Impact of rapid on-site evaluation combined with endobronchial ultrasound and virtual bronchoscopic navigation in diagnosing peripheral lung lesions.

BACKGROUND: To investigate the value of endobronchial ultrasound (EBUS) and virtual bronchoscopic navigation (VBN) combined with rapid on-site evaluation (ROSE) in diagnosing peripheral pulmonary lesions (PPLs). METHODS: Between January 1st 2019 to September 1st 2021, EBUS and VBN examination were performed in expected consecutive patients with PPLs who were admitted to Zhangzhou Affiliated Hospital of Fujian Medical University (Fujian, China). Finally, based on the calculation of expected diagnostic yield of R-EBUS biopsy and drop out, 198 eligible patients were randomly divided into ROSE group (100 cases) and non-ROSE group (98 cases). The diagnostic yield of brushing and biopsy, the complications, the procedure time, the diagnosis time and expense during diagnosis were analyzed. RESULTS: In the ROSE group, the positive rate of EBUS brushing and biopsy were 68%, 84%, respectively. The average procedure time and diagnosis time were 18.6 ± 6.8 min, 3.84 ± 4.28 days, respectively, and the average expense was 643.44 ± 706.56 US.$ (4093.15 ± 4494.67 yuan ¥). In the controls, the positive rate of brushing and biopsy were 44%, 74%, respectively. The average procedure time and diagnosis time were 15.4 ± 5.7 min, 6.46 ± 3.66 days, respectively. And the average expense during diagnosis was 1009.27 ± 713.89 US.$ (6420.28 ± 4541.33 yuan ¥). There was significant difference in the positive rate of EBUS brushing and biopsy, diagnosis time and expense during diagnosis between both groups. And no significant difference was observed in the complications and the procedure time. Additionally, the impact of ROSE on diagnostic yield in right upper lobe and the size of lesion ≤ 2 cm in diameter was significant. CONCLUSION: In combination with ROSE, EBUS could significantly improve the positive rate of diagnosing PPLs, shorten diagnosis time and reduce expense during diagnosis. ROSE will be of great importance in the diagnosis of PPLs and medical resource.

Patient Activeness During Online Medical Consultation in China: Multilevel Analysis.

BACKGROUND: Online medical consultation is an important complementary approach to offline health care services. It not only increases patients' accessibility to medical care, but also encourages patients to actively participate in consultation, which can result in higher shared decision making, patient satisfaction, and treatment adherence. OBJECTIVE: This study aims to explore multilevel factors that influence patient activeness in online medical consultations. METHODS: A data set comprising 40,505 patients from 300 physicians in 10 specialties was included for multilevel analysis. Patient activeness score (PAS) was calculated based on the frequency and the proportion of patient discourses to the total frequency of doctor-patient interactions. Intraclass correlation coefficients were calculated to identify between-group variations, and the final multilevel regression model included patient- and physician-level factors. RESULTS: Patients were not equally active in online medical consultations, with PASs varying from 0 to 125.73. Patient characteristics, consultation behavioral attributes, and physician professional characteristics constitute 3 dimensions that are associated with patient activeness. Specifically, young and female patients participated more actively. Patients' waiting times online (ß=-.17; P<.001) for physician responses were negatively correlated with activeness, whereas patients' initiation of conversation (ß=.83; P<.001) and patient consultation cost (ß=.52; P<.001) in online medical consultation were positively correlated. Physicians' online consultation volumes (ß=-.10; P=.01) were negatively associated with patient activeness, whereas physician online consultation fee (ß=.03; P=.01) was positively associated. The interaction effects between patient- and physician-level factors were also identified. CONCLUSIONS: Patient activeness in online medical consultation requires more scholarly attention. Patient activeness is likely to be enhanced by reducing patients' waiting times and encouraging patients' initiation of conversation in online medical consultation. The findings have practical implications for patient-centered care and the improvement of online medical consultation services.

Turn to the Internet First? Using Online Medical Behavioral Data to Forecast COVID-19 Epidemic Trend.

The surveillance and forecast of newly confirmed cases are important to mobilize medical resources and facilitate policymaking during a public health emergency. Digital surveillance using data available online has increasingly become a trend with the advancement of the Internet. In this study, we assessed the predictive value of multiple online medical behavioral data, including online medical consultation (OMC), online medical appointment (OMA), and online medical search (OMS) for the regional outbreak of coronavirus disease 2019 in Shenzhen, China during January 1, 2020 to March 5, 2020. Multivariate vector autoregression models were used for the prediction. The results identified a novel predictor, OMC, which can forecast the disease trend up to 2 days ahead of the official reports of confirmed cases from the local health department. OMS data had relatively weaker predictive power than OMC in our model, and OMA data failed to predict the confirmed cases. This study highlights the importance of OMC data and has implication in providing evidence-based guidelines for local authorities to evaluate risks and allocate resources during the pandemic.

Association between sleep apnea and ultrasound-defined liver fibrosis: Results from NHANES 2017 to 2020.

Liver fibrosis is a critical factor in the advancement of nonalcoholic fatty liver disease towards cirrhosis. There is limited research exploring the association between obstructive sleep apnea (OSA) and liver fibrosis among community populations. The present study aimed to assess the association between sleep apnea (SA) and liver fibrosis based on the National Health and Nutrition Examination Survey (NHANES). Data were acquired from NHANES survey cycle 2017 to 2020. We assessed liver fibrosis by the median values of liver stiffness measurement (LSM). The diagnosis of SA was based on participants' response to sleep questionnaire. Univariate and multivariate logistic regression were used to validate the association of SA and liver fibrosis. A total of 7615 participants were included in this study. The LSM level of SA group was significantly higher than non-SA group. The proportion of liver fibrosis in SA group was markedly higher than that in non-SA group (14.0% vs 7.3%, P < .001). Univariate logistic analysis showed that SA was positively associated with liver fibrosis (OR = 2.068, 95%CI = 1.715-2.494, P < .001). Further multivariate logistic analysis revealed that SA was independently associated with increased risk of liver fibrosis after adjusting for confounding factors (OR = 1.277, 95%CI = 1.003-1.625, P = .048). The current study demonstrated an independent association between self-reported SA and increased risk of ultrasound-defined liver fibrosis in community-based sample.

The relationship between obstructive sleep apnea and circulating tau levels: A meta-analysis.

BACKGROUND: Alzheimer's disease (AD) is an irreversible, progressive brain disorder that impairs memory, thinking, language, and, eventually, the ability to carry out the simplest of tasks. Tau protein, the major component of neurofibrillary tangles, is considered a key mediator of AD pathogenesis. The association between obstructive sleep apnea (OSA) and circulating tau remains unclear. The aim of the present meta-analysis was to evaluate the relationship between OSA and circulating tau via quantitative analysis. METHODS: A systematic search of Pubmed, Embase, and Web of Science were performed. The mean values of circulating total tau (T-tau) and phosphorylated tau (P-tau) in OSA and control groups were extracted. Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated by using a random-effect model or fixed-effect model. RESULTS: A total of seven studies comprising 233 controls and 306 OSA patients were included in this study. The meta-analysis showed that the circulating T-tau level was significantly higher in OSA patients than those in the control group (SMD = 1.319, 95% CI = 0.594 to 2.044, z = 3.56, p < .001). OSA patients also had significantly higher circulating P-tau level than control group (SMD = 0.343, 95% CI = 0.122 to 0.564, z = 3.04, p = .002). CONCLUSIONS: The present meta-analysis demonstrated that both circulating T-tau and P-tau levels were significantly increased in OSA subjects when compared with non-OSA subjects. Larger sample-size studies on the association between OSA and circulating tau are still required to further validate our results.

The reception of support in peer-to-peer online networks: Network position, support solicitation, and support provision in an online asthma caregivers group.

This study applies social network analysis and quantitative content analysis to messages exchanged within an online support forum of caregivers of children with chronic asthma to examine how peer-to-peer network positions and personal communication styles (seeking and providing support) impact the reception of social support. Content analysis is used to determine rates of giving and receiving informational and emotional support. Network analysis assesses levels of individual betweenness and closeness centrality in the online network. Relationships between network positions, solicitation strategies, and the provision and reception of informational and emotional support are examined. Betweenness and closeness centrality are associated with improved informational and emotional support. The provision of informational support is also improved by providing descriptions of personal experience. Practical implications for the design and use of online support platforms are discussed.

Vitamin D and iodine status was associated with the risk and complication of type 2 diabetes mellitus in China.

The purpose of this study was to assess the relationship between 25-hydroxyvitamin D (25(OH)D), urinary iodine concentration (UIC), and type 2 diabetes mellitus (T2DM) risk and complications and to establish a model to predict T2DM in the general population. A total of 567 adults (389 T2DM patients and 178 controls) were enrolled, and the levels of 25(OH)D, iodine, and blood biochemical parameters were measured. Pearson's correlation analysis showed an inverse correlation between 25(OH)D level, UIC, and T2DM risk. Low 25(OH)D level was a risk factor for developing T2DM (OR, 0.81; 95% CI, 1.90-2.63; P = 0.043) after adjustment for multiple risk factors. 25(OH)D level and UIC were inversely correlated with short-term and long-term glucose levels. 25(OH)D deficiency was also associated with a high incidence of T2DM complicated with thyroid dysfunction. A prediction model based on 25(OH)D, iodine status, and other risk factors was established and recommended to screen high-risk T2DM in the general population and provide early screening and timely treatment for them.

Development of a bead-based suspension array for the detection of pathogens in acute respiratory tract infections.

We developed a high-throughput bead-based suspension array for simultaneous detection of 20 respiratory tract pathogens in clinical specimens. Pathogen-specific genes were amplified and hybridized to probes coupled to carboxyl-encoded microspheres. Fluorescence intensities generated via the binding of phycoerythrin-conjugated streptavidin with biotin-labeled targets were measured by the Luminex 100 bead-based suspension array system. The bead-based suspension array detected bacteria in a significantly higher number of samples compared to the conventional culture. There was no significant difference in the detection rate of atypical pathogensatypical pathogens or viruses between the bead-based suspension array and real-time PCR. This technology can play a significant role in screening patients with pneumonia.

[Association between polymorphisms in pigment epithelium-derived factor gene promoter region and non-alcoholic fatty liver disease in type 2 diabetes mellitus].

OBJECTIVE: To investigate the association of serum pigment epithelium-derived factor (PEDF) level and polymorphisms in PEDF gene promoter region -358G→A with non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM) of Han Nationality in Fujian Province. METHODS: A total of 282 T2DM patients with NAFLD (DM1 group) and 170 age- and gender-matched T2DM patients without NAFLD (DM2 group) were examined for PEDF gene SNP-358G→A polymorphisms using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Serum pigment epithelium-derived factor(PEDF) level, fasting plasma glucose (FPG), fasting insulin (FINS) and glycosylated hemoglobin (HbA1c) were also measured. RESULTS: The patients in DM1 group showed a significantly higher mean level of serum PEDF than those in DM2 group (P<0.05). Logistic regression analysis revealed that PEDF level was an independent risk factor for NAFLD in T2DM. The frequencies of PEDF gene -358G→A genotypes (GG, GA, and AA) and alleles (G/A) differed significanly between DM1 and DM2 groups (P<0.05). In terms of PEDF gene SNP -358G→A alleles, the GA genotype carriers had a 2.032 times higher risk of developing NAFLD compared with the GG genotype carriers, and the risk increased to 2.068 times in the carriers of the A allele (GA and AA genotypes; P<0.05). CONCLUSION: Serum PEDF level is an independent risk factor of NAFLD in T2DM. Elevated serum PEDF level is a protective factor against insulin resistance. In T2DM patients, PEDF gene promoter region -358G→A polymorphism is associated with NAFLD, and the A allele contributes to an increased risk of NAFLD.