Retrospective cohort study based on the MIMIC-IV database: analysis of factors influencing all-cause mortality at 30 days, 90 days, 1 year, and 3 years in patients with different types of stroke

ObjectiveThis study aims to evaluate key factors influencing the short-term and long-term prognosis of stroke patients, with a particular focus on variables such as body weight, hemoglobin, electrolytes, kidney function, organ function scores, and comorbidities. Stroke poses a significant global health burden, and understanding its prognostic factors is crucial for clinical management.MethodsThis is a retrospective cohort study based on data from the MIMIC-IV database, including stroke patients from 2010 to 2020. A total of 5,110 patients aged 18 and older were included in the study. The exposure variables included body weight and hemoglobin levels, while the outcome variables were the 30-day, 90-day, 1-year, and 3-year mortality risks. Covariates included electrolyte levels, kidney function, organ function scores, and comorbidities. Random forest and gradient boosting tree models were employed for data analysis to assess mortality risk.ResultsKaplan–Meier survival analysis showed that ischemic stroke patients had the highest 30-day mortality rate at 8.5%, with only 20% 1-year survival. Traumatic subarachnoid hemorrhage patients had the best prognosis, with a 1-year survival rate of 60%. Multivariable Cox regression analysis revealed that each 1-point increase in the Charlson Comorbidity Index raised the 1-year and 3-year mortality risks by 1.39 times (95% CI: 1.10–1.56) and 1.44 times, respectively. Each 1-point increase in the SOFA score increased the 30-day, 90-day, 1-year, and 3-year mortality risks by 2.11 times, 2.03 times, and 1.84 times, respectively. Additionally, lower hemoglobin levels were significantly associated with increased mortality, with 30-day, 90-day, and 1-year mortality risks increasing by 3.33 times, 3.34 times, and 4.16 times, respectively (p < 0.005). Age ≥ 71 years, longer hospital stays, and organ dysfunction were also significant factors affecting mortality.ConclusionThis study highlights the critical role of stroke type, comorbidity index, SOFA score, hemoglobin levels, and length of hospital stay in stroke prognosis. These findings provide valuable insights for clinical risk assessment and the development of individualized treatment strategies, which may improve the management and outcomes of stroke patients. The predictive model constructed effectively assesses mortality risks in stroke patients, offering support for future clinical practice

Gastric-filling ultrasonography to evaluate gastric motor function in patients long-term bedridden undergoing stroke

ObjectivesGastric motor dysfunction is a common symptom in patients with stroke, yet lacks objective evaluation methods. This study aimed to assess the feasibility of using gastric filling ultrasonography to evaluate gastric motor function in patients undergoing stroke, and to explore the relationship between gastric ultrasound indicators and clinical features.MethodsWe conducted a case-control study where all participants underwent a 60-minute ultrasound examination after consuming a 300 mL test meal. The cross-sectional area (CSA) of the gastric antrum was measured at four-time points: fasting for six to eight hours (T0), immediately after the test meal (T1), and at 30 (T30) and 60 (T60) minutes. Using CSA, we calculated the gastric emptying rate (GER) at T30 and T60 (GER30, GER60). Additionally, we measured the frequency (ACF) and amplitude (ACA) of antral contractions, as well as the motor index (MI). We compared these ultrasound parameters between the two groups and evaluated their correlation with clinical features such as bed rest time, consciousness level, albumin or hemoglobin levels.ResultsWe recruited 37 stroke patients and 31 healthy controls. Stroke patients exhibited lower GER compared to controls, particularly evident at T30. Additionally, stroke patients showed significantly reduced ACA, ACF, and MI at T1 and T30, with ACA being the only measure showing statistical differences at T60. Correlation analysis revealed negative associations between ACA, GER30, GER60, MIT1 and bed rest time. For predicting anemia, GER30 had a cut-off of 31.52 (88% specificity, 50% sensitivity), while ACAT60’s cut-off was 23.64 (76% specificity, 75% sensitivity).ConclusionUltrasound measurement of gastric filling shows promise as a valuable screening tool for detecting reduced gastric motor function in patients with stroke

Construction and immunological characterization of CD40L or GM-CSF incorporated Hantaan virus like particle

Infection of Hantaan virus (HTNV) usually causes hemorrhagic fever with renal syndrome (HFRS). China has the worst epidemic incidence of HFRS as well as high fatality. Inactivated whole virus has been used for HFRS vaccination, however there are still problems such as safety concerns. CD40 ligand (CD40L) and granulocyte macrophage colony-stimulating factor (GM-CSF) are well-known immune stimulating molecules that can enhance antigen presenting, lymphocytes activation and maturation, incorporation of CD40L and GM-CSF to the surface of virus like particles (VLPs) can greatly improve the vaccination effect. We constructed eukaryotic vectors expressing HTNV M segment and S segment, as well as vectors expressing HTNV M segment with CD40L or GM-CSF, our results showed successful production of CD40L or GM-CSF incorporated HTNV VLPs. In vitro stimulation with CD40L or GM-CSF anchored HTNV VLP showed enhanced activation of macrophages and DCs. CD40L/GM-CSF incorporated VLP can induce higher level of HTNV specific antibody and neutralizing antibody in mice. Immunized mice splenocytes showed higher ability of secreting IFN-γ and IL-2, as well as enhancing CTL activity. These results suggest CD40L/GM-CSF incorporated VLP can serve as prospective vaccine candidate

Review of the protist Labyrinhula spp. and its relationship to seagrass disease under the influence of anthropogenic activities

Anthropogenic activities are driving significant changes in coastal ecological environments, increasingly spotlighting microorganisms associated with seagrass bed ecosystems. Labyrinthula is primarily recognized as a saprophytic protist associated with marine detritus, and it also acts as an opportunistic pathogen affecting marine algae, terrestrial plants and mollusks, especially in coastal environments. The genus plays a key role in the decomposition of marine detritus, facilitated by its interactions with diatoms and through the utilization of a diverse array of carbohydrate-active enzymes to decompose seagrass cell walls. However, human activities have significantly influenced the prevalence and severity of seagrass wasting disease (SWD) through factors such as climate warming, increased salinity and ocean acidification. The rise in temperature and salinity, exacerbated by human-induced climate change, has been shown to increase the susceptibility of seagrass to Labyrinthula, highlighting the adaptability of pathogen to environmental stressors. Moreover, the role of seagrass in regulating pathogen load and their immune response to Labyrinthula underscore the complex dynamics within these marine ecosystems. Importantly, the genotype diversity of seagrass hosts, environmental stress factors and the presence of marine organisms such as oysters, can influence the interaction mechanisms between seagrass and Labyrinthula. Besides, these organisms have the potential to both mitigate and facilitate pathogen transmission. The complexity of these interactions and their impacts driven by human activities calls for the development of comprehensive multi-factor models to better understand and manage the conservation and restoration of seagrass beds

Disentangling sources and transformation mechanisms of nitrogen, sulfate, and carbon in water of a Karst Critical Zone

In the Karst Critical Zone (KCZ), mining and urbanization activities produce multiple pollutants, posing a threat to the vital groundwater and surface water resources essential for drinking and irrigation. Despite their importance, the interactions between these pollutants in the intricate hydrology and land use of the KCZ remain poorly understood. In this study, we unraveled the transformation mechanisms and sources of nitrogen, sulfate, and carbon using multiple isotopes and the MixSIAR model, following hydrology and surface analyses conducted in spatial modelling with ArcGIS. Our results revealed frequent exchange between groundwater and surface water, as evidenced by the analysis of δD-H2O and δ18O-H2O. Nitrification predominantly occurred in surface water, although denitrification also made a minor contribution. Inorganic nitrogen in both groundwater and surface water primarily originated from soil nitrogen (48 % and 49 %, respectively). Sewage and manure were secondary sources of inorganic nitrogen in surface water, accounting for 41 % in urban and 38 % in mining areas. Notably, inorganic sulfur oxidation displayed significant spatial disparities between urban and mining areas, rendering groundwater more susceptible to sulfur pollution compared to surface water. The frequent interchange between groundwater and surface water posed a higher pollution risk to groundwater. Furthermore, the primary sources of CO2 and HCO3- in both groundwater and surface water were water‑carbonate reactions and soil respiration. Sulfide oxidation was found to enhance carbonate dissolution, leading to increased CO2 release from carbonate dissolution in the KCZ. These findings enhance our understanding of the transformation mechanisms and interactions of nitrogen, sulfur, and carbon in groundwater and surface water. This knowledge is invaluable for accurately controlling and treating water pollution in the KCZ.This study was funded by the China Postdoctoral Science Foundation (2023M733546), Key Technology Research and Development Program of Guizhou Province ([2023]126), Post-funded Project of National Key Research and Development Program of China (Guizhou, 2022), and Guangdong Basic and Applied Basic Research Foundation (2022B1515020014, 2022A1515110926, 2023A1515010957). J.P. and J.S. were supported by the Spanish Government grants TED2021-132627B-I00 and PID2022-140808NB-I00 funded by MCIN, AEI/10.13039/501100011033 and the European Union NextGenerationEU/PRTr, the Fundación Ramón Areces grant CIVP20A6621, and the Catalan Government grant SGR2021-1333. We thank Yingji Qin, Jinfang Shi and Han Tu from the Guizhou University, Jingsi Cui and Dr. Pengcheng Zhang from Sun Yat-Sen University, and Prof. Changfu Fan from Chinese Academy of Geological Sciences for their assistances in the field and laboratory. We are grateful to the journal editor and four anonymous reviewers for their thoughtful and insightful comments in this manuscript.Peer reviewe

Using standardized patients to assess the quality of type 2 diabetes care among primary care providers and the health system: Evidence from rural areas of western China

Background Improving type 2 diabetes (T2D) care is key to managing and reducing disease burden due to the growing prevalence of diabetes worldwide, but research on this topic, specifically from rural areas, is limited. This study uses standardized patients (SPs) to assess T2D care quality among primary care providers to access the healthcare system in rural China. Methods Using multi-stage random sampling, health facilities, providers, and households were selected. SPs were used to evaluate providers' T2D care quality and a questionnaire survey was used to collect patient sorting behaviors from households. Logistic regression was used to explore factors correlated with T2D care quality. Provider referral and treatment rates were combined with patient sorting behaviors to assess the overall quality of T2D management by rural China's healthcare system. Results A total of 126 providers, 106 facilities, and 750 households were enrolled into this study. During SP interactions, 20% of rural providers followed the national guidelines for T2D consultation, 32.5% gave correct treatment, and 54.7% provided lifestyle suggestions. Multi-variable regression results showed that providers who had earned practicing certificates (β = 1.56, 95% CI: 0.44, 2.69) and saw more patients (β = 0.77, 95%: 0.25, 1.28) were more likely to use a higher number of recommended questions and perform better examinations, whereas providers who participated in online training were less likely to practice these behaviors (β = −1.03, 95%: −1.95, −0.11). The number of recommended questions and examination (NRQE) was the only significant correlated factor with correct treatment (marginal effect = 0.05, 95%: 0.01, 0.08). Throughout the rural healthcare system, 23.7% of T2D patients were treated correctly.ConclusionThe quality of T2D care in rural western China, especially throughout the consultation and treatment process during a patient's first visit, is poor. Online training may not improve T2D care quality and low patient volume was likely to indicate poor care quality. Further research is needed to explore interventions for improving T2D care quality in rural China's healthcare system

The know-do gap in quality of health for chronic non-communicable diseases in rural China

Proper management of non-communicable diseases (NCDs) is a severe challenge to China's rural health system. This study investigates what influences the poor medical treatment of NCDs (diabetes and angina) by evaluating the “know-do gap” between provider knowledge and practice. To determine whether low levels of provider knowledge low quality of patient care is the primary constraint on the quality of NCDs diagnosis and treatment in rural China. Providers from Village Clinics (VC) and Township Health Centers (THC), and Standardized Patients (SP) were selected by a multi-stage random sampling method. Clinical vignettes were administered to 306 providers from 103 VCs and 50 THCs in rural Sichuan Province. SPs presented diabetes symptoms completed 97 interactions with providers in 46 VCs and 51 THCs; SPs presented angina symptoms completed 100 interactions with providers in 50 VCs and 50 THCs. Process quality, diagnosis quality, and treatment quality were assessed against national standards for diabetes and angina. Two-tailed T-tests and tests of proportions for continuous outcomes and tests of proportions for binary dependent variables were used to compare vignette and SP results. Differences between vignette and SP data calculated the know-do gap. Regression analyses were used to examine the providers/facility characteristics and knowledge/practice associations. THC providers demonstrated significantly more knowledge in vignettes and better practices in SP visits than VC providers. However, levels of knowledge were low overall: 48.2% of THC providers and 28.2% of VC providers properly diagnosed type 2 diabetes, while 23.8% of THC providers and 14.7% of VC providers properly diagnosed angina. With SPs, 2.1% of THC providers and 6.8% of VC providers correctly diagnosed type 2 diabetes; 25.5% of THC providers and 12.8% of VC providers correctly diagnosed angina. There were significant know-do gaps in diagnosis process quality, diagnosis quality, and treatment quality for diabetes (p < 0.01), and in diagnosis process quality (p < 0.05) and treatment quality for angina (p < 0.01). Providers in rural China display low levels of knowledge when treating diabetes and angina. Despite low knowledge, evidence of the know-do gap indicates that low-quality healthcare is the primary constraint on the quality of NCD diagnosis and treatment in rural China. Our research findings provide a new perspective for the evaluation of the medical quality and a technical basis for the development of new standardized cases in the future

Corneal Surface Ablation Laser Refractive Surgery for the Correction of Myopia: A Network Meta-analysis

PURPOSE: To systematically compare the efficacy, predictability, safety, postoperative haze, pain scores, and epithelial healing time of four corneal surface ablation procedures. METHODS: PubMed, Embase, Cochrane Library, and the U.S. trial registry were searched up to June 2018. Randomized controlled trials were selected. Efficacy (uncorrected distance visual acuity of 20/20 or better), predictability (refractive spherical equivalent within ±0.50 diopters [D] of the target), and safety (loss of two or more lines of spectacle corrected distance visual acuity) were set as primary outcome measures. Haze, pain scores, and epithelial healing time were set as secondary outcome measures. RESULTS: Eighteen studies involving 1,423 eyes were included. According to the Grading of Recommendations Assessment, Development, and Evaluation, the quality of outcomes were moderate to high (70.6%). There were no differences in efficacy, predictability, safety, haze, day 1 pain, and epithelial healing time between treatments. Epithelial laser in situ keratomileusis (epi-LASIK) had statistically significantly higher pain scores on day 3 compared to photorefractive keratectomy (PRK) (weighted mean differences [WMD] = 2.2, 95% credible intervals [CrI] = 0.19 to 4.01) and transepithelial PRK (T-PRK) (WMD = 2.7, 95% CrI = 0.51 to 4.84). The surface under the cumulative ranking curve ranking results (best to worst) showed laser epithelial keratomileusis (LASEK) ranked highest for efficacy, predictability, safety, and day 1 pain scores. Epi-LASIK ranked best for grade 1 haze scores. T-PRK ranked best for haze of 0.5 or higher, haze scores day 3 pain scores, and epithelial healing time. CONCLUSIONS: Surface laser refractive surgeries are comparable in terms of efficacy, predictability, safety, and postoperative haze except for day 3 pain scores, with epi-LASIK being more painful compared to PRK and T-PRK. [J Refract Surg. 2018;34(11):726-735.]

Political Selection in China: The Complementary Roles of Connections and Performance

Who becomes a top politician in China? We focus on provincial leaders - a pool of candidates for top political office - and examine how their chances of promotion depend on their performance in office and connections with top politicians. Our empirical analysis, based on the curriculum vitae of Chinese politicians, shows that connections and performance are complements in the Chinese political selection process. This complementarity is stronger the younger provincial leaders are relative to their connected top leaders. To provide one plausible interpretation of these empirical findings, we propose a simple theory in which the complementarity arises because connections foster loyalty of junior officials to senior ones, thereby allowing incumbent top politicians to select competent provincial leaders without risking being ousted. Auxiliary evidence suggests that the documented promotion pattern does not distort the allocation of talent. Our findings shed some light on why a political system known for patronage can still select competent leaders