Factors Affecting Adenoma Risk Level in Patients with Intestinal Polyp and Association Analysis

Objective. To explore the factors affecting the adenoma risk level in patients with intestinal polyp and association. Methods. The clinical data of 3,911 patients with intestinal polyp treated in our hospital from January 2018 to January 2021 were retrospectively analyzed, all patients accepted the histopathological examination, their risk of suffering from adenoma was evaluated according to the results of pathological diagnosis, and relevant hazard factors affecting adenoma risk level in them were analyzed by multifactor logistic regression analysis. Results. The results of multifactor logistic analysis showed that male gender, age ≥60 years, number of polyps >3, diameter ≥2 cm, onset at colon, and physiologically tubulovillous adenoma were the hazard factors causing high-grade adenoma risk in patients with intestinal polyp. Conclusion. There are many risk factors causing high-grade adenoma in patients with intestinal polyp, and therefore, the screening for high-risk population shall be enhanced to reduce the potential of carcinomatous change in such patients.

Effects of Transthoracic Echocardiography on the Prognosis of Patients with Acute Respiratory Distress Syndrome: A Propensity Score Matched Analysis of the MIMIC-III Database

Introduction: Acute respiratory distress syndrome (ARDS) has high mortality and is mainly related to the circulatory failure.Therefore, real-time monitoring of cardiac function and structural changes has important clinical significance.Transthoracic echocardiography (TTE) is a simple and noninvasive real-time cardiac examination which is widely used in intensive care unit (ICU) patients.The purpose of this study was to analyze the effect of TTE on the prognosis of ICU patients with ARDS.Methods: The data of ARDS patients were retrieved from the MIMIC-III v1.4 database and patients were divided into the TTE group and non-TTE group. Then, the baseline data were compared between the two groups, and the effect of TTE on the prognosis of ARDS patients was analyzed through multivariate logistic analysis and the propensity score (PS).Results: A total of 1,346 ARDS patients were enrolled, including 519 (38.6%) cases in the TTE group and 827 (61.4%) cases in the non-TTE group. Compared with the non-TTE group, the 28-day mortality of patients in the TTE group was greatly improved (OR=0.64 95%CI: 0.48-0.86, P=0.003). The length of ICU stay in the TTE group was significantly shorter than that in the non-TTE group (17d vs.14d, P=0.0001). The infusion volume in the TTE group was significantly less than that of the non-TTE group (6.2L vs.5.5L on day 1, P=0.0012). Importantly, the patients in the TTE group were weaned ventilators earlier than those in the non-TTE group (ventilator-free days within 28 d: 21 d vs. 19.8 d, respectively, P = 0.071).Conclusion: TTE can lower the risk of 28-d mortality in patients with ARDS.

Relationship between tracheal intubation and the drugs used by patients with drug overdose due to self-harm

Background Tracheal intubation may be performed in patients with drug overdose due to self-harm; however, the details of the causative drug are unknown. The purpose of this study was to clarify the relationship between drugs or its blood levels of patients with drug overdose and the need for tracheal intubation based on the actual measurement results. Methods From October 2018 to March 2020, 132 patients with drug overdose due to self-harm who were transported to the emergency department (ED) were studied. Patient drugs were measured using gas chromatography–mass spectrometry (GC-MS) and were analyzed on the basis of the GC/MS Forensic Toxicological Database. Logistic analysis was performed by combining patient information and GC-MS information. Results The Glasgow Coma Scale (GCS) and Japan Coma Scale (JCS) efficiently predicted tracheal intubation in patients with drug overdose during transport triage; GCS (cut-off value: 12, area under the curve (AUC): 0.81, 95% confidence interval (CI): 0.71–0.88, sensitivity: 0.85, specificity: 0.71, P < 0.05) and JCS (cut-off value: 3, AUC: 0.74, 95% CI: 0.60–0.84, sensitivity: 0.60, specificity: 0.84, P < 0.05). The drugs detected in all patients with drug overdose in order were benzodiazepine receptor agonists (BZs; 43.9%), anticonvulsants (38.6%), antipsychotics (25.0%), and antidepressants (9.8%). In univariate logistic analysis, antipsychotics (odds ratio (OR) 2.46, 95% CI 1.19–5.20, P < 0.05), anticonvulsants (OR 2.71, 95% CI 1.26–5.98, P < 0.05), and anticonvulsants above alert blood levels (OR 27.8, 95% CI 2.92–264.1, P < 0.05) were significantly associated with tracheal intubation in patients with drug overdose, but not BZs and antidepressants. Also, in multivariate logistic analysis, antipsychotics (OR 2.27, 95% CI 1.07–4.83, P < 0.05), anticonvulsants (OR 2.50, 95% CI 1.14–5.64, P < 0.05) and in multivariate logistic analysis of blood levels, anticonvulsants above the alert blood levels (OR 24.9, 95% CI 2.56–241.6, P < 0.05) were significantly associated with tracheal intubation in patients with drug overdose respectively. Conclusions Logistic analysis revealed that the use of anticonvulsants and antipsychotics were significantly associated with an increased OR in the tracheal intubation of patients with drug overdose due to self-harm.

The Association between Parenting Confidence and Later Child Mental Health in the Area Affected by the Fukushima Nuclear Disaster: The Fukushima Health Management Survey

After the 2011 Fukushima Daiichi Nuclear Power Station accident, the Fukushima Health Management Survey was conducted to assess children’s lifestyle and mental health conditions. The participants in this study were 1126 children, aged 0 to 3 years, living in the evacuation zone at the time of the disaster. The parenting confidence of their mothers was assessed using a self-administered questionnaire as a baseline in 2013. We examined the association of parenting confidence level at baseline, using a total difficulty score of the Strengths and Difficulties Questionnaire (SDQ) and reluctance to attend school among children in a follow-up study in 2016 and 2017. As a result, no confidence was reported by 178 (15.8%) mothers, while 477 (42.4%) responded with “not sure” and 471 (41.8%) were confident. In the multiple logistic analysis, after adjusting for covariates such as the child’s sex, age, and current health condition, the group lacking parenting confidence demonstrated a significantly higher risk level for SDQ total difficulties (OR, 2.8; 95% CI, 1.59–4.93) and reluctance to attend school (OR = 1.98, 95% CI: 1.24–3.18) than the confident mothers. After a major disaster, which can have long-term effects on communities, intensive psychological care for mothers with young children is needed to prevent various mental health problems in their children.

Statin Therapy May Be Associated with Reduced Mortality Risk of Sepsis Patients: A Retrospective Study from the MIMIC-IV Database

BackgroundIt is controversial whether statin therapy is beneficial for sepsis patients. A large retrospective cohort study was conducted to evaluate the association between statin therapy and mortality in sepsis patients.MethodsAdult (≥18 years) sepsis patients were enrolled and divided into two groups: the statin group and the no-statin group. Data including demographic features, vital signs, laboratory tests, and comorbidities from MIMIC-IV v1.0 were extracted. Delirium was assessed via the Confusion Assessment Method for the ICU (CAM-ICU). Ninety-day mortality, 28-day mortality and the incidence of delirium after statin therapy were evaluated using multivariable logistic analysis, the PSM model and subgroup analysis based on univariate analysis. ResultsIn univariate analysis and multivariable logistic analysis, statin therapy showed a significant association with both reduced 28-day and 90-day mortality (90-day mortality: OR 0.58, 95% CI: 0.46-0.72, p<0.001; 28-day mortality: OR 0.47, 95% CI: 0.37-0.60, p<0.001), while no relationship was found between statin therapy and delirium (OR 0.92, 95% CI: 0.49-1.72, p=0.787). In further PSM model and subgroup analyses or sensitivity analysis, consistent results were shown. ConclusionStatin therapy is significantly associated with 28-day and 90-day mortality without decrease in the incidence of delirium.

Drug Legalization, Elite Support, and Government Effectiveness in Latin America

In Latin America, the legalization of drugs—where it occurred—has been driven mainly by elites, although much attention has been placed on public opinion. Considering that efforts toward legalization have been top-down, analysis should concentrate on opinions of the governing elites. To undertake such an analysis, we draw on data from surveys conducted in 18 Latin American parliaments (2012–2018), and we examine elite perspectives on the legalization of all drugs. Results from a Bayesian hierarchical logistic analysis show that in countries where the government is less effective, and where public health problems persist, legislators are less likely to support legalization. We argue that this is due to a lack of trust by MPs in legalization as a solution to trafficking. Wherever those concerned with drug trafficking see the current government as problematic, they will be less likely to support so challenging and complex a policy as drug legalization.

Effects of Transthoracic Echocardiography on the Prognosis of Patients with Acute Respiratory Distress Syndrome: a Propensity Score Matched Analysis of the MIMIC-III Database

Introduction: Acute respiratory distress syndrome (ARDS) has high mortality and is mainly related to the circulatory failure.Therefore, real-time monitoring of cardiac function and structural changes has important clinical significance.Transthoracic echocardiography (TTE) is a simple and noninvasive real-time cardiac examination which is widely used in intensive care unit (ICU) patients.The purpose of this study was to analyze the effect of TTE on the prognosis of ICU patients with ARDS.Methods: The data of ARDS patients were retrieved from the MIMIC-III v1.4 database and patients were divided into the TTE group and non-TTE group. Then, the baseline data were compared between the two groups, and the effect of TTE on the prognosis of ARDS patients was analyzed through multivariate logistic analysis and the propensity score (PS).Results: A total of 1,346 ARDS patients were enrolled, including 519 (38.6%) cases in the TTE group and 827 (61.4%) cases in the non-TTE group. Compared with the non-TTE group, the 28-day mortality of patients in the TTE group was greatly improved (OR=0.64 95%CI: 0.48-0.86, P=0.003). The length of ICU stay in the TTE group was significantly shorter than that in the non-TTE group (17d vs.14d, P=0.0001). The infusion volume in the TTE group was significantly less than that of the non-TTE group (6.2L vs.5.5L on day 1, P=0.0012). Importantly, the patients in the TTE group were weaned ventilators earlier than those in the non-TTE group (ventilator-free days within 28 d: 21 d vs. 19.8 d, respectively, P = 0.071).Conclusion: TTE can lower the risk of 28-d mortality in patients with ARDS.

Improved management of placenta accreta spectrum disorders: experience from a single institution

Objectives To assess the applicability of a standardized multidisciplinary protocol for managing placenta accreta spectrum (PAS) disorders and its impact on the outcomes. Methods We compared patients with PAS manage by a standardized multidisciplinary protocol (T2) to historic controls managed on a case-by-case basis by individual physicians between (T1). The primary outcome is composite maternal morbidity. Secondary outcomes were the rates of surgical complications, estimated blood loss, number of blood products transfused, intensive care unit admissions, ventilator use, and birth weight. Multivariate logistic analysis was used to identify independent predictors of composite maternal morbidity. Results During T1 and T2, we managed 39 and 36 patients with confirmed PAS, respectively. During T2, the protocol could be implemented in 21 cases (58%). Compared to T1, patients managed during T2 had 70% less composite maternal morbidity (95% CI: 0.11–0.82) and lower blood loss (median, 2,000 vs. 1,100 mL, p=0.008). Also, they were 68% less likely to require transfusion of blood products (95% CI: 0.12–0.81; p=0.01), including fewer units of packed red blood cells (median, 2 vs. 0, p=0.02). Management following the protocol was the only independent factor associated with lower composite maternal morbidity (OR: 0.22; 95% CI: 0.05–0.95; p=0.04). Selected maternal and neonatal outcomes were not different among 12 and 15 patients with suspected but unconfirmed PAS disorders managed during T1 and T2, respectively. Conclusions Most patients can be managed under a standardized multidisciplinary protocol for PAS disorders, leading to improved outcomes.

Public Perceptions and Acceptance of COVID-19 Booster Vaccination in China: A Cross-Sectional Study

Coronavirus disease 2019 (COVID-19) booster vaccination has been proposed in response to the new challenges of highly contagious variants, yet few studies have examined public acceptance of boosters. This study examined public acceptance of COVID-19 booster vaccination and its influencing factors by using the data from a self-administered online cross-sectional survey conducted in June 2021 in China. Multiple logistic analysis was used to examine the influencing factors of booster acceptance based on the health belief model (HBM). Among 1145 respondents, 84.80% reported to accept COVID-19 booster vaccination. Having COVID-19 vaccination history, perceiving high benefits and low barriers to booster vaccination, being younger (18–30 vs. 41–50), having a lower education level, being employed, and belonging to priority groups for vaccination were associated with increased odds of booster acceptance. The primary reason for refusing booster vaccination was concern about vaccine safety. The vast majority (92.8%) of respondents reported an annual willingness to pay between 0 and 300 CNY (0–46.29 USD) if the booster was not free. Our findings suggest that the acceptance rate of booster vaccination is relatively high in China, and the HBM-based analysis reveals that more efforts are needed to increase perceived benefits and reduce perceived barriers of vaccination to design effective and proper vaccination extension strategies when boosters become widely recommended.

Development and Validation of a Nomogram for Renal Involvement in Primary Sjögren Syndrome Patients: A Retrospective Analysis

Objective To establish and validate a nomogram for individualized prediction of renal involvement in pSS patients. Methods A total of 1293 patients with pSS from the First Affiliated Hospital of Wenzhou Medical University between January 2008 to January 2020 were recruited and further analyzed retrospectively. The patients were randomly divided into a development set (70%, n = 910) and a validation set (30%, n = 383). The univariable and multivariate logistic regression were performed to analyze the risk factors of renal involvement in pSS. Based on the regression β coefficients derived from multivariate logistic analysis, an individualized nomogram prediction model was developed. The prediction model of discrimination and calibration was evaluated with the area under the receiver operating characteristic curves and Calibration plot. Results Multivariate logistic analysis showed that hypertension, anemia, albumin, uric acid, anti-Ro52, hematuria and Chisholm-Mason grade were independent risk factors of renal involvement in pSS. The area under the receiver operating characteristic curves were 0.797 and 0.750 respectively in development set and validation set, indicating the nomogram had a good discrimination capacity. The Calibration plot showed nomogram had a strong concordance performance between the prediction probability and the actual probability. Conclusion The individualized nomogram for pSS patients those who had renal involvement could be used by clinicians to predict the risk of pSS patients developing into renal involvement and improve early screening and intervention.