PURPOSE: Boarding is a common problem in the emergency department (ED) and is associated with poor health care and outcome. Imam Khomeini Hospital is the main healthcare center in Urmia, a metropolis in the northwest of Iran. Due to the overcrowding and high patient load, we aim to characterize the rate, cause and consequence of boarding in the ED of this center. METHODS: All medical records of patients who presented to the ED of Imam Khomeini Hospital from August 1, 2017 to August 1, 2018 were retrospectively analyzed. Patients with uncompleted records were excluded. Boarding was defined as the inability to transfer the admitted ED patients to a downstream ward in ≥2 h after the admission order. Demographic data, boarding rate, mortality and triage levels (1-5) assessed by emergency severity index were collected and analyzed. The first present time of patients was classified into 4 ranges as 0:00-5:59, 6:00-11:59, 12:00-17:59 and 18:00-23:59. Descriptive, parametric and non-parametric statistical tests were performed and the risk of boarding was determined by Pearson Chi-square test. RESULTS: Demographic data analysis showed that 941 (58.5%) male and 667 (41.5%) female, altogether 1608 patients were included in this study. Five patients (0.3%) died. The distribution of patients with the triage levels 1-5 was respectively 79 (4.9%), 1150 (71.5%), 374 (23.3%), 4 (0.2%) and 0 (0%). Most patients were of level 2. Only 75 (4.7%) patients required intensive care. The majority of patients (84.2%) were presented at weekdays. The maximum patient load was observed between 12:00-17:59. Of the 1608 patients, 340 (21.1%) experienced boarding within a mean admission time of 13.70 h. Among the 340-boarded patients, 20.1% belonged to surgery, 12.1% to orthopedics, 10.9% to neurosurgery and 10.3% to neurology. The boarding rate was higher in females, patients requiring intensive care and those with low triage levels. Compared with the non-boarded, the boarded patients had a higher mean age. CONCLUSION The boarding rate is higher in the older and female patients. Moreover, boarding is dependent on the downstream ward sections: patients requiring surgical management experience the maximum boarding rate.
Age Factors ; Chi-Square Distribution ; Cross-Sectional Studies ; Crowding ; Emergency Service, Hospital ; Female ; Hospital Mortality ; Hospitalization/statistics & numerical data* ; Humans ; Iran ; Length of Stay ; Male ; Patient Admission ; Retrospective Studies ; Risk Assessment/methods* ; Risk Factors ; Sex Factors ; Time Factors ; Triage

BACKGROUND: In China, upper airway cough syndrome (UACS) is only less frequent than cough-variant asthma and accounts for 24.71% of chronic cough. This study aimed to determine the pathogenetic constituents and factors affecting UACS in children of different age groups, and to identify clinical clues for diagnosing UACS and a method for curative effect evaluation. METHODS: A total of 103 children with UACS whose chief complaint was chronic cough were studied from January to November 2013 at Children's Hospital, Capital Institute of Pediatrics. According to their age, children with UACS were divided into 3 groups: nursing children, pre-school children, and school-age children. We analyzed the differences in pathogenetic constituents and factors affecting UACS in children. The effect of UACS treatment was evaluated by the visual analog scale (VAS) and an objective examination. Chi-squared test and analysis of variance were performed with the SPSS 19.0 statistical software. RESULTS: There was a high incidence of UACS in school-age children. Rhinitis with adenoid hypertrophy was the main cause of 103 suspected UACS cases. Adenoidal hypertrophy was the major cause of UACS in the pre-school children group, while rhinitis was the major reason in the nursing children and school-age children groups. Among the 103 children, there were 45 allergen-positive children, with no significant difference among different age groups. VAS scores in the different disease groups after treatment were lower than those before treatment (all P < 0.01). VAS scores in different disease groups showed significant differences, except for 12 vs. 24 weeks after treatment (P = 0.023). Different age groups had different secondary complaints. CONCLUSIONS There are different pathogeneses in different UACS age groups. Clinical treatment efficacy of children with UACS can be evaluated by the VAS combined with an objective examination. We recommend that the course of treatment should be 12 weeks.
Adolescent ; Asthma ; epidemiology ; Chi-Square Distribution ; Child ; Child, Preschool ; China ; epidemiology ; Chronic Disease ; epidemiology ; Cough ; epidemiology ; Female ; Humans ; Incidence ; Male ; Nose Diseases ; epidemiology ; Rhinitis ; epidemiology ; Rhinitis, Allergic ; epidemiology

BACKGROUND: The mortality of cardiovascular disease is constantly rising, and novel biomarkers help us predict residual risk. This study aimed to evaluate the predictive value of serum homocysteine (HCY) levels on prognosis in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: The 419 consecutive patients with STEMI, treated at one medical center, from March 2010 to December 2015 were retrospectively investigated. Peripheral blood samples were obtained within 24 h of admission and HCY concentrations were measured using an enzymatic cycling assay. The patients were divided into high HCY level (H-HCY) and low HCY level (L-HCY) groups. Short- and long-term outcomes were compared, as were age-based subgroups (patients aged 60 years and younger vs. those older than 60 years). Statistical analyses were mainly conducted by Student t-test, Chi-squared test, logistic regression, and Cox proportional-hazards regression. RESULTS: The H-HCY group had more males (84.6% vs. 75.4%, P = 0.018), and a lower prevalence of diabetes (20.2% vs. 35.5%, P < 0.001), compared with the L-HCY group. During hospitalization, there were seven mortalities in the L-HCY group and 10 in the H-HCY group (3.3% vs. 4.8%, P = 0.440). During the median follow-up period of 35.8 (26.9-46.1) months, 33 (16.2%) patients in the L-HCY group and 48 (24.2%) in the H-HCY group experienced major adverse cardiovascular and cerebrovascular events (MACCE) (P = 0.120). History of hypertension (hazard ratio [HR]: 1.881, 95% confidence interval [CI]: 1.178-3.005, P = 0.008) and higher Killip class (HR: 1.923, 95% CI: 1.419-2.607, P < 0.001), but not HCY levels (HR: 1.007, 95% CI: 0.987-1.027, P = 0.507), were significantly associated with long-term outcomes. However, the subgroup analysis indicated that in older patients, HCY levels were significantly associated with long-term outcomes (HR: 1.036, 95% CI: 1.011-1.062, P = 0.005). CONCLUSION Serum HCY levels did not independently predict in-hospital or long-term outcomes in patients with STEMI; however, among elderly patients with STEMI, this study revealed a risk profile for late outcomes that incorporated HCY level.
Aged ; Chi-Square Distribution ; Coronary Angiography ; Female ; Homocysteine ; blood ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction ; blood ; Proportional Hazards Models ; Retrospective Studies ; ST Elevation Myocardial Infarction ; blood ; pathology

BackgroundDespite recent advances that have improved the pregnancy success rates that can be achieved via in vitro fertilization (IVF) therapy, it is not yet clear which blastocyst morphological parameters best predict the outcomes of single blastocyst transfer. In addition, most of the previous studies did not exclude the effect of embryo aneuploidy on blastocysts transfer. Thus, the present study investigated the predictive value of various parameters on the pregnancy outcomes achieved via the transfer of frozen euploid blastocysts.

MethodsThe study retrospectively analyzed 914 single euploid blastocyst transfer cycles that were performed at the Peking University Third Hospital Reproductive Medical Center between June 2011 and May 2016. The expansion, trophectoderm (TE), and inner cell mass (ICM) quality of the blastocysts were assessed based on blastocyst parameters, and used to differentiate between "excellent", "good", "average", and "poor"-quality embryos. The relationship between these embryo grades and the achieved pregnancy outcomes was then analyzed via the Chi-square and logistic regression tests.

ResultsFor embryo grades of excellent, good, average and poor, the clinical pregnancy rates were 65.0%, 59.3%, 50.3% and 33.3%, respectively; and the live-birth rates were 50.0%, 49.7%, 42.3% and 25.0%, respectively. Both the clinical pregnancy rate (&chi; = 21.28, P = 0.001) and live-birth rate (&chi; = 13.50, P < 0.001) increased with the overall blastocyst grade. Both rates were significantly higher after the transfer of a blastocyst that exhibited either an A-grade or B-grade TE, and similarly, an A-grade ICM, than after the transfer of a blastocyst that exhibited a C-grade TE and/or ICM. The degree of blastocyst expansion had no apparent effect on the clinical pregnancy or live-birth rate. All odds ratio were adjusted for patient age, body mass index, length (years) of infertility history, and infertility type.

ConclusionsA higher overall euploid blastocyst quality is shown to correlate most strongly with optimal pregnancy outcomes. The study thus supports the use of the described TE and ICM morphological grades to augment current embryo selection criteria.

Blastocyst ; cytology ; physiology ; Chi-Square Distribution ; Embryo Transfer ; Female ; Humans ; Logistic Models ; Odds Ratio ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies

BackgroundPromoter methylation of MGMT and C13ORF18 has been confirmed as a potential biomarker for early diagnosis of cervical cancer. The aim of this study was to evaluate the performance of MGMT and C13ORF18 promoter methylation for triage of cytology screening samples and explore the potential mechanism.

MethodsMethylation-sensitive high-resolution melting was used to detect promoter methylation of MGMT and C13ORF18 in 124 cervical samples. High-risk human papillomavirus (HR-HPV) was detected by the Digene Hybrid Capture 2. Gene methylation frequencies in relation to cervical intraepithelial neoplasia (CIN) were analyzed. Frequencies were compared by Chi-square tests. The expression of gene biomarkers and methylation regulators was analyzed by immunohistochemical staining, real-time fluorescence quantitative polymerase chain reaction, and Western blot.

ResultsFor triage of low-grade squamous intraepithelial lesion (LSIL), gene methylation increased specificity from 4.0% of HR-HPV detection to 30.8% of MGMT (&chi; = 9.873, P = 0.002) and to 50.0% of C13ORF18 (&chi; = 21.814, P = 0.001). For triage of atypical squamous cells of undetermined significance, HR-HPV detection had higher positive predictive value of 54.8%. Either MGMT or C13ORF18 methylation combined with HR-HPV increased the negative predictive value to 100.0% (&chi; = 9.757, P = 0.002). There was no relationship between MGMT and C13ORF18 expression and DNA methylation (&chi; = 0.776, P = 0.379 and &chi; = 1.411, P = 0.235, respectively). MBD2 protein level in cervical cancer was relatively lower than normal cervical tissue (t = 4.11, P = 0.006).

ConclusionsHR-HPV detection is the cornerstone for triage setting of CIN. Promoter methylation of MGMT and C13ORF18 plays a limited role in triage of LSIL. Promoter methylation of both genes may not be the causes of gene silence.

Adult ; Cervical Intraepithelial Neoplasia ; genetics ; pathology ; Chi-Square Distribution ; DNA Methylation ; genetics ; DNA Modification Methylases ; genetics ; DNA Repair Enzymes ; genetics ; Female ; Humans ; Middle Aged ; Promoter Regions, Genetic ; genetics ; Squamous Intraepithelial Lesions of the Cervix ; genetics ; pathology ; Tumor Suppressor Proteins ; genetics ; Uterine Cervical Neoplasms ; genetics ; pathology ; Young Adult

OBJECTIVE: To explore the relationship between sugary drinks and diabetes of adults in Wuhai city. METHODS: A multiple stage stratified cluster sampling was conducted on 8 131 residents who were between 35 and 79 years by cross-sectional study in Wuhai city. Questionnaires, physical measurements and laboratory tests were used to collect information on demographic information, dietary behavior, health status, blood glucose indicators. Besides, other covariate information was also collected by these ways. The analysis was carried out by chi-square test, trend chi-square test and multifactor Logistic regression. RESULTS: The detection rates of impaired fasting glucose and diabetes of people who were 35 years old and above in Wuhai city were 6.0% and 18.4%, respectively, and they both increased with age (P<0.01, P< 0.01). The detection rates of impaired fasting glucose and diabetes of the men were both far higher than the women (P< 0.01, P< 0.01). For the men, the detection rate of diabetes increased with age (P_trend<0.01), but for the women, and the detection rate of impaired fasting glucose and diabetes both increased with age (P_trend<0.01, P_trend<0.01). The consumption rate of sugary drinks of the people who were 35 years old and above in Wuhai city was 30.2%. And after all the subjects were classified into three groups, A (0- mL/d), B (16- mL/d), and C (237- mL/d) according to the daily different drinking quantities, statistical results found that group A accounted for 75.4%, group B for 21.5%, and group C for 3.1%. In group A, for comparison, the impaired fasting glucose OR values of group B and group C were 1.4 and 2.2, respectively. And diabetes OR values of group B and group C were 1.2 and 2.1 respectively compared with group A, and the trend of OR values increased both had statistical significance (P_trend <0.01, P_trend < 0.01). Also, after adjusting for other covariates in multifactor Logistic regression, the OR values of impaired fasting glucose in group B and group C were 1.6 and 3.8 respectively, and the OR values of diabetes were 1.9 and 4.9 respectively, compared with group A, and besides, the trend of OR values increased both still had statistical significance (P_trend <0.01, P_trend < 0.01). CONCLUSION Increased consumption of sugary drinks will increase the risk of impaired fasting glucose and diabetes. Residents in Wuhai city should control their consumption of sugary drinks.
Adult ; Aged ; Beverages ; Blood Glucose ; Chi-Square Distribution ; Cross-Sectional Studies ; Diabetes Mellitus/epidemiology* ; Dietary Sugars ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Risk Factors ; Surveys and Questionnaires

No abstract available.
Biometry ; Chi-Square Distribution ; Research Personnel ; Data Interpretation, Statistical

OBJECTIVETo assess the value of 15 short tandem repeat (STR) loci selected by an AmpFLSTR Identifilersystem for personal identification and paternity testing among ethnic Hans from Xiamen, Fujian.

METHODSFor 400 unrelated individuals, allelic frequencies for the 15 STR loci from the AmpFLSTR Identifilerkit were determined. Population genetics parameters for forensic usage were calculated.

RESULTSNo deviation of the observed allele frequency from Hardy-Weinberg equilibrium expectations was found by Chi-square test (P>0.05). All of the 15 loci were highly polymorphic. Observed heterozygosity has varied between 0.580 and 0.868. Matching probability was between 0.036 and 0.148. Power of discrimination was between 0.798 and 0.967. Polymorphic information content was between 0.560 and 0.850. And power of exclusion was between 0.268 and 0.730.

CONCLUSIONAll of the 15 loci selected by the AmpFLSTR Identifilersystem are highly polymorphic among ethnic Hans from Xiamen. By determining the alleles and allelic frequencies, data for genetic polymorphisms usable for paternity testing and personal identification for local population were obtained.

Alleles ; Asian Continental Ancestry Group ; genetics ; Chi-Square Distribution ; China ; Forensic Genetics ; methods ; Gene Frequency ; Genetics, Population ; methods ; Genotype ; Humans ; Linkage Disequilibrium ; Microsatellite Repeats ; genetics ; Polymorphism, Genetic

BACKGROUNDThe pathogenesis of some types of preeclampsia is related to fatty acid oxidation disorders. Rapamycin can regulate fatty acid metabolism. This study aimed to investigate the effects of rapamycin on the clinical manifestations and blood lipid parameters in different preeclampsia-like mouse models.

METHODSTwo preeclampsia-like mouse models and a control group were established: L-NA (injected with Nω-nitro-L-arginine methyl ester), LPS (injected with lipopolysaccharide), and the control group with normal saline (NS). The mouse models were established at preimplantation (PI), early- and late-pregnancy (EP, LP) according to the time of pregnancy. The administration of rapamycin (RA; L-NA+RA, LPS+RA, and NS+RA) or vehicle as controls (C; L-NA+C, LPS+C, NS+C) were followed on the 2nd day after the mouse models' establishment. Each subgroup consisted of eight pregnant mice. The mean arterial pressure (MAP), 24-h urinary protein, blood lipid, fetus, and placental weight were measured. The histopathological changes and lipid deposition of the liver and placenta were observed. Student's t-test was used for comparing two groups. Repeated measures analysis of variance was used for blood pressure analysis. Qualitative data were compared by Chi-square test.

RESULTSThe MAP and 24-h urinary protein in the PI, EP, and LP subgroups of the L-NA+C and LPS+C groups were significantly higher compared with the respective variables in the NS+C group (P < 0.05). The preeclampsia-like mouse models were established successfully. There was no significant difference in the MAP between the PI, EP, and LP subgroups of the L-NA+RA and L-NA+C groups and the LPS+RA and LPS+C groups. The 24-h urine protein levels in the PI and EP subgroups of the L-NA+RA group were significantly lower compared with the respective levels in the L-NA+C groups (1037 ± 63 vs. 2127 ± 593 μg; 976 ± 42 vs. 1238 ± 72 μg; bothP < 0.05), also this effect appeared similar in the PI and EP subgroups of the LPS+RA and LPS+C groups (1022 ± 246 vs. 2141 ± 432 μg; 951 ± 41 vs. 1308 ± 30 μg; bothP < 0.05). The levels of serum-free fatty acid (FFA) in the PI and EP subgroups of the L-NA+RA groups were significantly lower compared with the respective levels in the L-NA+C group (2.49 ± 0.44 vs. 3.30 ± 0.18 mEq/L; 2.23 ± 0.29 vs. 2.84 ± 0.14 mEq/L; bothP < 0.05). The levels of triglycerides (TG) and total cholesterol in the PI subgroup of the L-NA+RA group were significantly lower compared with the respective levels in the L-NA+C (1.51 ± 0.16 vs. 2.41 ± 0.37 mmol/L; 2.11 ± 0.17 vs. 2.47 ± 0.26 mmol/L; bothP < 0.05), whereas high-density lipoprotein serum concentration was significantly higher (1.22 ± 0.19 vs. 0.87 ± 0.15 mmol/L;P < 0.05) and low-density lipoprotein serum concentration did not exhibit a significant difference. There were no significant differences in the FFA of the PI, EP, and LP subgroups between the LPS+RA and the LPS+C groups. The levels of TG in the PI subgroup of the LPS+RA group were significantly lower compared with the respective levels in the LPS+C group (0.97 ± 0.05 vs. 1.22 ± 0.08 mmol/L;P < 0.05).

CONCLUSIONRapamycin can improve clinical manifestations and blood lipid profile in part of the preeclampsia-like mouse models.

Animals ; Blood Pressure ; drug effects ; Chi-Square Distribution ; Cholesterol ; blood ; Disease Models, Animal ; Female ; Lipid Metabolism ; drug effects ; Lipids ; blood ; Lipoproteins, HDL ; blood ; Lipoproteins, LDL ; blood ; Mice ; Mice, Inbred C57BL ; Placenta ; drug effects ; metabolism ; Pre-Eclampsia ; blood ; drug therapy ; Pregnancy ; Pregnancy Outcome ; Sirolimus ; therapeutic use ; Triglycerides ; administration & dosage ; blood

BACKGROUNDHyperglycemia is associated with adverse pregnancy outcomes. However, the relationships between them remain ambiguous. This study aimed to analyze the effect of different oral glucose tolerance test (OGTT) results on adverse perinatal outcomes.

METHODSThis retrospective cohort study included data from 15 hospitals in Beijing from June 20, 2013 to November 30, 2013. Women with gestational diabetes mellitus (GDM) were categorized according to the number and distribution of abnormal OGTT values, and the characteristics of adverse pregnancy outcomes were evaluated. Chi-square test and logistic regression analysis were used to determine the associations.

RESULTSIn total, 14,741 pregnant women were included in the study population, 2927 (19.86%) of whom had GDM. As the number of hyperglycemic values in the OGTT increased, the risk of cesarean delivery, preterm births, large-for-gestational age (LGA), macrosomia, and neonatal complications significantly increased. Fasting hyperglycemia had clear associations with macrosomia (odds ratios [OR s]:1.84, 95% confidence intervals [CI s]: 1.39-2.42,P < 0.001), LGA (OR: 1.70, 95% CI: 1.29-2.25,P < 0.001), and cesarean delivery (OR: 1.33, 95% CI: 1.15-1.55,P < 0.001). The associations were stronger as fasting glucose increased. GDM diagnosed by hyperglycemia at OGTT-2 h was more likely to lead to preterm birth (OR: 1.50, 95% CI: 1.11-2.03,P < 0.01).

CONCLUSIONSVarious characteristics of OGTTs are associated with different adverse outcomes. A careful reconsideration of GDM with hierarchical and individualized management according to OGTT characteristics is needed.

Birth Weight ; physiology ; Blood Glucose ; metabolism ; Body Mass Index ; Cesarean Section ; Chi-Square Distribution ; Diabetes, Gestational ; blood ; physiopathology ; Female ; Fetal Macrosomia ; blood ; physiopathology ; Glucose Tolerance Test ; methods ; Humans ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Premature Birth ; blood ; physiopathology ; Retrospective Studies