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Prevalence and risk factors for impaired renal function among Asian patients with nonalcoholic fatty liver disease

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Hepatobiliary & Pancreatic Diseases International 2024年第3期23卷 241-248页

作者： Chao Sun George Boon-Bee Goh Wan-Cheng Chow Wah-Kheong Chan grace lai-hung wong Wai-Kay Seto Yi-Hsiang Huang Han-Chieh Lin I-Cheng Lee Hye Won Lee Seung Up Kim Vincent Wai-Sun wong Jian-Gao Fan Center for Fatty Liver Disease Department of GastroenterologyXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai Key Lab of Pediatric Gastroenterology and NutritionShanghai 200092China Department of Gastroenterology&Hepatology Singapore General HospitalSingaporeSingapore Gastroenterology and Hepatology Unit Department of MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia Department of Medicine and Therapeutics and State Key Laboratory of Digestive Disease The Chinese University of Hong KongHong KongChina Department of Medicine The University of Hong KongHong KongChina Institute of Clinical Medicine National Yang Ming Chiao Tung University School of MedicineTaipeiTaiwanChina Division of Gastroenterology and Hepatology Taipei Veterans General HospitalTaipeiTaiwanChina Faculty of Medicine National Yang Ming Chiao Tung University School of MedicineTaipeiTaiwanChina Department of Internal Medicine Yonsei University College of MedicineSeoulKorea

Background:Nonalcoholic fatty liver disease(NAFLD)is associated with impaired renal function,and both diseases often occur alongside other metabolic ***,the prevalence and risk factors for impaired renal function in patients with NAFLD remain *** objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD ***:All adults aged 18-70 years with ultrasound-diagnosed NAFLD and transient elastography examination from eight Asian centers were enrolled in this prospective *** fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase(FAST),Agile 3+and Agile 4 *** renal function and chronic kidney disease(CKD)were defined by an estimated glomerular filtration rate(eGFR)with value of<90 mL/min/1.73 m^(2) and<60 mL/min/1.73 m^(2),respectively,as estimated by the CKD-Epidemiology Collaboration(CKD-EPI)***:Among 529 included NAFLD patients,the prevalence rates of impaired renal function and CKD were 37.4%and 4.9%,*** multivariate analysis,a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+and Agile 4 scores were independent risk factors for CKD(P<0.05).Furthermore,increased fasting plasma glucose(FPG)and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome(P<0.05).Compared with patients with normoglycemia,those with prediabetes[FPG≥5.6 mmol/L or hemoglobin A1c(HbA1c)≥5.7%]were more likely to have impaired renal function(P<0.05).Conclusions:Agile 3+and Agile 4 are reliable for identifying NAFLD patients with high risk of *** glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.

关键词： Nonalcoholic fatty liver disease Impaired renal function Agile 3+ Agile 4 Metabolic syndrome

Hepatocyte apoptosis fragment product cytokeratin-18 M30 level and non-alcoholic steatohepatitis risk diagnosis:an international registry study

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Chinese Medical Journal 2023年第3期136卷 341-350页

作者： Huai Zhang Rafael S.Rios Jerome Boursier Rodolphe Anty Wah-Kheong Chan Jacob George Yusuf Yilmaz Vincent Wai-Sun wong Jiangao Fan Jean-Francois Dufour George Papatheodoridis Li Chen Jorn M.Schattenberg Junping Shi Liang Xu grace lai-hung wong Naomi F.Lange Margarita Papatheodoridi Yuqiang Mi Yujie Zhou Christopher D.Byrne Giovanni Targher Gong Feng Minghua Zheng Department of Biostatistics and Medical Record The First Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiang 325000China Department of Hepatology MAFLD Research CenterThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiang 325000China Service d’Hépato-Gastroentérologie et Oncologie Digestive Centre Hospitalier Universitaire d’AngersAngersFrance Laboratoire HIFIH UPRES EA3859SFR ICAT 4208Universitéd’AngersAngersFrance Université Cote d’Azur CHUINSERMU1065C3M06204 NiceFrance Gastroenterology and Hepatology Unit Department of MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia Storr Liver Centre Westmead Institute for Medical ResearchWestmead Hospital and University of SydneySydneyNSWAustralia Department of Gastroenterology School of MedicineMarmara UniversityIstanbulTurkey Department of Gastroenterology School of MedicineRecep Tayyip Erdogan UniversityRizeTurkey Department of Medicine and Therapeutics The Chinese University of Hong KongHong Kong 999077China Department of Gastroenterology Xinhua HospitalShanghai Jiao Tong University School of MedicineShanghai 200000China University Clinic for Visceral Surgery and Medicine InselspitalUniversity Hospital BernBernSwitzerland Graduate School for Health Sciences University of BernBernSwitzerland Academic Department of Gastroenterology Medical School of National and Kapodistrian University of AthensGeneral Hospitalof Athens“Laiko”AthensGreece Department of Gastroenterology Ruijin HospitalShanghai 200000China Metabolic Liver Research Program I Department of MedicineUniversity Medical Center MainzMainzGermany The Affiliated Hospital of Hangzhou Normal University HangzhouZhejiang 310000China Tianjin Second People’s Hospital Tianjin 300000China Division of Gastroenterology and Hepatology Key Laboratory of Gastroenterology and HepatologyMinistry of HealthRenji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai Institute of Digestive DiseaseShanghai 200000Ch

Background:Liver biopsy for the diagnosis of non-alcoholic steatohepatitis(NASH)is limited by its inherent invasiveness and possible sampling *** studies have shown that cytokeratin-18(CK-18)concentrations may be useful in diagnosing NASH,but results across studies have been *** aimed to identify the utility of CK-18 M30 concentrations as an alternative to liver biopsy for non-invasive identification of ***:Individual data were collected from 14 registry centers on patients with biopsy-proven non-alcoholic fatty liver disease(NAFLD),and in all patients,circulating CK-18 M30 levels were *** with a NAFLD activity score(NAS)≥5 with a score of≥1 for each of steatosis,ballooning,and lobular inflammation were diagnosed as having definite NASH;individuals with a NAS≤2 and no fibrosis were diagnosed as having non-alcoholic fatty liver(NAFL).Results:A total of 2571 participants were screened,and 1008(153 with NAFL and 855 with NASH)were finally *** CK-18 M30 levels were higher in patients with NASH than in those with NAFL(mean difference 177 U/L;standardized mean difference[SMD]:0.87[0.69–1.04]).There was an interaction between CK-18 M30 levels and serum alanine aminotransferase,body mass index(BMI),and hypertension(P<0.001,P=0.026 and P=0.049,respectively).CK-18 M30 levels were positively associated with histological NAS in most *** area under the receiver operating characteristics(AUROC)for NASH was 0.750(95%confidence intervals:0.714–0.787),and CK-18 M30 at Youden’s index maximum was 275.7 U/*** sensitivity(55%[52%–59%])and positive predictive value(59%)were not ***:This large multicenter registry study shows that CK-18 M30 measurement in isolation is of limited value for non-invasively diagnosing NASH.

关键词： Apoptosis Diagnosis Cytokeratin-18 Liver histology Non-alcoholic steatohepatitis Non-alcoholic fatty liver disease

Hepatocellular carcinoma surveillance and quantile regression for determinants of underutilisation in at-risk Australian patients

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World Journal of Gastrointestinal Oncology 2021年第12期13卷 2149-2160页

作者： Elizabeth SL Low Ross Apostolov Darren wong Sandra Lin Numan Kutaiba Josephine A grace Marie Sinclair Department of Gastroenterology and Liver Transplant Unit Austin HealthHeidelberg 3084VictoriaAustralia Department of Medicine University of MelbourneMelbourne 3000VictoriaAustralia Department of Radiology Monash HealthClayton 3168VictoriaAustralia Department of Radiology Austin HealthHeidelberg 3084VictoriaAustralia

BACKGROUND While clinical guidelines recommend hepatocellular carcinoma(HCC)surveillance for at-risk individuals,reported surveillance rates in the United States and Europe remain disappointingly *** To quantify HCC surveillance in an Australian cohort,and assess for factors associated with surveillance *** All patients undergoing HCC surveillance liver ultrasounds between January 1,2018 to June 30,2018 at a tertiary hospital in Melbourne,Australia,were followed until July 31,2020,or when surveillance was no longer *** primary outcome was the percentage of time up-to-date with HCC surveillance(PTUDS).Quantile regression was performed to determine the impact of factors associated with HCC surveillance *** Among 775 at-risk patients followed up for a median of 27.5 months,the median PTUDS was 84.2%(IQR:66.3%-96.3%).85.0%of patients were followed up by specialist *** those receiving specialist care,quantile regression demonstrated differential associations at various quantile levels of PTUDS for several *** age at the 25th quantile(estimate 0.002 per percent,P=0.03),and cirrhotic status at the 75th quantile(estimate 0.021,P=0.017),were significantly associated with greater percentage of time *** ethnicity(estimate-0.089,P=0.048)and a culturally and linguistically diverse(CALD)background(estimate-0.063,P=0.01)were significantly associated with lower PTUDS at the 50th quantile,and again for CALD at the 75th quantile(estimate-0.026,P=0.045).CONCLUSION While median PTUDS in this Australian cohort study was 84.2%,awareness of the impact of specific factors across PTUDS quantiles can aid targeted interventions towards improved HCC surveillance.

关键词： Liver cirrhosis Hepatitis,viral,human Carcinoma,hepatocellular Liver neoplasms Early detection of cancer Population surveillance

Management of synchronous lateral pelvic nodal metastasis in rectal cancer in the era of neoadjuvant chemoradiation: A systemic review

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World Journal of Gastrointestinal Surgery 2020年第5期12卷 247-258页

作者： Jolene Si Min wong grace Hwei Ching Tan Claramae Shulyn Chia Chin-Ann Johnny Ong Melissa Ching Ching Teo Department of Sarcoma Peritoneal and Rare Tumours(SPRinT)Division of Surgery and Surgical OncologyNational Cancer Centre SingaporeSingapore 169610Singapore Duke-NUS Medical School 8 College RoadSingapore 169857Singapore Laboratory of Applied Human Genetics Division of Medical SciencesNational Cancer Centre SingaporeSingapore 169610Singapore Institute of Molecular and Cell Biology A*STAR Research Entities61 Biopolis DriveSingapore 138673Singapore

BACKGROUND Lateral pelvic lymph node(LLN)metastasis(LLNM)occur in up to 28%of patients with low rectal *** prophylactic lateral pelvic lymph node dissection(LLND)has been abandoned by most western institutions in the era of neoadjuvant chemoradiation therapy(CRT),the role of selective LLND in patients with enlarged LLN on pre-CRT imaging remains *** studies have shown improved survival and recurrence outcomes when LLNs show"response"to ***,no management algorithm exists to differentiate treatment for"responders"vs"non-responders".AIM To determine if selective LLND in patients with enlarged LLNs results in improved survival and recurrence *** A systemic search of Pub Med and Embase databases for studies reporting on patients with synchronous radiologically suspicious LLNM(s-LLNM)in rectal cancer receiving preoperative-CRT was *** Fifteen retrospective,single-centre studies were included.793 patients with sLLNM were evaluated:456 underwent TME while 337 underwent TME with7,LLND *** the TME group,local recurrence(LR)rates range from 12.5%to 36%.Five-year disease free survival(DFS)was 42%to 75%.In the TME with LLND group,LR rates were 0%to 6%.Five years DFS was 41.2%to 100%.Radiological response was seen in 58%.Pathologically positive LLN was found in up to 94%of non-responders vs 0%to 20%in *** age,low tumour location and radiological non-response were associated with final positive LLNM and lowered *** LLND is associated with local control in patients with *** can be performed in radiological non-responders given a large majority represent true *** role in radiological responders should be considered in selected high risk patients.

关键词： Lateral pelvic lymph node Colorectal cancer Lateral pelvic lymph node dissection

Statin, aspirin and metformin use and risk of hepatocellular carcinoma related outcomes following liver transplantation: A retrospective study

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World Journal of Transplantation 2024年第3期14卷 120-131页

作者： William Chung Kevin wong Noel Ravindranayagam Lauren Tang Josephine grace Darren wong Danny Con Marie Sinclair Avik Majumdar Numan Kutaiba Samuel Hui Paul Gow Vijayaragavan Muralidharan Alexander Dobrovic Adam Testro Department of Gastroenterology Austin HealthHeidelberg 3084VictoriaAustralia Victorian Liver Transplant Unit Austin HealthHeidelberg 3084VictoriaAustralia Department of Radiology Austin HealthHeidelberg 3084VictoriaAustralia Department of Gastroenterology Monash HealthClayton 3168VictoriaAustralia Department of Surgery University of MelbourneAustin HealthHeidelberg 3048VictoriaAustralia Department of Surgery Beacon LaboratoryAustin PrecinctThe University of MelbourneAustin HospitalHeidelberg 3048VictoriaAustralia

BACKGROUND Liver transplantation(LT)is a potentially curative therapy for patients with hepatocellular carcinoma(HCC).HCC-recurrence following LT is associated with reduced *** is increasing interest in chemoprophylaxis to improve HCC-related outcomes *** To investigate whether there is any benefit for the use of drugs with proposed chemoprophylactic properties against HCC,and patient outcomes following *** This was a retrospective study of adult patients who received Deceased Donor LT for HCC from 2005-2022,from a single Australian *** use was defined as statin,aspirin or metformin therapy for≥29 days,within 24 months post-LT.A cox proportional-hazards model with time-dependent covariates was used for survival *** measures were the composite-endpoint of HCC-recurrence and all-cause mortality,HCC-recurrence and HCC-related *** analysis was performed to account for immortality time bias and statin *** Three hundred and five patients were included in this study,with 253(82.95%)males with a median age of 58.90 *** of liver disease were 150(49.18%)hepatitis C,73(23.93%)hepatitis B(HBV)and 33(10.82%)non-alcoholic fatty liver disease(NAFLD).56(18.36%)took statins,51(16.72%)aspirin and 50(16.39%)*** a median follow-up time of 59.90 months,34(11.15%)developed HCC-recurrence,48(15.74%)died,17(5.57%)from HCC-related ***,aspirin or metformin use was not associated with statistically significant differences in the composite endpoint of HCC-recurrence or all-cause mortality[hazard ratio(HR):1.16,95%CI:0.58-2.30;HR:1.21,95%CI:0.28-5.27;HR:0.61,95%CI:0.27-1.36],HCC-recurrence(HR:0.52,95%CI:0.20-1.35;HR:0.51,95%CI:0.14-1.93;HR 1.00,95%CI:0.37-2.72),or HCC-related mortality(HR:0.32,95%CI:0.033-3.09;HR:0.71,95%CI:0.14-3.73;HR:1.57,95%CI:0.61-4.04)*** dosing was not associated with statist-ically significant differences in HCC-related ***

关键词： Liver transplantation Hepatocellular carcinoma Transplant oncology Statins HMG-Co-A reductase Aspirin Metformin Mammalian target of rapamycin

Immunoregulatory and Anti-cancer Activities of Combination Treatment of Novel Four-Herb Formula and Doxorubicin in 4T1-Breast Cancer Bearing Mice

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Chinese Journal of Integrative Medicine 2024年第4期30卷 311-321页

作者： Lea Ling-Yu Kan Ben Chung-Lap Chan grace Gar-Lee Yue LI Pei-ting Sharon Sze-Man Hon HUANG Dan-qi Miranda Sin-Man Tsang Clara Bik-San Lau Ping-Chung Leung Chun-Kwok wong Institute of Chinese Medicine The Chinese University of Hong KongHong Kong SARChina State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants The Chinese University of Hong KongHong KongChina Department of Chemical Pathology The Chinese University of Hong KongHong Kong SARChina China-Australia International Research Centre for Chinese Medicine School of Health and Biomedical SciencesSTEM CollegeRMIT UniversityBundooraVictoriaAustralia Li Dak Sum Yip Yio Chin R&D Centre for Chinese Medicine The Chinese University of Hong Kong SARHong KongChina

Objective To investigate the in vivo immunomodulatory and anti-tumor mechanisms of the combined treatment of novel Four-Herb formula(4HF)and doxorubicin in triple-negative breast cancer(TNBC).Methods Murine-derived triple-negative mammary carcinoma cell line,4T1 cells,was cultured and inoculated into mouse mammary ***-six mice were randomly assigned into 6 groups(n=11 in ench):naive,control,LD 4HF(low dose 4HF),HD 4HF(high dose 4HF),LD 4HF+D(low dose and doxorubicin),and D(doxorubicin).Apart from the naive group,each mouse received subcutaneous inoculation with 5×10^(5)4T1 cells resuspended in 100µL of normal saline in the mammary fat *** from the day of tumor cell inoculation,tumors were grown for 6 *** LD and HD groups received daily oral gavage of 658 and 2,630 mg/kg 4HF,*** LD 4HF+D group received daily oral gavage of 658 mg/kg 4HF and weekly intraperitoneal injection of doxorubicin(5 mg/kg).The D group received weekly intraperitoneal injections of doxorubicin(5 mg/kg).The treatment naive mice received daily oral gavage of 0.2 mL double distilled water and 0.1 mL normal saline via intraperitoneal injection once a *** control group received daily oral gavage of 0.2 mL double-distilled *** treatment period was 30 *** the end of treatment,mice organs were harvested to analyze immunological activities via immunophenotyping,gene and multiplex analysis,histological staining,and gut microbiota *** Mice treated with the combination of 4HF and doxorubicin resulted in significantly reduced tumor and spleen burdens(P<0.05),altered the hypoxia and overall immune lymphocyte landscape,and manipulated gut microbiota to favor the anti-tumor immunological ***,immunosuppressive genes,cytokines,and chemokines such as C-C motif chemokine 2 and interleukin-10 of tumors were significantly downregulated(P<0.05).4HF-doxorubicin combination treatment demonstrated synergetic activities and was most effective

关键词： adjunctivetherapy breast cancer cytokines Chinese medicine tumor microenvironment

Sino-Nasal Malignant Melanoma: A Case Report

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International Journal of Otolaryngology and Head & Neck Surgery 2023年第2期12卷 61-68页

作者： grace wong Yan Yee Ranveer Singh Gill Guhan Kumarasamy Chelvam Rajesvaran Sharmila Rajendran Department of Otorhinolaryngology Bintulu Hospital Bintulu Malaysia

Melanoma is a malignant tumor and is commonly found second least in the head and neck region, with approximately 10% - 25% of melanomas followed by ear (8% - 11%). We reported a case of sino-nasal malignant melanoma in a 46-year-old Asian lady who presented with epistaxis and dysphagia. By nasoendoscopy and CT scan imaging, the diagnosis of sino-nasal malignant melanoma was later confirmed by histopathology examination along with immunohistochemistry by using Melan A and S100. Malignant melanoma in the head and neck is rare and has a poor prognosis. There has been an increase in the incidence of 5% per year and mortality at 2% per year. This dictates malignant melanoma has rapidly increased compared to any other cancer except lung cancer in women and has contributed to the third highest number of deaths among all cancers. The mortality rate has also increased, and that is attributed to the negligence of symptoms during the initial period. This usually leads to patients seeking consultation during the advanced stage of the disease. In conclusion, this paper is to report that malignant melanoma may be one of the differentials of sino-nasal masses, and it may mimic nasopharyngeal carcinoma in its presentation.

关键词： Malignant Melanoma Sino-Nasal Immunohistochemistry

Obesity in children and adolescents:Overview of the diagnosis and management

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Chronic Diseases and Translational Medicine 2023年第2期9卷 122-133页

作者： Joanna Y.L.Tung grace W.K.Poon Juan Du Kenneth K.Y.wong Department of Paediatrics and Adolescent Medicine The University of Hong KongPokfulamHong KongChina Department of Paediatrics and Adolescent Medicine Hong Kong Children's HospitalHong KongChina Department of Endocrinology Jilin Province People's HospitalJilinChina The Paediatric Precision Medicine Centre Children's Hospital of ChangchunJilinChina Department of Surgery The University of Hong KongPokfulamHong KongChina

Childhood obesity is one of the biggest public health challenges *** is associated with various adverse health consequences throughout *** and early intervention represent the most reasonable and costeffective *** progress has been achieved in the management of obesity in children and adolescents;yet,implementation in the real world remains a *** article aimed to present an overview of the diagnosis and management of obesity in children and adolescents.

关键词： adolescent children diagnosis management obesity

Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity:a territory-wide target trial emulation

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Family Medicine and Community Health 2024年第3期12卷 25-35页

作者： Cuiling Wei Vincent Ka Chun Yan Camille Maringe Wenxin Tian Rachel Yui Ki Chu Wenlong Liu Boyan Liu Yuqi Hu Lingyue Zhou Celine Sze Ling Chui Xue Li Eric Yuk Fai Wan Ching Lung Cheung Esther Wai Yin Chan William Chi Wai wong Ian Chi Kei wong Francisco Tsz Tsun lai Centre for Safe Medication Practice and Research Department of Pharmacology and PharmacyLi Ka Shing Faculty of MedicineThe University of Hong KongHong KongHong Kong Department of Health Services Research and Policy Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK School of Nursing Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongHong Kong School of Public Health Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongHong Kong Laboratory of Data Discovery for Health(D24H) Hong KongHong Kong Advanced Data Analytics for Medical Science(ADAMS)Limited Hong KongHong Kong Department of Medicine School of Clinical MedicineLi Ka Shing Faculty of MedicineThe University of Hong KongHong KongHong Kong Department of Family Medicine and Primary Care School of Clinical MedicineLi Ka Shing Faculty of MedicineThe University of Hong KongHong KongHong Kong Department of Pharmacy The University of Hong Kong-Shenzhen HospitalShenzhenPeople's Republic of China Aston Pharmacy School Aston UniversityBirminghamUK School of Pharmacy Macao University of Science and TechnologyTaipaMacao

Objectives Older individuals with multimorbidity are at an elevated risk of infection and complications from *** of post-COVID-19 interventions or care models in reducing subsequent adverse outcomes in these individuals have rarely been *** study aims to examine the effectiveness of attending general outpatient within 30 days after discharge from COVID-19 on 1-year survival among older adults aged 85 years or above with *** Retrospective cohort study emulating a randomised target trial using electronic health *** We used data from the Hospital Authority and the Department of Health in Hong Kong,which provided comprehensive electronic health records,COVID-19 confirmed case data,population-based vaccination records and other individual characteristics for the *** Adults aged 85 years or above with multimorbidity who were discharged after hospitalisation for COVID-19 between January 2020 and August *** Attending a general outpatient within 30 days of last COVID-19 discharge defined the exposure,compared to no outpatient *** outcome measures Primary outcome was all-cause mortality within one *** outcomes included mortality from respiratory,cardiovascular and cancer *** A total of 6183 eligible COVID-19 survivors were included in the *** all-cause mortality rate following COVID-19 hospitalisation was lower in the general outpatient visit group(17.1 deaths per 100 person-year)compared with non-visit group(42.8 deaths per 100 person-year).After adjustment,primary care consultations within 30 days after discharge were associated with a significantly greater 1-year survival(difference in 1-year survival:11.2%,95%CI 8.1%to 14.4%).We also observed significantly better survival from respiratory diseases in the general outpatient visit group(difference in 1-year survival:6.3%,95%CI 3.5%to 8.9%).In a sensitivity analysis for different grace period lengths

关键词： morbidity visit records