Risk factors for necrotizing enterocolitis in preterm infants: a Meta analysis. / æ—©äº§å„¿åæ­»æ€§å°è‚ ç»“è‚ ç‚Žå±é™©å› ç´ çš„Meta分析.

OBJECTIVES: To systematically evaluate the risk factors for necrotizing enterocolitis (NEC) in preterm infants. METHODS: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data were searched for case-control studies and cohort studies on the risk factors for NEC in preterm infants published up to December 2021. RevMan 5.3 software was used to perform the Meta analysis. RESULTS: A total of 38 studies were included (28 case-control studies and 10 cohort studies). The Meta analysis showed that maternal gestational diabetes (OR=2.96, P<0.001), intrahepatic cholestasis during pregnancy (OR=2.53, P<0.001), preeclampsia (OR=1.73, P=0.020), history of neonatal asphyxia (OR=2.13, P<0.001), low gestational age (OR=1.23, P=0.010), sepsis (OR=5.32, P<0.001), patent ductus arteriosus (OR=1.57, P=0.001), congenital heart disease (OR=3.78, P<0.001), mechanical ventilation (OR=2.23, P=0.020), history of antibiotic use (OR=1.07, P<0.001), use of vasopressors (OR=2.34, P=0.040), and fasting (OR=1.08, P<0.001) were risk factors for NEC in preterm infants, while cesarean section (OR=0.73, P=0.004), use of pulmonary surfactant (OR=0.43, P=0.008), and breastfeeding (OR=0.24, P=0.020) were protective factors against NEC. CONCLUSIONS: Maternal gestational diabetes, intrahepatic cholestasis during pregnancy, preeclampsia, low gestational age, fasting, sepsis, patent ductus arteriosus, congenital heart disease, and histories of asphyxia, mechanical ventilation, antibiotic use, and use of vasopressors may increase the risk of NEC in preterm infants, while cesarean section, use of pulmonary surfactant, and breastfeeding may decrease the risk of NEC in preterm infants.

Cost-Effectiveness Analysis of the Application of a Porcine-Derived Fibrin Sealant for the Treatment of Cerebrospinal Fluid Leak in China.

PURPOSE: This study aimed to evaluate the cost-effectiveness of a porcine-derived fibrin sealant (PFS) for treating cerebrospinal fluid (CSF) leaks in cranial surgery compared with sutures alone from the perspective of public hospital management in China. METHODS: A decision tree model of cranial surgery patients with intraoperative CSF leak was constructed in R 3.6.3. The cost-effectiveness of using PFS with dural sutures was compared versus using sutures alone. Efficacy and safety data were obtained from a randomized controlled, single-blinded clinical trial that enrolled 200 patients (NCT03110783). Effectiveness was measured as the success rate of CSF leak treatment and the rate of postoperative complication. Hospital procurement costs were used to provide cost measurements from the hospital administrator's perspective. FINDINGS: The PFS strategy had a higher success rate of CSF leak treatment (97.81% vs 49.21%) and a lower complication rate (9.49% vs 14.29%), based on results from the clinical trial. Using PFS also resulted in cost savings amounting to $374.97 in additional intraoperative CSF leak repairs ($18.07 vs $393.04) and $66.68 in postoperative complication treatment ($131.90 vs $198.58). Both one-way sensitivity analysis and probabilistic sensitivity analysis confirmed that the model results were stable against input variations. IMPLICATIONS: The decision tree analysis revealed that using PFS in conjunction with sutures was associated with improved clinical performance and lower overall costs. PFS in combination with sutures is the dominant strategy for treating CSF leak from the perspective of hospital decision-makers.

Association between polypharmacy and mortality in the older adults: A systematic review and meta-analysis.

BACKGROUND: Polypharmacy and related adverse consequences are common in the older adults, especially mortality, but the causality of this relationship remains unclear. This meta-analysis aimed to explore the relationship between polypharmacy and mortality in older adults. METHODS: We systematically searched Pubmed, Embase, and the Cochrane Library from inception until August 2021 to identify observational studies providing quantitative estimates on the association between polypharmacy(≥5drugs) and mortality in the elderly (≥65 years). Results from individual studies were pooled using a random-effects or fixed-effects model. RESULTS: A total of twenty-four cohort studies including 2,967,952 participants of 65 years or older in this meta-analysis. twenty-four studies found a significant increase in mortality associated with polypharmacy (≥5 drugs) [Relative Risk, RR=1.28, 95%CI (1.19,1.39), P<0.05] or excessive polypharmacy (≥10 drugs) [Relative Risk, RR=1.44, 95%CI (1.03,2.01), P<0.05] among older adults. Eight studies showed an 50% increased hospitalization rate for polypharmacy in the older adults [RR=1.50, 95%CI (1.18,1.89), P<0.05]. Subgroup analysis showed that the relationship between polypharmacy and mortality was different among older adults in community [RR=1.41, 95%CI (1.24,1.60), P<0.05], in hospital [RR=1.10, 95%CI (1.00,1.20), P<0.05], in institutions [RR=1.47, 95%CI (1.29,1.68), P<0.05]. The mortality rate of the elderly using 5 to 9 drugs was [RR=1.23, 95%CI (1.06,1.43), P<0.05] and using more than 10 drugs was [RR=1.44, 95%CI (1.03,2.01), P<0.05]. CONCLUSIONS: The results of this meta-analysis suggest that polypharmacy may be associated with increased mortality in older adults, but this association must be carefully considered and needed further validation. GLOSSARY: CI=confidence interval; MOOSE=Meta-analysis of Observational Studies in Epidemiology; NOS = Newcastle-Ottawa Scale; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RR = relative risk; HR = hazard ratio; OR = odds ratio; GRADE = Grading of Recommendations Assessment Development and Evaluation.

Characterization of the metabolites of irisflorentin by using ultra-high performance liquid chromatography combined with quadrupole/orbitrap tandem mass spectrometry.

Irisflorentin is one of the bioactive constituents from the root of Belamcanda chinensis (L.) DC, which displayed anti-inflammatory and anti-tumor activities. In this work, the in vitro metabolism of irisflorentin was investigated using liver microsomes and hepatocytes. The metabolites were identified by ultra-high performance liquid chromatography combined with quadrupole/orbitrap tandem mass spectrometry. Under the current conditions, a total of 11 metabolites were detected and structurally identified according to accurate masses, fragment ions and retention times. Metabolite M10, identified as 6,7-dihydroxy-5,3',4',5'-tetramethoxy isoflavone, was biosynthesized and unambiguously characterized by nuclear magnetic resonance spectroscopy. The metabolic pathways of irisflorentin included oxidation, demethylation and glucuronidation. M10 was the most abundant metabolite in all tested species. Further phenotyping studies revealed that α-naphthoflavone and ketoconazole displayed significant inhibitory effect on the formation of M10. Cytochrome P450 (CYP) 1A2 and 3A4 were the major enzymes responsible for the formation of M10 by using individual recombinant human CYP450 enzymes. For the first time the current study provides an overview of the in vitro metabolic fates of irisflorentin, which is helpful for us to predict the human metabolism and the potential drug-drug interactions caused by irisflorentin.

Screening Tools Based on Nomogram for Diabetic Kidney Diseases in Chinese Type 2 Diabetes Mellitus Patients.

BACKGROUND: The influencing factors of diabetic kidney disease (DKD) in Chinese patients with type 2 diabetes mellitus (T2DM) were explored to develop and validate a DKD diagnostic tool based on nomogram approach for patients with T2DM. METHODS: A total of 2,163 in-hospital patients with diabetes diagnosed from March 2015 to March 2017 were enrolled. Specified logistic regression models were used to screen the factors and establish four different diagnostic tools based on nomogram according to the final included variables. Discrimination and calibration were used to assess the performance of screening tools. RESULTS: Among the 2,163 participants with diabetes (1,227 men and 949 women), 313 patients (194 men and 120 women) were diagnosed with DKD. Four different screening equations (full model, laboratory-based model 1 [LBM1], laboratory-based model 2 [LBM2], and simplified model) showed good discriminations and calibrations. The C-indexes were 0.8450 (95% confidence interval [CI], 0.8202 to 0.8690) for full model, 0.8149 (95% CI, 0.7892 to 0.8405) for LBM1, 0.8171 (95% CI, 0.7912 to 0.8430) for LBM2, and 0.8083 (95% CI, 0.7824 to 0.8342) for simplified model. According to Hosmer-Lemeshow goodness-of-fit test, good agreement between the predicted and observed DKD events in patients with diabetes was observed for full model (χ2=3.2756, P=0.9159), LBM1 (χ2=7.749, P=0.4584), LBM2 (χ2=10.023, P=0.2634), and simplified model (χ2=12.294, P=0.1387). CONCLUSION: LBM1, LBM2, and simplified model exhibited excellent predictive performance and availability and could be recommended for screening DKD cases among Chinese patients with diabetes.

Cost-Effectiveness Analysis of PEG-rhG-CSF as Primary Prophylaxis to Chemotherapy-Induced Neutropenia in Women With Breast Cancer in China: Results Based on Real-World Data.

Background: Pegylated recombinant human granulocyte colony-stimulating factors (PEG-rhG-CSFs) are more commonly and widely used than recombinant human granulocyte colony-stimulating factors (rhG-CSFs) in preventing chemotherapy-induced neutropenia in patients with stage II-IV breast cancer. To reduce the financial burden on these patients, the corresponding medical insurance directory needs to be revised. Objectives: To evaluate the cost-effectiveness of PEG-rhG-CSF versus rhG-CSF in patients with stage II-IV breast cancer in central China. Methods: Two Markov models, a chemotherapy model and a post-chemotherapy model, were developed to study the effects and costs, with a time horizon of 12 weeks and 35 years, respectively. Cost and probability input data were primarily obtained from a retrospective real-world study conducted in five tertiary hospitals. Propensity score matching was adopted to overcome retrospective bias. Other parameters were extracted from literature as well as advice from clinical experts. Univariate and probabilistic sensitivity analyses were conducted. Results: In the first chemotherapy model, PEG-rhG-CSF was associated with fewer episodes of febrile neutropenia (FN) (N = 19 per 1000 patients treated), infections (N = 24 per 1000 patients treated) and deaths (N = 2 per 1000 patients treated), but higher costs (¥36 more per patient treated). The post-chemotherapy model indicated that PEG-rhG-CSF led to higher gains in quality-adjusted life years (QALYs) (11.695 versus 11.516) in comparison to rhG-CSF. Sensitivity analysis showed that the cost of PEG-rhG-CSF had the greatest impact on the incremental costs, and incremental QALYs were very sensitive to the risk of RDI <85%. The probability of PEG-rhG-CSF being cost-effective compared to rhG-CSF was 66% at the willingness to pay (WTP) thresholds of ¥72,371 per QALY gained. Conclusion: According to this economic evaluation based on real-world data, PEG-rhG-CSF may be considered as a more cost-effective strategy relative to rhG-CSF for stage II-IV breast cancer patients in central China. However, to reflect a national perspective, further evidence is needed using data from larger-scale studies.