Objective:To investigate the influence of potentially inappropriate medication (PIM) on emergency treatment or hospitalization events due to heart failure in elderly outpatients.Methods:The data of outpatient, emergency patient, and inpatient above 65 years old collected in Beijing Medical Insurance Affairs Management Center database from July 1, 2016 to September 30, 2016 were retrospectively analyzed. PIM in the outpatient western medicine prescription was identified using the 2015 Beers Criteria ?. PIM exposure was defined as at least one PIM was prescribed within 3 months and patients were divided into the PIM exposure and non-PIM exposure groups accordingly. Clinical outcome events were defined as experiencing emergency treatment or hospitalization events due to heart failure after ≥14 days of PIM exposure. Clinical characteristics in patients between the 2 groups were compared and the exposure of specific PIM (PIM with the 3 highest use frequency) in the PIM exposure group was described. Influencing factors of clinical outcome events were analyzed using logistic regression analysis. Results:A total of 506 214 patients were entered in the study, including 252 604 males (49.90%) and 253 610 females (50.10%), aged from 65 to 105 years with a median age of 74 (68, 80) years. Definition of PIM exposure was met in 192 740 patients (38.07%); clinical outcome events occurred in 249 patients, of which 131 patients (0.03%) received emergency treatment and 118 patients (0.02%) hospitalized due to heart failure. Incidences of emergency treatment and hospitalization due to heart failure in patients of the PIM exposure group were higher than those of the non-PIM exposure group [0.04% (78/192 740) vs. 0.02% (53/313 474), P<0.001; 0.04% (71/192 740) vs. 0.01% (47/313 474), P<0.001]. The 3 PIM that used most frequently were vasodilators, diuretics, and central nervous system drugs. Multivariate analysis showed that PIM exposure and use of vasodilators and central nervous system drugs had no significant effects on the occurrence of emergency treatment and hospitalization events due to heart failure, while age ≥75 years old and use of diuretics had significant effects. Compared with the 65-74 age group, the risk of emergency treatment for heart failure in patients of the 75-84 age group and ≥85 age group increased by 3.00 times ( OR=4.00, 95 %CI: 2.46-6.51) and 7.14 times ( OR=8.14, 95 %CI: 4.64-14.29), respectively, and the risk of hospitalization for heart failure increased by 1.33 times ( OR=2.33, 95 %CI: 1.52-3.57) and 2.59 times ( OR=3.59, 95 %CI: 2.03-6.36), respectively. Compared with patients without diuretics treatment, patients treated with diuretics had a 1.91-fold increase in the risk of emergency treatment and hospitalization events due to heart failure ( OR=2.91, 95 %CI: 1.72-4.93) and 1.72-fold increase ( OR=2.72, 95 %CI: 1.56-4.74), respectively. Conclusions:PIM increases the risk of emergency treatment or hospitalization due to heart failure in elderly outpatients, but it is not an independent influencing factor. Age ≥75 years and diuretics use were independent influencing factors of emergency treatment or hospitalization in elderly patients.

Objective:To investigate the influence of potentially inappropriate medication (PIM) on emergency treatment or hospitalization events due to heart failure in elderly outpatients.Methods:The data of outpatient, emergency patient, and inpatient above 65 years old collected in Beijing Medical Insurance Affairs Management Center database from July 1, 2016 to September 30, 2016 were retrospectively analyzed. PIM in the outpatient western medicine prescription was identified using the 2015 Beers Criteria ?. PIM exposure was defined as at least one PIM was prescribed within 3 months and patients were divided into the PIM exposure and non-PIM exposure groups accordingly. Clinical outcome events were defined as experiencing emergency treatment or hospitalization events due to heart failure after ≥14 days of PIM exposure. Clinical characteristics in patients between the 2 groups were compared and the exposure of specific PIM (PIM with the 3 highest use frequency) in the PIM exposure group was described. Influencing factors of clinical outcome events were analyzed using logistic regression analysis. Results:A total of 506 214 patients were entered in the study, including 252 604 males (49.90%) and 253 610 females (50.10%), aged from 65 to 105 years with a median age of 74 (68, 80) years. Definition of PIM exposure was met in 192 740 patients (38.07%); clinical outcome events occurred in 249 patients, of which 131 patients (0.03%) received emergency treatment and 118 patients (0.02%) hospitalized due to heart failure. Incidences of emergency treatment and hospitalization due to heart failure in patients of the PIM exposure group were higher than those of the non-PIM exposure group [0.04% (78/192 740) vs. 0.02% (53/313 474), P<0.001; 0.04% (71/192 740) vs. 0.01% (47/313 474), P<0.001]. The 3 PIM that used most frequently were vasodilators, diuretics, and central nervous system drugs. Multivariate analysis showed that PIM exposure and use of vasodilators and central nervous system drugs had no significant effects on the occurrence of emergency treatment and hospitalization events due to heart failure, while age ≥75 years old and use of diuretics had significant effects. Compared with the 65-74 age group, the risk of emergency treatment for heart failure in patients of the 75-84 age group and ≥85 age group increased by 3.00 times ( OR=4.00, 95 %CI: 2.46-6.51) and 7.14 times ( OR=8.14, 95 %CI: 4.64-14.29), respectively, and the risk of hospitalization for heart failure increased by 1.33 times ( OR=2.33, 95 %CI: 1.52-3.57) and 2.59 times ( OR=3.59, 95 %CI: 2.03-6.36), respectively. Compared with patients without diuretics treatment, patients treated with diuretics had a 1.91-fold increase in the risk of emergency treatment and hospitalization events due to heart failure ( OR=2.91, 95 %CI: 1.72-4.93) and 1.72-fold increase ( OR=2.72, 95 %CI: 1.56-4.74), respectively. Conclusions:PIM increases the risk of emergency treatment or hospitalization due to heart failure in elderly outpatients, but it is not an independent influencing factor. Age ≥75 years and diuretics use were independent influencing factors of emergency treatment or hospitalization in elderly patients.

Objective To establish simple screening models for nonalcoholic fatty liver disease (NAFLD) in the adult Blang population. Methods Based on the survey data of metabolic diseases in the Blang people aged 18 years or above in 2017, 2993 respondents were stratified by sex and age (at an interval of 5 years) and then randomly divided into modeling group with 1497 respondents and validation group with 1496 respondents. Related information was collected, including demographic data, smoking, drinking, family history of diseases and personal medical history, body height, body weight, waist circumference, and blood pressure, and related markers were measured, including fasting plasma glucose, 2-hour postprandial plasma glucose or blood glucose at 2 hours after glucose loading, triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase. The chi-square test was used for comparison of categorical data between two groups. Logistic regression analysis was used to establish the screening model. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value were used to evaluate the screening performance of established models versus existing models in the study population, and the DeLong method was used for comparison of AUC. Results Three screening models for NAFLD were established based on physical and biochemical measurements, i.e., simple noninvasive model 1 (age, body mass index, and waist circumference), noninvasive model 2 with the addition of blood pressure, and model 3 with the combination of hematological parameters (diabetes and ALT/AST). In the modeling group, the three models had an AUC of 0.881 (95% confidence interval [ CI ]: 0.864-0.897), 0.892 (95% CI : 0.875-0.907), and 0.894 (95% CI : 0.877-0.909), respectively, and there was a significant difference between model 1 and models 2/3 ( P =0.004 0 and P < 0.001); in the validation group, the three models had an AUC of 0.891 (95% CI : 0.874-0.906), 0.892 (95% CI : 0.875-0.907), and 0.893 (95% CI : 0.876-0.908), respectively, and there was no significant difference between the three groups ( P > 0.05). Based on the overall consideration of screening performance, invasiveness, and cost, the simple noninvasive model 1 was considered the optimal screening model for NAFLD in this population. Model 1 had the highest Youden index at the cut-off value of 5 points, and when the score of ≥5 points was selected as the criteria for NAFLD, the model had a sensitivity of 86.5%, a specificity of 79.7%, a positive predictive value of 50.3%, and a negative predictive value of 96.1% in the modeling group and a sensitivity of 85.6%, a specificity of 80.6%, a positive predictive value of 51.7%, and a negative predictive value of 95.8% in the validation group. Conclusion The NAFLD screening models established for the adult Blang population based on age and obesity indicators have relatively higher sensitivity, specificity, and negative predictive value, and this tool is of important practical significance for the intervention of NAFLD and its closely related metabolic diseases in this population.

Objective To investigate the role of serum specific IgE(sIgE)antibodies,autoantibody and contact allergens in the pathogenesis of urticaria and the possible correlation among them.Methods The serum sIgE antibodies,autoantibody and contact allergens were tested by IVT kit,autologous serum test-ing and patch testing in145cases of urticaria.Results72.4%(84/116)of patients were positive with spe-cific IgE antibodies,among them13.8%(16/116)were strongly positive.37.7%(20/53)patients were pos-itive with autologous serum testing.In twenty-six patients the above two antibodies were tested.Specific IgE antibodies were found to be strongly positive in4(33.3%)of12patients with negative autologous testing,while in none of14patients with positive autologous testing.Patch testing was performed in21patients with chronic urticaria,90.5%(19/21)patients were positive to15of20allergens tested.Conclusion The pathogenesis of urticaria is complicated,which may include allergy to food,aeroallergens,contact allergens,as well as autoimmunity.Different allergic reactions may be present in the same individual.Contact allergens may be the factor responsible for contact urticaria.

Objective To investigate the role of vascular endothelial cell growth factor (VEGF), nm23 and microvessel density (MVD) in the pathogenesis of malignant melanoma(MM). Methods The specimens from forty-seven cases of malignant melanoma and 10 cases of melanocytic nevus were examined for VEGF, nm23 and CD34 by immunohistochemistry. The density of microvessels was calculated. Results Positive VEGF expression rate and MVD in malignant melanoma were significantly higher than those in melanocytic nevus(both P