Objective To analyze the prescription patterns of Professor Huang Feng,a nationally renowned traditional Chinese medicine(TCM)practitioner,in treating osteomyelitis using data mining methods.Methods Prescription data from effective medical records of osteomyelitis treated by Professor Huang Feng between January 2018 and December 2022 were collected and screened.Microsoft Excel,SPSS Modeler 18.0,and SPSS Statistics 25 were used to analyze the frequency and the distribution of properties,flavors,and meridian tropism of prescribed medications,along with association rule analysis and cluster analysis of high-frequency drugs.Results A total of 137 prescriptions involving 86 Chinese medicinals were included.Eighteen high-frequency medicinals(frequency＞30 times)were identified,namely Glycyrrhizae Radix et Rhizoma,Astragali Radix,Coicis Semen,Angelicae Sinensis Radix,Smilacis Glabrae Rhizoma,Achyranthis Bidentatae Radix,Bletillae Rhizoma,Rehmanniae Radix,Paeoniae Radix Alba,Dendrobii Caulis,Polygalae Radix,Lablab Semen Album,Corydalis Rhizoma,Angelicae Dahuricae Radix,Drynariae Rhizoma,Sanguisorbae Radix,Poria,and Mume Fructus.Most of the prescribed medicinals were neutral in nature,sweet,bitter,and pungent in flavor,and had the meridian tropism of liver,spleen,and lung meridians.Association rule analysis yielded 67 drug association rules,and the high-support combinations were the drug combinations of Astragali Radix respectively with Coicis Semen,Angelicae Sinensis Radix,Smilacis Glabrae Rhizoma and Achyranthis Bidentatae Radix,reflecting the compatibility principles of supplementing and invigorating qi-blood,activating blood circulation to resolve stasis,and draining dampness to remove toxins.Cluster analysis revealed three core clusters:Cluster 1 consisted of Glycyrrhizae Radix et Rhizoma,Astragali Radix,Coicis Semen,Smilacis Glabrae Rhizoma,Angelicae Sinensis Radix,Bletillae Rhizoma,Paeoniae Radix Alba,Angelicae Dahuricae Radix,Mume Fructus,Polygalae Radix and Sanguisorbae Radix;Cluster 2 consisted of Rehmanniae Radix and Dendrobii Caulis;Cluster 3 consisted of Achyranthis Bidentatae Radix,Lablab Semen Album,Corydalis Rhizoma and Poria.Conclusion For the treatment of osteomyelitis,Professor Huang Feng follows the principle of combining supporting healthy qi with eliminating pathogens,focuses on clearing damp-heat and pathogenic toxins accompanied by activating blood circulation to resolve stasis,and lays stress on adaptation to local condition and activating spleen-stomach to reinforce vital qi.

BACKGROUND:Traditional Chinese medicine compound prescription has a long history in the treatment of primary osteoporosis,and the curative effect is definite,but the medication rule and mechanism are not clear. OBJECTIVE:Using the methodology of data mining and network pharmacology,to explore and verify the law of drug use and molecular mechanism of modern traditional Chinese medicine in the treatment of primary osteoporosis. METHODS:The relevant documents included in CNKI,WanFang,VIP and PubMed were used as data sources,and the relevant data were statistically counted and extracted by Microsoft EXCEL2019,IBMSPSS25.0 and other software.The high-frequency drugs obtained from the data statistics were analyzed by association rules analysis and cluster analysis,and the core drug combination of traditional Chinese medicine compound prescription in the treatment of primary osteoporosis was obtained by combining the two results.The therapeutic mechanism of this combination was explained by network pharmacology and verified by molecular docking. RESULTS AND CONCLUSION:Finally,151 articles were included and 207 prescriptions were selected,involving 285 flavors of Chinese herbs.(1)Ten groups of important drug combinations were obtained through the above two analyses,among which the core drug combination with the highest confidence and improvement was"Drynaria-Eucommia-Angelica."The key components of the combination in the treatment of primary osteoporosis were quercetin,kaempferol,naringenin and so on.The core targets were SRC proto-oncogene,phosphoinositide-3-Kinase regulatory subunit 1 and RELA proto-oncogene.The main pathways were cancer signaling pathway,JAK-STAT signaling pathway,VEGF signaling pathway,and NF-κB signaling pathway.(2)The key active components were docked with the core targets,and the two showed a good combination.To conclude,Chinese herbal compound therapy in the treatment of primary osteoporosis can use a variety of active components to exert its efficacy through multiple signal pathways and acting on multiple targets,which can provide a theoretical basis for the research and development of new drugs for the follow-up treatment of primary osteoporosis.

Objective:To study the role of neonatal panel detection based on next generation sequencing (NGS) combined with multiplex ligation-dependent probe amplification (MLPA) in the etiological differentiation of neonatal hypotonia.Methods:The clinical characteristics and gene test results of newborns with hypotonia as the main clinical manifestation treated at the Department of Neonatology of Jiangxi Provincial Children's Hospital from March 2017 to March 2021 were retrospectively analyzed.Results:A total of 23 children with hypotonia and feeding difficulties diagnosed by gene tests were included. 17 cases (73.9%) had obvious abnormal appearance, and 11 cases (47.8%) had congenital heart disease (atrial septal defect and/or patent ductus arteriosus). Among the 23 infants, 21 were detected by panel gene, 10 by methylation specific MLPA (MS-MLPA) and 4 by MLPA (SMN1 / SMN2). 14 cases of Prader-Willi syndrome, 4 cases of spinal muscular atrophy, 3 cases of congenital myopathy and 2 cases of Schaaf-Yang syndrome were diagnosed. 11 cases died (47.8%), 9 cases had growth retardation (39.1%), 2 cases had normal growth and development (8.7%), and 1 case survived without detailed information (4.3%). Newborns with unknown etiology and low muscle tone are often complicated with abnormal appearance and congenital heart disease. Neonatal panel combined with MLPA is helpful for accurate diagnosis.Conclusions:The detection of neonatal panel combined with MLPA is cheap, and can provide accurate diagnosis for most newborns with unexplained hypotonia in a short diagnosis cycle, which is conducive to the early formulation of clinical decision-making, and guide the treatment, follow-up and genetic consultation of children.

Objective:To summarize the clinical features of X-linked lymphoproliferative syndrome type 2 (XLP-2) , especially the cases with inflammatory bowel disease (IBD) as the clinical phenotype.Methods:The clinical features and the course of diagnosis and treatment of a XLP-2 patient with IBD as the primary phenotype at the Department of Gastroenterology of the Third Affiliated Hospital of Guangzhou Medical University in May 2021 were analyzed retrospectively. Key words of "X-linked lymphoproliferative syndrome type 2" , "X-linked inhibitor of apoptosis protein deficiency" , "hemophagocytic syndrome" were used to retrieve associated literatures in PubMed, CNKI and Wanfang database between January 2006 and October 2021. Associated literatures including the patients diagnosed as the XLP-2 were summarized and reviewed.Results:A total of 90 articles and 215 patients were included. Among them, 207 were males and 8 were females. There were 183 (85.1%) patients with age of diagnosis less than 14 years old. Hemophagocytic syndrome (55.3%, 119/215) , splenomegaly (27.0%, 58/215) and IBD (26.0%, 56/215) were the common clinical phenotypes. There were 56 patients with IBD as the clinical phenotype, including 52 males and 4 females. The average age of onset was 6.4 (0, 31.0) years old, the average age at diagnosis of IBD was 9.1 (0, 31.0) years old and the average age at diagnosis of XLP-2 was 10.8 (0, 41.0) years old. There were 49 of Crohn′s disease, 1 of ulcerative colitis and 6 of IBD unclassified. In the 56 patients with mutation of X-linked inhibitor of apoptosis protein ( XIAP) , nonsense mutations occurred in 26, missense mutations in 22 and deletion mutations in 8. In terms of treatment, 25 patients (44.6%) received hematopoietic stem cell transplantation, 8 (14.3%) received hormones, 11 (19.6%) received immunosuppressants, 27 (48.2%) received biologics, and 18 (32.1%) received 2 or more two biologics. Thirty-five patients were followed up for 8.46 (0.11, 34.00) years, 32 survived and 3 died. Conclusions:XLP-2 is an X chromosome recessive genetic disease, which is common in men and children. IBD is one of the common phenotypes. XLP-2 patients with IBD as phenotype mostly receive multiple drug treatments, and the disease has characteristics of refractory and delayed diagnosis. Early gene detection is of great significance for the differential diagnosis and early treatment of XIAP gene deficiency diseases.

Objective:To summarize the clinical features of X-linked lymphoproliferative syndrome type 2 (XLP-2) , especially the cases with inflammatory bowel disease (IBD) as the clinical phenotype.Methods:The clinical features and the course of diagnosis and treatment of a XLP-2 patient with IBD as the primary phenotype at the Department of Gastroenterology of the Third Affiliated Hospital of Guangzhou Medical University in May 2021 were analyzed retrospectively. Key words of "X-linked lymphoproliferative syndrome type 2" , "X-linked inhibitor of apoptosis protein deficiency" , "hemophagocytic syndrome" were used to retrieve associated literatures in PubMed, CNKI and Wanfang database between January 2006 and October 2021. Associated literatures including the patients diagnosed as the XLP-2 were summarized and reviewed.Results:A total of 90 articles and 215 patients were included. Among them, 207 were males and 8 were females. There were 183 (85.1%) patients with age of diagnosis less than 14 years old. Hemophagocytic syndrome (55.3%, 119/215) , splenomegaly (27.0%, 58/215) and IBD (26.0%, 56/215) were the common clinical phenotypes. There were 56 patients with IBD as the clinical phenotype, including 52 males and 4 females. The average age of onset was 6.4 (0, 31.0) years old, the average age at diagnosis of IBD was 9.1 (0, 31.0) years old and the average age at diagnosis of XLP-2 was 10.8 (0, 41.0) years old. There were 49 of Crohn′s disease, 1 of ulcerative colitis and 6 of IBD unclassified. In the 56 patients with mutation of X-linked inhibitor of apoptosis protein ( XIAP) , nonsense mutations occurred in 26, missense mutations in 22 and deletion mutations in 8. In terms of treatment, 25 patients (44.6%) received hematopoietic stem cell transplantation, 8 (14.3%) received hormones, 11 (19.6%) received immunosuppressants, 27 (48.2%) received biologics, and 18 (32.1%) received 2 or more two biologics. Thirty-five patients were followed up for 8.46 (0.11, 34.00) years, 32 survived and 3 died. Conclusions:XLP-2 is an X chromosome recessive genetic disease, which is common in men and children. IBD is one of the common phenotypes. XLP-2 patients with IBD as phenotype mostly receive multiple drug treatments, and the disease has characteristics of refractory and delayed diagnosis. Early gene detection is of great significance for the differential diagnosis and early treatment of XIAP gene deficiency diseases.

Objective:To investigate the anticoagulant causes, hemorrhagic susceptibility factors and clinical characteristics of patients with warfarin-related major bleeding in the emergency department of a general hospital.Methods:In a registry study from January 2017 to February 2020, 114 cases of warfarin-related major bleeding patients admitted to Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University were enrolled. The descriptive methods were used to analyze anticoagulant causes, hemorrhagic susceptibility factors and clinical characteristics. Patients were divided into the international normalized ratio (INR) overrange group and the INR non-overrange group according to INR value during bleeding. The Chi-square test, Student’s t test, and Wilcoxon rank sum test were used to compare the differences between the INR overrange group and the INR non-overrange group. The Wilcoxon rank sum test and Student’s t test were used to analyze the characteristics of gastrointestinal tract bleeding and cerebral hemorrhage. Results:Warfarin-related major bleeding accounted for 0.36% (114/32 040) of first aid cases and 9.84% (114/1 158) of warfarin-taking cases, respectively. Seventy-seven cases (67.5%) of anticoagulant causes were related to atrial fibrillation (AF) and 32 cases (28.1%) were related to post-operative cardiac valve replacement. Of the bleeding susceptibility factors, HAS-BLED scored at 4.0 (3.0, 5.0), 84 cases (73.7%) had a history of drug use, 77 cases (67.5%) aged older than 65 years old, 65 cases (57.0%) had irregular INR monitoring, and 29 cases (25.4%) had recent increase in dose. Forty cases (35.1%) were gastrointestinal tract bleeding with the lowest hemoglobin (Hb) value and the highest score of HAS-BLED. Twenty-one cases (18.4%) were cerebral hemorrhage with the shortest prothrombin time (PT), the lowest INR value, the highest Hb, and the lowest score of HAS-BLED. Twelve cases (10.5%) died or gave up treatment in critical condition, including 6 cases of cerebral hemorrhage, 5 cases of gastrointestinal tract bleeding, and 1 case of hemoptysis. There were statistically significant differences in previous history of antiplatelet therapy, recent increase in dose, HAS-BLED score and bleeding site between the INR overrange group and the INR non-overrange group (all P<0.05). Conclusions:Among patients with warfarin-related major bleeding, AF and post-operative cardiac valve replacement are the main causes of warfarin anticoagulation. INR overrange is related to the previous history of antiplatelet therapy, recent increase in dose, and the high score of HAS-BLED. The gastrointestinal tract bleeding is the most common, with the lowest Hb value and the highest score of HAS-BLED. Cerebral hemorrhage is the second common, with the shortest PT, the lowest INR value, and the highest Hb. The incidence and mortality rates of warfarin-related major bleeding are relatively high.

To investigate the therapeutic effect and mechanism of sodium formononetin-3′-sulphonate (SFS) on collagen-induced rheumatoid arthritis in mice, C57 mice were induced with chicken type II collagen to establish a model of rheumatoid arthritis (collagen-induced arthritis, CIA), and were injected intraperitoneally with different doses of SFS (50,100,200 mg/kg). Body weight, food intake and foot swelling of all groups were observed during the experiment.After the treatment, TNF-α, IL-6, and IL-10 in the serum were detected with the CBA kit; NF-κB p65, p-NF-κB p65 (p-p65), TIPE2, PCNP and IκB-α in spleen tissue were determined by Western blot; the organ index, pathological changes of ankle joint cartilage tissue and the positive expression of NF-κB p65 in ankle joint tissue were also observed.The results showed that, compared with the model group, the body weight and food intake of mice in the treatment group increased, while the degree of foot swelling decreased; the expression levels of inflammatory factors TNF-α and IL-6 in serum decreased, while the expression of anti-inflammatory factor IL-10 increased; the expression levels of NF-κB p65, p-p65 and PCNP in spleen tissue decreased, while the expression of TIPE2 and IκB-α protein increased; the index of spleen and thymus of the CIA mice in the treatment group, the infiltration of inflammatory cells in the ankle joint, the destruction of synovial tissue and cartilage, and the positive expression of NF-κB p65 decreased.Among them, the high-dose group of SFS showed a better therapeutic effect.It is suggested that SFS has a therapeutic effect on CIA mice, and the mechanism may be achieved by regulating the NF-κB p65 signaling pathway and inhibiting the expression of inflammatory factors.

Objective:To explore the occurrence and risk factors of bleeding events in acute coronary syndromes (ACS) patients treated with ticagrelor combined with aspirin.Methods:The study subjects were selected from ACS patients who were admitted to Beijing Anzhen Hospital, Capital Medical University from January to December 2017 and treated with ticagrelor and aspirin (aspirin 100 mg/d, ticagrelor 180 mg/d). Medical records of the patients who met the inclusion criteria(at age>18 years, with medication duration ≥ 1 year, and with complete follow-up records) were collected and retrospectively analyzed. The patients were divided into bleeding group and non-bleeding group according to whether there were bleeding events within 1 year. Baseline clinical characteristics such as gender, age, type of ACS, comorbidities, combined drugs, history of percutaneous coronary intervention, routine blood parameters, liver and kidney function, and etc. in patients between 2 groups were compared. The risk factors of bleeding events were analyzed using logistic regression method and the odds ratio ( OR) and its 95% confidence interval ( CI) were calculated. Results:A total of 180 patients were entered in the analysis, including 135 males and 58 females, aged (57±10) years, with the range of 31 to 81 years. There were 39 patients in the bleeding group and 141 patients in the non-bleeding group, and the incidence of bleeding events was 21.7%. None of the differences in gender distribution, age, comorbidities, history of percutaneous coronary intervention or combined drugs in patients between the 2 groups were statistically significant (all P>0.05). The platelet count of patients in the bleeding group was significantly lower than that in the non-bleeding group [(197±49) ×10 9/L vs. (220±60) ×10 9/L, t=2.254, P=0.025]. The shortest time from medication to the onset of bleeding of the 39 patients in the bleeding group was 14 days and the longest one was 12 months. The cumulative incidences of bleeding events at 3, 6, and 12 months of medication were 12.2% (22/180), 18.3% (33/180), and 21.7% (39/180), respectively. All bleeding events were minor bleeding, and the skin mucous ecchymosis had the highest incidence, which was 15.0% (27/180), followed by gingival bleeding or nosebleed, which was 7.2% (13/180). The incidence of fundus hemorrhage was 1.7% (3/180) and incidences of gastrointestinal bleeding and hematuria were both 0.6% (1/180). Multivariate logistic regression analysis showed that low platelet count was an independent risk factor for bleeding events [ OR=0.991, 95 %CI: 0.984-0.999, P=0.020]. Conclusions:ACS patients have a relative high risk of bleeding events when treated with ticagrelor combined with aspirin, but most of them were minor. For ACS patients with low platelet counts, this anti-platelet regimen should be used with caution and drug monitoring should be done in the whole course.

Objective:To explore the occurrence and risk factors of bleeding events in acute coronary syndromes (ACS) patients treated with ticagrelor combined with aspirin.Methods:The study subjects were selected from ACS patients who were admitted to Beijing Anzhen Hospital, Capital Medical University from January to December 2017 and treated with ticagrelor and aspirin (aspirin 100 mg/d, ticagrelor 180 mg/d). Medical records of the patients who met the inclusion criteria(at age>18 years, with medication duration ≥ 1 year, and with complete follow-up records) were collected and retrospectively analyzed. The patients were divided into bleeding group and non-bleeding group according to whether there were bleeding events within 1 year. Baseline clinical characteristics such as gender, age, type of ACS, comorbidities, combined drugs, history of percutaneous coronary intervention, routine blood parameters, liver and kidney function, and etc. in patients between 2 groups were compared. The risk factors of bleeding events were analyzed using logistic regression method and the odds ratio ( OR) and its 95% confidence interval ( CI) were calculated. Results:A total of 180 patients were entered in the analysis, including 135 males and 58 females, aged (57±10) years, with the range of 31 to 81 years. There were 39 patients in the bleeding group and 141 patients in the non-bleeding group, and the incidence of bleeding events was 21.7%. None of the differences in gender distribution, age, comorbidities, history of percutaneous coronary intervention or combined drugs in patients between the 2 groups were statistically significant (all P>0.05). The platelet count of patients in the bleeding group was significantly lower than that in the non-bleeding group [(197±49) ×10 9/L vs. (220±60) ×10 9/L, t=2.254, P=0.025]. The shortest time from medication to the onset of bleeding of the 39 patients in the bleeding group was 14 days and the longest one was 12 months. The cumulative incidences of bleeding events at 3, 6, and 12 months of medication were 12.2% (22/180), 18.3% (33/180), and 21.7% (39/180), respectively. All bleeding events were minor bleeding, and the skin mucous ecchymosis had the highest incidence, which was 15.0% (27/180), followed by gingival bleeding or nosebleed, which was 7.2% (13/180). The incidence of fundus hemorrhage was 1.7% (3/180) and incidences of gastrointestinal bleeding and hematuria were both 0.6% (1/180). Multivariate logistic regression analysis showed that low platelet count was an independent risk factor for bleeding events [ OR=0.991, 95 %CI: 0.984-0.999, P=0.020]. Conclusions:ACS patients have a relative high risk of bleeding events when treated with ticagrelor combined with aspirin, but most of them were minor. For ACS patients with low platelet counts, this anti-platelet regimen should be used with caution and drug monitoring should be done in the whole course.

OBJECTIVE: To analyze the current status of diagnosis and management of acute appendicitis (AA) in China. METHODS: Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary. RESULTS: A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001). CONCLUSIONS The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.
Acute Disease ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Appendectomy ; Appendicitis ; diagnosis ; therapy ; China ; Female ; Health Care Surveys ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult