AGE

奈梅亨断裂综合征
  • 文章类型: Journal Article
    目的:尽管已经对OXIS接触者进行了一系列研究,缺乏关于OXIS接触随时间变化的研究。因此,这项研究旨在评估3-7岁儿童3年后初级磨牙之间接触类型的变化。
    方法:这项纵向研究使用926名儿童的2922个分段模具模型进行。在基线(T0),根据OXIS标准,通过截面模模法复制对乳牙之间的接触类型进行评分.三年后,使用相同的标准(T1)对相同儿童的分段模具模型进行评分.
    结果:McNemar的测试显示,从基线到3年的接触发生了显着变化。事后测试解释了观察到的显着接触的特定变化。这些是O到X(p<0.001),O至I(p<0.001),O到S(p=0.035),和I到X(p<0.001)。
    结论:观察到OXIS接触随时间的显着变化。O型接触经历了最大变化。最不稳定的联系人是\"O\"和\"I\"类型,分别。接触类型随年龄的变化可能会改变儿童龋齿的风险。
    OBJECTIVE: Although a series of studies on OXIS contacts have been performed, studies regarding changes in OXIS contacts over time are lacking. Therefore, this study aimed to evaluate the change in contact type between primary molars after 3 years in children aged 3-7 years.
    METHODS: This longitudinal study was conducted using 2922 sectional die models of 926 children. At baseline (T0), the contact type between the primary molars was scored using replication via the sectional die model method according to the OXIS criteria. After 3 years, the sectional die models of the same children were scored using the same criteria (T1).
    RESULTS: McNemar\'s tests revealed a significant change in contacts from baseline to 3 years. The post hoc test explained specific changes in the contacts that were observed to be significant. These were O to X (p < 0.001), O to I (p < 0.001), O to S (p = 0.035), and I to X (p < 0.001).
    CONCLUSIONS: A significant change in OXIS contact over time was observed. The O-type contact underwent the maximum change. The least and most stable contacts are the \"O\" and \"I\" types, respectively. This change in contact type with age may alter the risk of caries in children.
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  • 文章类型: Journal Article
    引言肾衰竭,包括急性肾损伤(AKI)和慢性肾病(CKD),涉及肾功能下降或丧失。AKI是突然和可逆的,功能在数小时到数天内迅速下降,而CKD涉及持续至少3个月的持续性异常。发展中国家的AKI病例正在增加,尤其是危重病人。全球范围内,与CKD相关的发病率和死亡率不断上升。方法本研究采用回顾性横断面设计,分析巴西2019-2022年AKI和CKD死亡率。人口和人口统计数据,包括性别和年龄,是从巴西地理与统计研究所获得的。肾脏疾病的死亡率数据来自巴西医院信息系统。该分析利用Joinpoint回归程序来计算平均年度百分比变化(AAPC)及其各自的95%置信区间。使用加权贝叶斯信息准则来确定显著性水平并确定线段和连接点的最佳拟合组合。结果研究发现,男性和女性的AKI死亡率均显着上升,从2008年到2021年(APC=3.16;CI:2.29至5.93),在整个研究期间,男性死亡率高于女性。根据年龄组进行的分析表明,在2019-2021年期间,年龄在40至49岁之间的男性死亡率增长最快(APC=35.41;CI:16.72至46.57);同时,从2019年至2021年,女性死亡率增长最快的是30~39岁人群(APC=40.33;CI=6.48~59.78).此外,与CKD相关的死亡率有可观察到的上升趋势(APC=0.70;CI:0.41至1.01),在整个研究期间,男性的死亡率一直较高。老年人口,男性和女性,经历了与CKD相关的死亡率增长最快,男性AAPC值为2.32(CI:1.82至2.89),女性为1.62(CI:1.08至2.10)。结论我们观察到自2008年以来男性和女性急性肾脏疾病死亡率持续增加,男性总体死亡率更高。该研究强调需要进一步研究以了解导致这些趋势的潜在因素。此外,针对可改变的危险因素的干预措施和改善获得医疗保健的机会可能有助于降低与肾衰竭相关的死亡率.
    Introduction Renal failure, comprising acute kidney injury (AKI) and chronic kidney disease (CKD), involves a decline or loss of kidney function. AKI is sudden and reversible, with a rapid decline in function over hours to days, while CKD involves persistent abnormalities lasting at least three months. Developing countries are seeing a rise in AKI cases, especially in critically ill patients. Globally, there\'s a growing occurrence and mortality rate linked to CKD. Methods The study used a retrospective cross-sectional design to analyze AKI and CKD mortality rates in Brazil from 2019 to 2022. Data on population and demographics, including sex and age, were obtained from the Brazilian Institute of Geography and Statistics. Mortality data for kidney diseases were sourced from the Brazilian Hospital Information System. The analysis utilized the Joinpoint Regression Program to calculate average annual percentage changes (AAPCs) and their respective 95% confidence intervals. Weighted Bayesian information criterion was used to determine the significance levels and identify the best-fitting combination of line segments and joinpoints. Results The study findings revealed a significant rise in AKI mortality rates for both males and females, from 2008 to 2021 (APC = 3.16; CI: 2.29 to 5.93), with higher mortality rates recorded among males compared to women over the entire study period. Analyses according to age groups showed that males between the ages 40 to 49 experienced the most rapid increase in mortality during the 2019 - 2021 period (APC = 35.41; CI: 16.72 to 46.57); meanwhile, the most rapid increase in mortality for females was observed from 2019 to 2021, and this was among those aged 30 to 39 (APC = 40.33; CI = 6.48 to 59.78). Furthermore, there was an observable upward trend in mortality related to CKD (APC = 0.70; CI: 0.41 to 1.01), with males consistently having higher mortality rates throughout the entire study period. The elderly population, both males and females, experienced the most rapid increase in CKD-related mortality, with AAPC values of 2.32 (CI: 1.82 to 2.89) for males and 1.62 (CI: 1.08 to 2.10) for females. Conclusion We observed a consistent increase in mortality rates from acute kidney diseases for both males and females since 2008, with males experiencing higher mortality rates overall. The study highlighted the need for further research to understand the underlying factors contributing to these trends. Additionally, interventions targeting modifiable risk factors and improving access to healthcare could help reduce mortality related to renal failure.
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  • 文章类型: Journal Article
    背景:诊断为肝细胞癌(HCC)的年轻患者的发病率预计会上升。本研究旨在调查青少年和青少年(AYA)HCC患者的独特特征,并确定影响其生存的危险因素。
    方法:本研究包括1005名AYA患者和55,435名老年(OA)HCC患者,利用监测的数据,流行病学,和结束结果数据库。倾向评分匹配用于调整患者特征的基线差异。使用Kaplan-Meier曲线和对数秩检验来比较两组之间的总生存期。使用Cox比例风险回归模型进行亚组分析,以确定AYA患者总体生存的危险因素。
    结果:AYA患者表现出更高的临床晚期比例(49.15%vs37.57%,P<0.001)和纤维板层肝细胞癌(14.13%vs0.09%,P<0.001),但甲胎蛋白阳性发生率较低(32.04%vs45.32%,P<0.001)和肝硬化(8.86%vs18.32%,P<0.001)。亚组分析结果表明,在大多数亚组中,AYA患者的预后优于OA患者。未分化癌是AYA患者的主要危险因素(危险比[HR],6.08[2.53-14.62]),而部分肝切除术被确定为最有利的因素(HR,0.29[0.23-0.37])。
    结论:AYA肝癌患者表现出更积极的特征,但与OA组相比,预后更好,需要个性化的监测和治疗。
    BACKGROUND: The incidence of young patients diagnosed with hepatocellular carcinoma (HCC) is projected to rise. This study aimed to investigate the distinctive characteristics of adolescent and young adult (AYA) patients with HCC and identify the risk factors that impact their survival.
    METHODS: This study included 1005 AYA patients and 55,435 older adult (OA) patients with HCC, using data from the Surveillance, Epidemiology, and End Results database. Propensity score matching was used to adjust for baseline differences in patient characteristics. The Kaplan-Meier curve and log-rank test are utilized to compare the overall survival between the two groups. The Cox proportional hazards regression model was used for subgroup analysis to identify risk factors for overall survival in AYA patients.
    RESULTS: AYA patients exhibited a higher proportion of advanced clinical stage (49.15% vs 37.57%, P < 0.001) and fibrolamellar hepatocellular carcinoma (14.13% vs 0.09%, P < 0.001), but a lower incidence of alpha-fetoprotein positivity (32.04% vs 45.32%, P < 0.001) and cirrhosis (8.86% vs 18.32%, P < 0.001). The subgroup analysis results indicated that AYA patients had a more favorable prognosis than OA patients in most subgroups. Undifferentiated carcinoma emerged as the predominant risk factor for AYA patients (Hazard Ratio [HR], 6.08 [2.53-14.62]), whereas partial hepatectomy was determined to be the most advantageous factor (HR, 0.29 [0.23-0.37]).
    CONCLUSIONS: AYA patients with HCC exhibit more aggressive characteristics but demonstrate a better prognosis compared to the OA group, necessitating personalized surveillance and treatment.
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  • 文章类型: Journal Article
    这项研究的目的是评估多重睡眠潜伏期测试(MSLT)结果和Epworth嗜睡量表(ESS)在分类客观睡眠过度(平均睡眠潜伏期(MSL)≤8分钟)方面的年龄和性别相关差异。我们连续研究了480名成年人(39.3±15.3岁[18-93],67.7%的女性)进行了睡眠过度评估。我们拟合线性回归模型来调查年龄和性别与睡眠潜伏期之间的关系(平均和每次午睡),在调整总睡眠时间和睡眠效率(多导睡眠图)后,和REM抑制抗抑郁作用。进行逻辑回归以评估年龄和性别是否与睡眠发作性REM期(SOREMP)发生有关。ROC分析评估ESS评分的诊断性能,以确定不同年龄/性别组的MSL≤8分钟。每10岁,MSL降低0.41(95%CI0.11-0.72,p=0.008)分钟。客观上(MSL≤8分钟),睡眠患者随着年龄的增长,午睡4和5的潜伏期缩短。仅在MSL>8分钟的患者中,女性性别与较高的MSL相关。在客观困倦的患者中,每一年的年龄观察到SOREMP发生的几率降低了2.4%(p=0.045)。ESS评分在老年(≥50岁)男性中的诊断性能优于年轻(<50岁)女性(p<0.05)。有客观证实的睡眠过度的老年患者在以后的午睡中可能会更加困倦,可能是由于较少的恢复性午睡和/或昼夜节律因素。自我报告的嗜睡比年轻女性更能预测老年男性的客观嗜睡。
    The aim of this study was to assess age- and sex-related differences in multiple sleep latency test (MSLT) results and in the performance of the Epworth Sleepiness Scale (ESS) at classifying objective hypersomnia (mean sleep latency (MSL) ≤ 8 min). We studied 480 consecutive adults (39.3 ± 15.3 years old [18-93], 67.7% female) who underwent hypersomnia evaluation. We fit linear regression models to investigate associations between age and sex and sleep latencies (mean and for every nap), after adjusting for total sleep time and sleep efficiency (on polysomnography), and REM-suppressing antidepressant effect. A logistic regression was performed to assess whether age and sex were associated with sleep-onset REM period (SOREMP) occurrence. ROC analysis assessed the diagnostic performance of ESS scores to identify a MSL ≤ 8 min in different age/sex groups. For every 10 years of age, there was 0.41 (95% CI 0.11-0.72, p = 0.008) min reduction in MSL. Objectively (MSL ≤ 8 min) sleepy patients had shortening of latencies in naps 4 and 5 with aging. Female sex was associated with a higher MSL only in patients with MSL > 8 min. A 2.4% reduction in the odds of SOREMP occurrence was observed for every year of age in objectively sleepy patients (p = 0.045). ESS scores had a better diagnostic performance in older (≥ 50 years old) men than younger (< 50 years old) women (p < 0.05). Older patients with objectively confirmed hypersomnia may be sleepier in later naps, possibly due to less restorative naps and/or circadian rhythm factors. Self-reported sleepiness is more predictive of objective sleepiness in older men than younger women.
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  • 文章类型: Journal Article
    中国人群的心脏骤停患病率越来越高。这项研究旨在调查澳门特别行政区(SAR)院外心脏骤停(OHCA)成人患者的院前生存到入院和出院的相关因素。中国。
    OHCA患者的基线特征和院前因素是从公开获取的医疗记录和澳门消防局收集的,中国。使用多因素logistic回归分析存活至入院和出院的患者的人口统计学和其他院前OHCA特征。
    共纳入904例,平均年龄74.2±17.3(范围:18-106)岁(78%>65岁,62%男性)。初始可电击心律是住院(OR=3.57,95%CI:2.26-5.63;p<0.001)和出院(OR=12.40,95%CI:5.70-26.96;p<0.001)生存率的最强预测因子。男性(OR=1.63,95%CI:1.08-2.46;p=0.021)和较低的急诊医疗服务(EMS)响应时间(OR=1.62,95%CI:1.12-2.34;p=0.010)也与住院生存率相关2倍。此外,获得院前除颤(OR=4.25,95%CI:1.78-10.12;p<0.001)与生存至出院有4倍的相关性.这些关联都没有随着年龄的增长而实质性增加。
    OHCA生存的主要预测因子是最初的可电击心律,作为男性,较低的EMS响应时间,并获得院前除颤。这些发现表明需要提高公众意识和更多教育。
    UNASSIGNED: Chinese populations have an increasingly high prevalence of cardiac arrest. This study aimed to investigate the prehospital associated factors of survival to hospital admission and discharge among out-of-hospital cardiac arrest (OHCA) adult cases in Macao Special Administrative Region (SAR), China.
    UNASSIGNED: Baseline characteristics as well as prehospital factors of OHCA patients were collected from publicly accessible medical records and Macao Fire Services Bureau, China. Demographic and other prehospital OHCA characteristics of patients who survived to hospital admission and discharge were analyzed using multivariate logistic regression analysis.
    UNASSIGNED: A total of 904 cases with a mean age of 74.2±17.3 (range: 18-106) years were included (78%>65 years, 62% male). Initial shockable cardiac rhythm was the strongest predictor for survival to both hospital admission (OR=3.57, 95% CI: 2.26-5.63; p<0.001) and discharge (OR=12.40, 95% CI: 5.70-26.96; p<0.001). Being male (OR=1.63, 95% CI:1.08-2.46; p =0.021) and the lower emergency medical service (EMS) response time (OR=1.62, 95% CI: 1.12-2.34; p =0.010) were also associated with a 2-fold association with survival to hospital admission. In addition, access to prehospital defibrillation (OR=4.25, 95% CI: 1.78-10.12; p <0.001) had a 4-fold association with survival to hospital discharge. None of these associations substantively increased with age.
    UNASSIGNED: The major OHCA predictors of survival were initial shockable cardiac rhythm, being male, lower EMS response time, and access to prehospital defibrillation. These findings indicate a need for increased public awareness and more education.
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  • 文章类型: Journal Article
    综合分析35-64岁女性人乳头瘤病毒(HPV)和HPV相关宫颈疾病的流行病学特征。
    共纳入了从2018年1月至2023年12月筛查HPV和相关宫颈病变的149,559个脱落的宫颈细胞样本。检测15个高危型和6个低危型HPV基因型的患病率,并对宫颈细胞学进行分析。单个和多个HPV感染的影响被表征,研究了年龄的影响。
    86.60%的女性宫颈细胞学检查正常,而7.13%的女性被诊断为宫颈炎症,0.60%与ASC-US,0.22%与ASC-H,使用LSIL的0.72%,0.49%与HSIL,0.03%与ICC。在54岁的ASC-H组中观察到最高的中位年龄。受过小学教育或以下的女性的阳性率最高。HPV总患病率为8.60%。相对流行的HPV类型是HPV52、58、16、39、51。HPV16,HPV18,HPV58,HPV33和HPV52是ICC患者的top5主要类型。17.41%的女性患有多种HPV感染,最常见的共感染亚型是HPV52,HPV58和HPV16。所有HPV亚型的患病率随年龄增长而增加。在55岁以上的人群中,多重HPV感染占较大比例。在45-49岁和55-59岁的病例中,ICC组的HPV16患病率达到峰值。在患有ICC的40-44岁的年轻个体中观察到HPV33患病率峰值。
    应对HPV33感染采取更多措施。
    UNASSIGNED: To comprehensively analyze the epidemiological features of human papillomavirus (HPV) and HPV-related cervical diseases in females aged 35-64 years.
    UNASSIGNED: A total of 149,559 samples of exfoliated cervical cells screened for HPV and related cervical lesions from January 2018 to December 2023 were enrolled. The prevalence of 15 high-risk and 6 low-risk HPV genotypes were detected, and the cervical cytology were analyzed. The impact of single and multiple HPV infections was characterized, and the effect of age was studied.
    UNASSIGNED: The cervix cytology was normal in 86.60% of the females, while 7.13% of the females were diagnosed with cervix inflammation, 0.60% with ASC-US, 0.22% with ASC-H, 0.72% with LSIL, 0.49% with HSIL, 0.03% with ICC. The highest median age was observed in ASC-H group with 54 years old. Females with primary school education or lower have the highest positive rates. The overall HPV prevalence was 8.60%. The relatively prevalent HPV types were HPV52, 58, 16, 39, 51. HPV16, HPV18, HPV58, HPV33 and HPV52 were the top5 predominant types in ICC patients. 17.41% females suffered from multiple HPV infection with the most frequently co-infection subtypes being HPV52, HPV58 and HPV16. The prevalence of all HPV subtypes increased with age. Multiple HPV infections accounted for a larger proportion in those aged above 55 years. The peak HPV16 prevalence was observed in ICC group in cases aged 45-49 and 55-59. The peak HPV33 prevalence was observed in younger individuals aged 40-44 who developed ICC.
    UNASSIGNED: More action should be taken against HPV33 infection.
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  • 文章类型: Journal Article
    背景:评估Centiloid(CL)量表的偏倚和变异性的潜在来源是其适当临床应用的基础。
    方法:我们纳入了533名来自AMYloid成像预防阿尔茨海默病(AMYPADDPMS)和阿尔茨海默病神经成像计划(ADNI)队列的参与者。使用参考区域(RR)的不同组合创建了32条CL管道,RR和目标类型,和量化空间。通过淀粉样蛋白阳性分层的广义估计方程用于评估定量管道的影响,放射性示踪剂,年龄,脑萎缩,和CL的协调地位。
    结果:RR选择和RR类型对CL的影响最大,尤其是淀粉样蛋白阴性个体。以整个小脑作为RR的标准CL管道对脑萎缩和图像分辨率差异具有鲁棒性,淀粉样蛋白β阳性截止值的95%置信区间低于±3.95CL(CL<24)。
    结论:大多数情况下建议使用标准CL管道。在临床和研究环境中操作CL截止值时,应考虑置信区间。
    结论:我们开发了一个评估不同因素的Centiloid(CL)变异性的框架。参考区域选择和划分对CL值的影响最大。整个小脑(WCB)和整个小脑加脑干(WCBBSTM)作为参考区域在示踪剂中产生了一致的结果。标准CL管线对于萎缩和图像分辨率变化是稳健的。以绝对CL单位估计管道内和管道间的变异性(95%置信区间)。
    BACKGROUND: Assessing the potential sources of bias and variability of the Centiloid (CL) scale is fundamental for its appropriate clinical application.
    METHODS: We included 533 participants from AMYloid imaging to Prevent Alzheimer\'s Disease (AMYPAD DPMS) and Alzheimer\'s Disease Neuroimaging Initiative (ADNI) cohorts. Thirty-two CL pipelines were created using different combinations of reference region (RR), RR and target types, and quantification spaces. Generalized estimating equations stratified by amyloid positivity were used to assess the impact of the quantification pipeline, radiotracer, age, brain atrophy, and harmonization status on CL.
    RESULTS: RR selection and RR type impact CL the most, particularly in amyloid-negative individuals. The standard CL pipeline with the whole cerebellum as RR is robust against brain atrophy and differences in image resolution, with 95% confidence intervals below ± 3.95 CL for amyloid beta positivity cutoffs (CL < 24).
    CONCLUSIONS: The standard CL pipeline is recommended for most scenarios. Confidence intervals should be considered when operationalizing CL cutoffs in clinical and research settings.
    CONCLUSIONS: We developed a framework for evaluating Centiloid (CL) variability to different factors. Reference region selection and delineation had the highest impact on CL values. Whole cerebellum (WCB) and whole cerebellum plus brainstem (WCB+BSTM) as reference regions yielded consistent results across tracers. The standard CL pipeline is robust against atrophy and image resolution variation. Estimated within- and between-pipeline variability (95% confidence interval) in absolute CL units.
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  • 文章类型: Journal Article
    校际马展协会(IHSA)比赛在随机骑马时评估骑手的马匹和技巧。这项研究考虑了参与IHSA比赛的马匹的人口统计学和竞争相关变量,以及它们通过累积积分与绩效的相关性。在为期两天的HunterSeat和WesternIHSA表演中记录了59匹马的人口统计数据,并使用了人工骑行工具,比赛日,骑行次数,和点,评估绩效。使用混合效应模型和相关系数分析数据,显著性设置为P<0.05(SAS9.4)。HunterSeat马匹平均每天的骑行次数比西方人多(P<0.0001),但是每次骑行的分数在不同学科(P=0.57)或表演天数(P=0.47)之间没有差异。使用人工辅助装置并没有影响每骑一匹马累积的点数(P=0.63,P=0.41西方)。年龄,(r=-0.10,P=0.60;r=0.02,P=0.90),BCS(r=0.15,P=0.42;r=0.17,P=0.34),身高(r=0.20,P=0.28;r=0.15,P=0.39),体重(r=0.23,P=0.23;r=0.20,P=0.25)与HunterSeat和西方马匹的得分弱相关,分别。IHSA中的随机抽签建议对平等竞赛有效,给骑手一个公平的机会,无论这项研究中评估的马相关因素如何。
    Intercollegiate Horse Show Association (IHSA) competitions evaluate riders on equitation and skills when riding randomly drawn horses. This study considered demographic and competition-related variables of horses involved in IHSA competitions, and their correlation to performance through points accumulated. Demographics were recorded for fifty-nine horses in two-day Hunter Seat and Western IHSA shows along with use of artificial riding aids, day of competition, number of rides, and points, to evaluate performance. Data were analyzed using a mixed effect model and correlation coefficients with significance set at P < 0.05 (SAS 9.4). Hunter Seat horses averaged more rides per day than Western (P < 0.0001), but points per ride were not different between disciplines (P = 0.57) or days of shows (P = 0.47). Use of artificial aids did not impact points per ride a horse accumulated (P = 0.63 Hunter Seat, P = 0.41 Western). Age, (r = -0.10, P = 0.60; r = 0.02, P = 0.90), BCS (r = 0.15, P = 0.42; r = 0.17, P = 0.34), height (r = 0.20, P = 0.28; r = 0.15, P = 0.39), and weight (r = 0.23, P = 0.23; r = 0.20, P = 0.25) were weakly correlated with points earned for Hunter Seat and Western horses, respectively. Random draw in IHSA is suggested to be effective for equitation competitions, allowing a fair opportunity for riders, regardless of the horse-related factors evaluated in this study.
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  • 文章类型: Journal Article
    背景:65岁的任意年龄截止值可能无法准确定义大量输血(MT)后死亡风险较高的老年人。我们试图重新定义MT的新老年年龄阈值,并了解其与结局的关系。
    方法:在2013-2018年创伤质量改善计划数据库中查询了所有在入院24小时内接受≥10单位压积红细胞(pRBC)的成年人。使用多元逻辑回归建立的输血无效阈值(TT)进行自举分析,其中额外的pRBC不再改善各种年龄截止的死亡率。年龄相对较大和相对较年轻的人的TT具有统计学意义的年龄截止值用于定义MT的新“老年”年龄。然后比较新定义的老年和非老年患者的预后。
    结果:当年龄截止为63岁时,TT的差异首先变得显着。年龄≥63岁的患者的TT(新的老年病,n=2870)与<63y(非儿科,n=17,302)是34和40单位的pRBC,分别为(P=0.04)。尽管老年患者的格拉斯哥昏迷量表评分较高(9对6,P<0.01),而腹部的缩略损伤评分较低(3对4,P<0.01),他们的总死亡率更高(62%对45%,P<0.01)。老年患者出院回家的比例较低(7%对35%,P<0.01)。
    结论:MT的新老年年龄为63岁,TT为34个单位。尽管伤势较轻,生理上“老年”患者在MT后的预后更差。
    BACKGROUND: The arbitrary geriatric age cutoff of 65 may not accurately define older adults at higher risk of mortality following massive transfusion (MT). We sought to redefine a new geriatric age threshold for MT and understand its association with outcomes.
    METHODS: The 2013-2018 Trauma Quality Improvement Program database was queried for all adults who received ≥10 units of packed red blood cells (pRBCs) within 24 h of admission. A bootstrap analysis using multiple logistic regression established transfusion futility thresholds (TTs), where additional pRBCs no longer improved mortality for various age cutoffs. The age cutoff at which the TT for those relatively older and relatively younger was statistically significant was used to define the new \"geriatric\" age for MT. Outcomes were then compared between the newly defined geriatric and nongeriatric patients.
    RESULTS: The difference in TT first became significant when the age cutoff was 63 y. The TT for patients aged ≥63 y (new geriatric, n = 2870) versus <63 y (nongeriatric, n = 17,302) was 34 and 40 units of pRBCs, respectively (P = 0.04). Although geriatric patients had a higher Glasgow coma scale score (9 versus 6, P < 0.01) and lower abbreviated injury score-abdomen (3 versus 4, P < 0.01) than the nongeriatric, they suffered higher overall mortality (62% versus 45%, P < 0.01). A lower percentage of geriatric patients were discharged to home (7% versus 35%, P < 0.01).
    CONCLUSIONS: The new geriatric age for MT is 63 y, with a TT of 34 units. Despite suffering less severe injuries, physiologically \"geriatric\" patients have worse outcomes following MT.
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  • 文章类型: Journal Article
    针对COVID-19的疫苗接种是控制随着SARS-CoV-2变体的持续出现而持续存在的大流行的不可或缺的一部分。使用描述SARS-CoV-2宿主内感染动力学的数学模型,我们估计由于感染变异因素而导致的病毒和免疫差异,年龄,和疫苗接种史(疫苗接种品牌,接种疫苗后的剂量和时间)。我们在贝叶斯框架中将我们的模型拟合到从新加坡的Delta和Omicron感染病例获得的上呼吸道病毒载量测量,其中大多数人只有一个鼻咽拭子测量。有了这个数据集,我们能够重现在适合纵向患者数据的过去宿主内建模研究中观察到的URT病毒动力学的相似趋势.我们发现Omicron的R0高于Delta,表明宿主内感染的初始细胞间扩散更大。此外,通过将免疫相关参数拟合为疫苗接种史特异性,可以重建患者亚组之间感染动力学的异质性,有或没有年龄的修改。我们的模型结果与老年人SARS-CoV-2感染的免疫衰老的概念一致,以及自上次疫苗接种以来免疫力随着时间的增加而下降的问题。最后,在Omicron感染和Delta感染中,未发现疫苗接种会抑制病毒动力学。这项研究提供了有关疫苗引发的免疫对SARS-CoV-2宿主内动力学的影响的见解。以及年龄和疫苗接种史之间的相互作用。此外,它表明需要解开宿主因素和病原体的变化,以辨别影响病毒动态的因素。最后,这项工作展示了研究宿主内病毒动力学的前进道路,通过使用包括大量患者的病毒载量数据集,无需重复测量。
    Vaccination against COVID-19 was integral to controlling the pandemic that persisted with the continuous emergence of SARS-CoV-2 variants. Using a mathematical model describing SARS-CoV-2 within-host infection dynamics, we estimate differences in virus and immunity due to factors of infecting variant, age, and vaccination history (vaccination brand, number of doses and time since vaccination). We fit our model in a Bayesian framework to upper respiratory tract viral load measurements obtained from cases of Delta and Omicron infections in Singapore, of whom the majority only had one nasopharyngeal swab measurement. With this dataset, we are able to recreate similar trends in URT virus dynamics observed in past within-host modelling studies fitted to longitudinal patient data.We found that Omicron had higher R0,within values than Delta, indicating greater initial cell-to-cell spread of infection within the host. Moreover, heterogeneities in infection dynamics across patient subgroups could be recreated by fitting immunity-related parameters as vaccination history-specific, with or without age modification. Our model results are consistent with the notion of immunosenescence in SARS-CoV-2 infection in elderly individuals, and the issue of waning immunity with increased time since last vaccination. Lastly, vaccination was not found to subdue virus dynamics in Omicron infections as well as it had for Delta infections.This study provides insight into the influence of vaccine-elicited immunity on SARS-CoV-2 within-host dynamics, and the interplay between age and vaccination history. Furthermore, it demonstrates the need to disentangle host factors and changes in pathogen to discern factors influencing virus dynamics. Finally, this work demonstrates a way forward in the study of within-host virus dynamics, by use of viral load datasets including a large number of patients without repeated measurements.
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