网络的我国中药合作创新研究

全球竞争的新形势下,合作创新已成为创新主体规避创新风险和提高创新能力的重要选择之一。为探索我国中药研究领域中的合作创新模式及其演化路径,该研究采用科学计量学和社会网络分析等方法,对我国1985—2013年中药专利合作进行了深入剖析。研究发现,1虽然近年来我国以国内研发力量为主导的中药合作专利在数量上保持快速增长,但总体而言,我国中药合作创新程度并不高,合作规模也较小;2"个人+个人"曾是国内中药合作创新的最主要方式,但随着时间推移,机构主体逐渐崛起并在国内中药合作创新中取得重大突破;3以高校为代表的核心机构在当前国内机构间的中药合作创新中发挥了举足轻重的战略作用,不仅成为连接众多其他机构的关键纽带,促进了知识的转移和扩散,更在未来拥有重大发展潜力。     

遗传代谢病住院患儿的营养管理

遗传代谢病临床表现复杂,缺乏特异性,容易漏诊或误诊,有赖于遗传学或生化学等方法尽早确诊。饮食疗法是遗传代谢病的主要治疗手段之一,及时的临床诊断、治疗、适当的个体化营养干预及包括营养支持小组的多学科合作,对于改善遗传代谢病患儿的疾病转归及预后有重要意义。遗传代谢病患儿的长期营养管理过程中仍存在许多问题亟待解决。