Propensity Score Matching Model Research Articles

Association of internet use and health service utilization with self-rated health in middle-aged and older adults: findings from a nationally representative longitudinal survey.

This study aims to explore the relationship between internet use and self-rated health among middle-aged and older adults and further investigates the mediating role of health service utilization between internet use and self-rated health, providing a reference for more effectively utilizing the internet to improve the health status of middle-aged and older adults. We analyzed data from the 2018 and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS), this includes 10,011 in 2018 and 7,080 in 2020 over the age of 45. To explore the relationship between internet use and self-rated health, we employed propensity score matching (PSM) and instrumental variable regression analysis, accounting for a wide range of potential covariates. Additionally, the Sobel test was used to examine the mediating effect of health service utilization on this relationship. According to the fully adjusted propensity score matching and instrumental variable regression model, internet use significantly enhanced self-rated health among middle-aged and older adults (β = 0.348, P < 0.01; β = 0.293, P < 0.1). However, subgroup analyses revealed that this positive effect was not significant among middle-aged and older adults who were divorced (β = 0.190, P > 0.05), lived in special zone (β = -1.379, P > 0.05), and lacked medical insurance (β = 0.314, P > 0.05). Furthermore, mediation analysis revealed that inpatient services (β = 0.0215, P < 0.01) acted as a mediator in the relationship between internet use and self-rated health. Internet use positively correlates with self-rated health among middle-aged and older adults. Additionally, the utilization of health services can significantly influence this relationship. These findings underscore the importance of developing targeted government strategies to promote internet access and create a supportive online environment, thereby enhancing the health outcomes of this demographic group.

Transatlantic analysis of patient profiles and mid-term survival after isolated coronary artery bypass grafting: a head-to-head comparison between the European DuraGraft Registry and the US STS Registry.

Although cardiovascular surgery societies in Europe and the USA constantly strive for the exchange of knowledge and best practices in coronary artery bypass grafting (CABG), the available evidence on whether such efforts result in similar patient outcomes is limited. Therefore, in the present analysis, we sought to compare patient profiles and overall survival outcomes for up to 3 years between large European and US patient cohorts who underwent isolated CABG. Patients from the European DuraGraft Registry (n = 2,522) who underwent isolated CABG at 45 sites in eight different European countries between 2016 and 2019 were compared to randomly selected patients from the US STS database who were operated during the same period (n = 294,725). Free conduits (venous and arterial grafts) from the DuraGraft Registry patients were intraoperatively stored in DuraGraft, an endothelial damage inhibitor, before anastomosis, whereas grafts from the STS Registry patients in standard-of-care solutions (e.g., saline). Propensity score matching (PSM) models were used to account for differences in patient baseline and surgical characteristics, using a primary PSM with 35 variables (2,400 patients matched) and a secondary PSM with 25 variables (2,522 patients matched, sensitivity analysis). The overall survival for up to 3 years after CABG was assessed as the primary endpoint. The comparison of patient profiles showed significant differences between the European and US cohorts. The European patients had more left main disease, underwent more off-pump CABG, and received more arterial grafts together with more complete arterial grafting procedures. In contrast, the US patients received more distal anastomoses with more saphenous vein grafts (SVGs) that were mainly harvested endoscopically. Such differences, however, were well balanced after PSM for the mortality comparison. Mortality comparison at 30 days, 12 months, and 24 months between the European and US patients was 2.38% vs. 1.96%, 4.32% vs. 4.79%, and 5.38% vs. 6.96%, respectively. At 36 months, the mortality was significantly lower in the European patients than that of their US counterparts (7.37% vs. 9.65%; p-value = 0.016). The estimated hazard ratio (HR) was 1.29 (95% CI 1.05-1.59). This large-scale transatlantic comparative analysis shows that there are some significant differences in patient profiles between large cohorts of European and US patients. These differences were adjusted by using PSM for the mortality analysis. No significant difference in mortality was detected between groups through 2 years, but survival was significantly better in the European DuraGraft Registry patients at 3 years post-CABG.

Does environmental protection tax law accelerate energy transition? Evidence from electrification of 262 cities in China

While global climate risk is increasing substantially with greenhouse gas emission, energy transition is a key approach to alleviate this concern. This paper constructs the difference in difference model (DID) and the difference-in-differences based propensity score matching model (PSM-DID) to estimate the effects of China’s Environmental Protection Tax Law on energy transition and its transmission path. The empirical results show that (1) China’s Environmental Protection Tax Law can promote energy transition through electrification, and this conclusion is still valid after a series of robustness tests. (2) China’s Environmental Protection Tax Law can facilitate energy transition by improving both the quantity and the quality of industrial structure upgrading. The findings of this paper not only enrich the literature on the energy transition and environmental tax designs in developing countries but also provide an empirical reference for the government to promote energy transition orderly by implementing environmental tax.

Research on the Evaluation and Enhancement Strategies of College Students’ Health Human Capital in “Healthy Hunan” under the Background of Big Data

Abstract This paper precisely explores the structure and characteristics of college students’ healthy human capital and its influencing factors. It aims to enhance students’ positive and healthy mindset and promote optimism in life and learning. A solid analytical framework is constructed by sorting out the ordered multicategorical logistic regression model and parameter estimation methods and the application steps of the propensity score matching model. College students from ten colleges and universities in Hunan Province were selected as research subjects, and a questionnaire was designed to assess their healthy human capital. The specific factors affecting college students’ healthy human capital accumulation were analyzed in depth through the probability density analysis of propensity score matching, standard support hypothesis testing, and the parallel line test and regression results of the ordered multicategorical regression model. The findings show that the curves of the experimental and control groups after propensity score matching almost overlap in the [0.2,0.4] interval, indicating the method’s validity. A more important finding is that the number of college students with poor self-assessed physical health is 8.063 times higher than that of college students with self-assessed mental health as good, which emphasizes the significant impact of mental health on healthy human capital. Therefore, to effectively improve the health human capital of college students, students, families and universities must form a linkage mechanism and work together to cultivate college students’ health awareness.

The Determinants of Beef Cattle Market Participation on Beef Cattle Producers’ Welfare: A Case Study of West Shewa Zone, Oromia Region, Ethiopia

Due to their ability to produce meat, milk, leather, glue, gelatin, and other products that people may utilize, beef cattle are domesticated. Beef cattle production and marketing play a vital role in the growth and development of the globe and the African economy. Ethiopia has great potential for livestock population in Africa and in the world but earns less from beef cattle production and marketing. Ethiopian farmers are reluctant to beef cattle market participation. Their reluctant to participate in beef cattle marketing causes lack of beef cattle products in the market and causes high prices for beef cattle and its products. The research objective was to analyze the impact of beef cattle market participation on the welfare of beef cattle smallholder farmers in Ethiopia. The primary data come from 400 randomly selected beef cattle farmers involved in beef cattle production and marketing and actors. Descriptive statistics and inferential statistics propensity score matching (PSM) model have used to analyze the collected data. The data analysis result indicated that smallholder beef cattle farmers participating in beef cattle marketing and farmers’ annual per capita consumption expenditure (economic welfare) increased by 84% more than the nonbeef cattle market participants. We assume this is a first result and investigation in the study area. The research study is important for farmers, policymakers, researchers, and the academia in general. Providing education and training, promoting the participation of more women in beef cattle marketing, and promoting and encouraging more full-time beef cattle farmers are suggested recommendations.

Does basic medical insurance promote public health? Evidence from China family panel study.

To promote common prosperity, China government has devoted much financial resources to the basic medical insurance system, it is of great significance to improve the health level of the insured groups to prevent them from returning to poverty due to illness. Whether or not the basic medical insurance can improve health status is an important policy issue after China has win the absolute poverty alleviation movement. Based on the data of China Family Panel Studies this paper constructs a strong balanced panel data with two levels information, which including variables from family level and personal level. This paper uses the panel data fixed effect model and propensity score matching model to analysis. This paper finds that after controlling the family and personal confounding variables, the basic medical insurance has positive effect toward health status. With propensity score matching model, this paper finds that there is causality between basic medical insurance and public health. Basic medical insurance has a significant health effect, that is, basic medical insurance has a significant positive impact on individual self-rated health. Participating in basic medical insurance can significantly improve the ability of families to face risk shocks, promote the accumulation of health capital in families, promote the diversification of livelihood strategies, and effectively prevent the occurrence of returning to poverty due to illness.

Ablation for atrial fibrillation improves the outcomes in patients with heart failure with preserved ejection fraction.

Patients with heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) have worse clinical outcomes than those with sinus rhythm (SR). We aim to investigate whether maintaining SR in patients with HFpEF through a strategy such as AF ablation would improve outcomes. This is a cohort study that analysed 1034 patients (median age 69 [63-76] years, 46.2% [478/1034] female) with HFpEF and AF. Of these, 392 patients who underwent first-time AF ablation were assigned to the ablation group, and the remaining 642 patients, who received only medical therapy, were assigned to the no ablation group. The primary endpoint was a composite of all-cause death or rehospitalization for worsening heart failure. After a median follow-up of 39 months, the cumulative incidence of the primary endpoint was significantly lower in the ablation group compared to the no ablation group (adjusted hazard ratio [HR], 0.55 [95% CI, 0.37-0.82], P = 0.003) in the propensity score-matched model. Secondary endpoint analysis showed that the benefit of AF ablation was mainly driven by a reduction in rehospitalization for worsening heart failure (adjusted HR, 0.52 [95% CI, 0.34-0.80], P = 0.003). Patients in the ablation group showed a 33% relative decrease in atrial tachycardia/AF recurrence compared to the no ablation group (adjusted HR, 0.67 [95% CI, 0.54-0.84], P < 0.001). Among patients with HFpEF and AF, the strategy of AF ablation to maintain SR was associated with a lower risk of the composite outcome of all-cause death or rehospitalization for worsening heart failure.

Financial Stress and COVID-19: A Comprehensive Analysis of the Factors Associated with the Pandemic

The COVID-19 pandemic introduced unprecedented challenges for households globally, serving as a precursor to and trigger for financial stress. This study examined the associations across various factors thought to be associated with financial stress (a psychological syndrome) resulting from the COVID-19 pandemic. Using survey data collected in 2019 (n = 997) and 2021 (n = 988), propensity score matching and hierarchical linear modeling were employed to identify the association between financial stress and the pandemic. Results indicated that financial stress increased during the COVID-19 pandemic. Three covariate groups, including financial characteristics, health status, and socio-demographic characteristics, were found to be associated with financial stress levels. The primary contribution of this paper lies in offering a comprehensive understanding of how the dynamics of financial stress evolve with shifting macroeconomic events. This paper serves as a framework to employ a comprehensive financial stress measure and matched samples at various data points. Findings from this study contribute to the existing literature on financial well-being, financial stress, and societal outcomes associated with global health events while providing implications for policy and practice.

Preoperative prognostic nutritional index predicts postoperative delirium in aged patients after surgery: A matched cohort study

ObjectivePrognostic nutritional index (PNI) is an indicator to evaluate the nutritional immune status of patients. This study aimed to assess whether preoperative PNI could predict the occurrence of postoperative POD in aged patients undergoing non-neurosurgery and non-cardiac surgery. MethodThe aged patients undergoing non-neurosurgery and non-cardiac surgery between January 2014 and August 2019 were included in the retrospective cohort study. The correlation between POD and PNI was investigated by univariate and multivariable logistic regression analysis, propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and subgroup analysis. ResultsIn the cohort (n = 29,814), the cutoff value of PNI was 46.01 determined by the receiver operating characteristic (ROC) curve. In univariate and three multivariable regression analysis, the ORs of PNI ≤ 46.01 was 2.573(95% CI:2.261–2.929, P < 0.001),1.802 (95% CI:1.567-2.071, P < 0.001),1.463(95% CI:1.246–1.718, P < 0.001),1.370(95% CI:1.165–1.611, P < 0.001). In the PSM model and IPTW model, the ORs of PNI ≤ 46.01 were 1.424(95% CI:1.172–1.734, P < 0.001) and 1.356(95% CI:1.223–1.505, P < 0.001). ConclusionThe PNI was found to have a predictive value for POD in patients undergoing non-neurosurgery and non-cardiac surgery. Improving preoperative nutritional status may be beneficial in preventing POD for aged patients.

Polypharmacy in atrial fibrillation: A prospective analysis of mortality and ischemic stroke using the Clinical Practice Research Datalink.

Observational studies of polypharmacy and the risk of death or stroke in individuals with atrial fibrillation (AF) have produced inconsistent findings. By using propensity score matching (PSM) and Cox regression, this study aimed to determine whether polypharmacy (five to nine medicines) in the 3 months following AF diagnosis, is associated with an increased risk of death or ischemic stroke, compared to non-polypharmacy (one to four medicines). A prospective cohort study using data from the Clinical Practice Research Datalink (2006-2019). Data from 23 629 individuals with AF were analyzed. Cox regression models were adjusted for age, gender, morbidities, obesity, alcohol, smoking, and wealth. In the PSM models, cases and controls with near identical health profiles were selected from the study pool. The risk of death and stroke were presented as hazard ratios (HRs) with 95% confidence intervals (CIs). 68.9% (n = 16 271) of the participants had polypharmacy. PSM showed that polypharmacy was associated with an increased risk of death during follow-up (HR 1.32; 95% CI: 1.19-1.47, p < .01), but not ischemic stroke (HR 0.84; 95% CI: 0.69-1.02, p = .08). Polypharmacy was associated with an increased risk of death during follow-up, but not ischemic stroke, in individuals with AF. The effects of comorbidity and other confounding factors were reduced by using PSM. This study focused on the overall medication burden; however, further research is needed to identify which specific medications in polypharmacy regimens increase the risk of mortality in AF. These findings could inform prescribing practices in the future.

Do flexible exchange rates matter for monetary autonomy?

This paper studies the impact of exchange rate regimes on monetary autonomy, by applying a propensity score matching (PSM) model for 174 countries over the period 1970–2017. The PSM technique, that we used here to account for self-selection bias and endogeneity, reveals that the average treatment effect of flexible exchange rates on monetary autonomy is statistically significant, providing support for the impossible trinity. We also find that the effect of flexible exchange rates on monetary autonomy is more prominent in advanced economies than in emerging and developing ones. Furthermore, we show that the global financial recession (GFC) affects the monetary autonomy responses to flexible exchange rates. In particular, the GFC causes an increase in the level of monetary autonomy in countries adopting flexible exchange rates during the post-crisis period.

Relocation of hydropower immigrants and transformation of farmers’ energy consumption structure: an empirical study from western China

Based on the research perspective of hydropower migration, the energy consumption structure of farmers in western China was analyzed. The OLS, Probit, and propensity score matching models are used to empirically analyze the impact of the relocation of hydropower immigrants on the household energy consumption structure. The results show that: 1) Although the relocation of hydropower immigrants increases the energy consumption burden of farmers to a certain extent, it has a significant inhibitory effect on the quantity of energy consumption and can promote the improvement of the quality of energy consumption. 2) The age structure of the head of household is different in the impact of the relocation of hydropower immigrants on the energy consumption choices of the households. This difference has different effects on different groups and energy consumption structure, especially in the impact on the energy consumption quality of the households with duality. 3) For low-income households, the economic burden of improving the quality of energy consumption is still large, and income is still an important factor affecting the transformation and upgrading of the energy consumption structure of households. 4) Mechanism analysis shows that the relocation of hydropower immigrants can reduce the dependence of households on the quantity of energy consumption by affecting the increase of non-agricultural income and the decrease of agricultural income, but it cannot affect the quality of households’ energy consumption. 5) The moderating effect shows that the relocation of hydropower immigrants can enrich the information types and information elements of farmers, and coordinate the household energy consumption decisions affecting farmers from both digital information and traditional information, thus promoting the transformation and upgrading of the household energy consumption structure of farmers.

Effectiveness and impact of community-based health insurance on health service utilization in northwest Ethiopia: a quasi-experimental evaluation.

Addressing the health challenges of lower socioeconomic groups in Ethiopia is still a huge problem. In that regard, the government piloted the community-based health insurance (CBHI) in 2011 in a few districts and subsequently scaled up. However, the effectiveness of the program on the utilization of health services and its impact was not well explored. Thus, we aimed to evaluate the effectiveness of CBHI toward health services' utilization and its impact in northwest Ethiopia. A quasi-experimental matched comparison group evaluation design with sequential explanatory mixed methods was employed. To evaluate the CBHI program, the effectiveness and impact dimensions from the Organization for Economic Cooperation and Development framework were used. A multistage sampling technique was used to select a total of 332 households enrolled in the CBHI program; 341 comparison households who did not enroll in the program were also randomly selected. A structured interviewer-administrated questionnaire was used to evaluate the effectiveness and impact of CBHI on health service utilization. The Propensity score matching model was employed for the estimation of the effect of the CBHI program on health service utilization. Challenges for program achievement toward health service utilization were explained through qualitative data and these were then analyzed thematically. The evaluation showed 1.3 visits per capita per year of health service utilization among CBHI members. Households enrolled in CBHI increased health service utilization by 6.9 percentage points (ATT = 0.069; 95% CI: 0.034, 0.114). There was an improvement in health service utilization after the introduction of CBHI, however, there are challenges: (i) shortage of human resources, (ii) out-of-stock of drugs and medical supplies, and (iii) long waiting times for service and reimbursement claims. These issues limit the success of the program toward health service utilization. The CBHI program contributed to health service utilization improvement among CBHI members. However, the utilization rate of health services among CBHI members is still less than the target stated for the program and also the WHO recommendation. Therefore, the findings of this evaluation can be used by program implementers, policy makers, and other stakeholders to overcome the identified challenges and to increase the success of the program.

Assessing the prognostic impact of prostatic urethra involvement and developing a nomogram for T1 stage bladder cancer

PurposeTo investigate prognostic values of prostatic urethra involvement (PUI) and construct a prognostic model that estimates the probability of cancer-specific survival for T1 bladder cancer patients.Method and materialsWe investigated the national Surveillance, Epidemiology, and End Results (SEER) database (2004–2015) to get patients diagnosed with T1 bladder cancer. An external validation cohort was obtained from the First Affiliated Hospital of Nanchang University. The Kaplan–Meier method with the log-rank test was applied to assess cancer-specific survival (CSS) and overall survival (OS). Moreover, the propensity score matching (PSM) and multivariable Cox proportional hazard model were performed. All patients were randomly divided into the development cohort and validation group at the ratio of 7:3. The performance of the model was internally validated by calibration curves and the concordance index (C-index).ResultsThe PUI group had a lower survival rate of both CSS and overall survival OS before and after PSM when compared to non-involved patients (All P < 0.05). Multivariate analysis revealed a poor prognosis in the PUI group for cancer-specific mortality (CSM) and all-cause mortality (ACM) analyses before and after PSM (All P < 0.05). Seven variables, including age, surgery, radiotherapy, tumour size, PUI, and marital status, were incorporated in the final nomogram. The C-index in the development cohort was 0.715 (0.711–0.719), while it was 0.672 (0.667–0.677) in the validation group. Calibration plots for 3- and 5-year cancer-specific survival showed good concordance in the development and validation cohorts.ConclusionsPUI was an independent risk factor of ACM and CSM in T1 bladder cancer patients. In addition, a highly discriminative and precise nomogram that predicted the individualized probability of cancer-specific survival for patients with T1 bladder cancer was constructed.

Characteristics and outcome of chest pain among patients with and without a history of cancer

Abstract Background Progress in medical oncology has led to remarkable contributions and prolonged life expectancy among cancer patients. Despite the improved prognosis, cancer treatment is associated with adverse cardiovascular outcomes in the oncologic population. This study aims to investigate the clinical characteristics and outcomes of cancer survivors presenting to the emergency department with chest pain. Methods We included consecutive adult patients (18 years and older) who presented at a large tertiary medical center, with chest pain between 2007 and 2022 and were hospitalized for further investigation. All-cause mortality and cancer data were available for all patients from national registries. Patients with active cancer were excluded. Patients were divided into two groups; (1) past cancer (defined as no oncologic therapy in the previous 6 months) and (2) no cancer history. A binary logistics regression model was used to identify patients diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI), pulmonary embolism, new-onset atrial fibrillation, or death within 30 days of presentation. Results Final study population included 37,633 patients with a median age of 65 (IQR, 55-75), of whom 13,089 (34.8%) were women. There were 1807 (5%) patients with a history of cancer and 35,829 (95%) with no oncologic background. Patients with a cancer history were older (65 vs. 64, p&amp;lt;0.001) and were less likely to be men (50% vs. 66%, P&amp;lt;0.001). Univariate binary logistic regression demonstrated that cancer survivors were almost three times more likely to meet the study end-point and to have a cardiovascular diagnosis during hospitalization (OR 2.55, 95% CI 2.24-2.91, p&amp;lt;0.001). The association was consistent in a multivariate model (OR 1.7, 95% CI 1.46-1.96, p&amp;lt;0.001) and was more pronounced among females. During a median follow-up of 5.8 years (IQR, 2.4-8.1), 6,987 patients died. Kaplan-Meier survival analysis demonstrated that cancer survivors were more likely to die during follow-up (7.2% vs. 2.2%, respectively, log-rank P&amp;lt;0.001). A propensity score matching model demonstrated that cancer survivors were twice more likely to meet the study end-point of in-hospital cardiovascular diagnosis or mortality within 30 days (17% vs. 8%, p&amp;lt;0.001). Conclusions Among patients hospitalized with chest pain, those with an oncologic background are twice more likely to have a cardiovascular diagnosis that can explain their symptoms. In addition, these patients are at risk for short and long-term mortality. Our results support including a history of cancer in risk stratification models of patients presenting with chest pain.Kaplan-Meier curve by oncologic historyCardiovascular endpoints (log. scale)

Abstract 16587: Sodium Glucose Cotransporter-2 Inhibitors Post Acute Coronary Syndrome Induced New Heart Failure

Introduction: Patients with acute coronary syndrome (ACS) have an unmet need for further risk reduction in major adverse cardiovascular events (MACE) and heart failure (HF) development despite guideline-directed medical therapy. As sodium glucose cotransporter-2 inhibitors (SGLT2i) are cardioprotective, in this study, we assessed the effectiveness of SGLT2i post-ACS with new onset HF. Hypothesis: SGLT2i use improves the effectiveness outcomes post-ACS induced new HF. Methods: We conducted a retrospective observational cohort study that included all diabetic patients admitted to the main tertiary cardiology center in Qatar between 1/06/2017 and 1/06/2021 with ACS complicated by new HF defined as new clinical HF requiring diuretics during the index admission, or ejection fraction (EF) &lt;40%. We divided the study population in two groups; (1) SGLT2i users; (2) non-SGLT2i users. Primary outcomes were evaluated at 30 and 360 days, including a composite of ACS, HF hospitalization, and all-cause mortality. A propensity score-matched model (1:1) was used to adjust for baseline characteristics between the study groups. Cox proportional hazard regression analysis was used to evaluate the outcomes. P-value &lt;0.05 indicated statistical significance. Results: We included 465 ACS patients who met the eligibility criteria (93% male, mean age 55±10 years, and 72% Asian). Using 1:1 propensity score matching, 78 patients were included per arm with an absolute standardized difference &lt;0.1 for all baseline characteristics. The use of SGLT2i post ischemia-induced new HF resulted in lower composite outcomes at 30 and 360 days [ 30-day: 2.6% vs. 11.5%, HR= 0.20 (0.04-0.94), P =0.041; 360-Day: 14.1% vs. 23.1, HR= 0.46 (0.22-0.99), P= 0.046]. Conclusions: Our findings suggest cardioprotective effects of SGLT2i post-ACS induced new HF, which widens the SGLT2i spectrum of indications and may encourage cardiologists to prescribe SGLT2i for this population.

Abstract 17959: Cardiovascular Outcomes and Readmissions of Atrial Fibrillation Among Patent Foramen Ovale Occluder Device Recipients : A Propensity Matched National Readmission Study

Introduction: Patent foramen ovale (PFO) occluder devices are increasingly utilized minimally invasive procedures used to treat cryptogenic stroke. Data on the impact of Atrial Fibrillation (AF) among PFO occluder device recipients are limited. Methods: The Nationwide Readmissions Database was queried between 2016 to 2019 to identify PFO patients with and without AF. The two groups were compared using propensity score matching (PSM) and multivariate regression models. The outcomes included in-hospital mortality, acute kidney injury (AKI), Mechanical circulatory support use (MCS), Cardiogenic shock (CS) acute ischemic stroke, bleeding and other cardiovascular outcomes. Statistical analysis was performed using STATA v. 17. Results: Out of 6,508 Weighted hospitalizations for PFO occluder device procedure over the study period, 877 (13.4%) had AF compared to 5,631 (86.6%) who did not. On adjusted analysis, PFO with AF group had higher rates of MCS (PSM, 4.5% vs. 2.2 %, p value=0.011) and SCA (PSM, 7.6% vs. 4.6 %, p value=0.015) compared to PFO with no AF. There was no statistically significant difference in the rate of in hospital mortality (PSM, 5.4% vs. 6.4 %, p value=0.39), CS (PSM, 8.3% vs. 5.9 %, p value=0.075), AKI (PSM, 32.4% vs. 32.3 %, p value=0.96), bleeding (PSM, 2.08% vs. 1.3 %, p value=0.235) or the readmission rates among both cohorts. Additionally, AF was associated with higher hospital length of stay (9.5 +/-13.2 vs. 8.2 +/-24.3 days, p value =0.012 ) and total cost ($66,513+/-$80,922 vs. $52,013+/-$125,136, 0.025, p value = 0.025) compared to PFO without AF. Conclusions: The presence of AF among PFO occluder device recipients is associated with increased adverse outcomes including MCS use and SCA with no difference in mortality and the readmission rates among both cohorts. Long term follow up needs further studies.

Optimal Treatment Strategies for Resectable Locally Advanced Esophageal Squamous Cell Carcinoma: A Real-World Triple Cohort Analysis Using Propensity Score Matching.

This study aims to identify the most effective treatment approach and compares the survival rates, along with complications, in patients with locally resectable esophageal squamous cell carcinoma (ESCC) who were treated with one of the three treatment patterns: neoadjuvant chemotherapy followed by surgery (NCT+S), neoadjuvant chemoradiotherapy followed by surgery (NCRT+S), or surgery followed by chemoradiotherapy (S+CRT). We conducted a retrospective analysis of the medical records of ESCC patients who received one of these treatments between March 2015 and March 2022. This analysis aimed to identify differences in long-term survival, pathological responses, and complications across the three treatment groups. To address potential confounding factors, propensity score matching (PSM) and Cox proportional hazards models were utilized. This study included a cohort of 715 patients: 197 in the NCT+S group, 188 in the NCRT+S group, and 330 in the S+CRT group, all meeting the selection criteria. After PSM, the median disease-free survival (DFS) time was 38.9 months, 25.6 months, and 15.3 months for NCRT+S, NCT+S, and S+CRT groups, respectively. There were statistically significant differences in the 5-year DFS and 5-year OS among the three groups (P=0.04 and P=0.02, post-matching, respectively). Notably, neoadjuvant therapy showed a correlation with increased postoperative anastomotic leakage rates (17.5% in NCRT+S, 10% in NCT+S, and 5% in S+CRT; P=0.03, post-matching), regardless of the PSM adjustment. The findings indicate that neoadjuvant therapy before surgery offers a significant survival advantage over postoperative adjuvant therapy for patients with locally advanced resectable ESCC. Despite similar safety profiles, neoadjuvant therapy appears to be associated with a higher incidence of anastomotic leakage after surgery.

The impact of previous conservative treatment of atypical hyperplasia on pregnancy outcomes after IVF/ICSI-embryo transfer: a propensity score-matched retrospective cohort study.

Do women have worse pregnancy and neonatal outcomes of IVF/ICSI-fresh embryo transfer (ET) after conservative treatment of atypical hyperplasia (AH)? AH has no impact on live birth but is associated with increased risks of pregnancy loss and preterm delivery (PTD). AH is a precancerous lesion of endometrial cancer. Several recognized AH risk factors include nulliparity, increased body mass index, ovulation disorders, diabetes mellitus, and others. As such, patients are suggested to attempt conception upon achieving AH regression. Recently, successful pregnancies with IVF/ICSI have been increasingly reported. Forty-two patients with AH regression and 18700 women with no evidence of endometrial abnormality, who underwent their first autologous oocytes' retrieval and fresh ET cycles of IVF/ICSI in the Center for Reproductive Medicine, Shandong University, from May 2008 to July 2021, were retrospectively enrolled. First, 42 AH patients were propensity score matched with control women (n = 168) at a 1:4 ratio. Reproductive outcomes and maternal/neonatal complications were compared between the matched pairs. Binary logistic regression analyses were conducted to assess odds ratios (ORs) of AH for live birth, pregnancy loss, and PTD from AH women and all 18700 eligible controls. Patients with AH achieved a numerically lower live birth rate (LBR) as compared to the matched controls, but without significant difference (26% versus 37%, P = 0.192). However, compared with the matched controls, AH patients showed significantly higher rates of pregnancy loss (52% versus 21%, P = 0.003) and PTD (45% versus 16%, P = 0.041). Further analyses revealed a statistically significantly increased rate of late pregnancy loss (17% versus 3%, P = 0.023), but not early miscarriage (35% versus 18%, P = 0.086), in the AH group. Furthermore, after correcting for potential confounders, the likelihood of a live birth in AH patients narrowly failed to be statistically significantly different from controls (adjusted OR [aOR]: 0.51, 95% CI: 0.25-1.04, P = 0.064). Nonetheless, the logistic regression reconfirmed that AH was an independent risk factor for pregnancy loss (aOR: 3.62, 95% CI: 1.55-8.46, P = 0.003), late pregnancy loss (aOR: 9.33, 95% CI: 3.00-29.02, P < 0.001), and PTD (aOR: 5.70, 95% CI: 1.45-22.38, P = 0.013). Selection bias was an inherent drawback of this study. First, because of the low AH prevalence among women receiving IVF/ICSI treatment, and consequently, limited sample size, the relationship between AH with LBR and adverse complications might be concealed and underestimated. Hence, the results should be interpreted cautiously. Similarly, the impacts of diverse clinical features of AH patients on the pregnancy outcomes need further studies in a larger population. Second, although most data used in this study were obtained by reviewing the medical records, missing data did exist and so did the recall bias. Third, although the propensity score matching and multivariable logistic models were performed collectively in order to minimize potential confounders between AH and controls, the intrinsic disadvantages of the retrospective nature of this study could not be avoided completely, and additional confirmation bias might be induced with reduplication of statistical analyses. Our results highlight the necessity of adequate counseling and intensive pregnancy monitoring for AH individuals and their families. This work was supported by grants from the National Key Research & Developmental Program of China (2022YFC2703800), the Natural Science Foundation of Shandong Province (ZR2022MH009), and Projects of Medical and Health Technology Development Program in Shandong Province (202005010520, 202005010523). There are no conflicts of interest to declare. N/A.

Association between polyunsaturated fatty acid intake and the prevalence of erectile dysfunction: A cross-sectional analysis of the NHANES 2001–2004

BackgroundPolyunsaturated fatty acids (PUFAs) have demonstrated significant therapeutic potential across a wide range of disease. The aim of this study was to investigate the potential impact of PUFA intake on the prevalence of erectile dysfunction (ED).MethodsThe study included a total of 3730 participants from the National Health and Nutrition Examination Survey (NHANES) 2001–2004. Univariate analysis, multivariate regression analysis, subgroup analysis and machine learning were utilized to explore the relationship of variables to ED. Dose response curves were constructed to observe the linear or nonlinear relationship between PUFA intake and the prevalence of ED. Propensity score matching (PSM) was used for sensitivity analysis. Finally, the potential mechanistic link between PUFA intake and ED was explored.ResultsThrough univariate and multivariate regression analysis results before and after PSM and XGBoost algorithm model results, arachidonic acid (AA) was chosen as the main research object. The consumption of AA was found to be associated with a decreased prevalence of ED under the fully adjusted model [OR = 0.33 (0.20, 0.56), P < 0.001]. The interaction between AA and education was found in the subgroup analysis. Dose-response curves indicated a linear negative correlation between AA intake and the prevalence of ED. The above results were confirmed in the data analysis after 1:1 PSM. In addition, AA intake was associated with a decrease in inflammatory biomarkers and homocysteine.ConclusionsThe results suggest that AA intake is negatively correlated with the prevalence of ED. Further, anti-inflammatory and anti-endothelial damage may play a role in this.