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Association of Antidepressant Medications With Incident Type 2 Diabetes Among Medicaid-Insured Youths.
Antidepressants are one of the most commonly prescribed classes of psychotropic medications among US youths. For adults, there is emerging evidence on the increased risk of type 2 diabetes in association with antidepressant use. However, little is known about the antidepressant treatment-emergent risk of type 2 diabetes among youths.
To assess the association between antidepressant use and the risk of incident type 2 diabetes in youths by antidepressant subclass and according to duration of use, cumulative dose, and average daily dose.
A retrospective cohort study was conducted using Medicaid claims data from 4 geographically diverse, large states of youths 5 to 20 years of age who initiated antidepressant treatment from January 1, 2005, to December 31, 2009.
Antidepressant use (selective serotonin reuptake inhibitors [SSRIs] or serotonin-norepinephrine reuptake inhibitors [SNRIs], tricyclic or other cyclic antidepressants, and other antidepressants) was assessed using the following 4 time-varying measures: current or former use, duration of use, cumulative dose, and average daily dose.
Incident type 2 diabetes was assessed using discrete-time failure models, adjusting for disease risk score estimated using more than 125 baseline and time-dependent covariates.
In this cohort of 119 608 youths aged 5 to 20 years who initiated antidepressant treatment (59 087 female youths and 60 521 54.7% between 5 and 14 years of age) with a mean follow-up of 22.8 months, 79 285 [66.3%] had SSRI or SNRI exposure. The risk of type 2 diabetes was significantly greater during current use than former use of SSRIs or SNRIs (absolute risk, 1.29 per 10 000 person-months vs 0.64 per 10 000 person- adjusted relative risk [RR], 1.88; 95% CI, 1.34-2.64) and tricyclic or other cyclic antidepressants (absolute risk, 0.89 per 10 000 person-months vs 0.48 per 10 000 person- RR, 2.15; 95% CI, 1.06-4.36), but not of other antidepressants (absolute risk, 1.15 per 10 000 person-months vs 1.12 per 10 000 person- RR, 0.99; 95% CI, 0.66-1.50). Furthermore, for youths currently using SSRIs or SNRIs, the risk of type 2 diabetes increased with the duration of use (RR, 2.66; 95% CI, 1.45-4.88 for >210 days and RR, 2.56; 95% CI, 1.29-5.08 for 151-210 days compared with 1-90 days) and with the cumulative dose (RR, 2.44; 95% CI, 1.35-4.43 for >4500 mg and RR, 2.17; 95% CI, 1.07-4.40 for
mg compared with 1-1500 mg in fluoxetine hydrochloride dose equivalents). By contrast, neither the duration nor the cumulative dose of other antidepressants was associated with an increased risk of type 2 diabetes. The risk of type 2 diabetes increased significantly with the average daily dose among youths with more than 150 days of SSRI or SNRI use (RR, 2.39; 95% CI, 1.04-5.52 for >15.0 vs ≤15.0 mg/d) but not among youths with 1 to 150 days of SSRI or SNRI use.
In a large cohort of youths insured by Medicaid, the use of SSRIs or SNRIs-the most commonly used antidepressant subclass-was associated with an increased risk of type 2 diabetes that intensified with increasing duration of use, cumulative dose, and average daily dose.
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A Risk Score to Predict the Development of Hepatic Encephalopathy in a Population-Based Cohort of Patients with Cirrhosis.
Over 40% of patients with cirrhosis will develop hepatic encephalopathy (HE). HE is associated with decreased survival, falls, motor vehicle accidents, and frequent hospitalization. Accordingly, we aimed to develop a tool to risk-stratify patients for HE development. We studied a population-based cohort of all patients with cirrhosis without baseline HE (N=1,979) from the Veterans Administration from Michigan, Indiana, and Ohio (1/1//10) using demographic, clinical, laboratory, and pharmacy data. The primary outcome was the development of HE. Risk-scores were constructed with both baseline and longitudinal data (annually updated parameters) and validated using bootstrapping. The cohort had mean age of 58.0±8.3 years, 36% had hepatitis C, 17% had ascites. Opiates, benzodiazepines, statins, and nonselective beta-blockers were taken at baseline by 24%, 13%, 17%, and 12%. Overall, 863(43.7%) developed HE within 5 years. In multivariable models, risk factors (HR, 95%CI) for HE included higher bilirubin (1.07, 1.05-1.09) and nonselective beta-blocker use (1.34, 1.09-1.64), while higher albumin (0.54, 0.48-0.59) and statin use (0.80, 0.65-0.98) were protective. Other clinical factors, including opiate and benzodiazepine use were not predictive. The AUROC for HE using the 4 significant variables in baseline and longitudinal models were 0.68 (0.66-0.70) and 0.73 (0.71-0.75), respectively. Model effects were validated and converted into a risk score. A score ≤0 in our longitudinal model assigns a 6% 1-year probability of HE while a score >20 assigns a 38% 1-year risk.
Patients with cirrhosis can be stratified by a simple risk-score for HE that accounts for changing clinical data. Our data also highlight a role for statins in reducing cirrhosis complications including HE. This article is protected by copyright. All rights reserved.
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丁香园旗下网站P1.07-002 The Expression of PD-L1 Protein as a Prognostic Factor in Lung Squamous Cell Carcinoma
29.83National Hospital Organization Kyushu Cancer Center+ 839.62Graduate School of Medical Sciences, Kyushu UniversityShow
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CitationsCitations0ReferencesReferences0This research doesn't cite any other publications.ProjectElucidation of the significance of PD-1/PD-L1 in lung cancer ProjectProjectData provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.This publication is from a journal that may support self archiving.Last Updated: 08 Nov 17血压变异性与急性缺血性卒中患者早期神经功能恶化的相关性
Correlation between blood pressure variability and early neurological deterioration in patients with acute ischemic stroke
目的 探讨早期血压变异性与急性缺血性卒中患者早期神经功能恶化(early neurological deterioration,END)的相关性.方法 前瞻性收集住院治疗的急性缺血性卒中患者.连续记录入组患者入院72 h内的血压值,计算收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP)的平均值(mean)、最大值(maximum,max)、极差(differences between the maximum and minimum,max-min)、标准差(standard deviation,SD)和变异系数(coefficient of variation,CV).END定义为美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)最高时的评分较基线增加≥2分.采用多变量logistic回归分析在校正混杂因素后确定不同血压变异性参数与急性缺血性卒中后END的独立相关性.结果 共纳入128例急性缺血性卒中患者,其中男性75例,女性53例;平均年龄(63.30±11.82)岁.经过标准治疗,35例(27.34％)患者在入院72 h内发生END.END患者与非END患者年龄、性别、糖尿病、基线NIHSS评分、C反应蛋白以及SBPmax、SBPmax.mm、SBPsD、SBPCv、DBPmax、DBPmax-min、DBPsD和DBPCV的差异有统计学意义(P＜0.05).多变量logistic回归分析表明,血压变异性指标中的SBPmax--min[优势比(odds ratio,OR)1.040,95％可信区间(confidence interval,CI)1.014 ～1.067]、SBPsD(OR 1.191,95％ CI 1.052～1.347)、SBPCv(OR 1.317,95％ CI1.100 ～1.578)、DBPmax-min(OR 1.076,95％ CI1.018 ～1.138)、DBPSD(OR 1.508,95％ CI1.128～2.016)和DBPCv(OR 1.338,95％ CI1.093 ～1.638)是急性缺血性卒中患者发生END的独立危险因素.结论 急性缺血性卒中患者72 h内血压变异性与END显著相关.
Abstract：
Objective To investigate the correlation between early blood pressure variability and early neurological deterioration (END) in patients with acute ischemic stroke.Methods Inpatients with acute ischemic stroke were collected prospectively.The blood pressure values of the enrolled patients were recorded continuously for 72 h after admission.The mean value (mean),maximum value (max),differences betw een the maximum and minimum (max-min),standard deviation (SD),and coefficient of variation (CV) for the systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated.END was as an increase of at least 2 in the highest score of the National Institute of Health Stroke Scale (NIHSS) compared to the baseline.Multivariate logistic regression analysis was used to identify the independent correlation between the different blood pressure variability parameters and END following acute ischemic stroke after adjusting the confounding factors.Results A total of 128 patients with acute ischemic stroke were enrolled,including 53 females and 75 males,and their mean age was 63.30 ± 11.82 years.After standard treatment,35 patients (27.34％) developed END within 72 h after admission.There were significant differences in age,sex,diabetes mellitus,baseline NIHSS,C-reactive protein and SBPmax,SBP in,SBPSD,SBPCv,DBPmax,DBP max-min,DBPsD,and DBPCv between END group and non-END group (all P ＜0.05).Multivariate logisticregression analysis showed that SBPmax-min(odds ratio [OR] 1.040,95％ confidence interval [CI] 1.014-1.067,SBPsD(OR 1.191,95％ CI 1.052-1.347),SBPCv(OR 1.317,95％ CI 1.100-1.578),DBP max-min(OR 1.076,95％ CI 1.018-1.138),DBPsD(OR 1.508,95％ CI 1.128-2.016),and DBPCv(OR 1.338,95％ CI 1.093-1.638) in blood pressure variability indices were the independent risk factors for END in patients with acute ischemic stroke.Conclusion Blood pressure variability is significantly associated with END within 72 h after admission in patients with acute ischemic stroke.
Duan Zuowei
Fu Changbiao
Tang Tieyu
Zhang Xinjiang
225001,扬州市第一人民医院神经内科
& ISTICPKU
年，卷(期)
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扬州市科技局社会发展项目(YZ2015048).Social Development Project of Yangzhou Science and Technology Bureau of China
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&&8:00-11:30,13:00-17:00(工作日)Summary (text)
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Exposure to fine particulate matter during pregnancy and risk of term low birth weight in Jinan, China, .
Existing studies exploring the association between low birth weight (LBW) and maternal fine particulate matter (aerodynamic diameter<2.5μm, PM2.5) exposure have presented equivocal results, and one of the possible reasons for this finding might be due to relatively low maternal exposures. In addition, relatively narrow maternal exposure windows to PM2.5 have not been well established for LBW.
We employed a nested matched case-control design among 43,855 term births in a large maternity and child care hospital in Jinan, China. A total of 369 cases were identified, and four controls per case matched by maternal age were randomly selected among those with normal birth weight (n=1,476) from 2014 to 2016. Ambient air monitoring data on continuous measures of PM2.5, nitrogen dioxide (NO2), and sulfur dioxide (SO2) (24-h average concentrations) from 2013 to 2016 were collected from thirteen local monitoring stations. An inverse distance weighting method based on both home and work addresses was adopted to estimate the individual daily exposures to these air pollutants during pregnancy by weighting the average of the twelve nearest monitoring stations within 30km of each 100m×100m grid cell by an inverse squared distance, and then the average exposure concentrations for gestational months, trimesters and the entire pregnancy were calculated. Adjusted conditional logistic regression models were used to estimate the odds ratios (ORs) per 10μg/m(3) increment in PM2.5 and by PM2.5 quartiles during different gestational periods.
In this study, the estimated mean values of PM2.5, NO2, and SO2 exposure during the entire pregnancy were 88.0, 54.6, and 63.1μg/m(3), respectively. Term low birth weight (TLBW) increased in association with per 10μg/m(3) increment in PM2.5 for the 8th month [OR=1.13, 95% confidence interval (CI): 1.04, 1.22], the 9th month (OR=1.06, 95% CI: 0.99, 1.15), the third trimester (OR=1.17, 95% CI: 1.05, 1.29), and the entire pregnancy (OR=1.38, 95% CI: 1.07, 1.77) in models adjusted for one pollutant (PM2.5). In models categorizing the PM2.5 exposure by quartiles, comparing the second, third, and highest with the lowest PM2.5 exposure quartile, the PM2.5 was positively associated with TLBW during the 8th month (OR: 1.77, 95% CI: 1.09, 2.88; OR: 1.77, 95% CI: 1.03, 3.04; OR: 1.92, 95% CI: 1.04, 3.55, respectively) and for the 9th month, only association for exposure in the third versus the lowest quartile was significant (OR: 1.91, 95% CI: 1.02, 3.58).
The study provides evidence that exposure to PM2.5 during pregnancy might be associated with the risk of TLBW in the context of very high pollution level of PM2.5, and the 8th and 9th months were identified as potentially relevant exposure windows.
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