Global burden attributable to high sodium intake from 1990 to 2019

Background and aimsHigh sodium intake is associated with a higher risk of a wide range of diseases. We aimed to estimate the pattern and trend of the global disease burden associated with high sodium intake from 1990 to 2019.Methods and resultsWe obtained numbers and rates of death and disability-adjusted life year (DALY) attributable to high sodium intake by sex, socio-demographic index, and country from the Global Burden of Disease Study 2019. We calculated the estimated annual percentage change to evaluate the age-standardized rate (ASR) of the burden attributable to high sodium intake between 1990 and 2019. We further calculated the contribution of population growth, population aging, and age-specific rates of death and DALY to the net change in the total number of deaths and DALYs attributable to high sodium intake. From 1990 to 2019, global age-standardized rates of death and DALY attributable to high sodium intake substantially decreased for both sexes. However, there were significant increases in the total numbers of deaths and DALYs attributable to high sodium intake, which were driven by population growth and population aging. The attribution of population growth and population aging varied widely across countries, with a higher contribution of population growth in most developing countries and a higher contribution of population aging in countries with slow population growth.ConclusionsAlthough the global burden attributable to high sodium intake in terms of age-standardized rate declined from 1990 to 2019, the absolute burden increased significantly, which was driven by population growth and population aging.     

Civic Participation and Self-rated Health: A Cross-national Multi-level Analysis Using the World Value Survey

Objectives:

Civic participation, that which directly influences important decisions in our personal lives, is considered necessary for developing a society. We hypothesized that civic participation might be related to self-rated health status.

Methods:

We constructed a multi-level analysis using data from the World Value Survey (44 countries, n=50 859).

Results:

People who participated in voting and voluntary social activities tended to report better subjective health than those who did not vote or participate in social activities, after controlling for socio-demographic factors at the individual level. A negative association with unconventional political activity and subjective health was found, but this effect disappeared in a subset analysis of only the 18 Organization for Economic Cooperation and Development (OECD) countries. Moreover, social participation and unconventional political participation had a statistically significant contextual association with subjective health status, but this relationship was not consistent throughout the analysis. In the analysis of the 44 countries, social participation was of borderline significance, while in the subset analysis of the OECD countries unconventional political participation was a stronger determinant of subjective health. The democratic index was a significant factor in determining self-rated health in both analyses, while public health expenditure was a significant factor in only the subset analysis.

Conclusions:

Despite the uncertainty of its mechanism, civic participation might be a significant determinant of the health status of a country.     

HPV联合TCT检查应用于宫颈癌筛查的临床效果

目的观察HPV联合TCT检查应用于宫颈癌筛查的临床效果。方法选择2018年1-10月于北京市昌平区医院妇科门诊实施宫颈癌筛查的妇女400例为研究对象,均接受病理检查和HPV、TCT检查,比较联合检查与单独检查的应用价值。结果HPV联合TCT检查的阳性率高于单独检查,但差异无统计学意义(P>0.05);HPV联合TCT检查的灵敏度、阴性预测值、诊断准确率均高于单独检查(P<0.05)。结论HPV联合TCT检查用于宫颈癌筛查的价值较高,值得临床推广应用。     

Cement use in total knee arthroplasty: 40 versus 80 grams

BackgroundStudies of cement use in total knee arthroplasty (TKA) have historically addressed mechanical properties and application strategies. Recently, cement technique has been studied as a means to reduce cost. We transitioned from opening two bags (80 grams) of cement to one bag (40 grams) of cement for primary TKA to improve cost efficacy. This study investigates the radiographic outcome and cost of TKAs performed with 40 versus 80 grams of cement.MethodsTKAs from January 2017 to January 2019 were evaluated. Cement mantle and implant alignment were assessed per the Modern Knee Society Radiographic Evaluation System at four months by three blinded reviewers. Data was analyzed according to quantity of cement used. Cement mantle quality at 16 implant zones was compared. Cost was evaluated.Results163 patients (age 66.8 yrs. +/− 8.9, 51.5% female) underwent TKA with 80 grams of cement, while 142 patients (age 67.1 yrs. +/− 9.3, 56.3% female) underwent TKA utilizing 40 grams of cement. There was no significant difference in cement mantle quality. The most common zone of cement deficiency was the femoral posterior flange (9% in 40 gram group versus 4% in 80 gram group, p value = 0.08). There was no difference in implant size. Cost saving was calculated at $7,810 for the 40 gram group.ConclusionThere was no difference in radiographic cement mantle appearance between primary knees performed with 40 or 80 grams of cement. Cement usage represents a target for cost saving and opportunity to increase the value of primary TKA. Based on the current incidence of TKA in the United States, cost savings could exceed 33 million dollars annually.     

嗜酸性粒细胞胃肠炎的CT与MRI诊断价值

目的 探讨嗜酸性粒细胞胃肠炎(EG)的CT与MRI表现及其临床诊断价值.方法 回顾性分析16例经临床证实的EG患者的CT、MRI的影像资料.结果 黏膜型6例,混合型8例,浆膜型2例,无单纯肌层型EG患者.食管壁肿胀增厚者5例;胃窦壁肿胀增厚者9例,胃黏膜增粗6例;十二指肠黏膜增粗者9例;空肠黏膜增粗者12例,4例合并肠壁增厚;回肠黏膜增粗者8例,4例合并肠壁增厚;结、直肠增厚者2例;肠系膜渗出8例;肠系膜淋巴结肿大者6例;腹腔积液7例.结论 EG的影像表现主要为食管、胃窦部肿胀增厚、胃与小肠黏膜弥漫性增粗、肠壁分层状增厚,具有一定的特征性,可为临床明确诊断提供依据.     

Diagnostic Utility of Diffusion-weighted Magnetic Resonance Imaging in Differentiating Small Solid Renal Tumors (≤4 cm) at 3.0T Magnetic Resonance Imaging

Background:

The aim of this study was to assess the performance of apparent diffusion coefficient (ADC) measurement obtained with diffusion-weighted magnetic resonance imaging (DW-MRI) to distinguish renal cell carcinomas (RCCs) from small benign solid renal tumors (≤4 cm).

Methods:

In this cross-sectional study, 49 consecutive patients with histopathologically confirmed small solid renal tumors, and seven healthy volunteers were imaged using nonenhanced MRI and DW-MRI. The ADC map was calculated using the b values of 0, 50, 400, and 600 s/mm² and values compared via the Kruskal–Wallis and Mann–Whitney tests. The utility of ADC for differentiating RCCs and benign lesions was assessed using a receiver operating characteristic curve. Multiple nonenhanced MRI features were analyzed by Logistic regression.

Results:

The tumors consisted of 33 cases of clear-cell RCCs (ccRCCs) and 16 cases of benign tumors, including 14 cases of minimal fat angiomyolipomas and 2 cases of oncocytomas. The ADCs showed significant differences among benign tumors ([0.90 ± 0.52] × 10⁻³ mm²/s), ccRCCs ([1.53 ± 0.31] × 10⁻³ mm²/s) and the normal renal parenchyma ([2.22 ± 0.12] × 10⁻³ mm²/s) (P < 0.001). Moreover, there was statistically significant difference between high and low-grade ccRCCs (P = 0.004). Using a cut-off ADC of 1.36 × 10⁻³ mm²/s, DW-MRI resulted in an area under the curve (AUC), sensitivity, and specificity equal to 0.839, 75.8%, and 87.5%, respectively. Nonenhanced MRI alone and the combination of imaging methods led to an AUC, sensitivity and specificity equal to 0.919, 93.9%, and 81.2%, 0.998, 97%, and 100%, respectively. The Logistic regression showed that the location of the center of the tumor (inside the contour of the kidney) and appearance of stiff blood vessel were significantly helpful for diagnosing ccRCCs.

Conclusions:

DW-MRI has potential in distinguishing ccRCCs from benign lesions in human small solid renal tumors (≤4 cm), and in increasing the accuracy for diagnosing ccRCCs when combined with nonenhanced MRI.     

Application of Percutaneous Balloon Mitral Valvuloplasty in Patients of Rheumatic Heart Disease Mitral Stenosis Combined with Tricuspid Regurgitation

Background:

Tricuspid regurgitation (TR) is frequently associated with severe mitral stenosis (MS), the importance of significant TR was often neglected. However, TR influences the outcome of patients. The aim of this study was to investigate the efficacy and safety of percutaneous balloon mitral valvuloplasty (PBMV) procedure in rheumatic heart disease patients with mitral valve (MV) stenosis and tricuspid valve regurgitation.

Methods:

Two hundred and twenty patients were enrolled in this study due to rheumatic heart disease with MS combined with TR. Mitral balloon catheter made in China was used to expand MV. The following parameters were measured before and after PBMV: MV area (MVA), TR area (TRA), atrial pressure and diameter, and pulmonary artery pressure (PAP). The patients were followed for 6 months to 9 years.

Results:

After PBMV, the MVAs increased significantly (1.7 ± 0.3 cm² vs. 0.9 ± 0.3 cm², P < 0.01); TRA significantly decreased (6.3 ± 1.7 cm² vs. 14.2 ± 6.5 cm², P < 0.01), right atrial area (RAA) decreased significantly (21.5 ± 4.5 cm² vs. 25.4 ± 4.3 cm², P < 0.05), TRA/RAA (%) decreased significantly (29.3 ± 3.2% vs. 44.2 ± 3.6%, P < 0.01). TR velocity (TRV) and TR continue time (TRT) as well as TRV × TRT decreased significantly (183.4 ± 9.4 cm/s vs. 254.5 ± 10.7 cm/s, P < 0.01; 185.7 ± 13.6 ms vs. 238.6 ± 11.3 ms, P < 0.01; 34.2 ± 5.6 cm vs. 60.7 ± 8.5 cm, P < 0.01, respectively). The postoperative left atrial diameter (LAD) significantly reduced (41.3 ± 6.2 mm vs. 49.8 ± 6.8 mm, P < 0.01) and the postoperative right atrial diameter (RAD) significantly reduced (28.7 ± 5.6 mm vs. 46.5 ± 6.3 mm, P < 0.01); the postoperative left atrium pressure significantly reduced (15.6 ± 6.1 mmHg vs. 26.5 ± 6.6 mmHg, P < 0.01), the postoperative right atrial pressure decreased significantly (13.2 ± 2.4 mmHg vs. 18.5 ± 4.3 mmHg, P < 0.01). The pulmonary arterial pressure decreased significantly after PBMV (48.2 ± 10.3 mmHg vs. 60.6 ± 15.5 mmHg, P < 0.01). The symptom of chest tightness and short of breath obviously alleviated. All cases followed-up for 6 months to 9 years (average 75 ± 32 months), 2 patients with severe regurgitation died (1 case of massive cerebral infarction, and 1 case of heart failure after 6 years and 8 years, respectively), 2 cases lost access. At the end of follow-up, MVA has been reduced compared with the postoperative (1.4 ± 0.4 cm² vs. 1.7 ± 0.3 cm², P < 0.05); LAD slightly increased compared with the postoperative (45.2 ± 5.7 mm vs. 41.4 ± 6.3 mm, P < 0.05), RAD slightly also increased compared with the postoperative (36.1 ± 6.3 mm vs. 28.6 ± 5.5 mm, P < 0.05), but did not recover to the preoperative level. TRA slightly increased compared with the postoperative, but the difference was not statistically significant (P > 0.05). The PAP and left ventricular ejection fraction appeared no statistical difference compared with the postoperative (P > 0.05), the remaining patients without serious complications.

Conclusions:

PBMV is a safe and effective procedure for MS combined with TR in patients of rheumatic heart disease. It can alleviate the symptoms and reduce the size of TR. It can also improve the quality-of-life and prognosis. Its recent and mid-term efficacy is certain. While its long-term efficacy remains to be observed.     

Nurses' decision making in heart failure management based on heart failure certification status

Background

Research findings on the value of nurse certification were based on subjective perceptions or biased by correlations of certification status and global clinical factors. In heart failure, the value of certification is unknown.

Prioritizing HIV comparative effectiveness trials based on value of information: generic versus brand-name ART in the US

Value of Information (VOI) analysis examines whether to acquire information before making a decision. We introduced VOI to the HIV audience, using the example of generic antiretroviral therapy (ART) in the US.

Methods and Findings:We used a mathematical model and probabilistic sensitivity analysis (PSA) to generate probability distributions of survival (in quality-adjusted life years, QALYs) and cost for three potential first-line ART regimens: three-pill generic, two-pill generic, and single-pill branded. These served as input for a comparison of two hypothetical two-arm trials: three-pill generic versus single-pill branded; and two-pill generic versus single-pill branded. We modeled pre-trial uncertainty by defining probability distributions around key inputs, including 24-week HIV-RNA suppression and subsequent ART failure. We assumed that, without a trial, patients received the single-pill branded strategy. Post-trial, we assumed that patients received the most cost-effective strategy. For both trials, we quantified the probability of changing to a generic-based regimen upon trial completion and the expected VOI in terms of improved health outcomes and costs. Assuming a willingness to pay (WTP) threshold of $100?000/QALY, the three-pill trial led to more treatment changes (84%) than the two-pill trial (78%). Estimated VOI was $48?000 (three-pill trial) and $35?700 (two-pill trial) per future patient initiating ART.

Conclusions:A three-pill trial of generic ART is more likely to lead to post-trial treatment changes and to provide more value than a two-pill trial if policy decisions are based on cost-effectiveness. Value of Information analysis can identify trials likely to confer the greatest impact and value for HIV care.