Related factors of quality of life of type 2 diabetes patients: a systematic review and meta-analysis.

BACKGROUND: Diabetes is a chronic disease, and it could affect both health and quality of life (QOL). A lot of studies have reported some predictors of QOL of type 2 diabetes patients. While their results were not completely consistent. So the aim of our study was finding out the related factors (including characteristics related to the disease, life styles and mental health factors) of QOL of type 2 diabetes patients. METHODS: We searched Cochrane library, EmBase, PubMed and CNKI databases for published studies that evaluated the related factors of QOL of type 2 diabetes patients by using a proper statistic method and had effect sizes (OR or ß) and 95% confidence intervals from January 1st 2000 to May 31st 2016. Any study types were acceptable, and we excluded the reviews, letters, editorials and pooled analyses. The data were analyzed using STATA software (Version 12.0; Stata Corporation). Effect sizes and 95% confidence intervals were calculated to evaluate the relationship between these factors and QOL. RESULTS: Eighteen studies were included into our systematic review and meta-analysis, totaling 57,109 type 2 diabetes patients. Do more physical exercises (The pooled ORs ranged from 0.635 to 0.825 for different scales, less than 1.00), glucose check more frequently [pooled OR (95%CI): 0.175 (0.041, 0.756)] were associated with a better QOL. Presence of complications (The pooled ORs ranged from 1.462 to 3.038 for different scales, more than 1.00), presence of hypertension [pooled OR (95%CI): 1.389 (1.173, 1644)], longer duration of diabetes [pooled OR (95%CI): 1.865 (1.088, 3.197)], diet with more red meat [pooled OR (95%CI): 2.085 (1.063, 4.089)] and depression (The pooled ORs ranged from 3.003 to 11.473 for different scales, higher than 1.00) were associated with a worse QOL. CONCLUSION: The results of this study show that physical exercise, glucose check frequently, complications, hypertension, duration of diabetes, diet with more red meat, and depression were associated with the QOL of type 2 diabetes patients.

Latent class analysis suggests four classes of persons with type 2 diabetes mellitus based on complications and comorbidities in Tianjin, China: a cross-sectional analysis.

The aim of this study was to explore a new classification way in persons with type 2 diabetes mellitus based on complications and comorbidities using Latent Class Analysis, moreover, finding out the factors associated with different latent classes and making specific suggestions. In this study, 5,500 patients with type 2 diabetes mellitus from ten hospitals in Tianjin, China were selected, and the response rate was 96.2%. Latent Class Analysis was used to cluster patients. After compared the baseline characteristics, multinomial logistic regression was applied. Patients with type 2 diabetes mellitus were classified into four classes. In the univariate analysis, all variables were significant (p<0.05). According to multinomial logistic regression, we found longer duration of type 2 diabetes mellitus, family history of diabetes, older age, obesity and central obesity, female menopause, living in a suburb, having a higher 2hPG at diagnosis, smoking and drinking were associated with the prevalence of complications and comorbidities. In conclusion, LCA was shown to be an effective method for grouping patients with T2DM, which presented a nuanced approach to data reduction. Further research using LCA may be especially useful to investigate causal relationships between complications and the significant factors identified in our study.

Research on Relationship Between Dysphagia and Sudden Death After Medullary Infarction.

BACKGROUND: Medullary infarction (MI) often leads to severe dysphagia and sudden death. We investigated whether dysphagia was associated with sudden death. METHODS: Patients with MI were divided into sudden death group and nonsudden death group. Dysphagia was evaluated in 2 ways: the water-swallowing test (WST) points and the degree of dysphagia. Random undersampling (RUS), random oversampling (ROS), and synthetic minority oversampling technique (SMOTE) techniques were used to process the original data and solve the imbalance problem between 2 classes. Univariate and multivariate logistic regressions were used to analyze the association between the independent variables (WST and degree of dysphagia) and the dependent variable (sudden death or not), while the National Institutes of Health Stroke Scale (NIHSS) score was used as a control. RESULTS: Univariate logistic regression analysis showed that for all resampling methods, both the WST and NIHSS were risk factors for sudden death after MI. For multivariable logistic regression, the fitting effect of RUS logistic regression was satisfactory, which showed the same results. The results of the univariate logistic regression analysis of dysphagia degree showed that for all resampling methods, compared with no dysphagia, both mild to moderate dysphagia degree and severe dysphagia degree were risk factors for sudden death. For multivariable logistic regressions, the logistic regressions of the original data and the RUS resampling method were satisfactory which showed the same results. CONCLUSIONS: Dysphagia is closely related to sudden death after MI. The more severe the dysphagia, the higher is the incidence of sudden death.

Association between Systemic Immunity-Inflammation Index and Hyperlipidemia: A Population-Based Study from the NHANES (2015-2020).

The systemic immunity-inflammation index (SII) is a novel inflammatory marker, and aberrant blood lipid levels are linked to inflammation. This study aimed to look at the probable link between SII and hyperlipidemia. The current cross-sectional investigation was carried out among people with complete SII and hyperlipidemia data from the 2015-2020 National Health and Nutrition Examination Survey (NHANES). SII was computed by dividing the platelet count × the neutrophil count/the lymphocyte count. The National Cholesterol Education Program standards were used to define hyperlipidemia. The nonlinear association between SII and hyperlipidemia was described using fitted smoothing curves and threshold effect analyses. A total of 6117 US adults were included in our study. A substantial positive correlation between SII and hyperlipidemia was found [1.03 (1.01, 1.05)] in a multivariate linear regression analysis. Age, sex, body mass index, smoking status, hypertension, and diabetes were not significantly correlated with this positive connection, according to subgroup analysis and interaction testing (p for interaction > 0.05). Additionally, we discovered a non-linear association between SII and hyperlipidemia with an inflection point of 479.15 using a two-segment linear regression model. Our findings suggest a significant association between SII levels and hyperlipidemia. More large-scale prospective studies are needed to investigate the role of SII in hyperlipidemia.

The Prognostic Impact of Radiotherapy in Conjunction with Temozolomide in Diffuse Intrinsic Pontine Glioma: A Systematic Review and Meta-Analysis.

OBJECTIVE: Diffuse intrinsic pontine glioma (DIPG) is a rare and devastating brainstem glioma that occurs predominately in children. To date, the prognostic impact of radiotherapy (RT) in conjunction with temozolomide (TMZ) in DIPG has not been thoroughly analyzed. The aim of this meta-analysis was to analyze the effectiveness of RT quantitatively and precisely in conjunction with TMZ in improving the prognosis of DIPG. METHODS: A systematic search of 8 electronic databases was conducted. Articles mainly discussing the prognostic impact of RT in conjunction with TMZ in DIPG were selected. The pooled 1- and 2-year overall survival (OS) and progression-free survival (PFS) were calculated. RESULTS: A total of 14 studies fulfilled our inclusion criteria, involving 283 cases of patients with DIPG who were treated with RT in conjunction with TMZ. The pooled 1- and 2-year OS of this treatment was 43% and 11%, respectively. The pooled 1- and 2-year PFS was 20% and 2%, respectively. Subgroup analysis revealed that the heterogeneity remained almost the same in all stratum. Egger's test demonstrated that the possibility of publication bias was low. CONCLUSIONS: Requirements of up-to-date evidence on evaluating the prognostic impact of this therapy are urgent.

Therapeutic Effect of Enteral Nutrition Supplemented with Probiotics in the Treatment of Severe Craniocerebral Injury: A Systematic Review and Meta-Analysis.

BACKGROUND: Whether early enteral nutrition with probiotics can reduce the mortality and infection rate of patients with severe craniocerebral injury (SCI), improve their gastrointestinal function, and shorten the length of stay in the intensive care unit (ICU) has not been determined. METHODS: PubMed, China National Knowledge Infrastructure, and Embase were electronically searched for the purpose of identifying randomized controlled trials investigated the potential of early enteral nutrition supplemented with probiotics on patients with SCI from the establishment of databases to August 26, 2019. STATA software version 12.0 was used to perform meta-analysis. RESULTS: A total of 39 trials enrolling 3387 patients were included. Early enteral nutrition supplemented with probiotics was associated with decreased risk of infection (pooled risk ratio [RR], 0.486; 95% confidence interval [CI], 0.394-0.599), decreased risk of 7-, 14-, and 28-day mortality (pooled RRs, 0.415, 0.497, and 0.385; 95% CIs, 0.196-0.878, 0.297-0.833, and 0.197-0.751, respectively), and decreased risk of gastrointestinal complications (pooled RR, 0.363; 95% CI, 0.274-0.481). It also shortened the time course recovery of enteral function and shortened the length of stay in hospital and length of ICU stay (standardized mean differences, -3.327 and -1.461; 95% CIs, -6.213 to -0.440 and -2.111 to -0.811, respectively). CONCLUSIONS: Enteral nutrition supplemented with probiotics effectively decreases the risk of mortality, gastrointestinal complications, and infection, and shortens the stays in ICU; therefore, it should be extensively adopted to manage these given patients.

Impact of capitation on outpatient expenses among patients with diabetes mellitus in Tianjin, China: a natural experiment.

OBJECTIVES: Capitation policy, a new medical insurance settlement method implemented on 1 January 2014 in Tianjin, China, aimed to control unreasonable increases in medical costs. The goal of the current study was to evaluate the impact of capitation on outpatient expenses among patients with diabetes mellitus and provide scientific evidence for health policy-makers. DESIGN: A natural experiment. SETTING: The medical insurance database of Tianjin from 1 January 2010 to 31 December 2014. PARTICIPANTS: In total, 35 529 records were included, comprising 9646 records in the pilot group (4907 records in 2014 and 4739 records in 2013) and 25 883 records in the control group (9814 records in 2014 and 16 069 records in 2013). MAIN OUTCOME MEASURES: The outcome variables included annual total outpatient expenses, drug expenses, examination expenses, treatment expenses and other expenses. RESULTS: Capitation produced an increase in total outpatient expenses of ¥1993.76 (95% CI, ¥1643.74 to ¥2343.77) in the pilot group relative to the control group. There was also an increase in drug expenses of ¥1904.30 (95% CI, ¥1578.63 to ¥2229.96) after the implementation of capitation. An increase in examination expenses of ¥44.90 (95% CI, ¥19.11 to ¥70.68) was found in the pilot group versus the control group. Capitation also produced an increase in treatment expenses of ¥3.55 (95% CI, ¥1.01 to ¥6.09) and an increase in other expenses of ¥43.46 (95% CI, ¥26.81 to ¥60.11) in the pilot group versus the control group. CONCLUSION: Compared with those who participated in the 'control' policy, outpatient expenses of patients enrolled in capitation increased significantly. The increases were due to the actual needs of patients, changes in drug directories, and the autonomy and independence of hospitals. It is necessary for the government, policy-makers, hospitals, doctors, patients and supervisory agencies to improve the capitation policy.

Prevalence of and factors related to microvascular complications in patients with type 2 diabetes mellitus in Tianjin, China: a cross-sectional study.

BACKGROUND: Since chronic hyperglycemia-related damage to small blood vessels results in complications, patients with longer durations of type 2 diabetes mellitus (T2DM) are more likely to develop microvascular complications, such as retinopathy, neuropathy and nephropathy, which are very harmful to the health of humans. Therefore, this study aimed to assess the prevalence of diabetes-related microvascular complications and to explore their risk factors in patients with T2DM in Tianjin, China. METHODS: This observational, cross-sectional study was conducted at 8 hospitals in urban and suburban regions of Tianjin, China. The information collected from the subjects mainly included demographic characteristics, anthropometric measurements and clinical information. Univariate and multivariate logistic regression was used to identify the possible risk factors for microvascular complications (retinopathy, neuropathy and nephropathy). RESULTS: A total of 4,490 patients with T2DM from 8 hospitals in Tianjin, China were selected from November 2015 to January 2016. Of the study subjects, 2,270 (50.6%) were males. The median age was 64.0±13.0 years. The percentage of patients with T2DM who had at least one microvascular complication was 34.5%. The prevalence rates of neuropathy, retinopathy, and nephropathy were 23.5%, 17.4%, and 10.8%, respectively. The results of the multivariate logistic regression showed that the duration of diabetes, insulin use, and the presence of hypertension and dyslipidemia were the main risk factors for developing microvascular complications of T2DM. CONCLUSIONS: The incidence of diabetes complications in Tianjin is high. Increasing the control of risk factors can reduce the occurrence of complications to reduce the disease burden and improve the quality of life of patients.

Assessment of factors affecting diabetes management in the City Changing Diabetes (CCD) study in Tianjin.

OBJECTIVE: This study aimed to identify the local levels of vulnerability among patients with Type-II diabetes (T2DM) in Tianjin. The study was aimed at curbing the rise of T2DM in cities. METHODS: 229 participants living with T2DM were purposively sampled from hospitals in Tianjin. Collected data were coded and analysed following well-established thematic analysis principles. RESULTS: Twelve themes involving 29 factors were associated with diabetes patients' vulnerability: 1. Financial constraints (Low Income, Unemployment, No Medical Insurance/Low ratio reimbursement); 2. Severity of disease (Appearance of symptoms, complications, co-morbidities, high BMI, poor disease control); 3. Health literacy (No/Low/Wrong knowledge of health literacy); 4. Health beliefs (Perceived diabetes indifferently, Passively Acquire Health Knowledge, Distrust of primary health services); 5. Medical environment (Needs not met by Medical Services); 6. Life restrictions (Daily Life, Occupational Restriction); 7. Lifestyle change (Adhering to traditional or unhealthy diet, Lack of exercise, Low-quality sleep); 8. Time poverty (Healthcare-seeking behaviours were limited by work, Healthcare-seeking behaviours were limited by family issues); 9. Mental Condition (Negative emotions towards diabetes, Negative emotions towards life); 10. Levels of Support (Lack of community support, Lack of support from Friends and Family, Lack of Social Support); 11. Social integration (Low Degree of Integration, Belief in Suffering Alone); 12. Experience of transitions (Diet, Dwelling Environment). CONCLUSION: Based on our findings, specific interventions targeting individual patients, family, community and society are needed to improve diabetes control, as well as patients' mental health care and general living conditions.

Percutaneous Endoscopic Lumbar Discectomy for L5S1 Lumbar Disc Herniation Using a Transforaminal Approach Versus an Interlaminar Approach: A Systematic Review and Meta-Analysis.

BACKGROUND: Several studies have compared the clinical efficacy of percutaneous endoscopic lumbar discectomy for L5-S1 lumbar disc herniation (LDH) using a transforaminal approach with an interlaminar approach, but with contradictory results. The aim of this study was to explore the comparison of efficacy and safety between percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) for L5-S1 LDH. METHODS: Six common databases were comprehensively searched, and relevant studies were included into the analysis when they met all the inclusion criteria. RESULTS: Nine studies involving 621 patients were included into the study. The results indicated that PETD was significantly associated with greater fluoroscopy times (mean difference [MD], 9.28 times; 95% confidence interval [CI], 6.84-11.71; P < 0.01) and longer operative time (MD, 16.51 minutes; 95% CI, 4.01-29.02; P = 0.01) compared with PEID. However, there were no distinct differences between PETD and PEID in estimated blood loss (P = 0.24), bed time after surgery (P = 0.32), hospitalization time (P = 0.27), or MacNab evaluation (P = 0.78). Similarly, no obvious differences were detected between PETD and PEID regarding Visual Analogue Scale score, Japanese Orthopedic Association (JOA) score, or Oswestry Disability Index (ODI) when measured preoperatively, 1 day postoperatively, 3 months postoperatively, or at the last follow up. In addition, no significant difference was found regarding overall incidence of complications between PETD and PEID (P = 0.14). Nevertheless, a significantly lower incidence rate of dural tear was observed in PETD compared with PEID (P = 0.04). CONCLUSIONS: PETD had comparable clinical efficacy and safety compared with PEID; however, PEID was superior to PETD regarding fluoroscopy times and operative time. Therefore, PEID might be a better surgical procedure for L5S1 LDH.

Identifying Patterns of Lifestyle Behaviors among People with Type 2 Diabetes in Tianjin, China: A Latent Class Analysis.

INTRODUCTION: Lifestyle behaviors are essential elements of diabetes care. The aims of this study were to identify distinct subgroups of people with type 2 diabetes based on personal levels of lifestyle behaviors and explore the different characteristics across these subgroups. METHODS: In 2015 and 2016, 1504 outpatients with a diagnosis of type 2 diabetes were selected via two-stage simple random sampling from 10 municipal district hospitals in Tianjin. Participants accepted an invitation by experienced physicians to complete a questionnaire containing demographic and lifestyle content. Clinical data were collected by reviewing medical records. Latent class analysis was applied to identify patterns of lifestyle behaviors. Multinomial logistic regression was used to investigate the characteristics of the subgroups. RESULTS: The final model yielded a four-class solution: the healthy behavioral group, unhealthy diet and less activity group, smoking and drinking group, and sedentary and extremely inactive group. Further analysis found that variables, including age, sex, general/central obesity, treatment modalities, glycemic control, diabetes duration, and diabetes-related complications and comorbidities, were disproportionately distributed across the four latent classes (P < 0.05). Participants in the unhealthy diet and less activity group were more likely to have a longer duration of diabetes, poor glycemic control and more diabetes-related diseases relative to the other three latent classes. CONCLUSIONS: Identification and characterization of subgroups based on lifestyle behaviors in individuals with type 2 diabetes can help health care providers to shift to targeted intervention strategies.

Association between serum C-reactive protein value and prognosis of patients with non-small cell lung cancer: a meta-analysis.

OBJECTIVE: C-reactive protein (CRP) has been reported, with controversy, to be associated with poor survival of patients with non-small cell lung cancer (NSCLC). This meta-analysis aimed to evaluate the prognostic role of CRP in NSCLC. METHODS: We searched PubMed, EMBASE and CNKI databases for published studies that evaluated the prognostic role of CRP in NSCLC up to March 1, 2014. The data were analyzed using STATA software (Version 12.0; Stata Corporation). Hazard ratios (HRs) with a 95% CI and 5-year survival rates were calculated to evaluate the relationships between CRP levels and the prognosis of NSCLC patients. RESULTS: Eight studies were included, totaling 1668 NSCLC patients. The results revealed that elevated CRP values might predict poor 5-year overall survival rates (RR=2.15, 95% CI: 1.78-2.59) and poor 5-year disease-specific survival rates (RR=2.12, 95% CI: 1.56-2.88). The pooled HR between stage I/II and stage III/IV patients was 0.98 (95% CI: 0.26-3.63, P=0.976), which indicated that the difference between the survival rates of the patients with elevated CRP and those with undetectable CRP was not significant. In our survival analysis, the results of Egger's testing did not demonstrate evidence of publication bias (P=0.099). CONCLUSION: Elevated CRP level is relevant to poorer survival of NSCLC patients and might be used as a prognostic biomarker for NSCLC.