Risk assessment of venous thromboembolism and bleeding in COVID-19 patients.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is a newly recognized illness that has spread rapidly all over the world. More and more reports highlight the risk of venous thromboembolism (VTE) in COVID-19. Our study aims to identify in-hospital VTE risk and bleeding risk in COVID-19 patients. METHODS: We retrospectively studied 138 consecutively enrolled patients with COVID-19 and identified in-hospital VTE and bleeding risk by Padua Prediction Score and Improve bleed risk assessment model. The clinical data and features were analyzed in VTE patients. RESULTS: Our findings identified that 23 (16.7%) patients with COVID-19 were at high risk for VTE according to Padua prediction score and 9 (6.5%) patients were at high risk of bleeding for VTE prophylaxis according to Improve prediction score. Fifteen critically ill patients faced double high risk from thrombosis (Padua score more than 4 points in all 15 [100%] patients) and hemorrhage (Improve score more than 7 points in 9 [60.0%] patients). Thrombotic events were identified in four patients (2.9%) of all COVID-19 patients. All of them were diagnosed with deep vein thrombosis by ultrasound 3 to 18 days after admission. Three (75.0%) were critically ill patients, which means that the incidence of VTE among critically ill patients was 20%. One major hemorrhage happened in critically ill patients during VTE treatment. CONCLUSION: Critically ill patients with COVID-19 suffered both a high risk of thrombosis and bleeding risks. More effective VTE prevention strategies based on an individual assessment of bleeding risks were necessary for critically ill patients with COVID-19.

Educational Attainment and Ischemic Stroke: A Mendelian Randomization Study.

Observational studies have evaluated the potential association of socioeconomic factors such as higher education with the risk of stroke but reported controversial findings. The objective of our study was to evaluate the potential causal association between higher education and the risk of stroke. Here, we performed a Mendelian randomization analysis to evaluate the potential association of educational attainment with ischemic stroke (IS) using large-scale GWAS datasets from the Social Science Genetic Association Consortium (SSGAC, 293,723 individuals), UK Biobank (111,349 individuals), and METASTROKE consortium (74,393 individuals). We selected three Mendelian randomization methods including inverse-variance-weighted meta-analysis (IVW), weighted median regression, and MR-Egger regression. IVW showed that each additional 3.6-year increase in years of schooling was significantly associated with a reduced IS risk (OR = 0.54, 95% CI: 0.41-0.71, and p = 1.16 × 10-5). Importantly, the estimates from weighted median (OR = 0.49, 95% CI: 0.33-0.73, and p = 1.00 × 10-3) and MR-Egger estimate (OR = 0.18, 95% CI: 0.06-0.60, and p = 5.00 × 10-3) were consistent with the IVW estimate in terms of direction and magnitude. In summary, we provide genetic evidence that high education could reduce IS risk.

Cross-cultural adaptation and validation of the First-Time Fathers Questionnaire in China.

OBJECTIVE: The study aimed to cross-culturally adapt and validate the First-Time Fathers Questionnaire (FTFQ) in the cultural context of China. DESIGN: Prospective validation study. SETTING: The study was conducted in four public hospitals in Hangzhou, a southeast coastal city of China. PARTICIPANTS: Four hundred and nineteen first-time fathers (mean age=30.45 years, SD=3.44, range 22-46) whose partners had given birth between July 20 and October 10, 2019. METHODS: The instrument "First Time Fathers Questionnaire (FTFQ)" was translated and culturally adapted to the Chinese context according to the methodological criteria of the International Society for Pharmacoeconomic and Outcomes Research. The construct-related validity of the instrument was tested through EFA and CFA. Content validity was evaluated with an analysis of the expert judgment. Reliability was assessed based on the internal consistency. RESULTS: Four domains were identified: "Worry", "Information", "Emotional Support", and "Acceptance", with 19 items and adequate internal reliability (0.86, 0.80, 0.86, and 0.72, respectively) and a total variance of 64.65%. The CFA model showed there is a good fit for the data: X2/df =1.20; RMSA = 0.03; CFI = 0.99; and NFI = 0.93. Additionally, each item achieved an I-CVI ≧0.83, and the S-CVI/Ave = 0.90. KEY CONCLUSIONS: The Chinese version of the FTFQ is a valid and reliable instrument to assess first-time fathers' experience of childbirth in China. IMPLICATIONS FOR PRACTICE: This study provides a validated questionnaire that is suitable for the Chinese cultural context. It contributes to the knowledge of first-time fathers' experience of childbirth and facilitate further actions to improve paternal satisfaction and behavior as labour companion.

Assessment of lung glucose uptake in patients with systemic lupus erythematosus pulmonary arterial hypertension: a quantitative FDG-PET imaging study.

PURPOSE: Pulmonary arterial hypertension (PAH) is a recognized complication of systemic lupus erythematosus (SLE-PAH) patients and its lung pathology shares similarity to idiopathic PAH (IPAH) with distinctive inflammatory feature. FDG-PET reports glucose metabolism from both hyperproliferative and inflammatory cellular elements of vascular pathology in PAH. We explored the application of FDG-PET in reporting SLE-PAH pulmonary vascular pathology. METHODS: Sixty-minute dynamic FDG-PET imaging was applied in 14 SLE-PAH patients, 20 IPAH patients and 10 healthy volunteers. Patlak analysis was used to quantify lung FDG uptake (influx rate Ki). RESULTS: Mean lung FDG uptake in SLE-PAH (Ki 0.00714 ± 0.000602 mL/g/min) was significantly higher than that of the healthy volunteers (Ki 0.000262 ± 0.000168 mL/g/min) (p < 0.05). SLE-PAH patients with SLE disease activity score SLEDAI ≥ 5 demonstrated significantly increased lung FDG uptake (Ki 0.001075 ± 0.00055 mL/g/min) than those with SLEDAI < 5 (Ki 0.000233 ± 0.00017 mL/g/min) (p = 0.0038) and IPAH (Ki 0.000524 ± 0.000314 mL/g/min) (p = 0.0025). Lung FDG uptake in SLE-PAH correlated with SLEDAI score and plasma complement C3 and C4 levels (Ki vs SLEDAI, r = 0.607, p = 0.021; Ki vs C3, r = - 0.568, p = 0.034; Ki vs C4, r = - 0.661, p = 0.010). There were no significantly correlations between lung FDG uptake and pulmonary vascular haemodynamics and 6 min walking distance in both IPAH and SLE-PAH patients. CONCLUSIONS: Our data indicated that increased lung FDG uptake in SLE-PAH patients correlates with SLE disease activity (SLEDAI) and immune/inflammatory status (C3 and C4). FDG-PET imaging may be developed as a potential intrapulmonary disease activity marker in SLE-PAH patients.

Race and socioeconomic effect on sarcopenia and sarcopenic obesity in the Louisiana Osteoporosis Study (LOS).

BACKGROUND: Sarcopenia and sarcopenic obesity are emerging public health issues. True prevalence rates are unknown and estimates differ substantially between studies. No large-scale single study has compared prevalence rates between whites, blacks, Asians, and Hispanics, as we intend to do here. This study also examined the effects of race and socioeconomic factors on sarcopenia and sarcopenic obesity. METHODS: This study included 10,325 participants from Louisiana. Appendicular lean mass (ASM), measured through dual energy x-ray absorptiometry (DXA) scans, was divided by height squared (ASM/h2) to define sarcopenia. Sarcopenic obesity was defined as sarcopenia plus obesity (waist-to-hip ratio). RESULTS: Overall sarcopenia and sarcopenic obesity rates were 17.6% and 7.0% for males, and 13.7% and 2.5% for females, respectively. The highest sarcopenia and sarcopenic obesity rates were found in Asian males (40.6%, 14.4%) and females (30.1%, 8.0%). The lowest sarcopenic obesity rates were observed in black males (3.7%) and females (0.9%). We found significant associations with sarcopenic obesity in males for age, race, and income; in females, for age, race, and education. CONCLUSIONS: Under one diagnostic definition, the prevalence of sarcopenia and sarcopenic obesity is highest among Asians and lowest amongst blacks. Income and education had significant associations with sarcopenia and sarcopenic obesity, in males and females, respectively.

Improvement in clinical and economic outcomes with empiric antibiotic therapy covering atypical pathogens for community-acquired pneumonia patients: a multicenter cohort study.

OBJECTIVE: To determine the effectiveness of empiric antibiotic regimens covering atypical pathogens with respect to detailed clinical and economic outcomes in community-acquired pneumonia (CAP). METHODS: A population-based, multicenter, retrospective cohort study was conducted from June 2010 to May 2011. Patients with a diagnosis of CAP were enrolled and categorized into two groups according to the initial antibiotic strategy used - covering or not covering atypical pathogens. Regression analysis was performed to assess their clinical outcomes (all-cause mortality, clinical improvement rate after 72 h of antimicrobial therapy, and clinical cure rate) and economic outcomes (length of stay, hospitalization costs, and antibiotic expenditure). RESULTS: A total of 827 patients met the criteria for CAP; 561 (67.8%) received antibiotics with atypical pathogen coverage (APC group), while 266 (32.2%) did not (non-APC group). Regression analysis revealed that the all-cause mortality was much lower in the APC group than in the non-APC group (0.9% vs. 4.9%, respectively), with an odds ratio (OR) of 0.18 (95% confidence interval (CI) 0.06-0.49). Clinical improvement at 72 h (87.7% vs. 85.0%, p=0.274) and the clinical cure rate (91.1% vs. 88.3%, p=0.213) were more favorable in the APC group, but with no significant difference compared to the non-APC group. Moreover, the APC group had a shorter mean length of stay (APC 10.2 days vs. non-APC 11.6 days, p<0.001). In addition, the mean total hospitalization costs for the APC group were markedly lower compared with the non-APC group (US$ 1172.7 vs. US$ 1510.7; p<0.001). CONCLUSION: Antimicrobial treatment covering atypical pathogens for hospitalized CAP patients is associated with reduced mortality and economic burden.

Assessment of the relationship between Helicobacter pylori and lung cancer: a meta-analysis.

BACKGROUND AND AIMS: Helicobacter pylori infection has been thought to play a critical role in gastric carcinoma tumorigenesis and progression. Several studies have been devoted to the relationship between H. pylori infection and lung cancer risk and have generated inconclusive results. In this study we aimed to evaluate the potential association of H. pylori infection with lung cancer risk. METHODS: We conducted a search in Medline, OVID, EMBASE and CNKI, covering all published papers until October 2008. The relevant published papers were deliberately selected according to the established inclusion criteria for publications. Essential data were then extracted from the included studies and further analyzed by a systematic meta-analysis. RESULTS: A total of 98 papers were identified. Of these, four case-control studies met the inclusion criteria and thus were finally selected. Lung cancer risk for H. pylori infection was 3.24-fold (95% CI=1.11-9.47) (Z=2.15, p<0.05) compared with the controls. CONCLUSIONS: The pooled data suggest infection of H. pylori as a potential risk factor for lung cancer.

Rising out-of-pocket spending for chronic conditions: a ten-year trend.

We examined the prevalence of self-reported chronic conditions and out-of-pocket spending using the 2005 Medical Expenditure Panel Survey (MEPS) and made comparisons to previously published MEPS data. Our study found that the prevalence of self-reported chronic conditions is increasing among not only the old-old but also people in midlife and earlier old age. The greatest growth occurred in the number of people affected by multiple chronic diseases, a group with sizable out-of-pocket spending. Policymakers should be aware that cost sharing at the point of care can disproportionately burden people with chronic conditions and discourage adherence to drugs that prevent disease progression.

A highly efficient integrated chromatographic procedure for the purification of recombinant hepatitis B surface antigen from Hansenula polymorpha.

The high expression level of recombinant hepatitis B surface antigen obtained from Hansenula polymorpha yeast cell (Hans-HBsAg) made it possible to produce HBsAg vaccine in a large scale and by cost-effective process. However, the present available purification process was somewhat tedious, time-consuming and difficult to scale up. To improve the purification efficiency and simplify the purification process, an integrated chromatographic process was developed and optimized. The downstream process included ion-exchange chromatography (IEC), hydrophobic interaction chromatography (HIC) and gel filtration chromatography (GFC). A series of chromatographic adsorbents were evaluated for their performances on the purification of Hans-HBsAg, and then the suitable adsorbents for IEC and HIC were screened out, respectively. After clarification by centrifugation, the supernatant of cell disruption (SCD) was purified by standard chromatographic steps, IEC on DEAE Sepharose FF, HIC on Butyl-S-QZT and GFC on Sepharose 4FF. Furthermore, HBsAg recovery, purification factor (PF) and purity during the downstream process were evaluated with enzyme-linked immunosorption assay (ELISA), sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and high-performance size-exclusion chromatography (HPSEC). The results demonstrated that in the scale of 550ml SCD, the total HBsAg recovery and PF of the whole procedure were about 21.0+/-0.9% and 80.7+/-8.4 (n=3) respectively, with the purity of above 99%. This new downstream process was efficient, reproducible and relatively easy to be scaled up.

Assessment of genetic linkage and parent-of-origin effects on obesity.

CONTEXT: Obesity is a growing health care problem worldwide and is a major underlying risk factor for common diseases such as diabetes. Parent-of-origin effect has been reported to be involved in the development of obesity. But the genes with imprinting effects related to obesity are largely unknown. OBJECTIVE: The objective of the study was to identify obesity-related genetic loci, both with and without imprinting effects. DESIGN AND SUBJECTS: We conducted genome-wide linkage analyses for obesity with and without consideration of imprinting effects in a large sample including more than 4000 individuals. In addition to body mass index (BMI), we also used a more stringent and accurate obesity definition, which simultaneously considers BMI and percentage of fat mass (PFM) in a gender-specific manner. Simulations were performed to identify the genome-wide significant and suggestive significant thresholds. RESULTS: In nonimprinted linkage analyses, we detected suggestive linkage at 2q31 (LOD = 2.23) and 16q22 (LOD = 1.87) for BMI and 2q37 (LOD = 2.23) for BMI and PFM. Interestingly, 2q37 also achieved a significant maternal linkage with BMI and PFM (LOD=3.34) in imprinted linkage analyses. Imprinted linkage analyses revealed suggestive linkage evidence for BMI at three additional genomic regions, including 3p14 (LOD = 2.20, paternal), 3q24 (LOD = 1.97, maternal), and 19q13 (LOD = 1.81, maternal). CONCLUSION: We reported linkage and imprinting effects for obesity on several chromosome regions and suggested the potential importance of parent-of-origin effects and phenotype definition of obesity in delineating the genetic basis of obesity.

Quality of life and cost-effectiveness of combined therapy for reflux esophagitis.

OBJECTIVE: To evaluate clinical, Quality of Life (QoL) and medical cost outcomes in patients with symptomatic reflux esophagitis (RE) receiving different "triple combination therapy". METHODS: A multicenter medical effectiveness trial conducted in 10 hospitals of 5 regions in Zhejiang Province. 248 patient-volunteers were assigned to 8 weeks of "triple combination therapy" with Lansoprazole plus Cisapride and Sucralfate or Ranitidine plus Cisapride and Sucralfate. Main outcomes assessment included symptoms scale scores, RE severity, QoL at baseline and 8 weeks. Medical cost data were collected with cost analysis questionnaire. RESULTS: (1) More Lansoprazole group patients noted RE symptoms resolution than Ranitidine group (92.3% vs 78.4%, P<0.01). There was no striking difference between two groups in RE healing rate (90.8% vs 82.9%, P>0.05). (2) RE significantly impaired QoL of patients (P<0.001). Compared with Ranitidine group, QoL in Lansoprazole group had significant improvement (rate of "good" QoL 64.5% vs 45.6%, P<0.01). (3) There was close correlation between symptomic effectiveness and QoL rating scale in both the Lansoprazole and Ranitidine group (P<0.01, r=0.235 and 0.353 respectively). There were no statistical difference of medical cost between the two groups (P>0.05). CONCLUSION: RE significantly impaired QoL of patients. "Triple combination therapies" can significantly improve RE symptoms and QoL. Lansoprazole combination therapy was more cost-effective than Ranitidine combination group.

Achieving equity in Medicare disproportionate share payments to rural hospitals: an assessment of the financial impact of recent and proposed changes to the disproportionate share hospital payment formula.

Historically, the Medicare Disproportionate Share Hospital (DSH) payment program has been less favorable to rural hospitals: eligibility thresholds were higher and the payment adjustment was smaller for rural than for urban hospitals. Although the Medicare, Medicaid, and SCHIP Benefit Improvement and Protection Act (BIPA) of 2000 established a uniform low-income threshold and increased the magnitude of the adjustment for certain small and rural hospitals as a means to promote payment equity, the DSH distribution formula continues to vary by location. This study examines how the DSH revisions mandated under BIPA are likely to affect rural hospitals' financial performance and simulates the financial impact of implementing a uniform DSH payment adjustment. Using data from the 1998 Medicare cost report and impact files, this study found that two-thirds of both rural and urban hospitals would have qualified for DSH payments following BIPA compared with only one-fifth of rural hospitals and one-half of urban hospitals prior to BIPA. Although the impact of BIPA revisions on rural hospitals' total margins were found to be modest, the financial impact of a uniform payment adjustment would be somewhat greater: rural hospitals' average total margins would have increased by 1.6 percentage points. Importantly, 20% of rural hospitals with negative total margins would have been "in the black" if rural and urban hospitals were reimbursed using the same DSH formula. These findings suggest that elimination of rural and urban disparities in DSH payment could strengthen the rural health care safety net.