Background: Microtia is a severe congenital malformation of the external ear. This study aimed to explore the epidemiologic characteristics and the possible risk factors in patients with severe microtia in China, and integrate significant variables into a predictive nomogram. Methods: A total of 965 patients with microtia were included. This retrospective case study was conducted from July 2014 to July 2019 at Plastic Surgery Hospital in China. The detailed questionnaires concerning potential risk factors were completed and data were gathered. Chi-Square and Fisher tests were used to analyze the variables, and a multivariate logistic regression model was used to select variables related to severe microtia, and then construct a nomogram. The nomogram model was evaluated by the concordance index (C-index), calibration plot, and receiver operating characteristics (ROCs) curve. Bootstraps with 1000 resamples were applied to these analyses. Results: Of the 965 microtia patients, 629 (65.2%) were male and 867 (89.8%) were sporadic. The cases were observed more commonly in unilateral (83.1%) and right-sided (52.0%). And multiple malformations were observed in 392 (40.6%) cases. Multivariate logistic regression analysis showed that maternal age, miscarriage frequency, virus infection, anemia, using progesterone, paternal alcohol intake, and topography of living areas were associated with a higher risk of severe microtia. All the significant variables were combined into a predictive nomogram (C-index = 0.755,95% CI = 0.703–0.807). Higher prediction accuracy (adjusted C-index = 0.749) was further verified via bootstrap validation. The calibration plot showed good performance, and the ROCs curve analysis demonstrated high sensitivity and specificity. Conclusions: Most microtia patients are male, sporadic, and accompanied by other malformations, which are similar to the phenotypic analysis results of other studies. A nomogram predicting severe microtia was constructed to provide scientific guidance for individualized prevention in clinical practice.

Background: The present study set out to investigate the epidemiological and clinical characteristics of 65 patients with tsutsugamushi disease. Methods:The clinical data of 65 patients with tsutsugamushi disease, who were admitted to the Affiliated Hospital of Nantong University were retrospectively analyzed. The clinical symptoms, laboratory examination results, clinical treatment plans, treatments, and outcomes of the patients were analyzed. Results:The 65 patients with tsutsugamushi disease, included 40 males (61.54%) and 25 females (38.46%).The patients were aged from 1 year and 7 months to 88 years old, and the peak age was 60-70 years old.Geographically, the patients were concentrated in Rugao and Tongzhou District. Infections were most common between October and December (categorized as "autumn type"), and peaked in November.Farmers had the highest infection rate of any occupation (66%). All patients had the symptom of fever, with the body temperature of 60 (92.31%) patients exceeding 38.5 ℃, while 58 (89%) and 51 (78%) patients had characteristic eschar and skin rash, respectively. There were 56 (86.15%) patients with varying degrees of liver damage, 8 (12.31%) cases of elevated D-dimer, 3 (4.62%) cases of myocardial injury, 38 (58.46%) cases of superficial lymph node enlargement, 8 (12.31%) cases of splenomegaly, and 2 cases (3.08%) of bulbar conjunctival congestion. Of the 65 patients enrolled, the overall misdiagnosis rate of first medical contact was 64.62%Conclusions: Tsutsugamushi disease, infection has obvious seasonality and a susceptible population, especially among farmers and the elderly.

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