Research on Graded Management of Construction Risk Factors of a Subway Station

Based on a subway station project, this paper puts forward the risk factors in the process of subway construction. The analytic hierarchy process (AHP) is used to establish the risk factor model of metro station. Establishes the risk judgment matrix at all levels by combining the results of expert investigation method. By evaluating the risk factors of the subway station, the weight values of the above risk factors are calculated and sorted. As a result, the risk management system of subway station is put forward.The research results of this method provide a theoretical basis for the project managers to determine the risk factors, and lay a foundation for the smooth progress of the subway station construction project.

Progression from Ocular Hypertension into Glaucoma

Ocular hypertension (OHT) is characterized by raised intraocular pressure (IOP) >21 mmHg without any visual field (functional) or optic nerve (structural) defect featuring glaucoma. Raised IOP is a major risk factor of glaucoma and a proportion of eyes with OHT progresses into primary open angle glaucoma. Glaucoma is a debilitating disease with potential for blindness if left untreated and associated reduction in the quality of life of the affected individual. It is challenging for the clinicians to decide whether an OHT will progress into glaucoma or not based on the risk factor model of the Ocular hypertension treatment study. Moreover, the question whether only IOP or a myriad of factors like central corneal thickness, baseline IOP, visual field, family history of glaucoma, ocular biomechanics are all important in determining the progression is yet to be answered. The rate of progression is also important and needs analysis for further discussion. Summarizing the landmark studies on ocular hypertension and glaucoma to date are imperative in this regard. This chapter presents the overview of OHT and its possible etiology and pathophysiology, risk factors, clinical tests evaluating OHT eyes and elaborates on the progression of OHT to glaucoma over time in relation to the treatment.

Constructe a novel 5 hypoxia genes signature for cervical cancer

Background Hypoxia, which affects the development, metastasis and prognosis of cancer, represents a key feature of cancer. This study describe a hypoxia risk factor model, with predicting the prognosis of cervical cancer. Methods Based on hypoxia pathway related genes, we divided cervical cancer samples into high and low expression groups. A cox analysis was then performed. Genes from these cervical cancer samples showing a significant impact on OS were selected for cluster analysis to obtain two subtypes. The TPM dataset of TCGA was divided into training and validation sets. For the training set, a lasso analysis was conducted as based on cox analysis of meaningful genes and a risk factor model was constructed. The constructed model was verified in internal and external data sets. Finally, RT-PCR, immunohistochemistry were used to detect the expression of relative genes or proteins and functional assays were used to evaluate the biological function of signature genes. Results Two molecular subtypes were obtained, Cluster2 vs Cluster1.These subtypes were obtained by clustering with a total of 149 DEGs (Differential expressed genes) being in line with this standard, of which 27 were up-regulated and 122 were down-regulated. The five genes with lambda = 0.0571 were selected to construct the model, the RiskScore = AK4*0.042 + HK2*0.021 + P4HA1*0.22 + TGFBI*0.1 + VEGFA*0.077. Further, in order to verify the signature, we used TCGA-test and GSE44001 chip datasets to test, and finally got a good risk prediction effect in those datasets. Moreover, the result of RT-PCR and immunohistochemistry demonstrated that AK4, HK2, P4HA1, TGFBI and VEGFA were all highly expressed in these cervical cancer tissue samples. The functional study shown that expression of AK4, HK2, P4HA1, TGFBI and VEGFA can regulate the proliferation, migration, and invasion ability of cervical cancer cells in vitro. Conclusions In summary, we developed a 5-gene signature prognostic hierarchical system based on the hypoxic pathway of cervical cancer, which is independent of clinical characteristics. And also conducted experimental verifications on these signature gene. Therefore, we propose that use of this classifier as a molecular diagnostic test can provide an effective means for evaluating the prognostic risk of cervical cancer patients, and provide potential targets for the treatment of cervical cancer patients.

Metabolic Abnormalities Rather Than BMI, Associated With Increased Risk of Recurrent Stroke in Chinese Hospitalized Stroke Patients: A Retrospective Study

Background Metabolic abnormalities and body mass index (BMI) are known as apparent risk factors of recurrent stroke, but which one is more likely related to recurrent stroke remains uncertain. This study aimed to compare the metabolic phenotypes and BMI as indicators of recurrent stroke in Chinese hospitalized stroke patients. Methods In this retrospective population-based study, 856 hospitalized stroke patients from the Third Affiliated Hospital of Soochow University were enrolled. Recurrent stroke was defined as newly-onset stroke patients with a history of previous stroke. Metabolic phenotypes were categorized based on Adult Treatment Panel III criteria. BMI ≥ 25kg/m2 was defined as obesity. Results Among the hospitalized stroke patients, the prevalence of recurrent stroke was 21.9%. Metabolic abnormalities rather than BMI were significantly associated with recurrent stroke. Compared with metabolically healthy patients, metabolically unhealthy ones had 72% (odds ratio [OR] = 1.72, 95% confidence interval [CI] 1.01–2.68) increased risk of recurrent stroke, regardless of BMI and other confounding factors. Whereas, no statistical association between BMI and recurrent stroke were found. Metabolic status significantly improved risk prediction of recurrent stroke when adding to the conventional-risk-factor model (net reclassification index 17.6%, P = 0.0047; integrated discrimination improvement 0.7%, P = 0.014), while BMI did not. Conclusions Recurrent stroke is likely associated with metabolic abnormalities rather than with BMI. For the secondary prevention of stroke, controlling metabolic abnormalities is a more crucial method then BMI controlling in stroke patients.

Kidney age - chronological age difference (KCD) score provides an age-adapted measure of kidney function

Background Given the age-related decline in glomerular filtration rate (GFR) in healthy individuals, we examined the association of all-cause death or cardiovascular event with the Kidney age - Chronological age Difference (KCD) score, whereby an individual’s kidney age is estimated from their estimated GFR (eGFR) and the age-dependent eGFR decline reported for healthy living potential kidney donors. Methods We examined the association between death or cardiovascular event and KCD score, age-dependent stepped eGFR criteria (eGFRstep), and eGFR < 60 ml/min/1.73 m2 (eGFR60) in a community-based high cardiovascular risk cohort of 3837 individuals aged ≥60 (median 70, interquartile range 65, 75) years, followed for a median of 5.6 years. Results In proportional hazards analysis, KCD score ≥ 20 years (KCD20) was associated with increased risk of death or cardiovascular event in unadjusted analysis and after adjustment for age, sex and cardiovascular risk factors. Addition of KCD20, eGFRstep or eGFR60 to a cardiovascular risk factor model did not improve area under the curve for identification of individuals who experienced death or cardiovascular event in receiver operating characteristic curve analysis. However, addition of KCD20 or eGFR60, but not eGFRstep, to a cardiovascular risk factor model improved net reclassification and integrated discrimination. KCD20 identified individuals who experienced death or cardiovascular event with greater sensitivity than eGFRstep for all participants, and with greater sensitivity than eGFR60 for participants aged 60–69 years, with similar sensitivities for men and women. Conclusions In this high cardiovascular risk cohort aged ≥60 years, the KCD score provided an age-adapted measure of kidney function that may assist patient education, and KCD20 provided an age-adapted criterion of eGFR-related increased risk of death or cardiovascular event. Further studies that include the full age spectrum are required to examine the optimal KCD score cut point that identifies increased risk of death or cardiovascular event, and kidney events, associated with impaired kidney function, and whether the optimal KCD score cut point is similar for men and women. Trial registration ClinicalTrials.gov NCT00400257, NCT00604006, and NCT01581827.

Predictive value of visit-to-visit blood pressure variability for cardiovascular events in patients with coronary artery disease with and without diabetes mellitus

Background High blood pressure is a major risk factor for cardiovascular disease. Visit-to-visit blood pressure variability (BPV) has recently been shown to predict cardiovascular outcomes. We investigated the predictive value of BPV for major adverse cardiovascular events (MACE) among patients with coronary artery disease (CAD), with and without type 2 diabetes mellitus (T2DM). Methods Patients with stable CAD were enrolled and monitored for new MACE. Visit-to-visit BPV was defined as the coefficient of variation (CV) of systolic and diastolic BP across clinic visits. Multivariable logistic regression analysis was performed to evaluate the association of BPV with MACE. Area under the receiver operating characteristic curve (AUC) was used to assess its predictive ability. Results Among 1140 Chinese patients with stable CAD, 192 (17%) experienced a new MACE. In multivariable analyses, the risk of MACE was significantly associated with CV of systolic BP (odds ratio [OR] for highest versus lowest quartile, 3.30; 95% CI 1.97–5.54), and diastolic BP (OR for highest versus lowest quartile, 2.39; 95% CI 1.39–4.11), after adjustment for variables of the risk factor model (age, gender, T2DM, hypertension, antihypertensive agents, number of BP measurements) and mean BP. The risk factor model had an AUC of 0.70 for prediction of MACE. Adding systolic/diastolic CV into the risk factor model with mean BP significantly increased the AUC to 0.73/0.72 (P = 0.002/0.007). In subgroup analyses, higher CV of systolic BP remained significantly associated with an increased risk for MACE in patients with and without T2DM, whereas the association of CV of diastolic BP with MACE was observed only in those without T2DM. Conclusions Visit-to-visit variability of systolic BP and of diastolic BP was an independent predictor of new MACE and provided incremental prognostic value beyond mean BP and conventional risk factors in patients with stable CAD. The association of BPV in CAD patients without T2DM with subsequent risk for MACE was stronger than in those with T2DM.

Combining renal cell arrest and damage biomarkers to predict progressive AKI in patient with sepsis

Background Sepsis is the most common trigger for AKI and up to 40% of mild or moderate septic AKI would progress to more severe AKI, which is associated with significantly increased risk for death and later CKD/ESRD. Early identifying high risk patients for AKI progression is a major challenge in patients with septic AKI. Objectives This study aims to evaluated the utility of combining renal cell arrest and damage biomarkers for predicting the progression of AKI in patient with sepsis. Methods This is a prospective, multicenter cohort study which enrolled adult patients with sepsis and initially developed stage 1 or 2 AKI from January 2014 to March 2018. AKI was diagnosed and staged according to 2012 KDIGO-AKI guidelines. Renal cell arrest biomarkers (urinary TIMP2*IGFBP7, u[TIMP-2]*[IGFBP7]) and renal damage biomarkers (urinary KIM-1[uKIM-1] and urinary IL-18 [uIL-18]) were measured at time of AKI clinical diagnosis, and the utility of biomarkers for predicting septic AKI progression alone or in combination were evaluated. The primary outcome was AKI progression defined as worsening of AKI stage. The second outcome was AKI progression with subsequent death during hospitalization. Results Among 433 screened patients, 149 patients with sepsis and stage 1 or 2 AKI were included, in which 63 patients developed progressive AKI and 49 patients subsequently died during hospitalization. u[TIMP-2]*[IGFBP7], uKIM-1 and uIL-18 independently predicted the progression of septic AKI in which u[TIMP-2]*[IGFBP7] showed the greatest AUC (0.745; 95%CI, 0.667–0.823) as compared to uKIM-1 (AUC 0.719; 95%CI 0.638-0.800) and uIL-18 (AUC 0.619; 95%CI 0.525–0.731). Combination of u[TIMP-2]*[IGFBP7] with uKIM-1 improved the performance of predicting septic AKI progression with AUC of 0.752. u[TIMP-2]*[IGFBP7], alone or combined with uKIM-1/uIL-18, improved the risk reclassification over the clinical risk factor model alone both for the primary and secondary outcomes, as evidenced by significant category-free net reclassification index. Conclusions Combination of renal cell arrest and damage biomarkers enhanced the prediction of AKI progression in patients with sepsis and improved risk reclassification over the clinical risk factors.

Hubungan Insomnia dengan Hipertensi

Insomnia and hypertension are very common and often coexist. There is evidence to suggest that the increase in the prevalence of hypertension in the past decade may be related to an increase of the prevalence of insomnia and with a decrease in sleep duration caused by modern lifestyles. The purpose of this study was to look at the association and magnitude of risk of insomnia with hypertension. This study used secondary data from the 2014 Indonesia Family Life Survey (IFLS5) with respondents ≥19 years old. Conceptual framework with a risk factor model approach. Insomnia disorders are the main independent variable, and hypertension is the main dependent variable. Confounding variables are age, overweight and sex. Association of insomnia disorders to hypertension was analyzed using multiple logistic regression analysis with the significance of P value <0.05. The prevalence of insomnia sufferers aged ≥19 years old in Indonesia based on IFLS5 data was 43.7%. This analysis showed that insomnia was not associated with the incidence of hypertension P>0.05; OR: 0.937 (95% CI 0.873-1.006). The variables associated with the risk of hypertension were age ≥ 40 years old with OR: 5,246 (95% CI 4,885-5,598) and overweight with OR: 2,112 (95% CI 1,985-2,269). In this study, age and overweight contributed 18.9% to the incidence of hypertension. Abstrak Insomnia dan hipertensi sangat umum dan sering kali berdampingan. Bukti menunjukkan bahwa peningkatan prevalensi hipertensi dalam dekade terakhir kemungkinan terkait dengan peningkatan prevalensi insomnia dan penurunan durasi tidur yang disebabkan oleh gaya hidup modern. Tujuan dari penelitian ini adalah untuk melihat hubungan dan besaran risiko insomnia terhadap hipertensi. Penelitian ini menggunakan data sekunder Indonesia Family Life Survey tahun 2014 (IFLS5) dengan responden berumur ≥19 tahun. Kerangka konsep dengan pendekatan model faktor risiko. Gangguan insomnia merupakan variabel independen utama, dan hipertensi adalah variabel dependent utama. Variabel perancu adalah umur, kelebihan berat badan (overweight) serta jenis kelamin. Untuk melihat hubungan gangguan insomnia dengan hipertensi menggunakan analisis regresi logistik berganda dengan kemaknaan P value < 0,05. Prevalensi penderita insomnia umur ≥19 tahun di Indonesia berdasarkan data IFLS5 adalah sebesar 43,7%. Analisis ini menunjukkan bahwa insomnia tidak berhubungan dengan kejadian hipertensi P>0,05; OR: 0,937 (95% CI 0,873-1,006). Variabel yang berhubungan dengan risiko hipertensi adalah umur ≥ 40 tahun dengan OR: 5,246 (95% CI 4,885-5,598) serta overweight dengan OR: 2,112 (95% CI 1,985-2,269). Pada penelitian ini umur dan overweight memberikan kontribusi terhadap kejadian hipertensi sebesar 18,9%.