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Objective:To explore the differences of risk stratification of very high-risk or extreme high-risk atherosclerotic cardiovascular diseases (ASCVD) and the attainment rates of low-density lipoprotein cholesterol (LDL-C) management targets evaluated by three different criteria, and the causal attributions of these differences.Methods:Patients with ASCVD were consecutively enrolled from January 1 to December 31 in 2019, and were evaluated for very high-risk or extreme high-risk and LDL-C goal attainment rates with 2018 American guideline on the management of blood cholesterol (2018AG), 2019 China Cholesterol Education Program (CCEP) Expert Advice for the management of dyslipidemias (2019EA) and 2020 Chinese expert consensus on lipid management of very high-risk ASCVD patients(2020EC), respectively. The causal attributions of the differences in attainment rates were analyzed as well.Results:A total of 1 864 ASCVD patients were included in this study. According to 2018AG, 2019EA and 2020EC, the proportions of the patients with very high-risk or extreme high-risk were 59.4%, 90.7%, and 65.6%, respectively. The absolute LDL-C target attainment rates were 37.2%, 15.7%, and 13.7%, respectively, the differences between each two rates were statistically significant (all P<0.001). As to the differences in attainment rates between 2020EC and 2018AG, 61.5% were due to the different LDL-C goal attainment values and 38.5% were caused by the different risk stratifications, while for the differences between 2020EC and 2019EA attainment rates, different LDL-C goal attainment values were responsible for 13.2%, and different risk stratifications were responsible for 86.8% of the differences. Conclusions:There are significant differences in the proportions and LDL-C attainment rates among the three different criteria for very high-risk or extreme high-risk ASCVD. 2020EC showed a moderate proportion of patients with extreme high-risk, and had the lowest LDL-C attainment rate. The differences between 2020EC and 2018AG are mainly due to the LDL-C target values, and the differences between 2020EC and 2019EA are mainly caused by the risk stratifications.
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Objective:To explore the hotspots of the public concerns about quitting smoking before and during the coronavirus disease 2019 (COVID-19) pandemic.Methods:The monthly search index data of four key words, “the harm of smoking”，“quitting smoking”，“passive smoking” and “electronic cigarette” before the COVID-19 (from January, 2016 to December, 2019) and during the COVID-19 (from January, 2020 to December, 2020) pandemic were manually collected from the Baidu Index platform. The one-way ANOVA was used to compare the differences among annual search indexes of four keywords. The linear regression model was used to test the annual linear trend of search index of each keyword before the COVID-19, and the one-sample t-test was used to analyze the differences of the search indexes during the COVID-19 and the means before the COVID-19. Results:During 2016—2020, the annual average search index of “electronic cigarette” was the highest (1.465 million), followed by “the harm of smoking” (0.884 million) and “quitting smoking” (0.780 million), while “passive smoking” was the lowest (0.171 million). Before the COVID-19 (2016—2019), the search index of each keyword had positive cumulative growth, but there was no significant linear trend of annual change ( P>0.05). During the COVID-19 period (2020), the search index of “the harm of smoking” decreased significantly (0.794 million vs 0.907 million, P=0.011), and “quitting smoking” (0.591 million vs 0.827 million, P=0.172) and “passive smoking” (0.164 million vs 0.172 million, P=0.257) showed a downward trend, while the search index of “electronic cigarettes” bucked the trend and increased significantly (1.825 million vs 1.375 million, P=0.010). Conclusions:The public′s online attention to “electronic cigarette” increases dramatically during COVID-19 along with other information about quitting smoking decreases. There are urgent needs for strengthening regulation and monitoring of electronic cigarettes and carrying out more effective publicity of scientific methods to help quit smoking.
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Objective:To establish an evaluation index system for the refinement management of respiratory specialties in four dimensions: medical care, teaching, scientific research and personnel training, to develop a refinement management system based on medical big data, and evaluate the effectiveness of its application.Methods:Based on evaluation indexes and literature of several domestic respiratory specialty influence rankings, an index system covering four dimensions (primary indexes), 16 secondary indexes and 73 tertiary indexes covering medical treatment (30%), teaching (15%), scientific research (40%) and personnel training (15%) was devised using brainstorming, Delphi, and hierarchical entropy weighting. Data from 13 professional groups and 248 respiratory discipline members integrated by the system in 2018 and 2019 were statistically analyzed using the refined index system embedded in the system to understand the system's application after a year of use with comparing the four dimensions of the discipline and the changes among specialty groups before and after implementation.Results:In 2019, respiratory medicine′s comprehensive score grew 30% compared to 2018. The subscores also grew, with scientific research showing the largest growth rate of 136% and talent cultivation showing the second highest. In 2019, ten of the 13 professional groups grew by 2% to 135%.Conclusions:An improved management system for respiratory medicine based on big data technology has provided a comprehensive, intuitive and quantitative view of the discipline′s development in four dimensions and the differences among specialty groups. It will be an effective decision-making tool for ensuring high-quality and balanced discipline development.
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Objective To investigate the relationship between benign paroxysmal positional dizziness (BPPV) and cerebrovascular disease and to promotethe practice of evidence bases medicinein thediagnosis,treatment and recurrenceprevention of BPPV in the elderly.Methods A total of 80 elderly patients were consecutively recruited from the Dizziness Outpatient Clinic from January 2013 to June,2014,with 80 non-BPPV elderly individuals receiving routine physical checkups during the same period serving as the control group.Clinical characteristics,lab test results and imaging data were compared between the two groups.Single factor and multivariate logistic regression analyses were conducted to identify independent risk factors for BPPV in the elderly.Results The experimental group showed higher rates of lacunar infarction,leukoaraiosis and intracranial artery stenosis than the control group(x2 =10.180,4.606 and 3.956,respectively;P=0.001,0.032 and 0.047,respectively).The prevalences of hyperlipidemia and type 2 diabetes were higher in the BPPV group than in the control group(x2 5.013 and 6.041,respectively;P=0.025 and 0.014,respectively).Differences in number of carotid atherosclerotic plaque cases,total cholesterol,triglyceride,homocysteine and uric were found between the two groups (x2 =11.237,t=2.862,2.230 and 4.270,respectively;P=0.001,0.005,0.027 and 0.000,respectively).Multivariate logistic regression analysisfound that blood uric acid,hyperglycemia,type 2 diabetes and hypertension were independent risk factors for BPPV (OR=1.006,7.104,3.152 and 3.273,respectively;P=0.005,0.000,0.004 and 0.002,respectively).The existence of carotid atherosclerotic plaques also increased the risk of BPPV (OR =384.570,95 ％ CI:46.935～ 3151.055,P =0.000).Conclusions BPPV in the elderlyis closely associated with cerebrovascular disease and its risk factors.Therefore,it is of great clinical significance to assess cerebrovascular function and carotid atherosclerotic plaque development for improved prognosis and effective prevention of recurrence of BPPV in the elderly.
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Objective To investigate the relationship between benign paroxysmal positional dizziness (BPPV) and cerebrovascular disease and to promotethe practice of evidence bases medicinein thediagnosis,treatment and recurrenceprevention of BPPV in the elderly.Methods A total of 80 elderly patients were consecutively recruited from the Dizziness Outpatient Clinic from January 2013 to June,2014,with 80 non-BPPV elderly individuals receiving routine physical checkups during the same period serving as the control group.Clinical characteristics,lab test results and imaging data were compared between the two groups.Single factor and multivariate logistic regression analyses were conducted to identify independent risk factors for BPPV in the elderly.Results The experimental group showed higher rates of lacunar infarction,leukoaraiosis and intracranial artery stenosis than the control group(x2 =10.180,4.606 and 3.956,respectively;P=0.001,0.032 and 0.047,respectively).The prevalences of hyperlipidemia and type 2 diabetes were higher in the BPPV group than in the control group(x2 5.013 and 6.041,respectively;P=0.025 and 0.014,respectively).Differences in number of carotid atherosclerotic plaque cases,total cholesterol,triglyceride,homocysteine and uric were found between the two groups (x2 =11.237,t=2.862,2.230 and 4.270,respectively;P=0.001,0.005,0.027 and 0.000,respectively).Multivariate logistic regression analysisfound that blood uric acid,hyperglycemia,type 2 diabetes and hypertension were independent risk factors for BPPV (OR=1.006,7.104,3.152 and 3.273,respectively;P=0.005,0.000,0.004 and 0.002,respectively).The existence of carotid atherosclerotic plaques also increased the risk of BPPV (OR =384.570,95 ％ CI:46.935～ 3151.055,P =0.000).Conclusions BPPV in the elderlyis closely associated with cerebrovascular disease and its risk factors.Therefore,it is of great clinical significance to assess cerebrovascular function and carotid atherosclerotic plaque development for improved prognosis and effective prevention of recurrence of BPPV in the elderly.
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<p><b>BACKGROUND</b>Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and has been the leading cause of death in China. Patients with COPD have significant decrements in their health-related quality of life (HRQL). It is necessary to identify the factors involved in worsening HRQL in order to improve the HRQL of COPD patients. However, evidence from longitudinal studies is limited. The aim of the study was to evaluate the determinants of the deterioration of HRQL in patients with COPD.</p><p><b>METHODS</b>At baseline, a total of 491 patients with stable COPD received comprehensive assessments, including psychosocial and clinical variables, six minutes walk distance (6MWD), dyspnea grade measured by the 5-grade Medical Research Council (MRC) dyspnea scale, anxiety and depression measured by the hospital anxiety and depression scale and HRQL measured by St. George's Respiratory Questionnaire (SGRQ). Patients were then monitored monthly for 12 months to document COPD exacerbations. At the end of the study period, the SGRQ values were reassessed. A 1-year change in SGRQ total score ≥ 4 was defined as a deterioration of the HRQL and as the outcome. A total of 450 patients completed the 12-month follow-up and were analyzed in the present study.</p><p><b>RESULTS</b>The age (mean ± SD) was (65.0 ± 10.6) years and 68.7% of subjects were men. The deterioration of the HRQL was 26.4%. In multivariate Logistic regression, independent and graded associations were found between the baseline MRC dyspnoea grade and the deterioration of HRQL (P = 0.012), OR 3.03 (95% CI 1.11-8.24) for patients with MRC dyspnoea grade ≥ 4 versus patients with MRC dyspnoea grade = 1. Similarly, the number of exacerbations during the follow-up was independently and gradually increased with the deterioration of HRQL (P < 0.001), OR 3.03 (95% CI 1.9-5.6) for the participants with exacerbations ≥ 3 versus participants with no exacerbation. The 6MWD evaluated by quartiles was negatively associated with the deterioration of HRQL with borderline statistical significance.</p><p><b>CONCLUSION</b>MRC dyspnea grade and the number of exacerbations impair the HRQL of patients with COPD.</p>
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Aged , Female , Humans , Male , Middle Aged , Dyspnea , Psychology , Pulmonary Disease, Chronic Obstructive , Psychology , Quality of Life , Risk Factors , Surveys and QuestionnairesABSTRACT
Objective: To explore the progression rate of cortid maximal plaque area and the risk of new ischemic cardiovascular disease (ICVD) in a rural cohort in Beijing. Methods: The PRC-USA collaborative study had been regularly conducted in Shijingshan area in Beijing. The carotid ultrasound examination, ICVD risk factor and acute cardiovascular events follow-up were conducted in those participants. A total of 1479 subjects who received at least 2 carotid ultrasound examinations and had no cardiovascular disease before the second ultrasound were studied. They were divided into 5 groups:①Control group, the participants had no plaque detected by 2 ultrasounds; ② New plaque group, new plaque was found at the second ultrasound examination; ③ Plaque regression group; ④ Plaque stabilized group and ⑤ Plaque progression group. The hazard ratio (HR) between the progression rate of corotid maximal plaque area and new ICVD events was estimated by Cox proportional hazard regression analysis . Results: Compared with Control group, the HR for new ICVD events were higher in groups②,③,④and⑤at 3.5, 5.7, 6.2 and 7.3 respectively, all P Conclusion: The progression rate of maximal corot id plaque area rate could predict the risk of new ICVD events in clinical practice.
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ObjectiveTo investigate the impact of antimicrobial resistance on clinical outcomes and medical care costs among patients with imipenem-resistant Acinetobacter baumannii (IRAB) nosocomial infection.MethodsA retrospective matched case-control study was performed to compare the differences of clinical outcomes and medical care costs between patients with IRAB infection and patients with imipenem-susceptive Acinetobacter baumannii (ISAB) infection in a tertiary care university teaching hospital in China from January 2007 to June 2009.Cases were matched to controls with ratio of 1:1 on the basis of age,sex,severity of underlying diseases,source of infection,duration of hospitalization period and length of hospital stay before onset of infection.The measurement data between groups were compared by t test and rank test.The numeration data between groups were compared by x2 test. Multiple analysis was performed by Logistic regression.ResultsThe total mortality rate of IRAB infection patients was significantly higher than that of ISAB infection patients (39.1％ vs 20.3 ％ ; x2 =11.728,P＜0.01).Among 138 pairs of patients in IRAB group and ISAB group,there were 72 matched case-control pairs survived,which were significantly different in length of total hospital stay (28.5 days vs 23.0 days; x2 =2.886,P＜0.01) and intensive care unit (ICU) stay (14.5 days vs 0 day; x2 =4.844,P＜0.01).For all the 138 case-control pairs,everyday total hospitalization cost and everyday antibiotic therapy cost in IRAB cases were both higher than ISAB controls (RMB 3652 yuan vs RMB 2092 yuan; Z=3.792,P＜0.01 and RMB 555 yuan vs RMB 338 yuan; Z=4.209,P＜0.01).ConclusionIRAB infection can increase the mortality rate,lengthen hospital stay and elevate the medical costs notably.
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2.5-7.0,a close correlation can be seen between the indoor and outdoor air.