Publications by authors named "Xiaotong Han"

114 Publications

[Predictive value of heparin binding protein for sepsis].

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2021 Jun;33(6):654-658

Hunan Provincial Institute of Emergency Medicine, Department of Emergency Medicine, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410005, Hunan, China. Corresponding author: Han Xiaotong, Email:

Objective: To investigate the predictive value of heparin binding protein (HBP) for sepsis.

Methods: From June 2019 to December 2020, 188 patients admitted to the department of emergency of Hunan Provincial People's Hospital were enrolled. The patients were divided into non-sepsis group (87 patients) and sepsis group (101 patients) according to Sepsis-3 criteria. Gender, age, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), HBP, sequential organ failure assessment (SOFA) score, quick SOFA (qSOFA) score, modified early warning score (MEWS) and patients' recent medication history were recorded, the differences in the above indicators between the two groups were compared. The risk factors of sepsis were analyzed by Logistic regression. Spearman correlation analysis was used to analyze the correlation between HBP, PCT, CRP and SOFA score to evaluate the predictive value of HBP, PCT and CRP for the severity of septic organ failure. Receiver operating characteristic curve (ROC curve) were drawn to evaluate the diagnostic value of HBP, PCT and CRP for sepsis.

Results: Compared with the non-sepsis group, the sepsis group had significantly higher levels of HBP, PCT, CRP, WBC, SOFA score, qSOFA score, and MEWS [HBP (μg/L): 55.46 (24.57, 78.49) vs. 5.90 (5.90, 9.01), PCT (μg/L): 6.83 (1.75, 30.64) vs. 0.23 (0.12, 0.75), CRP (mg/L): 67.35 (26.23, 123.23) vs. 4.45 (2.62, 47.22), WBC (×10/L): 11.84 (7.18, 16.06) vs. 6.58 (5.47, 8.99), SOFA score: 6 (4, 8) vs. 0 (0, 0), qSOFA score: 2 (1, 3) vs. 0 (0, 1), MEWS: 4 (3, 6) vs. 1 (0, 2)], the length of hospital stay was significantly prolonged [days: 10 (4, 17) vs. 0 (0, 7)], and the mortality was significantly increased [29.7% (30/101) vs. 4.6% (4/87)], with statistical significance (all P < 0.05). Correlation analysis showed that HBP, PCT and CRP were significantly positively correlated with SOFA score (r values were 0.60, 0.33, and 0.38, respectively, all P < 0.01), among which HBP had the strongest correlation, CRP was the second, and PCT was the weakest. Logistic regression analysis showed that HBP, PCT and CRP levels were independent risk factors for sepsis [odds ratio (OR) were 1.015, 1.094, 1.067, 95% confidence intervals (95%CI) were 1.007-1.022, 1.041-1.150, 1.043-1.093, all P < 0.01]. ROC curve analysis showed that HBP, PCT and CRP all had some diagnostic value for sepsis [the area under ROC curve (AUC) were 0.92, 0.87, 0.80, 95%CI were 0.88-0.97, 0.82-0.92, 0.74-0.87, respectively, all P < 0.01]. Among them, the diagnostic efficacy of HBP was higher when the cut-off value was ≥ 15.11 μg/L, its sensitivity and specificity were 86.14% and 89.66%, respectively, which were higher than the sensitivity (81.19%) and specificity (80.46%) when the PCT cut-off value was ≥ 1.17 μg/L. However, CRP had the best sensitivity of 94.06% for the diagnosis of sepsis but lacked of specificity (63.22%).

Conclusions: HBP can be used as a biological indicator for predicting sepsis and can assess the severity of organ failure in septic patients.
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http://dx.doi.org/10.3760/cma.j.cn121430-20210424-00605DOI Listing
June 2021

The impact of pharmacological dilation on intraocular pressure in primary angle closure suspects.

Am J Ophthalmol 2021 Jun 28. Epub 2021 Jun 28.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China. Electronic address:

Purpose: To assess changes in intraocular pressure (IOP) 1 hour after pharmacological dilation in eyes treated with laser peripheral iridotomy (LPI) and untreated fellow eyes of primary angle closure suspects (PACS).

Design: Randomized, fellow-eye controlled trial METHODS: : A total of 889 PACS participants aged 50 to 70 years with LPI in one randomly selected eye and a fellow untreated eye were included. All participants underwent comprehensive examinations before and at 2 weeks, 6 m, 18 m, 36 m, 54 m, and 72 m after LPI. IOP was measured using Goldmann applanation tonometry before and 1 hour after pharmacological dilation.

Results: The mean pre-dilation IOP in the untreated eyes was 14.8±2.7 mmHg, which increased to 16.4±2.7 mmHg after pharmacological dilation (p<0.001). The treated and untreated eyes had similar pre-dilation and post-dilation IOP (all p>0.05). The average post-dilation IOP elevation was 1.5 mmHg in the treated eyes and 1.6 mmHg in the untreated eye without significant differences (p=0.802). Lower pre-dilation IOP (p<0.001), smaller AOD500 (p=0.001), smaller ARA500 (p=0.030), smaller TISA500 (p=0.043), and larger Iarea(p<0.001) were associated with post-dilation IOP elevation 5 mmHg and greater. Three untreated (1.04 per 1000 pupil dilation) and one treated eye (0.34 per 1000 pupil dilation) developed acute angle closure (AAC) after dilation during the 72 m follow-up.

Conclusions: Post-dilation IOP elevation is similar among treated and untreated eyes, and the risk of developing AAC is very low even among PACS. Routine LPI before pupil dilation for PACS people is not recommended.
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http://dx.doi.org/10.1016/j.ajo.2021.06.018DOI Listing
June 2021

Follow-up study of pulmonary function among COVID-19 survivors 1 year after recovery.

J Infect 2021 May 29. Epub 2021 May 29.

Department of Emergency Medicine, Hunan Provincial Institute of Emergency Medicine, Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Hunan Provincial People's Hospital/The First Affiliated Hospital, Hunan Normal University, Changsha, Hunan, China; School of Life Sciences, Hunan Normal University, Changsha, Hunan, China. Electronic address:

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http://dx.doi.org/10.1016/j.jinf.2021.05.034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164517PMC
May 2021

Predicting the 10-year risk of cataract surgery using machine learning techniques on questionnaire data: findings from the 45 and Up Study.

Br J Ophthalmol 2021 May 26. Epub 2021 May 26.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China

Background/aims: To investigate the feasibility and accuracy of using machine learning (ML) techniques on self-reported questionnaire data to predict the 10-year risk of cataract surgery, and to identify meaningful predictors of cataract surgery in middle-aged and older Australians.

Methods: Baseline information regarding demographic, socioeconomic, medical history and family history, lifestyle, dietary and self-rated health status were collected as risk factors. Cataract surgery events were confirmed by the Medicare Benefits Schedule Claims dataset. Three ML algorithms (random forests [RF], gradient boosting machine and deep learning) and one traditional regression algorithm (logistic model) were compared on the accuracy of their predictions for the risk of cataract surgery. The performance was assessed using 10-fold cross-validation. The main outcome measures were areas under the receiver operating characteristic curves (AUCs).

Results: In total, 207 573 participants, aged 45 years and above without a history of cataract surgery at baseline, were recruited from the 45 and Up Study. The performance of gradient boosting machine (AUC 0.790, 95% CI 0.785 to 0.795), RF (AUC 0.785, 95% CI 0.780 to 0.790) and deep learning (AUC 0.781, 95% CI 0.775 to 61 0.786) were robust and outperformed the traditional logistic regression method (AUC 0.767, 95% CI 0.762 to 0.773, all p<0.05). Age, self-rated eye vision and health insurance were consistently identified as important predictors in all models.

Conclusions: The study demonstrated that ML modelling was able to reasonably accurately predict the 10-year risk of cataract surgery based on questionnaire data alone and was marginally superior to the conventional logistic model.
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http://dx.doi.org/10.1136/bjophthalmol-2020-318609DOI Listing
May 2021

Clearance of buprenorphine during pregnancy and neonatal outcomes.

Arch Womens Ment Health 2021 Apr 16. Epub 2021 Apr 16.

Department of Psychiatry, University of Wisconsin, Madison, WI, USA.

Buprenorphine is emerging as the preferred pharmacologic treatment for opioid use disorder during pregnancy. We examined the relative plasma clearance of buprenorphine (BUP) across pregnancy. Pregnant women with opioid use disorder participating in a prospective, observational study from 2013 to 2016 on stress in pregnancy who were receiving BUP for opioid use disorder were included. Women with an active eating disorder or suicidal ideation were excluded. Research visits occurred at 4-6-week intervals across pregnancy and the early postpartum period and included medication exposure history and blood samples. All assays for BUP serum concentrations at steady state were completed. Relative weight-adjusted clearance (Cl) was calculated using Cl = (daily dose [mg]/ body weight [kg])/serum concentration [ng/ml]. We collected 112 maternal blood samples from 29 women throughout pregnancy and the postpartum period. Serum concentrations for BUP ranged from < 0.2 to 15.8 ng/ml. Eleven women, with greater than three collected samples, increased their daily dose of BUP during pregnancy; however, there were no significant differences in relative clearance of BUP across this same period. This data suggests that women with opioid use disorder receiving BUP did not demonstrate a significant increase in BUP clearance across pregnancy despite increase in dosages during pregnancy. When selecting an appropriate BUP dosage for management of perinatal opioid use disorder, gestational stage appears not to be an important covariate and should be based on an individualized approach.
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http://dx.doi.org/10.1007/s00737-021-01128-1DOI Listing
April 2021

Layered Double Hydroxide Quantum Dots for Use in a Bifunctional Separator of Lithium-Sulfur Batteries.

ACS Appl Mater Interfaces 2021 Apr 6;13(15):17978-17987. Epub 2021 Apr 6.

School of Chemical Engineering, Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), and SKKU Advanced Institute of Nano Technology (SAINT), Sungkyunkwan University, Suwon 440-746, Republic of Korea.

Functional separators, which are chemically modified and coated with nanostructured materials, are considered an effective and economical approach to suppressing the shuttle effect of lithium polysulfide (LiPS) and promoting the conversion kinetics of sulfur cathodes. Herein, we report cobalt-aluminum-layered double hydroxide quantum dots (LDH-QDs) deposited with nitrogen-doped graphene (NG) as a bifunctional separator for lithium-sulfur batteries (LSBs). The mesoporous LDH-QDs/NG hybrids possess abundant active sites of Co and hydroxide groups, which result in capturing LiPSs through strong chemical interactions and accelerating the redox kinetics of the conversion reaction, as confirmed through X-ray photoelectron spectroscopy, adsorption tests, LiS nucleation tests, and electrokinetic analyses of the LiPS conversion. The resulting LDH-QDs/NG hybrid-coated polypropylene (LDH-QDs/NG/PP) separator, with an average thickness of ∼17 μm, has a high ionic conductivity of 2.67 mS cm. Consequently, the LSB cells with the LDH-QDs/NG/PP separator can deliver a high discharge capacity of 1227.48 mAh g at 0.1C along with a low capacity decay rate of 0.041% per cycle over 1200 cycles at 1.0C.
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http://dx.doi.org/10.1021/acsami.1c00974DOI Listing
April 2021

Structural Engineering of Ultrathin ReS on Hierarchically Architectured Graphene for Enhanced Oxygen Reduction.

ACS Nano 2021 Mar 23;15(3):5560-5566. Epub 2021 Feb 23.

School of Chemical Engineering, Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), and SKKU Advanced Institute of Nano Technology (SAINT), Sungkyunkwan University, Suwon 440-746, Republic of Korea.

Herein, binary heteronanosheets made of ultrathin ReS nanosheets and reduced graphene oxide (RGO) with either a two-dimensional (2D) "sheet-on-sheet" architecture (2D ReS/RGO) or a three-dimensional hierarchical structure (3D ReS/RGO) are constructed through rational structure-engineering strategies. In the resultant 3D ReS/RGO heteronanosheets, the ultrathin ReS nanosheets are bridged on the RGO surface through Re-O bonds in a vertically oriented manner, which endows the heteronanosheets with open frameworks and a hierarchical porous structure. In sharp contrast to the 2D ReS/RGO, the 3D ReS/RGO heteronanosheets are featured with abundant active sites and channels for efficient electrolyte ions transport. This, coupled with the strong affinity toward oxygen-containing intermediates intrinsically associated with the binary ReS/RGO structure, imparts excellent oxygen reduction performance to the 3D ReS/RGO heteronanosheets for potential applications in fuel cells and metal-air batteries.
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http://dx.doi.org/10.1021/acsnano.1c00420DOI Listing
March 2021

Enrollee Experience with Providers in the Arkansas Medicaid Expansion Program.

J Gen Intern Med 2021 06 2;36(6):1673-1681. Epub 2021 Feb 2.

Arkansas Center for Health Improvement (ACHI), Little Rock, AR, USA.

Background: Patient ratings of their healthcare experience as a quality measure have become critically important since the implementation of the Affordable Care Act (ACA). The ACA enabled states to expand Medicaid eligibility to reduce uninsurance nationally. Arkansas gained approval to use Medicaid funds to purchase a qualified health plan (QHP) through the ACA marketplace for newly eligible beneficiaries.

Objective: We compare patient-reported satisfaction between fee-for-service Medicaid and QHP participants.

Design: The Consumer Assessment of Healthcare Providers and Systems (CAHPS) was used to identify differences in Medicaid and QHP enrollee healthcare experiences. Data were analyzed using a regression discontinuity design.

Participants: Newly eligible Medicaid expansion participants enrolled in Medicaid during 2013 completed the Consumer Assessment of Health Providers and Systems (CAHPS) survey in 2014. Survey data was analyzed for 3156 participants (n = 1759 QHP/1397 Medicaid).

Measures: Measures included rating of personal and specialist provider, rating of all healthcare received, and whether the provider offered to communicate electronically. Demographic and clinical characteristics of the enrollees were controlled for in the analyses.

Methods: Regression-discontinuity analysis was used to evaluate differential program effects on positive ratings as measured by the CAHPS survey while controlling for demographic and health characteristics of participants.

Key Results: Adjusted logistic regression models for overall healthcare (OR = 0.71, 95%CI = 0.56-0.90, p = 0.004) and personal doctor (OR = 0.68, 95%CI = 0.53-0.87, p = 0.002) predicted greater satisfaction among QHP versus Medicaid participants. Results were not significant for specialists or for use of electronic communication with provider.

Conclusions: Using a quasi-experimental statistical approach, we were able to control for observed and unobserved heterogeneity showing that among participants with similar characteristics, including income, QHP participants rated their personal providers and healthcare higher than those enrolled in Medicaid. Access to care, utilization of care, and healthcare and health insurance literacy may be contributing factors to these results.
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http://dx.doi.org/10.1007/s11606-020-06552-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8175535PMC
June 2021

Differential associations between body mass index with diabetes and vision-threatening diabetic retinopathy in an adult Chinese population.

Br J Ophthalmol 2021 Jan 25. Epub 2021 Jan 25.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China

Purpose: To investigate the associations between body mass index (BMI) with diabetes mellitus (DM) and vision-threatening diabetic retinopathy (VTDR).

Methods: This was a longitudinal study which included DM-free participants aged ≥40 years from the Lingtou Eye Cohort Study at baseline (2008-2010). Physical and ocular examinations were performed at baseline and annual follow-ups under standardised protocol. Two 45° non-mydriatic colour digital retinal photographs were obtained for each eye at all study visits, and presence of VTDR at the 2016 follow-up was graded by a deep-learning algorithm (LableMe) with proved high accuracy for detection of VTDR.

Results: A total of 2934 participants were included with a mean (SD) age of 59.5 (7.3) years (58.3% men). Participants with incident DM (441/2934, 15%) were significantly older (p<0.001), had higher obesity levels (p<0.001), higher systolic blood pressure (SBP) (p<0.001), diastolic blood pressure (p<0.001), fasting plasma glucose (FPG) (p<0.001), triglycerides (p=0.002) and high-density lipoprotein cholesterol (p<0.001), as compared with those without. Participants with incident VTDR (48/2934, 1.63%) were also older (p<0.001), had higher SBP (p=0.013) and FPG (p<0.001), but did not differ in baseline BMI, comparing with those without. Regression analysis showed that higher baseline BMI was significantly related to incident DM (p<0.005), but not incident VTDR, during the follow-up. Subgroup analysis among participants with incident DM also revealed no association between BMI and VTDR.

Conclusions: Higher baseline BMI increased the risk of incident DM, but was not related to the risk of VTDR in this adult Chinese population.
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http://dx.doi.org/10.1136/bjophthalmol-2020-318252DOI Listing
January 2021

[Activation of NOD like receptor protein 3 signaling pathway in vascular endothelial cells induced by heat stress can be inhibited by ethyl pyruvate].

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2020 Nov;32(11):1367-1371

Department of Emergency, Hunan Provincial People's Hospital, Changsha 410005, Hunan, China. Corresponding author: Han Xiaotong, Email:

Objective: To investigate whether the activation of NOD like receptor protein 3 (NLRP3) signaling pathway in vascular endothelial cells induced by heat stress (HS) could be inhibited by ethyl pyruvate (EP).

Methods: Human umbilical vein endothelial cells (HUVEC) were cultured in vitro, and the cells in logarithmic growth phase were taken to carry out experiment. Different temperatures gradients (39, 41, 43 centigrade for 4-hour HS) and different duration gradients (43 centigrade continuously HS respectively for 2, 3, 4 hours) were set up respectively. For HS group, HUVECs were placed in incubators with corresponding different conditions to carry out HS, then 43 centigrade persisting for 4-hour HS (43 centigrade, 4 hours) was selected as the final experimental condition; during HS, EP 10 mmol/L was added. For control group, the cells were synchronously cultured in 37 centigrade cell incubator. The protein expression of NLRP3 in HUVEC and activity of aspartate specific cysteine protease 1 (caspase-1) were detected with Western blotting; enzyme linked immunosorbent assay (ELISA) was used to detect the released levels of interleukins (IL-18 and IL-1β) in the cell culture supernatant fluid after HS.

Results: After HS, the protein expression level of NLRP3 in HUVEC was increased with the increasing of HS temperature or extension of exposure duration in HS condition, and reached to the highest in 43 centigrade for 4 hours. Compared with control group, there was significant difference [NLRP3 protein expression (NLRP3/GAPDH): 1.54±0.08 vs. 0.97±0.17, P < 0.05]; after EP intervention, the expression of NLRP3 and the activation of caspase-1 in HUVEC were significantly lower than those in HS group [NLRP3 protein expression (NLRP3/GAPDH): 1.15±0.07 vs. 1.57±0.09, caspase-1 activity: 40.87±6.54 vs. 59.75±9.92, both P < 0.05], moreover, the released levels of IL-18 and IL-1β in cell supernatant were also significantly decreasing than those in HS group [IL-18 (ng/L): 1.09±0.08 vs. 1.41±0.13, IL-1β (ng/L): 1.38±0.10 vs. 2.02±0.10, both P < 0.05].

Conclusions: The activation of NLRP3 signaling pathway in vascular endothelial cells induced by HS could be significantly inhibited by EP, which helps to reduce the release of inflammatory cytokines from vascular endothelial cells induced by HS.
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http://dx.doi.org/10.3760/cma.j.cn121430-20200715-00527DOI Listing
November 2020

Effect of physical activity on reducing the risk of diabetic retinopathy progression: 10-year prospective findings from the 45 and Up Study.

PLoS One 2021 14;16(1):e0239214. Epub 2021 Jan 14.

Centre for Eye Research Australia, Ophthalmology, Department of Surgery, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia.

Objective: To examine the association of physical activities (PA) with diabetic retinopathy (DR) progression based on a 10-year follow-up of a large cohort of working-aged diabetic populations in Australia.

Methods: Nine thousand and eighteen working-aged diabetic patients were enrolled from the baseline of the 45 and Up Study from New South Wales, Australia. Self-reported PA collected by questionnaire at baseline in 2006 was graded into low (<5 sessions/week), medium (≥5-14), and high (≥14) levels. Retinal photocoagulation (RPC) treatment during the follow-up period was used as a surrogate for DR progression and was tracked through the Medicare Benefits Schedule, which was available from 2004 to 2016. Cox regression was used to estimate the association between PA and RPC incidence.

Results: In the fully adjusted model, higher PA level was significantly associated with a lower risk of RPC incident (Cox-regression, p-value for trend = 0.002; medium vs. low, hazard ratio (HR) = 0.78, 95% Confidence Interval (CI): 0.61-0.98; high vs. low, HR = 0.61, 95%CI: 0.36-0.84. In addition, gender, body mass index, insulin treatment, family history of diabetes, history of cardiovascular disease were significant effect modifiers for the association between PA and RPC.

Conclusions: Higher PA level was independently associated with a lower risk of DR progression among working-aged diabetic populations in this large cohort study.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239214PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808642PMC
April 2021

Basal Plane Bending of Homoepitaxial MPCVD Single-Crystal Diamond.

Materials (Basel) 2020 Oct 12;13(20). Epub 2020 Oct 12.

State Key Laboratory of Crystal Materials, Institute of Novel Semiconductors, Shandong University, Jinan 250100, China.

We report herein high-resolution X-ray diffraction measurements of basal plane bending of homoepitaxial single-crystal diamond (SCD). We define SCD (100) as the base plane. The results revealed that growth parameters such as temperature, growth time, and basal plane bending of the substrate all affect the basal plane bending of SCD. First, the basal plane bending of SCD depends mainly on the substrate and becomes severe with increasing basal plane bending of the substrate. The SCD growth experiments show that the basal plane bending increases with elevated growth temperature and increased growth time. Finally, to understand the mechanism, we investigated the substrate-surface temperature distribution as a function of basal plane bending of SCD fabricated by chemical vapor deposition (CVD). This allowed us to propose a model and understand the origin of basal plane bending. The results indicate that an uneven temperature distribution on the substrate surface is the main cause of the base-plane bending of CVD diamond.
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http://dx.doi.org/10.3390/ma13204510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599814PMC
October 2020

Computer-delivered brief alcohol intervention for patients with liver disease: a randomized controlled trial.

Addiction 2021 05 6;116(5):1076-1087. Epub 2020 Oct 6.

Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA.

Background And Aims: Reducing alcohol consumption by liver disease patients can reduce morbidity and mortality. This study compared a computer-delivered brief alcohol intervention (cBAI) with standard care in a sample of US military veterans with liver disease.

Design: Multi-site, randomized controlled trial of a cBAI plus standard care (n = 67) versus standard care only (n = 71). Participants were assessed at baseline and 3- and 6-month follow-up.

Setting: US Veterans Health Administration liver clinics.

Participants: Participants were mostly male and diagnosed with hepatitis C.

Interventions And Comparators: A cBAI tailored to veterans with liver disease and consisting of assessment and personalized feedback. Standard care was brief education and advice about alcohol and liver disease.

Measurement: Primary outcomes were self-reported number of drinking days and unhealthy drinking days (defined as more than two drinks for men and more than one for women) in the past 30 days at 6-month follow-up. Secondary outcomes were these two variables at 3-month follow-up, and drinks consumed per drinking day, depression and overall health at 3- and 6-month follow-ups. Missing data were imputed using multiple imputation.

Findings: Compared with standard care, cBAI participants reported significantly fewer drinking days at 6-month follow-up and fewer unhealthy drinking days at both 3- and 6-month follow-ups. Least square means (LS-means) for number of drinking days were 3.78 for the cBAI condition and 6.89 for the standard care condition at 6 months [LS-mean ratio = 3.78/6.89 = 0.55, 95% confidence interval (CI) = 0.34, 0.89]. LS-means for number of unhealthy drinking days were 1.04 for the cBAI condition and 2.57 for the standard care condition at 3-month follow-up (LS-mean ratio = 1.04/2.57 = 0.41, 95% CI = 0.19, 0.85). At 6-months follow-up, LS-means were 1.18 for the cBAI condition and 2.75 for the standard care condition (LS-mean ratio = 1.18/2.75 = 0.43, 95% CI = 0.20, 0.91).

Conclusions: A computer-delivered brief alcohol intervention reduced drinking days and unhealthy drinking days at 6-month follow up in military veterans with liver disease compared with brief education and advice to reduce consumption.
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http://dx.doi.org/10.1111/add.15263DOI Listing
May 2021

Clinical Characteristics and Prognosis of 218 Patients With COVID-19: A Retrospective Study Based on Clinical Classification.

Front Med (Lausanne) 2020 11;7:485. Epub 2020 Aug 11.

Hunan Provincial Institute of Emergency Medicine, Hunan Provincial People's Hospital/The First Affiliated Hospital, Hunan Normal University, Changsha, China.

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that has spread worldwide. This was a retrospective case series involving 218 patients admitted to three tertiary hospitals in the Loudi, Shaoyang, and Xiangtan areas of China from January 21 to June 27, 2020, who were confirmed by RT-PCR to have SARS-CoV-2. The patients' clinical characteristics, laboratory results, treatments, and prognoses based on clinical classification were recorded. Poor outcome was defined as admission to an ICU, the use of mechanical ventilation, or death. The patients were classified into four clinical groups based on disease severity, namely mild (10/218, 5%), moderate (146/218, 67%), severe (24/218, 11%), or critical (14/218, 6%); 24 (11%) asymptomatic cases were also included in the study. The most common symptoms were self-reported cough (162/218, 74%), fever (145/218, 67%), sputum production (99/218, 45%), and fatigue (77/218, 35%). Among the 218 patients, 192 (88%) received lopinavir/ritonavir and interferon-alpha inhalation, and 196 (90%) patients received traditional Chinese medicine. Among the severe and critical patients, 25 (11%) were admitted to an ICU with or without mechanical ventilation, and one patient died. The presence of diabetes [relative risk (RR), 3.0; 95% CI, 1.3-6.8; = 0.007) or other comorbidities (RR, 5.9; 95% CI, 1.9-17.8; = 0.002) was independently associated with poor outcome. To date, 20 (9%) patients have retested positive for SARS-CoV-2 RNA after recovering and being discharged. The majority of patients in this case series were clinically classified as having moderate COVID-19. Older patients tended to present with greater levels of clinical severity. The prognosis for patients who were elderly or had diabetes or other chronic comorbidities was relatively poor.
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http://dx.doi.org/10.3389/fmed.2020.00485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431472PMC
August 2020

Ultrafast Construction of Oxygen-Containing Scaffold over Graphite for Trapping Ni into Single Atom Catalysts.

ACS Nano 2020 Sep 26;14(9):11662-11669. Epub 2020 Aug 26.

State Key Lab of Fine Chemicals, School of Chemical Engineering, Liaoning Key Lab for Energy Materials and Chemical Engineering, Dalian University of Technology, Dalian, 116024, China.

Ultrafast construction of oxygen-containing scaffold over graphite for trapping Ni into single atom catalysts (SACs) was developed and presented by a one-step electrochemical activation technique. The present method for Ni SACs starts with graphite foil and is capable of achieving ultrafast preparation (1.5 min) and mass production. The defective oxygen featuring the strong electronegativity enables primarily attracting Ni ions and stabilizing Ni atoms via Ni-O coordination instead of conventional metal-C or metal-N. In addition, the oxygen defects for trapping are tunable through altering the applied voltage or electrolyte, further altering the loading of Ni atoms, indicative of enhanced oxygen evolution activity. This simple and ultrafast electrochemical synthesis is promising for the mass and controllable production of oxygen-coordinated Ni SACs, which exhibit good performance for oxygen evolution reaction.
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http://dx.doi.org/10.1021/acsnano.0c04210DOI Listing
September 2020

[Investigation and analysis on the capacity of cardiopulmonary resuscitation in Hunan Province].

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2020 Jul;32(7):850-853

Department of Emergency, Hunan Provincial People's Hospital, Changsha 410000, Hunan, China.

Objective: To investigate the people's cardiopulmonary resuscitation (CPR) ability in Hunan Province and whether there are differences in the skill level of CPR among respondents of different ages and education levels.

Methods: A self-made questionnaire was conducted to survey people in Hunan Province by means of WeChat from May 2018 to April 2019. The questionnaire referred to 2016 National consensus on cardiopulmonary resuscitation in China issued by Cardiopulmonary Resuscitation Specialized Committee of Chinese Research Hospital Association and 2017 version of American Heart Association (AHA) CPR operational guide, and combined with the CPR assessment scale of Hunan Provincial People's Hospital. The contents of the survey included the basic information of the subjects, the common knowledge and skills of first aid, the willingness to learn CPR skills and implement CPR, and the operational requirements of high quality CPR, etc.

Results: A total of 6 563 people received the on-site first aid knowledge questionnaire, and 4 355 people completed and submitted the questionnaire. The recovery rate was 66.36%, of which 3 602 valid questionnaires were from IP in Hunan Province, and the qualified rate was 82.71%. Among the subjects, 1 532 were men (42.53%) and 2 070 were women (57.47%). The majority aged group from 19 to 30 (59.41%) and from 31 to 50 (36.70%). 307 were rural (8.52%) and 3 295 were urban (91.48%); and the majority levels of education were senior or technical secondary school (38.26%) and undergraduate or junior college (44.50%). Of the 3 602 respondents, 39.09% indicated that they had been exposed to CPR knowledge and only 0.36% indicated that they did not wish to participate in CPR training. 69.93% of the respondents said they would actively to help if they wet cardic arrest, and 97.92% of those were willing to do so if the patients were relatives or friends. The survey results showed that only 8.91% of respondents chose relatively high-quality CPR options (chest compressions were performed first, the pressing point was located in the sternum of the midpoint of bilateral nipple line, the pressing frequency was 100-120 times/min, pressing depth was 5-6 cm, the ratio of chest compression to artificial ventilation was 30:2). Among these people, the correct rate was higher in the ages of 31-50 years old and ≤ 18, 19-30 than those ≥ 51 years old (12.71% vs. 0%, 6.87%, 8.70%, χ = 41.420, P < 0.01). The correct rate of education at graduate level and above was higher than those in junior middle school and below, high school or technical secondary school, undergraduate or junior college (19.57% vs. 2.07%, 3.41%, 13.72%, χ = 152.262, P < 0.01).

Conclusions: The public in Hunan Province have a strong sense of first aid, and some of the theoretical knowledge of CPR. People between 31 years old and 50 years old of age and with graduate education and above know more about CPR, but the overall mastery of CPR skills is poor. It is necessary to further improve the ability of the public as the first witness by teaching various skills of CPR in various forms.
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http://dx.doi.org/10.3760/cma.j.cn121430-20200321-00222DOI Listing
July 2020

Scleral HIF-1α is a prominent regulatory candidate for genetic and environmental interactions in human myopia pathogenesis.

EBioMedicine 2020 Jul 8;57:102878. Epub 2020 Jul 8.

School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; The State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China. Electronic address:

Background: Myopia is a good model for understanding the interaction between genetics and environmental stimuli. Here we dissect the biological processes affecting myopia progression.

Methods: Human Genetic Analyses: (1) gene set analysis (GSA) of new genome wide association study (GWAS) data for 593 individuals with high myopia (refraction ≤ -6 diopters [D]); (2) over-representation analysis (ORA) of 196 genes with de novo mutations, identified by whole genome sequencing of 45 high-myopia trio families, and (3) ORA of 284 previously reported myopia risk genes. Contributions of the enriched signaling pathways in mediating the genetic and environmental interactions during myopia development were investigated in vivo and in vitro.

Results: All three genetic analyses showed significant enrichment of four KEGG signaling pathways, including amphetamine addiction, extracellular matrix (ECM) receptor interaction, neuroactive ligand-receptor interaction, and regulation of actin cytoskeleton pathways. In individuals with extremely high myopia (refraction ≤ -10 D), the GSA of GWAS data revealed significant enrichment of the HIF-1α signaling pathway. Using human scleral fibroblasts, silencing the key nodal genes within protein-protein interaction networks for the enriched pathways antagonized the hypoxia-induced increase in myofibroblast transdifferentiation. In mice, scleral HIF-1α downregulation led to hyperopia, whereas upregulation resulted in myopia. In human subjects, near work, a risk factor for myopia, significantly decreased choroidal blood perfusion, which might cause scleral hypoxia.

Interpretation: Our study implicated the HIF-1α signaling pathway in promoting human myopia through mediating interactions between genetic and environmental factors.

Funding: National Natural Science Foundation of China grants; Natural Science Foundation of Zhejiang Province.
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http://dx.doi.org/10.1016/j.ebiom.2020.102878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348000PMC
July 2020

Influence of Distance and Near Visual Impairment on Self-Reported Near Visual Functioning in a Multinational Study.

Ophthalmology 2021 02 9;128(2):188-196. Epub 2020 Jul 9.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. Electronic address:

Purpose: To assess the influence of distance and near visual impairment on self-reported near visual functioning (VF) in a multinational study.

Design: Population-based cross-sectional study.

Participants: Participants aged 35 years or older were selected randomly with cluster sampling at 7 sites: rural sites in Nepal (Kaski) and India (Madurai), a semirural site in China (Shunyi), semiurban sites in South Africa (Durban) and Niger (Dosso), and urban sites in the United States (Los Angeles) and China (Guangzhou).

Methods: Binocular presenting distance and near visual acuity (VA) were measured with a logarithm of the minimum angle of resolution tumbling E chart at 4 m and 40 cm, respectively. A 12-item near VF questionnaire interview was administered by trained local interviewers, with responses scored from 100 to 0 as visual disability increased. Multiple linear regression was used to investigate the association of age, gender, education, and VA with overall eyesight, difficulty with activities, and social functioning subscale scores.

Main Outcome Measures: Visual functioning subscale scores.

Results: The study sample consisted of 6851 questionnaire respondents. The VF subscale scores decreased significantly with worse distance and near VA, and even mildly impaired VA could result in reduced VF. Lower VF subscale scores were associated with older age at 4 sites, female gender at 3 sites, and greater education at 2 sites. The influence of near VA was greater than distance VA at 3 sites, and at 1 site, distance VA was more influential than near VA. With study site included in the regression modeling, lower scores for the overall eyesight subscale (compared with the Shunyi reference site) were found in Guangzhou, Kaski, and Durban; lower difficulty in activities scores were found in Kaski and Durban, but better scores were found in Guangzhou and Madurai; and social functioning scores were lower in Kaski, Durban, and Dosso.

Conclusions: Along the entire VA spectrum, lower levels of distance and near VA led to significant reductions in VF subscale scores, with wide variation both within and between study sites. The impact of near vision on VF should receive greater emphasis with further investigation in various socioeconomic and cultural settings.
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http://dx.doi.org/10.1016/j.ophtha.2020.07.006DOI Listing
February 2021

Duration of SARS-CoV-2 viral RNA in asymptomatic carriers.

Crit Care 2020 05 24;24(1):245. Epub 2020 May 24.

Hunan Provincial Institute of Emergency Medicine, Hunan Provincial People's Hospital/The First Affiliated Hospital, Hunan Normal University, Changsha, Hunan, China.

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http://dx.doi.org/10.1186/s13054-020-02952-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245635PMC
May 2020

Visual impairment in highly myopic eyes: The ZOC-BHVI High Myopia Cohort Study.

Clin Exp Ophthalmol 2020 08 8;48(6):783-792. Epub 2020 Jun 8.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Importance: Understanding visual impairment (VI) under different definitions and potential risk factors in high myopic is important for future myopia control.

Background: Limited studies exists investigating the VI among high myopic and with varying VI definitions.

Design: Registry cohort study.

Participants: Eight hundred and eighty-four participants were from ZOC-BHVI study.

Methods: Subjects aged 7 to 70 years with high myopia were enrolled. Uncorrected visual acuity and best-corrected visual acuity (UCVA and BCVA), cycloplegic refraction, axial length (AL), corneal curvatures, anterior chamber depth and lens thickness were measured. Axial length/corneal radius of curvature ratio (AL/CR ratio) was calculated. Fundus lesions were graded into five categories. VI and blindness were defined based on the better-seeing eye according to the World Health Organization (WHO) criteria and US criteria. Multiple logistic regression analysis was used to assess risk factors for VI.

Main Outcome Measures: Rates of VI and blindness.

Results: A total of 884 participants were included, with mean (SD) age 18.5 (12.4) years and 46.4% male. Rate of UCVI/blindness were 72.6%/27.3% and 17.9%/82.1% based on WHO and US criteria. With respect to BCVA, 4.1%/5.9% of participants had BCVI using two definitions, whereas the rate for blindness was 0.2% and 0.6%. After adjusting confounders, multiple logistic regression showed that more severe fundus lesions, greater AL/CR ratio were at a higher risk of being VI, both in two definitions (P < .005).

Conclusions And Relevance: The rate of VI and blindness in highly myopic patients varies significantly using different definition. Severe fundus lesions and greater AL/CR ratios were associated with a higher risk of VI.
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http://dx.doi.org/10.1111/ceo.13779DOI Listing
August 2020

Associations between Augmentee Status, Deployment Stress Preparedness and Depression, Post-Traumatic Stress Disorder, and Binge Drinking in U.S. Servicewomen.

Womens Health Issues 2020 May - Jun;30(3):207-213. Epub 2020 Feb 18.

Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa; Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa.

Background: Being deployed without one's home unit (individual-augmentee) and low perceived deployment preparedness are risk factors for mental health symptoms and substance use in male service members. However, these relationships have not been examined specifically in U.S. servicewomen. This study sought to fill this gap by examining associations between augmentee status and deployment stress preparedness (independent variables) and depression, probable post-traumatic stress disorder (PTSD), and binge drinking (dependent variables) in a sample of U.S. servicewomen.

Methods: A community sample of service women from the Midwest, including both veterans and those serving at the time of data collection (N = 991), completed structured telephone interviews. Logistic regression was used to examine associations between augmentee status, deployment stress preparedness, and the likelihood of reporting depression, probable PTSD, and binge drinking after controlling for covariates.

Results: Findings showed that U.S. servicewomen in the Reserve/Guard who deployed as individual-augmentees were more likely to screen positive for depression, report probable PTSD, and disclose recent binge drinking than servicewomen in the Reserve/Guard deployed with their home unit. Also, among servicewomen deployed as individual-augmentees, those in the Reserve/Guard were more likely to report binge drinking than servicewomen in the active component. No statistically significant associations between deployment stress preparedness and mental health symptoms or binge drinking were observed.

Conclusions: Servicewomen in the Reserve/Guard who deployed as individual-augmentees may be at increased risk for depression, probable PTSD, and hazardous drinking when compared with their active component and Reserve/Guard peers deployed with their home units.
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http://dx.doi.org/10.1016/j.whi.2020.01.002DOI Listing
August 2020

Effect of a complex intervention to improve post-vision screening referral compliance among pre-school children in China: A cluster randomized clinical trial.

EClinicalMedicine 2020 Feb 4;19:100258. Epub 2020 Feb 4.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Background: We investigated whether specific appointments for quality-assured care could increase referral uptake, often low in China, in children's vision screening.

Methods: We randomized children aged 4-7 years in Yudu, Jiangxi, China, by school to Control (free school-based eye screening, parents of children failing screening recommended for further examination [usual practice]) or Intervention (identical examinations, with parents additionally provided with specific appointments for further examinations by quality-assured doctors at a designated local hospital). Both groups could select any hospital for referral exams, which were not free. Six months after screening, parents were interviewed on referral compliance at any hospital (primary outcome) and potential determinants. This trial is registered at the ClinicalTrials.gov, number NCT03251456.

Findings: Among 9936 children at 63 schools randomized to Intervention (32 schools, 5053 [50·9%] children) or Control (31 schools, 4883 [49·1%] children), 1114 children (11·2%) failed screening. Among 513 referred Intervention children (46·1%, 32 schools, mean age 5·36 years, 53·0% boys) and 601 referred Control children (53·9%, 31 schools, mean age 5·30 years, 57·7% boys), 104 (20·3%) and 135 (22·5%) were lost to follow-up respectively. Under Intention to Treat analysis, assuming children lost to follow-up were non-compliant, Intervention children had significantly higher compliance than Controls (308/513 = 60·0% vs. 225/601 = 37·4%,  < 0·001). In regression models, Intervention group membership (Relative risk [RR] 1·53, 95% confidence interval, 1·36-1·72), travel time to hospital (RR: 0·97, 0·95-0·999), baseline glasses wear (RR: 1·37, 1·17-1·60), strabismus (RR: 1·17, 1·01-1·36) and worse uncorrected vision (RR: 1·41, 1·03-1·92) were associated with compliance.

Interpretation: Providing specific appointments for quality-assured eye care improved referral compliance in this setting.
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http://dx.doi.org/10.1016/j.eclinm.2020.100258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005561PMC
February 2020

Bedside temporary transvenous cardiac pacemaker placement.

Am J Emerg Med 2020 04 9;38(4):819-822. Epub 2019 Dec 9.

Emergency Department, Hunan Provincial People's Hospital, Medical School of Hunan Normal University, Changsha, China.

Temporary transvenous cardiac pacing is a life-saving procedure in an emergency. Transvenous cardiac pacing catheterization guided by intracavitary electrocardiogram (IC-ECG), instead of fluoroscope, is practical. Tips for controlling the orientation of the pacing catheter tip and utilizing IC-ECG to monitor the positions of electrodes make bedside temporary transvenous cardiac pacing catheter placement feasible and 'visible'. The technique discussed here is comparable to the operation under fluoroscopy,but without exposure to X-ray.
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http://dx.doi.org/10.1016/j.ajem.2019.12.013DOI Listing
April 2020

Corneal differences between healthy and subclinical patients assessed using two diferente corneal tomographers.

Arq Bras Oftalmol 2020 Mar-Apr;83(2):92-97

Department of Ophthalmology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010050, China.

Purpose: To analyze subclinical keratoconus topography indexes using Pentacam and Orbscan-II measurements to identify evidences for seeking sensitive indexes to screen and diagnose subclinical keratoconus.

Methods: Fifty healthy participants (50 eyes) and 40 patients with subclinical keratoconus (40 eyes) were included. Seven common parameters including corneal thickness at the thinnest point; minimum curvature of the front surface (minimum simulated keratometry value, SimK's Min); maximum curvature of the front surface (maximum simulated keratometry value, SimK's Max); the frontal corneal surface best-fit spherical radius of the curvature; the back corneal surface best-fit spherical radius of curvature; the anterior corneal surface height (anterior Diff value); and the posterior corneal surface height (posterior Diff value) measured by Pentacam and Orbscan-II between normal and subclinical keratoconus eyes were compared.

Results: Statistical differences between the healthy and subclinical keratoconus groups (p<0.01) were found in all corneal parameters measured using both devices. Differences in the minimum curvature of the front surface (SimK's Min), thinnest point, anterior Diff value, and posterior Diff value were significant between Pentacam and Orbscan-II in the subclinical keratoconus group (p<0.05).

Conclusion: The findings of this study identify the differences between normal and subclinical keratoconus eyes at the minimum curvature of the front surface, maximum curvature of the front surface, frontal corneal surface best-fit spherical radius of curvature, back corneal surface best-fit spherical radius of curvature, Anterior Diff value, and Posterior Diff value measures using Orbscan II and Pentacam that can help eye care practitioners clinically diagnose subclinical keratoconus.
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http://dx.doi.org/10.5935/0004-2749.20200015DOI Listing
May 2020

Emerging protective roles of shengmai injection in septic cardiomyopathy in mice by inducing myocardial mitochondrial autophagy via caspase-3/Beclin-1 axis.

Inflamm Res 2020 Jan 11;69(1):41-50. Epub 2019 Nov 11.

Chest Pain Center of Hunan, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No. 61, Jiefang West Road, Changsha, 410000, People's Republic of China.

Background: Sepsis, a life-threatening systemic syndrome related to inflammatory response, usually accompanied by major organ dysfunctions. The aim of the present study was to elucidate the role by which Shengmai injection (SMI) acts to septic cardiomyopathy.

Methods: Initially, the induced mice with septic cardiomyopathy were treated with SMI or normal saline (NS) with oe-caspase-3, and HL-1 cells were treated with oe-Beclin-1 and oe-caspase-3 and then cultured with lipopolysaccharide (LPS). Subsequently, we measured the cardiac troponin I (cTnI) level, and expression of mitochondrial autophagy protein (parkin and pink1) and myocardial cell autophagy-related proteins (LC3-II and LC3-I). Additionally, we identified the cleavage of Beclin-1 by caspase-3 and detected the changes of mitochondrial membrane potential, level of reactive oxygen species (ROS), and apoptosis of myocardial cells in myocardial tissues of mice.

Results: It has been demonstrated that SMI contributed to the increase of myocardial mitochondrial autophagy, reduction of cTnI level, and elevation of mitochondrial membrane potential in septic cardiomyopathy mice. Both in vitro and in vivo experiments showed that caspase-3 promoted cleavage of Beclin-1 and release of ROS, whereas repressed lipopolysaccharide (LPS)-induced mitochondrial autophagy. Furthermore, the facilitation of myocardial mitochondrial autophagy and protection of myocardial mitochondria by SMI through inhibition of cleavage Beclin-1 by caspase-3 in septic cardiomyopathy mice were also proved by in vivo experiments.

Conclusion: Taken together, SMI could protect myocardial mitochondria by promoting myocardial mitochondrial autophagy in septic cardiomyopathy via inhibition of cleavage of Beclin-1 by caspase-3. Our study demonstrates that SMI could represent a novel target for treatment of septic cardiomyopathy.
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http://dx.doi.org/10.1007/s00011-019-01292-2DOI Listing
January 2020

Higher Rates of Preventive Health Care With Commercial Insurance Compared With Medicaid: Findings From the Arkansas Health Care Independence "Private Option" Program.

Med Care 2020 02;58(2):120-127

Arkansas Center for Health Improvement.

Background: A requirement of the Arkansas Medicaid Section 1115 demonstration waiver was to evaluate the level of care received for Medicaid expansion eligible beneficiaries enrolled in commercial Qualified Health Plans (QHPs) in the Health Care Independence "Private Option" Program. This allowed for a direct comparison of Medicaid and commercial system performance serving similar newly covered adults.

Research Design: In 2014, assignment to either Medicaid or a QHP was made based upon a psychometrically derived continuous composite score to exceptional health care needs assessment screener using a sharp a priori threshold cutpoint. Using a regression discontinuity design we compared preventive care (flu vaccination and screening rates) services in the 2 programs over 3 years.

Results: Compared with Medicaid enrollees, a higher percentage of QHP enrollees consistently received eligible preventive care screenings with 15.3, and 6.9% more receiving at least 1 or all eligible screenings, respectively. For individual preventive care outcomes and compared with Medicaid enrollees over the 3 years under study, a higher percentage of eligible QHP enrollees received a flu shot, cholesterol screenings, glycated hemoglobin assessment, and cervical and breast cancer periodic assessments. No differences were found for colorectal periodic assessments.

Conclusions: These findings suggest that at least for preventive services, the Medicaid federal equal access requirement is not being met for those within Medicaid fee-for-service coverage. This persisted across all 3 years of the program. Differential payment rates for services between Medicaid and QHPs are likely a major contributing factor.
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http://dx.doi.org/10.1097/MLR.0000000000001248DOI Listing
February 2020

Stigma, Treatment, and Health among Stimulant Users: Life Stage as a Moderator.

J Appl Dev Psychol 2019 Jan-Feb;60:96-104. Epub 2018 Dec 3.

Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205 USA.

This 3-year study examined associations among drug use stigma, life stage, treatment utilization and health among 710 US adults using stimulants. Consistent with substance use developmental frameworks, life stage was represented by Emerging adulthood (18-25 years old, n=223), Earlymid adulthood (26-44 years old; n=384), and Older adulthood (45-61 years old; n=103). Emerging adults experienced less enacted stigma (i.e., experiences of discrimination) and perceived less public stigma (i.e., unjust treatment) over the course of the study than other life stage groups. More baseline enacted stigma was associated with more mental health and substance use treatment, whereas more baseline self stigma (i.e., negative thoughts about the self) was associated with less treatment utilization. Life stage moderated stigma-outcome associations such that substance use outcomes were worse for Emerging adults reporting more enacted stigma. Although emerging adults experienced less drug use stigma, stigma had a more negative impact on adults in this life stage.
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http://dx.doi.org/10.1016/j.appdev.2018.11.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756791PMC
December 2018

A self-adaptive deep learning method for automated eye laterality detection based on color fundus photography.

PLoS One 2019 19;14(9):e0222025. Epub 2019 Sep 19.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Purpose: To provide a self-adaptive deep learning (DL) method to automatically detect the eye laterality based on fundus images.

Methods: A total of 18394 fundus images with real-world eye laterality labels were used for model development and internal validation. A separate dataset of 2000 fundus images with eye laterality labeled manually was used for external validation. A DL model was developed based on a fine-tuned Inception-V3 network with self-adaptive strategy. The area under receiver operator characteristic curve (AUC) with sensitivity and specificity and confusion matrix were applied to assess the model performance. The class activation map (CAM) was used for model visualization.

Results: In the external validation (N = 2000, 50% labeled as left eye), the AUC of the DL model for overall eye laterality detection was 0.995 (95% CI, 0.993-0.997) with an accuracy of 99.13%. Specifically for left eye detection, the sensitivity was 99.00% (95% CI, 98.11%-99.49%) and the specificity was 99.10% (95% CI, 98.23%-99.56%). Nineteen images were wrongly classified as compared to the human labels: 12 were due to human wrong labelling, while 7 were due to poor image quality. The CAM showed that the region of interest for eye laterality detection was mainly the optic disc and surrounding areas.

Conclusion: We proposed a self-adaptive DL method with a high performance in detecting eye laterality based on fundus images. Results of our findings were based on real world labels and thus had practical significance in clinical settings.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222025PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752776PMC
March 2020

Development and Validation of a Smartphone-Based Visual Acuity Test (Vision at Home).

Transl Vis Sci Technol 2019 Jul 19;8(4):27. Epub 2019 Aug 19.

Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.

Purpose: To describe the development and validation of a smartphone-based visual acuity (VA) test called Vision at home ([email protected]).

Methods: Three study populations (elderly Chinese, adolescent Chinese, and Australian groups) underwent distance and near VA testing using standard Early Treatment Diabetic Retinopathy Study (ETDRS) charts and the [email protected] device; all VA tests used tumbling E optotypes. VA tests were repeated with one eye, selected randomly. Distance VA was measured monocularly at 2 m, and near VA was measured binocularly at 40 cm. Participants also completed a questionnaire about their satisfaction with the device. [email protected] VA (logMAR) was compared to VA for ETDRS charts at distance and near and test-retest reliability.

Results: The mean difference between [email protected] and ETDRS distance VA across all groups ranged from -0.010 to -0.100 logMAR. Tolerant weighted kappa (TWK) agreement ranged from substantial (0.742) in the Australian group to almost perfect (0.950) in the adolescent Chinese group. There was high agreement of [email protected] with near ETDRS VA across all groups, with a mean difference of -0.092 to -0.042 logMAR and a TWK of 0.736 to 0.837. Test-retest reliability was also high (difference: -0.018 to 0.026) for both distance and near VA tests (95% limits of agreement: -0.289 to 0.258 for distance and -0.235 to 0.199 for near). The majority of participants were satisfied with [email protected]

Conclusions: [email protected] could accurately and reliably measure both distance and near VA and is well accepted by participants.

Translational Relevance: The [email protected] system could potentially serve as a useful tool to improve eye care accessibility, especially in underdeveloped areas with limited eye care personnel and resources.
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http://dx.doi.org/10.1167/tvst.8.4.27DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701871PMC
July 2019

Contribution of Genome-Wide Significant Single Nucleotide Polymorphisms in Myopia Prediction: Findings from a 10-year Cohort of Chinese Twin Children.

Ophthalmology 2019 12 2;126(12):1607-1614. Epub 2019 Jul 2.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Centre for Eye Research Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia. Electronic address:

Purpose: To determine the added predictive ability of genome-wide significant single nucleotide polymorphisms (SNPs) in refraction prediction in children and investigate the earliest age threshold for an accurate prediction of high myopia.

Design: Prospective longitudinal study.

Participants: A total of 1063 first-born twins followed annually between 2006 and 2015 in China. The exposures were genetic factors (parental myopia, SNPs) and environmental factors (near work, outdoor activity).

Methods: Five linear mixed-effect models, consisting of different combinations of age, gender, genetic, and environmental factors, were built to predict myopia development. All predictions were performed on the basis of spherical equivalent (SE) at baseline and the measurements on the second and third visits.

Main Outcome Measures: The primary outcome measure was SE at the last visit among all subjects, and the secondary outcome measure was the presence of high myopia at the age of 18 years.

Results: Mean age of the study population was 10.5±2.2 years (range, 7-15 years) at baseline, and 48.6% were male. In linear mixed-effect models, age, age square, gender, paternal SE, maternal SE, and genetic risk scores (GRSs) showed a significant fixed effect, whereas outdoor and near-work time were not significant to SE at the last visit. Incorporating more follow-up data into the model showed better performance across all models. In the prediction of the presence of high myopia at 18 years of age, the model consisting of only age and gender showed a good performance (area under the curve [AUC] = 0.95), whereas the addition of SNPs did not enhance the model performance significantly. The AUC for predicting high myopia was >0.95 after the age of 13 years for participants with a single visit and after the age of 12 years for those with 1 more visit data.

Conclusions: A simple model incorporating age, sex, and relevant refraction data is sufficient to accurately predict high myopia; there was limited improvement in the prediction model after adding genetic information. Furthermore, this prediction on the outcome at 18 years is possible when the child is aged 12 to 13 years.
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http://dx.doi.org/10.1016/j.ophtha.2019.06.026DOI Listing
December 2019
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