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Background and aims: Given the cause of self-stigmatization of patients with rare diseases is complicated, and the self-stigmatization can be prevented by managing the related risk factors. This study aimed to report the prevalence as well as influencing factors associated with self-stigmatization in patients with rare diseases. Methods: From January to April 2022, the respondent-driven sampling (RDS) method was used to select patients with rare diseases through the Chinese Organization for Rare Disorders as the subjects. Based on the theoretical model of health ecology, logistic regression analysis was used to explore the association between self-stigmatization level and sample characteristics of patients with rare diseases. Results: A total of 530 patients were included, 50.2% of whom were male, and most of them are under 45 years old (86.5%). The prevalence of self-stigmatization in patients with rare diseases was 85.7%. Logistic regression analysis indicated that age (OR: 0.624, 95% CI: [0.399, 0.976]), mental health status (OR: 0.184, 95% CI: [0.076, 0.445]), family relations (OR: 0.180, 95% CI: [0.074, 0.434]), full time work (OR: 2.835, 95% CI: [1.024, 7.849]) and medical insurance (OR: 0.296, 95% CI: [0.105, 0.835]) were risk factors for self-stigmatization of patients with rare diseases. Conclusions: Chinese patients with rare diseases have a high level of self-stigmatization, and the potential risk factors are multi-level and multi-dimensional. [ABSTRACT FROM AUTHOR]

Background: Childhood and peer experiences can influence adolescents' perceptions of interpersonal relationships, which can, in turn, influence their emotional states and behavior patterns. Non-suicidal self-injury (NSSI) is now a common problem behavior among adolescents. The present study examined the role of childhood trauma and peer victimization in adolescents' NSSI. Methods: A cross-sectional survey was conducted among 1783 adolescents (1464 girls and 318 boys) in the psychiatric outpatient clinics or wards of 14 psychiatric hospitals or general hospitals in nine provinces in China. Data were collected using the Multidimensional Peer Victimization Scale (MPVS), Short-form Childhood Trauma Questionnaire(CTQ-SF), and Functional Assessment of Self-Mutilation (FASM). Structural equation modeling (SEM) with latent variables was used to demonstrate the mediating role of peer victimization in the association between childhoodtrauma and NSSI. Results: The SEM analysis demonstrated that peer victimization plays a partial mediating role in the relationship between childhood trauma and NSSI. In addition, several covariates (such as age, gender, education level, and place of residence) effectively regulated the relationship between peer victimization and NSSI. Conclusion: In future studies of NSSI among Chinese adolescents, attention should be paid to the roles of childhood trauma and peer bullying; there is a temporal sequence between these two variables and, to some extent, childhood trauma can have an impact on bullying during adolescence which, in turn, influences NSSI behavior. [ABSTRACT FROM AUTHOR]

Coal gangue (CG), which is mainly generated during coal excavation, mining, and coal washing, is an industrial solid waste that is recognized as an environmental pollutant. The ever‐increasing amount of CG produced is a serious threat to the ecological environment and property safety, especially in China, which is the largest coal producer and consumer in the world. Considerable studies have investigated means for utilizing CG worldwide. This review summarizes and discusses various porous inorganic materials made from CG, including cement‐based porous materials, porous bricks, porous ceramics (cordierite and mullite) and glasses, porous geopolymers, zeolites, aerogels, and porous carbon materials. Different preparation processes and performances of each type of porous inorganic materials were reviewed. Porous CG‐based materials can be used as promising adsorbents for the removal of various pollutants and have good potential for use in construction industry as well as catalyst material applications. Besides, porous materials obtained from CG have also been tested as slow‐release fertilizers after the absorption of phosphate, as electrode materials, and as oil‐in‐water separation agents. The systematic summary of porous materials based on CG aims at promoting high‐value‐added applications for this waste. Future research directions for the use of CG as a raw material are also presented. [ABSTRACT FROM AUTHOR]

Hedychium coronarium Koen is a perennial flowering plant that has ornamental, nutritional and medicinal value. In October 2019, root rot symptoms were observed in fields of H. coronarium in Yunnan Province, China. Fungal isolates were obtained from the diseased samples and the pathogenicity was confirmed by fulfilling Koch's postulates using wounded and unwounded plant inoculations. The pathogen was identified as Ceratobasidium sp. (binucleate Rhizoctonia) through morphological characterization and anastomosis grouping as well as sequence analysis of both rDNA-ITS and EF-1α. To our knowledge, this is the first report of Ceratobasidium sp. AG-I (binucleate Rhizoctonia) causing root rot on H. coronarium. [ABSTRACT FROM AUTHOR]

Skiing is currently the most popular winter outdoor recreation in China, thanks to the progressive growth of the ski sector. The construction of ski resorts would assist mountain communities economically. The Chinese ski sector is now booming, with the number of ski resorts expanding considerably. The geographical structure and driving causes for these ski regions, however, are poorly understood. Applying nearest neighbor ratio (NNR) analysis and the Spatial Lorentz Curve, this research examines the spatial patterns of these venues in detail. Kernel density estimation is used to identify hotspots (KDE). Furthermore, a regression analysis was used to discover the characteristics that influence the spatial distribution. We also look at the impact of the Internet of Things (IoT) on venue structural optimization. While China's ski regions were regionally distributed, the results show that ski areas are much a higher chance of being found at latitudes (northeast and northwest China) than at latitudes (central and south China). The key elements that affect the distribution of resorts vary by location and ski resort type. The implications for the ski resorts sector are explored, including the varied practices for cold and hot spot regions of China's ski areas, as well as the ski industry's future development orientation. [ABSTRACT FROM AUTHOR]

Polycyclic aromatic hydrocarbons (PAHs) are emitted into the environment by daily anthropogenic activities and they potentially threaten human health. Over the past 40 years, the coupling between PAHs emissions driven by energy transition and socioeconomic factors has yet to be determined, and future trends between the two parameters are unclear. In China, the emissions of PAHs increased from 1980 to 2016, and the average annual variation rate was 3.5%. After 2016, PAHs emissions were decoupled from socioeconomic growth. PAHs emissions exhibited a change from a developed region (eastern region) to an undeveloped region (central region and western region). The emissions of PAHs, if only driven by energy transition, will reach a peak in 2035 under the shared economic pathways (SSP1, SSP2, SSP4, and SSP5), which are defined to assess sustainable development. The emissions of PAHs will continuously increase by +9.8% under SSP3 during 2020–2050. Comparing these five socioeconomic pathways, SSP1 is the possible choice to achieve the sustainable decoupling of the emissions of PAHs and socioeconomic growth by transforming the drivers of economic growth, thereby optimizing the energy system and cultivating environmentally friendly behaviors. Plain Language Summary: The widespread occurrences of polycyclic aromatic hydrocarbons (PAHs) in air, surface water, soils, sediments, and biota have been a concern because of their toxic effects on ecosystem and human health. Thus, it is imperative to alleviate emissions of PAHs to reduce human health risks. Significant knowledge gaps exist regarding whether China's PAHs emissions driven by energy transition will decline or continue to increase. In this study, we analyzed the dynamic changes in PAHs emissions from industrial coal combustion, domestic coal combustion, primary aluminum production, gasoline, diesel oil, straw burning, natural gas, and coking coal during the period 1980–2020. Then, a coupling model was employed to explore the coupling relationship between PAHs emissions and socioeconomic growth (gross domestic product and population). Finally, future PAHs emissions were predicted using five shared socioeconomic scenarios (SSP1, SSP2, SSP3, SSP4, and SSP5) during the period 2020–2050. The emissions of PAHs, if only driven by energy transition, will reach a peak in 2035 under the shared economic pathways (SSP1, SSP2, SSP4, and SSP5), which are defined to assess sustainable development. The results will provide a solid basis for policymakers to enact mitigation strategies of PAHs emissions in China. Key Points: Polycyclic aromatic hydrocarbons (PAHs) emissions exhibited a change from a developed region to an undeveloped regionThe emissions of PAHs driven by energy transition will reach a peak in 2035 under the shared economic pathwaysSSP1 is the possible choice to achieve the sustainable decoupling of the emissions of PAHs and socioeconomic growth [ABSTRACT FROM AUTHOR]

Aims/Introduction: Few people have reported whether there are sex differences in blood lipids and lipid ratios in type 2 diabetic foot (T2DF) patients in China. This study attempts to identify the contribution to sex‐specific differences in blood lipids and lipid ratios in these patients. Materials and Methods: In this case–control study, we explore 306 patients with T2DF as the study group and 306 patients with type 2 diabetes mellitus as the control group. Patients were diagnosed according to the Standards of Medical Care in Diabetes–2014 (American Diabetes Association). Blood lipid and lipid ratios were determined according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Results: We studied male patients with T2DF who were aged 68.00 years (18.00 years) and females who were aged 73.50 years (19.00 years); 61.76% of the patients were men. Men had higher body mass index and glycated hemoglobin levels than women. Compared with type 2 diabetes mellitus patients, T2DF patients had significant differences in total cholesterol/high‐density lipoprotein cholesterol (HDL‐C), low‐density lipoprotein cholesterol/HDL‐C and apolipoprotein (apo)B/apoA‐I ratios. HDL‐C, triglyceride, apoA‐I and apoB/apoA‐I ratio showed cardiovascular disease risk in men, whereas total cholesterol, low‐density lipoprotein cholesterol, apoB, and the low‐density lipoprotein cholesterol/HDL‐C and total cholesterol/HDL‐C ratios were better predictors in women. The apoB/apoA‐I ratio odds ratio values were 2.18 (95% confidence interval 1.17–4.41) and 2.14 (95% confidence interval 1.14–4.00) in male patients with T2DF before and after adjusting for age, respectively (P < 0.05). Conclusions: T2DF patients present sex‐specific differences in their blood lipid and lipid ratios, especially in the apoB/apoA‐I ratio, which could be a better indicator for cardiovascular disease risk. [ABSTRACT FROM AUTHOR]

The impact of meteorological factors on the transport behavior and distribution of volatile and semi-volatile organic pollutants has become an area of increasing concern. Here, we analyzed seasonal variation in climatic variables including wind, temperature, and precipitation to quantitatively assess the impact of these factors on the multimedia transport and fate of BaP in the continental region of China using a Berkeley-Trent (BETR) model. The advective rates of air exhibited an increasing trend of autumn (1.830 mol/h) < summer (1.975 mol/h) < winter (2.053 mol/h) < spring (2.405 mol/h) in association with increasing wind speed, indicating that lower atmospheric BaP concentrations are present in regions with high wind speeds and advective rates. The air-soil transport rates (0.08–45.55 mol/h) in winter were higher than in summer (0.07–32.41 mol/h), while low winter temperatures accelerate BaP accumulation in terrestrial ecosystems due to cold deposition. Cold deposition effects were more evident in northern regions than in southern regions. Further, increasing precipitation enhanced air-soil and soil-freshwater transport rates with the correlation coefficients of r = 0.445 and r = 0.598 respectively, while decreasing the air-vegetation transport rates (r = 0.475), thereby contributing to the accumulation of BaP in soils and freshwaters. In the light of the potential dispersion of BaP pollution at regional and global scales affected by these key climatic factors, this indirectly indicated the impact of future climate change on the BaP transport. Thus, flexible policy interventions should be enacted to slow future climate change. [Display omitted] • Wind drives the dispersion of BaP to adjacent regions. • Low temperatures accelerate BaP accumulation in terrestrial ecosystems. • The cold deposition effects were more obvious in the north than in the south of China. • Increasing precipitation contributes to the accumulation of BaP in soils and freshwaters. [ABSTRACT FROM AUTHOR]

Out-of-hospital cardiac arrest (OHCA) is a global public health concern. Nationwide studies on the effects of short-term exposure to particulate matter (PM) on OHCA risk are rare in regions with high PM levels, and evidence for coarse PM (PM 2.5–10) is limited and inconsistent. To evaluate the associations between fine PM (PM 2.5) and PM 2.5–10 and OHCA onset, a time-stratified case-crossover study was conducted on 77,261 patients with cardiac OHCA in 26 cities across China in 2020. Daily PM 2.5 and PM 2.5–10 concentrations were assessed with high-resolution and full-coverage PM estimations. Conditional logistic regression models were applied in analyses. Each interquartile range of PM increase in 3-day moving average was associated with an increased risk of cardiac OHCA onset of 2.37% (95% CI, 1.20–3.56%) for PM 2.5 and 2.12% (95% CI, 0.70–3.56%) for PM 2.5–10. Stratified analyses showed higher susceptibility in patients over 75 years for PM 2.5 exposure and with diabetes for PM 2.5–10. This first nationwide study in region with high PM levels and great PM variability found not only PM 2.5 but also PM 2.5–10 were associated with a higher risk of OHCA onset, which could add powerful epidemiological evidence to this field and provide new evidence for the formulation of air quality guidelines. [Display omitted] • The first nationwide case-crossover study on PM-OHCA in areas of high PM level. • Daily PM exposure was assessed with full-coverage and high-resolution predictions. • Higher fine and coarse PM pollution are both associated with increased OHCA risk. [ABSTRACT FROM AUTHOR]

Emission intensity and climate change control the transport flux and fate of persistent organic pollutants (POPs) in multiple environmental compartments. This study applied a multimedia model (BETR model) to explore alternations in the spatio-temporal trends of concentrations and transport flux of benzopyrene (BaP), phenanthrene (Phe), perfluorooctane sulfonates (PFOS) and polychlorinated biphenyls (PCBs) in the Chaohu watershed, located in the lower reaches of the Yangtze River, China in response to changes in source emissions and climate. The potential historic and future risks of these pollutants also were assessed. The results suggest that current trends in concentrations and transport were similar to that of their emissions between 2005 and 2018. During the next 100 years, temporal trends and spatial patterns were not predicted to change significantly, which is consistent with climate change. Based on sensitivity and correlation analyses, climate change had significant effects on multi-media concentrations and transport fluxes of BaP, Phe, PFOS and PCBs, and rainfall intensity was the predominant controlling factor. Risk quotients (RQs) of BaP and Phe-in soil increased from 0.42 to 0.95 and 0.06 to 0.35, respectively, from 2005 to 2090, indicating potential risks. The RQs of the other examined contaminants exhibited little potential risk in soil, water, or sediment. Based on spatial patterns, it was inferred that the ecosystem around Lake Chaohu is the most at risk. The study provides insights needed for local pollution control of POPs in the Chaohu watershed. In addition, the developed approach can be applied to other watersheds world-wide. [Display omitted] [ABSTRACT FROM AUTHOR]

Objectives: To explore the prevalence and risk factors associated with circadian syndrome (CricS) in community-dwelling middle-aged to older adults., Method: We performed a cross-sectional analysis of 13,516 participants from the China Health and Retirement Longitudinal Study (CHARLS). We used logistic regression to compute the odds ratios (OR) and 95 % confidence intervals (Cls), using covariates derived through the health ecology model., Results: The overall prevalence of CricS was 31.5 % (25.0 % males and 37.1 % females). With controlling all covariates, social isolation (OR 1.164, 95%CI 1.033-1.310), irritable mood (OR 1.689, 95%CI 1.488-1.917), fear responses (OR 1.546, 95%CI 1.262-1.894), chronic disease (OR 1.577, 95%CI 1.392-1.788), and financial debt (OR 0.806, 95%CI 0.657-0.990) were significantly correlated with increased CricS risk in males, whereas CricS syndrome was significantly associated with age (OR 1.285, 95%CI 1.214-1.361), married (OR 1.258, 95%CI 1.089-1.452), current drinkers (OR 0.835, 95%CI 0.716-0.974), social isolation (OR 1.175, 95%CI 1.065-1.296), irritable mood (OR 1.346, 95%CI 1.210-1.497), fear responses (OR 1.202, 95%CI 1.047-1.378), chronic disease (OR 1.363, 95%CI 1.225-1.517), chronic pain (OR 1.177, 95%CI 1.058-1.309), and universal basic income (OR 0.742, 95%CI 0.611-0.900) in females., Conclusion: CricS is common in middle-aged to older adults, and health behavior factors have an important impact on CricS. The potential predictors identified for CricS should be further studied to prevent the occurrence of adverse health events in the presenium stage., Competing Interests: Declaration of competing interest Authors declare none., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: Comparing the effects of extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) on outcomes in patients with in-hospital cardiac arrest (IHCA) in China. The benefits of ECPR over CCPR in patients with IHCA remain controversial., Design: This article analyzed data from the BASeline Investigation of In-hospital Cardiac Arrest (BASIC-IHCA) study, which consecutively enrolled patients with IHCA from July 1, 2019, to December 31, 2020. Patients who received ECPR were selected as the case group and matched with patients who received CCPR as the control group by propensity score at a ratio of 1:4. A parallel questionnaire survey of participating hospitals was conducted, to collect data on ECPR cases from January 1, 2021 to November 30, 2021. The primary outcome was survival to discharge or 30-day survival., Setting: We included 39 hospitals across 31 provinces in China., Patients: Patients receiving cardiopulmonary resuscitation and without contraindications to ECPR were selected from the BASIC-IHCA database. Patients older than 75 years, not witnessed, or with cardiopulmonary resuscitation duration less than 10 min were excluded., Interventions: None., Measurements and Main Results: A total of 4853 patients met the inclusion criteria before matching, with 34 undergoing ECPR (median age, 56.5 yr; 67.65% male) and 4819 underwent CCPR (median age, 59 yr; 64.52% male). There were 132 patients receiving CCPR and 33 patients receiving ECPR who were eventually matched. The ECPR group had significantly higher survival rates at discharge or 30-day survival (21.21% vs. 7.58%, p = 0.048). The ECPR group had significantly lower mortality rates (hazard ratio 0.57; 95% CI, 0.38-0.91) than the CCPR group at discharge or 30 days. Besides the BASIC-IHCA study, the volume of ECPR implementations and the survival rate of patients with ECPR (29.4% vs. 10.4%. p = 0.004) in participating hospitals significantly improved., Conclusions: ECPR may be beneficial compared with CCPR for patient survival after IHCA and should be considered for eligible patients with IHCA., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Few studies have assessed sex differences in the management of suspected acute coronary syndrome (ACS). We aimed to compare the evaluation, treatment, and outcomes between males and females with suspected ACS in the emergency department. Data were obtained from a prospective registry of acute chest pain involving 21 emergency departments in Shandong Province, China. The primary endpoint was 30-day major adverse cardiac events (MACEs). Overlap propensity score weighting was used to address potential confounding. A total of 8046 patients were analysed (42.8% female). Overlap-weighted analysis showed no significant association of female sex with 30-day MACEs (odds ratio, 0.91; 95% CI 0.75 to 1.11; P = 0.363). Secondary analyses found that women were less likely to be identified as high risk at first presentation (odds ratio, 0.86; 95% CI 0.78 to 0.94; P < 0.001). In the emergency department, women were less likely to undergo antiplatelet therapy (odds ratio, 0.87; 95% CI 0.79 to 0.96; P = 0.004) or coronary angiography (odds ratio, 0.78; 95% CI, 0.69 to 0.88; P < 0.001). Women had a longer length of stay in the emergency department and were less likely to be admitted to a ward at disposition. These sex differences existed only in the non-ST-elevation subgroup and were independent of risk stratification. Women with non-ST-elevation chest pain in China received suboptimal treatment in the emergency department. However, their clinical outcomes were not significantly different from those of men. Further studies are needed to determine the causes and impacts of these sex differences., (© 2023. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)

Baccaurea ramiflora Lour., an evergreen tree of the Baccaurea genus of the Phyllanthaceae family, is primarily distributed in South Asia, Southeast Asia, and southern China, including southern Yunnan Province. It is a wild or semi-cultivated tree species with ornamental, edible, and medicinal value, exhibiting significant development potential. In this study, we present the whole-genome sequencing of B. ramiflora, employing a combination of PacBio SMRT and Illumina HiSeq 2500 sequencing techniques. The assembled genome size was 975.8 Mb, with a contig N50 of 509.33 kb and the longest contig measuring 7.74 Mb. The genome comprises approximately 73.47% highly repetitive sequences, of which 52.1% are long terminal repeat-retrotransposon sequences. A total of 29,172 protein-coding genes were predicted, of which 25,980 (89.06%) have been annotated, Additionally, 3452 non-coding RNAs were identified. Comparative genomic analysis revealed a close relationship between B. ramiflora and the Euphorbiaceae family, with both being sister groups that diverged approximately 59.9 million years ago. During the evolutionary process, B. ramiflora exhibited positive selection in 278 candidate genes. Synonymous substitution rate and collinearity analysis demonstrated that B. ramiflora underwent a single ancient genome-wide triploidization event, without recent genome-wide duplication events. This high-quality B. ramiflora genome provides a valuable resource for basic research and tree improvement programs focusing on the Phyllanthaceae family., (© 2024. The Author(s).)

Prior research has reported that perfluoroalkyl and polyfluoroalkyl substances (PFAS) may be linked to impaired glucose homeostasis in pregnant women. However, few studies have investigated PFAS alternatives and isomers, and even less is known about the association among women conceiving through assisted reproductive technology (ART). The prospective cohort study aimed to explore associations of legacy PFAS, alternatives and isomers with gestational diabetes mellitus (GDM) and glucose homeostasis during pregnancy among 336 women conceiving through ART. Nineteen PFAS, including nine linear legacy PFAS, four short-chain alternatives, four branched isomers, and two emerging PFAS alternatives, were determined in first-trimester maternal serum. Fasting plasma glucose (FPG), 1-h and 2-h glucose concentrations following the oral glucose tolerance test (OGTT), and glycated hemoglobin (HbA1c) were measured during the second trimester. After adjusting for confounding variables, nearly half of individual PFAS (10/19) and PFAS mixtures were correlated with increased GDM risk or elevated 2-h glucose levels. Among PFAS congeners, emerging PFAS alternatives, chlorinated perfluoroalkyl ether sulfonic acids (Cl-PFESAs), showed a notable association with impaired glucose homeostasis. For example, 6:2 Cl-PFESA exhibited a correlation with GDM (OR = 1.31, 95% CI = 1.02, 1.68) and 2-h glucose concentrations (β = 0.22, 95% CI = 0.08, 0.36), and contributed most to the overall association with 2-h glucose concentrations. Compared to those diagnosed with male factor infertility, the associations were more pronounced in infertile women with reproductive endocrine diseases. We provide evidence that exposure to PFAS, especially emerging PFAS alternatives, may impair glucose homeostasis and increase the risk of GDM among women conceiving through ART., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Establishing registries to collect demographic characteristics, processes of care, and outcomes of patients with out-of-hospital cardiac arrest (OHCA) can better understand epidemiological trends, measure care quality, and identify opportunities for improvement. This study aimed to describe the design, implementation, and scientific significance of a nationwide registry-the BASIC-OHCA (Baseline Investigation of Out-of-Hospital Cardiac Arrest)-in China., Methods: BASIC-OHCA was designed as a prospective, multicenter, observational, population-based study. The BASIC-OHCA registry was developed based on Utstein templates. BASIC-OHCA includes all OHCA patients confirmed by emergency medical services (EMS) personnel regardless of age, sex, or cause. Patients declared dead at the scene by EMS personnel for any reasons are also included. To fully characterize an OHCA event, BASIC-OHCA collects data from 3 sources-EMS, the receiving hospital, and patient follow-up-and links them to form a single record. Once data entry is completed and quality is checked, individual identifiers are stripped from the record., Results: Currently, 32 EMS agencies in 7 geographic regions contribute data to BASIC-OHCA. They are distributed in the urban and rural areas, covering ≈9% of the population of mainland China. Data collection started on August 1, 2019. By July 31, 2020, a total of 92 913 EMS-assessed OHCA patients were enrolled. Among 28969 (31.18%) EMS-treated OHCAs, the mean age was 65.79±17.36 years, and 68.35% were males. The majority of OHCAs (76.85%) occurred at home or residence. A shockable initial rhythm was reported in 5.43% of patients. Any return of spontaneous circulation, survival to hospital discharge, and favorable neurological outcome at hospital discharge were 5.98%, 1.15%, and 0.83%, respectively., Conclusions: BASIC-OHCA is the first nationwide registry on OHCA in China. It can be used as a public health surveillance system and as a platform to produce evidence-based practices to help identify opportunities for improvement., Registration: URL: https://www., Clinicaltrials: gov; Unique identifier: NCT03926325.

Background: This study aimed at developing a risk score predicting the probability of developing an osteonecrosis of the femoral head (ONFH) in patients with femoral neck fracture within 3 years after closed reduction internal fixation and evaluating its performance, clinical utility, and internal validity., Methods: A retrospective follow-up study of 378 newly injured femoral neck fracture patients treated with 3 partially threaded parallel cannulated screws in 3 hospitals in Shanghai from March 2013 to January 2017 was performed. The patients were divided into development (n = 284) and validation (n = 94) cohorts. The risk score was constructed by Cox regression analysis in a form of nomogram. The performance and clinical utility were illustrated by box plots, calibration plots, and decision curve analysis., Results: Eighty-three of 378 patients had developed ONFH within 3 years. Garden alignment index, time to surgery, preoperative displace, impaction, and postoperative malposition were used as predictors to construct the risk score in a form of nomogram. In the development and validation cohort, the concordance index was 0.96 and 0.94, respectively; the discrimination slope was 0.51 and 0.47, respectively. In both cohorts, the calibration slopes and intercepts were 1 and 0, respectively. The risk score was clinically useful between the risk threshold of 0% and 88%. The performance and utility in the validation data illustrated good repeatability., Conclusion: The risk score had satisfactory discrimination and calibration performance and demonstrated clinical utility with good internal validity. It managed to distinguish high-risk groups for post-traumatic ONFH., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The Global Registry of Acute Coronary Events (GRACE) score is recommended for stratifying chest pain. However, there are six formulas used to calculate the GRACE score for different outcomes of acute coronary syndrome (ACS), including death (Dth) or composite of death and myocardial infarction (MI), while in hospital (IH), within 6 months after discharge (OH6m) or from admission to 6 months later (IH6m). We aimed to perform the first comprehensive evaluation and comparison of six GRACE models to predict 30-day major adverse cardiac events (MACEs) in patients with acute chest pain in the emergency department (ED)., Methods: Patients with acute chest pain were consecutively recruited from August 24, 2015 to September 30, 2017 from the EDs of two public hospitals in China. The 30-day MACEs included death, acute myocardial infarction (AMI), emergency revascularization, cardiac arrest and cardiogenic shock. The correlation, calibration, discrimination, reclassification and diagnostic accuracy at certain cutoff values of six GRACE models were evaluated. Comparisons with the History, ECG, Age, Risk Factors, and Troponin (HEART) and Thrombolysis in Myocardial Infarction (TIMI) scores were conducted., Results: A total of 2886 patients were analyzed, with 590 (20.4%) patients experiencing outcomes. The GRACE (IHDthMI), GRACE (IH6mDthMI), GRACE (IHDth), GRACE (IH6mDth), GRACE (OH6mDth) and GRACE (OH6mDthMI) showed positive linear correlations with the actual MACE rates (r ≥ 0.568, P < 0.001). All these models had good calibration (Hosmer-Lemeshow test, P ≥ 0.073) except GRACE (IHDthMI) (P < 0.001). The corresponding C-statistics were 0.83(0.81,0.84), 0.82(0.81,0.83), 0.75(0.73,0.76), 0.73(0.72,0.75), 0.72(0.70,0.73) and 0.70(0.68,0.71), respectively, first two of which were comparable to HEART (0.82, 0.80-0.83) and superior to TIMI (0.71, 0.69-0.73). With a sensitivity ≥95%, GRACE (IHDthMI) ≤81 and GRACE (IH6mDthMI) ≤79 identified 868(30%) and 821(28%) patients as low risk, respectively, which were significantly better than other GRACEs and HEART ≤3(22%). With a specificity ≥95%, GRACE (IHDthMI) > 186 and GRACE (IH6mDthMI) > 161 could recognize 12% and 11% patients as high risk, which were greater than other GRACEs, HEART ≥8(9%) and TIMI ≥5(8%)., Conclusions: In this Chinese setting, certain strengths of GRACE models beyond HEART and TIMI scores were still noteworthy for stratifying chest pain patients. The validation and reasonable application of appropriate GRACE models in the evaluation of undifferentiated chest pain should be recommended.

Background: Triage decisions for chest pain patients receiving usual care are based on a dynamic and comprehensive strategy performed in the physician's mind. It remains controversial whether simple, structured risk tools can surpass real, complex judgments., Hypothesis: The potentially used History, Electrocardiogram, Age, Risk factors, Troponin (HEART) score would help identify low-risk patients for discharge., Methods: Patients with acute, non-traumatic chest pain managed according to usual care were consecutively enrolled in a tertiary university hospital in China from August 24, 2015 to September 30, 2017. Major adverse cardiac events (MACE) included death, acute myocardial infarction, revascularization, and significant coronary stenosis (>50%) within 30 days. We compared the efficacy and safety of usual care and the potentially used HEART score in this population., Results: Of 2185 patients analyzed, 926 (42.4%) patients were directly discharged by usual care, whereas HEART≤3 would have identified 524 (24.0%) patients as low-risk (P < .001). The MACE rate in discharged patients was 2.2% (20/926) and would have been 5.2% (27/524) in those with HEART≤3 (P = .002). For discharged patients, the MACE rates in HEART≤3 vs HEART>3 groups were not significantly different (1.5% vs 2.7%, P = .225). Negative predictive value (NPV) was higher with usual care than with the HEART score (P = .003), but sensitivity was similar. For 340 patients with serial troponins, usual care was superior to the potentially used HEART score in regard to efficacy., Conclusions: At this institution, usual care identified many more patients for discharge than the HEART score would have without apparently different outcomes in discharged patients with lower vs higher HEART scores. The HEART score would not appear to provide helpful risk stratification., (© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.)

Critically ill patients with fecal incontinence are at high risk of developing incontinence-associated dermatitis (IAD). Scientific prediction and prevention of IAD are essential., Purpose: The purpose of this study was to determine the risk factors for IAD among critically ill patients with fecal incontinence. Based on this information, a predictive risk assessment model was developed to provide research evidence for IAD prevention., Methods: A prospective study was conducted from October 2016 to December 2017. Convenience sampling was used to recruit patients with fecal incontinence treated in intensive care units (ICUs) at Tianjin Medical University General Hospital in China. Trained nurses collected demographic data (age, gender, and ICU type), data related to fecal incontinence (Perineal Assessment Tool [PAT] scores, bowel movement frequency, and stool traits per the Bristol Stool Scale), and clinical data (length of ICU hospitalization, body temperature, diabetes history, hypertension history, consciousness, nutrition support, oxygen supply, number of antibiotic species, sedative use, and albumin levels) from participants and their medical records. The PAT was used to assess patient risk of developing IAD, and the Bristol Stool Scale was used to assess patient stool traits. Names were coded anonymously, and data were entered from paper-and-pencil questionnaires into a software program for statistical analysis. Univariate analysis and multivariate logistic regression were performed to identify risk factors for IAD. A predictive risk factor model was established using a receiver operating characteristic curve., Results: Among 266 critically ill patients with fecal incontinence (182 male, 84 female; mean age 64.18 ± 17.10), IAD incidence was 65.4%. The use of sedative drugs, coma status, higher PAT score, more frequent bowel movements, and loose stool were found to be independent risk factors for IAD (P <.05). The subsequent risk factor predictive model had a sensitivity and specificity of 99.4% and 96.7%, respectively, and the agreement rate was 98.1%., Conclusion: The identified risk factors and subsequent predictive model may contribute to timely identification and quantitative risk assessment of IAD among critically ill patients. Additional quantitative research could provide a scientific basis for the development of specific preventive interventions.

Background: Symptom is still indispensable for the stratification of chest pain in the emergency department. However, it is a sophisticated aggregation of several aspects of characteristics and effective combination of those variables remains deficient. We aimed to develop and validate a chest pain symptom score (CPSS) to address this issue., Hypothesis: The CPSS may help stratifying acute undifferentiated chest pain in ED., Methods: Patients with non-ST segment elevation chest pain and negative cardiac troponin (cTn) over 3 hours after symptom onset were consecutively recruited as the derivation cohort. Logistic regression analyses identified statistical predictors from all symptom aspects for 30-day acute myocardial infarction (AMI) or death. The performance of CPSS was compared with the symptom classification methods of the history variable in the history, electrocardiograph, age, risk factors, troponin (HEART) score. This new model was validated in a separated cohort of patients with negative cTn within 3 hours., Results: Seven predictors in four aspects of chest pain symptom were identified. The CPSS was an independent predictor for 30-day AMI or death (P < 0.001). In the derivation (n = 1434) and validation (n = 976) cohorts, the expected and observed event rates were well calibrated (Hosmer-Lemeshow test P > 0.30), and the c-statistics of CPSS were 0.72 and 0.73, separately, significantly better than the previous history classifications in HEART score (P < 0.001). Replacing the history variable with the CPSS improved the discrimination and risk classification of HEART score significantly (P < 0.001)., Conclusions: The effective combination of isolated variables was meaningful to make the most stratification value of symptoms. This model should be considered as part of a comprehensive strategy for chest pain triage., (© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.)