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Objective To assess the clinical benefit and compare the cost‐effectiveness of total knee arthroplasty (TKA) in patients with different personality traits. Methods The present study was retrospectively conducted from January 2017 to May 2018. A total of 232 patients between 46 and 71 years old who underwent unilateral, primary TKA with the diagnosis of knee osteoarthritis were interviewed. Three types of data were required to compare the cost‐effectiveness differences among groups: personality traits, postoperative clinical outcomes about health‐related quality of life, and costs associated with TKA. Personality was assessed using the Eysenck Personality Questionnaire, functional outcome was assessed through the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, and costs were evaluated. Besides, the marginal cost‐effectiveness ratio (MCER) as the primary outcome, which relates the direct costs to the associated patient benefit as assessed by the clinical endpoint ($/quality‐adjusted life years [QALY]), was compared among different personality traits. All information for this study was acquired by directly interviewing the patients and reviewing the medical computer records at our hospital. Results Two hundred and eleven patients completed the final analysis with an average of 24.6 months follow‐up postoperatively. The choleric group, sanguine group, melancholic group, and phlegmatic group has 41, 70, 46, and 54 patients, respectively. A statistically significant difference in MECR, QALYs, and postoperative WOMAC existed among different personality traits (all P 0.05), preoperative albumin, Melancholic personality is a severe problem for a good cost‐effectiveness ratio of TKA, producing high costs but less benefit on quality of life for the public health system. Before surgery, screening the melancholic patients would significantly reduce the economic burden, avoid unnecessary suffering, and shorten the recovery period.

Background/objectives The assessment of nutritional status and the quality of life in patients with gastric cancer has become one of the important goals of current clinical treatment. The purpose of this study was to assess the nutritional status in hospitalized gastric cancer patients by using patient-generated subjective global assessment (PG-SGA) and to analyze the influence of nutritional status on the patients’ quality of life (QOL). Methods We reviewed the pathological diagnosis of gastric cancer for 2322 hospitalized patients using PG-SGA to assess their nutritional status and collected data on clinical symptoms, the anthropometric parameters (height, weight, body mass index (BMI), mid-arm circumference (MAC), triceps skin-fold thickness (TSF), and hand-grip strength (HGS). We also collected laboratory data (prealbumin, albumin, hemoglobin) within 48 h after the patient was admitted to the hospital. The 30-item European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) was used for QOL assessment in all patients. Results By using PG-SGA, we found 80.4% of the patients were malnourished (score ≥ 4) and 45.1% of the patients required urgent nutritional support (score ≥ 9). In univariate analysis, old age (> 65 years, p

Background Obesity worsens asthma control partly through enhanced airway neutrophilia, altered lung mechanics and comorbidities, including obstructive sleep apnea syndrome, gastroesophageal reflux disease and depression. Although controversial, obesity may also cause poorer outcomes in acute asthma. IL-17 is associated with neutrophilic inflammation, steroid resistance and severe asthma, but its importance in the association between asthma and obesity is unknown. Objective To investigate the role of IL-17 in obese asthma in both acute and stable settings. Methods Both stable (n = 177) and acute (n = 78) asthmatics were recruited and categorized into lean (n = 77 and 39 respectively), overweight (n = 41 and 17 respectively) and obese (n = 59 and 22 respectively) groups and compared for clinical characteristics, including sputum and plasma IL-17 protein concentrations, sputum cellularity, spirometry and comorbidities. Correlations of IL-17 expression with other measures were explored. Results In stable subjects, airway neutrophilia and IL-17 concentrations were most prominent in the obese, and correlated positively with each other. Significant increase in plasma IL-17 levels was also noted and associated with elevated depressive symptoms in obesity. In acute asthma, IL-17 expression, like most other clinical measures, was similar among lean, overweight and obese groups, but was higher in acute versus stable asthma subjects, with sputum IL-17 correlating positively with sputum neutrophils and negatively with FEV 1 and plasma IL-17 showing a positive connection to airway eosinophilia during exacerbation. Conclusions IL-17 contributes to worse disease control in obese asthma through enhancing airway neutrophilia and depression, and may implicate in asthma exacerbations. Effects of adiposity on acute asthma remain uncertain.

The level of the systemic inflammatory marker C-reactive protein (CRP) is elevated in many patients with malignant disease and may be related to nutritional status.To analyze the association between serum CRP levels in patients with malignant tumors and their nutritional status.A total of 3,692 cases were analyzed and the serum CRP levels were determined using an immunometric assay. Nutritional status was assessed by using patient-generated subjective global assessment (PG-SGA). The biochemical evaluation of prealbumin (PA), albumin (ALB), cholesterol (CHOL), and triglycerides (TG) were assayed within 48 h admission to the hospital. The association between serum CRP concentration and the nutritional status, the stage of the tumor and other factors was analyzed by univariate and multivariate logistic regression analysis.Elevated serum CRP was observed in 47.6% (1,548/3,269) of patients compared with the reference value, and the median CRP concentration was 18.29 mg/l. Patient serum CRP concentrations in the malnourished group (PG-SGA B + C) were higher than in the well-nourished (PG-SGA A) patients (P 0.05). The serum CRP level was related to the patients' age, gender, tumor stage, and was affected by hepatitis, liver cirrhosis, diabetes, but it has no effect on hypertension. The CRP high patients had lower PA and ALB levels, lower Karnofsky performance status scores, and higher PG-SGA scores (P 0.05), and there was no relationship with CHOL and TG levels. Weight loss in the previous 1 mo was seen with CRP positive patients (P 0.05).Almost 50% of malignant tumor patients had elevated serum CRP levels indicating a systemic inflammatory state. The nutritional status was worse in cancer patients with higher concentrations of serum CRP. The level of CRP was associated with the tumor stage, and, as stage is a prognostic factor, so can CRP be used as a prognostic maker in malignant tumors patients.

Hand grip strength (HGS) has emerged as a predictor of the nutritional status. However, many factors may modify the malnutrition-HGS association. This study explored the nutritional assessment value and determinants of HGS in patients hospitalized with cancer.In this multicenter, retrospective, observational study (11,314 patients), the Receiver operator characteristic curve was used to observe HGS and nutritional status sensitivity/specificity. Sex; age; height; weight; mid-upper arm circumference (MAMC); Patient-Generated Subjective Global Assessment (PG-SGA) score; Karnofsky score; physical function (PF) domain; cognitive function (CF) domain; global health and quality of life (QL) domain of EORTC QLQ-C30 (a quality of life instrument designed by the European Organization for Research and Treatment of Cancer); and albumin, prealbumin, and hemoglobin levels were included in a Stepwise analysis model to identify the factors influencing HGS.HGS showed a very low diagnostic value and accuracy for identifying severe malnourishment (area under the curve, 0.615-0.640; p0.01). HGS positively correlated with sex; height; weight; MAMC; Karnofsky score; QL, PF, and CF domains; and hemoglobin and prealbumin levels (Beta= 0.02-0.42, p=0.05), and negatively with age (Beta=-0.19, p0.01). However, the PG-SGA score was excluded because of its very limited contribution to HGS variability.HGS is a mutifactorial index. The use of HGS cutoff values to identify malnutrition is markedly challenging. Thus, HGS may be of limited use as a predictor of nutritional status.

ContextCardiac troponins have become the gold standard for diagnosing acute myocardial infarction (AMI) in the general population; however, their diagnostic accuracy for hemodialysis (HD) patients presenting with chest pain or dyspnea is uncertain.ObjectiveTo examine the diagnostic accuracy of high-sensitivity cardiac troponin T (hs-cTnT) assay for AMI in HD patients.DesignIn this prospective study, we enrolled 670 consecutive stable HD patients presenting with chest pain or dyspnea on routine predialysis therapy in the nephrology department. Receiver operating characteristic (ROC) curves were used to examine the diagnostic accuracy of hs-cTnT levels at enrollment in HD patients presenting with chest pain or dyspnea, and the dynamic change in these levels after 3 hours.ResultsAcute myocardial infarction was the adjudicated final diagnosis in 12% of HD patients. Among patients with a final diagnosis other than AMI, 97% had a plasma hs-cTnT concentration above the 99th percentile. At the time of enrollment, the area under the ROC curve of hs-cTnT levels for diagnosis of AMI was 0.68 (95% confidence interval [CI], 0.62–0.74; P < .001) with a cutoff value of 107.7 ng/L; the relative change after 3 hours was 0.90 (95% CI, 0.82–0.96, P < .001) with a cutoff value of 24%, and the absolute change was 0.88 (95% CI, 0.82–0.94, P < .001) with a cutoff value of 32.6 ng/L. The prognostic value for 40-day mortality varied with the magnitude of elevation in hs-cTnT levels.ConclusionsTracking the dynamic change in hs-cTnT levels during the short term significantly increased this measure's diagnostic accuracy for AMI in HD patients.

To evaluate the incidence and risk factors of ROP (retinopathy of prematurity) through a prospective multicenter study.Eleven children's or maternalchild hospitals participated in a collective network. All infants of birth weight2000 g, born in or transferred to one of the participating centers from January 1st 2005 to February 28th 2006 were recruited. Timely ophthalmologic examinations were performed. The relevant data at baseline and endpoints were collected at each unit.A total of 882 preterm infants fulfilled the screening criteria and 752 finished a followup. And 123 infants (16.4%) had some degree of ROP. Infants with ROP had a lower gestational age, birth weight and a longer duration of oxygen versus those without ROP [(30.82 +/- 0.20) weeks vs (32.56 +/- 0.09) weeks, (1430 +/- 25) g vs (1636 +/-10) g, (11.6 +/- 1.4) d vs (4.4 +/- 0.3) d]. Through a univariate analysis, birth weight, gestational age, asphyxia, oxygen duration5 days, apnea, surfactant usage, pneumonia, anemia, blood transfusion, acidosis and neonatal respiratory distress syndrome (NRDS) were associated with ROP (P0.05). Logistic regression analysis showed that birth weight (OR = 0.998), apnea (OR = 1.653) and blood transfusion (OR = 1.763) were independent risk factors for ROP.Asphyxia, oxygen duration5 days, surfactant usage, anemia, acidosis and NRDS, lower birth weight, apnea and blood transfusion may improve the risks of ROP.

Poor growth is a common problem in premature neonates. No sufficient attention has been paid to the nutrition deficit and extrauterine growth retardation in premature neonates in China. The present study aimed to assess the incidences of intrauterine growth retardation (IUGR) and extrauterine growth retardation (EUGR) in premature neonates in Shanghai area and their correlated factors.Data of the neonates discharged between January 1, 2003 and December 31, 2004 from 5 hospitals (Xinhua Hospital, Shanghai Children's Medical Center, Shanghai Children's Hospital, Pediatric Hospital Affiliated to Fudan University, and Shanghai International Peace Maternity and Child Health Hospital) were reviewed. The criteria of exclusion were cases who died or had a malformed appearance, the mother had endocrine or metabolic diseases. The criteria for enrollment were (1) gestational age37 weeks, (2) admitted less than 24 hours after birth and discharged from the same hospital, (3) duration of hospitalization wasor = 7 days. The growth values on discharge of each patient were compared to the expected values based on the intrauterine growth data and postmenstrual day on discharge. Growth retardation was defined as measured growth values (weight, head circumference)or = 10th percentile of the values (growth expectation based on estimated postmenstrual age). In each specific group, the number of neonates withor = 10(th) percentile for each growth parameter was counted and the percentages of patients who had valuesor = 10(th) percentile on birth and discharge were calculated. The growth curves used for assessing birth weight and head circumference for different gestational age neonates were those published in 1986. All the data were analyzed using the SPSS statistical software package. The risk factors for extrauterine growth retardation on weight and head circumference were estimated with logistic regression model.The subjects included 1196 premature neonates in the five hospitals (734 boys and 462 girls). The incidence of IUGR was 22.7% and 19.2% assessed by weight and head circumference, respectively. The incidence of EUGR was 49.7% and 23.1% assessed by weight and head circumference, respectively. Assessment of IUGR in accordance with the birth weight and head circumference in the five hospitals showed no significant correlation between IUGR and non-IUGR by birth weight (chi(2) = 4.944) and head circumference (chi(2) = 0.017) respectively. Whereas the assessment of EUGR in accordance with weight and head circumference showed a significant correlation between EUGR and non-EUGR by weight on discharge (chi(2) = 28.109), but no significant correlation was found between EUGR and non-EUGR by head circumference on discharge (chi(2) = 0.275). In specific birth weight groups, the lower the weight, the higher the incidence of IUGR and EUGR by the weight and head circumference. The incidence of EUGR in VLBWI was 78.9% and 50.0% assessed by weight and head circumference, respectively. Assessed by weight, significant correlation was observed between EUGR and non-EUGR in birth weight (t = 18.674), hospitalization duration (Z = -8.790) and the median number of day for total using EN (Z = -4.650); but by the head circumference, significant correlation was observed in head circumference at birth (t = 9.555), hospitalization duration (Z = -3.930) and the median number of day for total using EN (Z = -3.004). The relationship between EUGR and some risk factors was analyzed with Logistic regression model. Assessed by the weight, the following 4 factors were related to EUGR: sex (chi(2) = 10.351), gestation age at birth (chi(2) = 56.275), birth weight (chi(2) = 102.126) and different hospital (chi(2) = 4.773). Assessed by the head circumference, the following 2 factors were correlated: gestation age at birth (chi(2) = 10.322) and head circumference (chi(2) = 10.620).This study showed that the incidence of EUGR in premature neonates was significantly higher than the data reported in other countries. The incidence of EUGR increased with the decreased birth weight. Different nutritional support had influence on EUGR.