Objective To explore the association between triglyceride glucose-waist circumference (TyG-WC) index and the risk of stroke among the middle-aged and older people, and compare the differences among TyG-WC, triglyceride glucose (TyG), and waist circumference (WC) in the prediction of stroke. Methods The data of adults aged 45 years or older enrolled in the China Health and Retirement Longitudinal Study registry in 2011 were collected, and the endpoint was self-reported or physician-diagnosed new stroke event by 2015. According to the baseline TyG-WC tertile, individuals were divided into three groups: TyG-WC tertile 1, tertile 2, and tertile 3 groups. Multiple logistic regression analyses were performed to analyze the associations of TyG-WC, TyG, and WC with the risk of stroke. The area under the curve (AUC) of receiver operating characteristic (ROC) curve, integrated discrimination improvement (IDI) score, and net reclassification improvement (NRI) score were calculated to evaluate the predictive value of TyG-WC, TyG, and WC in stroke. Results A total of 5847 participants were finally included, with 1949 in each group. After 4 years of follow-up, there were 252 cases of new stroke. There was significant difference in the incidence of stroke among the three groups (TyG-WC tertile 1 group: 2.57%, TyG-WC tertile 2 group: 4.16%, TyG-WC tertile 3 group: 6.21%; P<0.05). The results of multiple logistic regression analyses showed that the risk of new stroke in the third tertile group of TyG-WC and WC was higher than that in the first tertile group, respectively [TyG-WC: odds ratio (OR)=1.465, 95% confidence interval (CI) (1.033, 2.078), P=0.032; WC: OR=1.717, 95%CI (1.190, 2.478), P=0.004], while TyG was not the risk factor of stroke (P>0.05). The ROC curve analysis showed that the AUC of WC (0.566) was slightly higher than that of TyG-WC (0.556) and TyG (0.527). The IDI of TyG-WC (0.25%) was slightly higher than that of WC (0.22%), and the both were higher than that of TyG (0.07%). The NRI of WC (25.04%) was slightly higher than that of TyG-WC (19.68%), and the both were high than that of TyG (12.02%). Conclusions Compared with TyG, higher TyG-WC and WC are associated with the increased risk of new stroke among the middle-aged and older people. The predictive value of TyG-WC and WC for the risk of new stroke in the middle-aged and elderly is similar, and is better than that of TyG.
The aging of the population is grim, and the functional disability of older adults is increasing, bringing heavy burden to society. Previous studies have shown that rehabilitation is beneficial to improve the various functional disorders of the functional disability of older adults, and help them recover their activities of daily living and improve their quality of life. However, the multi-disciplinary comprehensive management model is still in its infancy in China, and there is a lack of multi-disciplinary full-period comprehensive rehabilitation management exploration for the functional disability of older adults. Therefore, based on the relevant literature, this experts consensus summarizes the rehabilitation evaluation and intervention of the functional disability of older adults from nine functional dimensions: movement, vision, hearing, cognition, swallowing, cardiopulmonary, defecation, psychology and activities of daily life, in order to provide reference for the comprehensive rehabilitation management of the functional disability of older adults.
ObjectiveTo explore the clinical features, etiological characteristics of co-infections in adult patients with rhinovirus pneumonia.MethodsFourty-nine patients admitted to hospitals for rhinovirus pneumonia were enrolled from 8 medical centers in mainland China between August 2016 and August 2018. Multiplex real-time polymerase chain reaction assays for viral detection were implemented to all bronchoalveolar lavage fluid specimens obtained from the patients. The patients were divided into two groups depending on the status of other etiology co-infection (simple rhinovirus pneumonia group, n=24; coinfections group, n=25). The general data were collected, age, gender, underlying diseases, corticosteroids, symptoms, disease severity, imaging manifestations, etiology, whether patients with respiratory failure, mechanical ventilation, whether the application of vasoactive drugs, antibiotics application, hospital mortality rate of the two groups were reviewed and compared in detail.ResultsThirteen patients (26.5%) with rhinovirus pneumonia had no underlying diseases, 8 patients (16.3%) with chronic underlying lung diseases, 6 patients (12.2%) with diabetes mellitus, 10 patients (20.4%) were immunocompromised patients, 16 patients (32.7%) with respiratory failure, and the hospital mortality rate was 8.2% (4/49). Cases with coinfection were remarkably correlated with more cerebrovascular diseases and disturbance of consciousness, higher PSI score and higher ratio of CURB-65 score >1, more respiratory failure and hospital mortality than those of simple rhinovirus pneumonia group (P< 0.05). There were 25 cases (51.0%) with mixed infection, including 18 bacteria (36.7%), 12 viruses (24.5%), 12 (24.5%) fungi (pneumocystis, aspergillus). Enterobacter and Pseudomonas aeruginosa were most frequently identified bacteria in the viral-bacterial group. Four patients with coinfections died.ConclusionsRhinovirus pneumonia in adult patients often has underlying diseases, and is prone to coinfections (bacteria, fungi, and other viruses). The outcome of these patients is always poor.
ObjectivesTo analyze the effect of bronchiectasis (BE) on the clinical characteristics and prognosis of hospitalized patients with community acquired pneumonia (CAP), and to explore the independent risk factors affecting the 30-day mortality. MethodsA national multi-center retrospective study based on the CAP-China network platform. The clinical data of 6056 patients with CAP who were hospitalized in 13 tertiary teaching hospitals in Beijing, Shandong and Yunnan from January 1, 2014 to December 31, 2014 were collected. To compare the differences in clinical characteristics, etiological distribution and treatment prognosis of patients with CAP with bronchiectasis (BE-CAP) and patients without bronchiectasis (non-BE-CAP). Logistic regression analysis was performed to analyze independent risk factors affecting 30-day mortality in hospitalized patients with BE-CAP. ResultsIn the final analysis, 5880 CAP patients were included, and BE-CAP patients accounted for 10.8% (637/5880). Compared with non-BE-CAP patients, more BE-CAP patients were women, and a higher proportion of patients had chronic obstructive pulmonary disease, bronchial asthma, previous history of glucocorticoid inhalation, and a history of CAP within 1 year. BE-CAP patients had more dyspnea and cyanosis, lower arterial partial pressure of oxygen, longer median time to clinical stability (6 d vs. 4 d, P<0.001), and the incidence of respiratory failure was significantly higher than that of non-BE-CAP patients (27.8% vs. 19.7%, P<0.001). Pseudomonas aeruginosa is the most common bacterial infection in BE-CAP patients. Comorbid bronchiectasis has no significant effect on disease severity, total length of hospital stay, and mortality in CAP patients. The 30-day mortality rate of BE-CAP patients was 2.2%. Logistic regression analysis showed that initial treatment failure [odds ratio (OR) 6.675, 95% confidence interval (CI) 4.235-10.523, P<0.001], respiratory failure (OR 5.548, 95%CI 3.681-8.363, P<0.001), blood urea nitrogen>7.0 mmol/L (OR 2.490, 95%CI 1.625-3.815, P<0.001), albumin<35.0 g/L (OR 1.647, 95%CI 1.073-2.529, P=0.022) and CURB-65 score (OR 1.691, 95%CI 1.341-2.133, P<0.001) were independent risk factors for 30-day mortality in BE-CAP patients. ConclusionsBE-CAP patients have more serious hypoxia symptoms and higher incidence of respiratory failure. For BE-CAP patients with failure of initial treatment, complicated with respiratory failure, blood urea nitrogen>7.0 mmol/L, and albumin<35.0 g/L, treatment evaluation should be performed in time to reduce the mortality rate.