Carotid atherosclerosis (CAS) is a significant indicator of early systemic atherosclerosis. Previous studies have demonstrated a close relationship between elevated remnant cholesterol (RC) levels and the pathogenesis of CAS. However, limited information is available regarding the association between RC and the development of CAS in menopausal women.
To investigate the correlation between RC and the pathogenesis of CAS in menopausal women.
A total of 307 menopausal women from Fengxiang Town, Anding District, Dingxi City were selected as the research subjects. These women had participated in the national high-risk stroke screening project and completed carotid artery ultrasound examination between January 2020 and October 2023. General information on the ordinary people was collected and participants' characteristics of the carotid artery intima were analyzed by means of using color doppler ultrasound. Based on the cervical ultrasound results, the subjects were divided into CAS group and non-CAS group. Spearman rank correlation analysis was used to explore the correlation between RC and other risk factors for CAS. Furthermore, multifactor Logistic regression was employed to analyze and explore the correlation between RC and CAS in menopausal women.
The findings revealed that participants in the CAS group (n=130) has higher levels than those in the non-CAS group (n=177) in terms of menopausal female age, history of stroke and transient ischemic attack (TIA), fasting plasma glucose (FPG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), RC and pulse pressure (P<0.05). Spearman rank correlation analysis indicated a positive correlation between RC and FPG as well as TC (rs=0.113, 0.280, P<0.05), while a negative correlation was observed with LDL-C (rs=-0.112, P<0.05). Furthermore, multivariate logistic regression analysis identified high RC levels (OR=1.539, 95%CI=1.185-1.999, P=0.001), age (OR=1.059, 95%CI=1.003-1.117, P=0.038), and history of stroke and TIA (OR=1.910, 95%CI=1.047-3.485, P=0.035) as risk factors for the onset of CAS in menopausal women. The menopausal women were further divided into high RC (RC≥0.70 mmol/L, n=155) and low RC (RC<0.70 mmol/L, n=152) groups based on the median RC. The high RC group had a higher proportion of women with dyslipidemia, CAS, waist circumference, BMI, and TG compared to the low RC group (P<0.05). Additionally, the high RC group had lower levels of high density lipoprotein cholesterol (HDL-C) compared to the low RC group (P<0.05) .
High RC levels are associated with CAS in menopausal women and may be an independent risk factor for CAS in menopausal women.
Continuous glucose monitoring (CGM) is rarely applied to outpatient treatments. The impact of CGM-based diabetes education to change unhealthy living and eating habits on the blood glucose profile is still unclear.
Based on the retrospective results of CGM, outpatient education such as diet and exercise was applied to outpatients with type 2 diabetes mellitus (T2DM) who were managed by oral hypoglycemic drugs. This study aims to evaluate the effects on blood glucose profiles.
A total of 88 outpatient T2DM patients medicated with oral hypoglycemic drugs in the Department of Endocrinology, Nanjing First Hospital in 2021 were included and managed by CGM, involving 60 male and 28 female patients. The enrolled patients maintained the original hypoglycemic treatment regimen and lifestyle habits on the 1st to 3rd day. On the 4th day, we downloaded and analyzed CGM data and provided outpatient education based on individualized eating habit and exercise. On the 6th day, the CGM sensor and recorder were removed. CGM data on the 2nd day versus 5th day were compared for dynamic blood glucose profiles, including the 24 h mean blood glucose (MBG), mean amplitude of glycemic excursion (MAGE) and time in target glucose range (TIR) .
Based on the CGM results, MBG in outpatients with T2DM on the 5th day after outpatient education was significantly reduced from (8.34±1.97) mmol/L to (7.85±1.65) mmol/L (P<0.05). TIR was significantly elevated from (78.21±24.64) % to (84.28±21.87) % (P<0.05). Moreover, MAGE was significantly reduced from (4.53±2.25) mmol/L to (3.80±1.80) mmol/L (P<0.05). Stratified by the course of T2DM, MBG after outpatient education significantly decreased in both patients with T2DM course <10 years (n=62) and those with T2DM course ≥10 years (n=26) than the baseline before education (P<0.05). After outpatient education, the standard deviation (SD), MAGE and target glucose range (TAR) were significantly reduced, while TIR was significantly elevated in patients with T2DM course <10 years (P<0.05). Stratified by age, MBG and TAR after outpatient education were significantly reduced in both patients aged <65 years old (n=55) and those aged ≥65 years old (n=33) than the baseline before education, while TIR was significantly elevated (P<0.05). SD and MAGE were significantly reduced after outpatient education in patients aged <65 years old (P<0.05) .
Based on CGM results, outpatient education such as diet and exercise could effectively improve MBG, TIR levels, and blood glucose variability in outpatient T2DM patients using oral hypoglycemic drugs. Patients with less than 10 years of T2DM course and younger than 65 years of age gain more clinical benefits.
Diuretic resistance is associated with increased mortality in patients with heart failure (HF). Qi Li Qiang Xin Jiao Nang, a Traditional Chinese Medicine, are used in the treatment of HF. However, clinical evidence of their effectiveness in improving diuretic resistance is lacking.
To investigate whether Qi Li Qiang Xin Jiao Nang can reduce the risk of diuretic resistance and improve prognosis in patients with acute decompensated chronic heart failure (ADCHF) .
This study included 374 HF patients treated in the CICU ward of Tianjin University Chest Hospital from January 2018 to June 2022. Patients were divided into diuretic resistance (118 patients) and non-diuretic resistance groups (256 patients) based on the occurrence of diuretic resistance. Patient data and laboratory results were collected. A 12-month follow-up was conducted to observe rehospitalization due to cardiovascular events or all-cause mortality. Kaplan-Meyer survival curves were plotted for each group, and the Log-rank test was used for comparison. Multivariate Logistic regression analysis was performed to explore factors influencing diuretic resistance. Multivariable Cox regression analysis was used to explore factors affecting the occurrence of endpoint events in ADCHF patients.
The diuretic resistance group showed higher age, body mass, NT-proBNP, blood urea nitrogen, creatinine, uric acid, and international normalized ratio (INR) but lower 24-hour fluid intake, estimated glomerular filtration rate (eGFR), lymphocyte count, and usage of Qi Li Qiang Xin Jiao Nang. Multivariate Logistic regression analysis indicated that the use of Qi Li Qiang Xin Jiao Nang (OR=0.363, 95%CI=0.186-0.708, P=0.003) and increased 24-hour fluid intake (OR=0.286, 95%CI=0.177-0.461, P<0.001) were protective factors against diuretic resistance in ADCHF patients. Increased body mass (OR=1.064, 95%CI=1.040-1.088, P<0.001) and elevated uric acid (OR=1.002, 95%CI=1.000-1.004, P=0.027) were risk factors. Log-rank test results showed that the average survival time without endpoint events was shorter in the diuretic resistance group (χ2=11.866, P=0.001) and in patients not using Qi Li Qiang Xin Jiao Nang (χ2=6.502, P=0.011). Multivariable Cox regression analysis revealed that the use of Qi Li Qiang Xin Jiao Nang (HR=0.536, 95%CI=0.308-0.933, P=0.027) and angiotensin receptor enkephalase inhibitors/angiotensin converting enzyme inhibitors/angiotensin receptor blockers (HR=0.435, 95%CI=0.229-0.826, P=0.011) were protective factors against endpoint events, while increased total bilirubin (HR=1.019, 95%CI=1.008-1.030, P=0.001) and total bile acids (HR=1.029, 95%CI=1.002-1.058, P=0.036) were risk factors.
The use of Qi Li Qiang Xin Jiao Nang in addition to standard HF treatment can reduce the risk of diuretic resistance in patients with ADCHF and decrease the risk of rehospitalization due to cardiovascular events or all-cause mortality within one year.
Maintenance hemodialysis (MHD) and peritoneal dialysis (PD) are main treatment methods for uremic patients. It remains an important content of clinical research on better developing treatment protocols to address overhydration (OH) in dialysis patients, and the effect of applying body composition monitor (BCM) on the prognosis of dialysis patients treated with different dialysis models is still controversial.
To explore the relationship between OH parameters of BCM and prognosis in patients treated with MHD and PD.
From October 2017 to March 2022, 334 patients on maintenance dialysis in Beijing Jishuitan Hospital affiliated to Capital Medical Medical University, Beijing Boai Hospital, Aviation General Hospital, Beijing Changping District Hospital and Beijing Changping Hospital of Integrated Traditional Chinese and Western Medicine were included as the study objects and divided into MHD group (n=188) and PD group (n=146) according to their renal replacement therapy mode. The general data of and BCM related parameters were collected through the electronic medical record system. Patients included in the study were followed up, dialysis treatment parameters, body weight, systolic blood pressure and diastolic blood pressure were recorded, and the average of multiple follow-up results were calculated. Endpoint events were recorded during follow-up period, with the primary endpoint event as all-cause death (ACM), secondary endpoint events as cardiovascular events (CVE), combined adverse events (CAE), surgery or fracture (SOF). Spearman rank correlation analysis was used to explore the correlation between endpoint events and BCM parameters, and stepwise multiple Logistic regression analysis was used to explore the influencing factors of secondary endpoint events in patients. The ACM survival curve was plotted by Kaplan-Meier method, and the difference of survival curve between the two groups was compared by Log-rank test. Multivariate Cox regression analysis was used to explore the influencing factors of ACM.
A total of 311 patients completed follow-up, with a median follow-up time of 29.9 (18.0, 36.0) months, including 176 patients in MHD group and 135 patients in PD group. Dialysis age, body weight, target body weight, adipose tissue content and adipose tissue index in MHD group were higher than those in PD group, and OH was lower than that in PD group (P<0.05). The mean values of body weight, target body weight, systolic blood pressure, adipose tissue content and adipose tissue index in MHD group were higher than those in PD group, while the mean value of OH, standard deviation of OH (OHsd), maximum change value of OH (OHd) and maximum change value of OH in MHD group were lower than those in the PD group (P<0.05). The incidence of CVE, CAE and SOF was 16.5% (29/176), 39.2% (69/176) and 4.0% (7/176) in the MHD group, and 45.9% (62/135), 83.0% (112/135) and 8.2% (11/135) in PD group, respectively. The incidence of CVE and CAE in MHD group was significantly lower than PD group (χ2=32.009, P<0.001; χ2=60.132, P<0.001). Multivariate Logistic regression analysis showed that the ratio of mean value of extracellular water to mean value of intracellular water in MHD group (OR=57.974, 95%CI=1.393-2 413.247) was the influencing factor of CVE, OHd (OR=1.255, 95%CI=1.076-1.462) was the influencing factor of CAE (P<0.05). The age of patients in PD group (OR=1.029, 95%CI=1.008-1.052) was the influencing factor of CVE (P<0.05), and OHd (OR=1.962, 95%CI=1.355-2.842) was the influencing factor of CAE (P<0.05). Kaplan-Meier survival curve of ACM between the two groups showed that the incidence of ACM in PD group was higher than that in MHD group (χ2=7.145, P=0.008). Multivariate Cox regression analysis showed that age (HR=1.070, 95%CI=1.019-1.123) was the influencing factor of ACM in MHD group (P<0.05), DBPm (HR=0.942, 95%CI=0.854-0.992) and OHsd (HR=3.612, 95%CI=2.072-6.296) were the influencing factors of ACM in PD group (P<0.05) .
The incidence of primary endpoint event and secondary endpoint events in PD group was higher than that in MHD patients, and OH was more obvious in PD patients than MHD patients. The fluctuation of OH value obtained by BCM could predict ACM in PD patients.
Primary hyperaldosteronism (PA) has been recommended by numerous hypertension guidelines to expand screening, early diagnosis and treatment, as a secondary hypertension disease with the highest incidence, great cardiovascular and cerebrovascular dangers but high cure rate after surgery. However, the diagnosis, classification and clinical outcomes evaluation of these patients are varied and controversial. Captopril challenge test (CCT) is expected to provide whole-course management for PA patients because it is convenient, safe and can be used directly in the community or outpatient clinic.
To explore the diagnostic efficacy, classification and biochemical remission assessment of CCT in patients with PA.
The study population consisted of 824 patients who completed the cause screening for hypertension and were enrolled in the Department of Endocrinology and Metabolism, West China Hospital, Sichuan University from October 1 th 2020 to December 30 th 2022. After screening, 247 patients with PA and 123 patients with essential hypertension (EH) were enrolled, and PA was classified into aldosterone-producing adenoma (APA, 81 patients), idiopathic hyperaldosteronism (IHA, 55 patients), and uncategorized PA (u-PA, 111 patients). The differences among the four groups were compared and the receiver operating characteristic (ROC) curve analysis showed the diagnostic performance for the prediction of PA. Secondly, the ROC curves of each post-CCT index for APA and IHA respectively were plotted. Finally, according to the postoperative clinical outcomes, the patients with unilateral adrenal resection were divided into three groups: clinical remission, clinical improvement, and no remission group. The difference between the three groups was compared, and the cut-off point of biochemical remission of CCT in APA patients was analyzed.
The post-CCT plasma aldosterone concentration (PAC) level had the highest diagnostic efficiency for PA (AUC=0.921, 95%CI=0.893-0.950), and the cut-off was 11.7 ng/dL. The sensitivity and specificity respectively was 84.6% and 86.0%. The post-CCT aldosterone to renin ratio (ARR) also had a good diagnostic efficacy for PA (AUC=0.868, 95%CI=0.823-0.923). The cut-off was 2.8 (ng/dL) / (mU/L), and the sensitivity and specificity respectively were 82.2% and 81.0%. The post-CCT PAC>17 ng/dL can assist in the diagnosis of APA subtypes. When post-CCT PAC<11.7 ng/dL combined with post-CCT ARR< 2.8 (ng/dL) / (mU/L), APA was almost excluded. The inhibition rate of PAC after CCT and the PAC remission rate after surgery were less effective in judging the biochemical remission assessment of APA, and post-CCT PAC<11.7 ng/dL or post-CCT ARR<2.8 (ng/dL) / (mU/L) could better. Among the patients receiving surgical treatment, 87.2% had post-CCT PAC<11.7 ng/dL, and 89.7% had post-CCT ARR<2.8 (ng/dL) / (mU/L), which was close to the postoperative clinical remission level (88.0%) .
CCT can be used throughout the diagnosis, classification and clinical outcomes evaluation of PA patients. post-CCT PAC 11.7 ng/dL and post-CCT ARR 2.8 (ng/dL) / (mU/L) are good cut-off for the diagnosis, and can also be used for the classification of APA and the judgment of postoperative biochemical remission. Secondly, detection before CCT has little clinical significance and can simplify the process.
The elderly colorectal cancer population has a high prevalence and complex condition, and postoperative rehabilitation faces various challenges. It is of great significance to construct a scientific, practical and comprehensive postoperative health management program for colorectal cancer in the elderly to improve patients' health.
To construct a comprehensive health management program for elderly postoperative colorectal cancer patients, and provide reference for postoperative rehabilitation of elderly colorectal cancer patients.
Based on literature review and qualitative interviews, the management program for elderly postoperative colorectal cancer patients was initially formulated. The Delphi method was used to conduct 2 rounds of correspondence with 16 experts from tertiary hospitals in Nanjing and Shanghai. The motivation degree of the experts was evaluated based on questionnaire recovery rate and text revision rate. Furthermore, the authority coefficient was used to evaluate the degree of expert authority, while the coefficient of variation and Kendall's W coefficient were used to evaluate the coordination of expert opinions. Based on opinions and discussion of experts, the ultimate formation of the health management program for elderly postoperative colorectal cancer patients was constructed after adjusting the content of entries.
The recovery rates of the two rounds of expert correspondence were 94.12% and 100.00%, respectively. The text revision rates were 56.25%, and the authority coefficient was 0.91. The mean importance scores of items in the two rounds of the consultation ranged from 3.81 to 5.00 and 4.13 to 5.00, with the coefficients of variation from 0 to 0.24 and 0 to 0.20. The Kendall's W coefficients of expert opinions were 0.211 and 0.222, respectively (P<0.001), with an improvement observed in the second round compared to the first round. After two rounds of expert correspondence and the expert group discussion, the final management program for elderly postoperative colorectal cancer patients was determined, including 9 primary items (team building, psychological support, physical activity, stoma care, nutritional intervention, TCM rehabilitation techniques, peer education, treatment and follow-up, self-management) and 39 secondary items.
The health management program constructed in this study for elderly postoperative colorectal cancer patients is scientific, reliable, applicable and practical, and can provide guidance for rehabilitation of elderly patients after colorectal cancer surgery.
Lawyer is one of the most stressful jobs, but lawyers' occupational stress is rather under-researched in China. Previous studies have shown that occupational stress and mental health are related to self-regulatory fatigue and health literacy in lawyers, but there is a lack of research on their interaction mechanism.
To explore the association of occupational stress and mental health in lawyers and the internal mechanism of action of self-regulatory fatigue and health literacy between them.
A convenience sample of 660 lawyers from 7 leading Chinese law firms were surveyed from May to June 2022 using questionnaires including a self-compiled Demographic Questionnaire, the Lawyers' Occupational Stress Scale, Symptom Checklist-90 (SCL-90), Self-regulatory Fatigue Scale (SRF-S) and National Residents' Health Literacy Surveillance Rapid Assessment Questionnaire (HLSRAQ). Stepwise regression was used to explore the mediating effect of self-regulatory fatigue between occupational stress and mental health, and bootstrap method was used to test the mediating effect of self-regulatory fatigue. Model 5 in PROCESS 3.4 was used to explore the moderated mediating effect of health literacy between occupational stress and mental health. Bootstrap method was used to test the moderating mediating effect of health literacy, and further simple slope test was used to test the moderating effect, and the effects of occupational stress on the mental health of lawyers with different health literacy levels were analyzed.
Six hundred and fifty-six cases (99.39%) who effectively responded to the survey were included for final analysis. The average scores of occupational stress, SCL-90, SRF-S and HLSRAQ were (106.9±34.8), 39.0 (15.0, 84.0), (39.4±10.0) and (13.9±3.7), respectively. Stepwise regression analysis showed that occupational stress could positively predict mental health (β=0.36, t=13.40, P<0.01). Self-regulatory fatigue also had a significant positive predictive effect on mental health (β=0.55, t=20.32, P<0.01). Bootstrap analysis showed that 95%CI of the total effect, indirect effect and direct effect of occupational stress on mental health did not include 0 (P<0.01). The moderated mediating effect analysis showed that the product of occupational stress and health literacy had a significant predictive effect on mental health (β=-0.02, t=-2.00, P<0.05). The Bootstrap method showed that the 95%CI of the indirect effect of lawyer occupational stress on mental health did not include 0 (P<0.01). Simple slope test showed that the association between them was found to be statistically significant regardless of being moderated by different levels of health literacy (P<0.01), and the predictive effect of occupational stress showed a downward trend with the improvement of health literacy level (P<0.01) .
Occupational stress influenced mental health in lawyers medicated by self-regulatory fatigue with health literacy as a moderator.
Salidroside has been shown to protect diabetic kidney disease (DKD) rats, however, whether it is equally effective in a hypoxic environment and the specific mechanism of action remain unclear.
To observe the effects of salidroside on biochemical parameters, renal tissue pathological lesion, and the expression of cell pyroptosis-related proteins in a rat model of DKD under hypoxia, and explore its mechanisms of action.
From March 2022 to March 2023, forty 6-week-old SPF-grade SD male rats were used, with eight randomly selected as the control group, the remaining were modeled. Twenty-four DKD model rats were randomly divided into three groups of the model group, salidroside group, and salidroside+nod-like receptor protein 3 (NLRP3) activator group for intervention, with 8 in each group. After the intervention, blood was collected from the abdominal aorta for biochemical parameter testing, hematoxylin-eosin (HE) staining, and transmission electron microscopy were used to observe renal pathological changes. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of interleukin (IL) 1β and IL-18. Western blotting was used to measure the expression levels of Caspase-1, Gasdermin D (GSDMD), NLRP3, and transforming growth factor β1 (TGF-β1) in renal tissue.
The body weight of the rats after modeling was significantly lower than that of the control group (P<0.05). Compared to the control group, the levels of triglyceride (TG), total cholesterol (TC), fasting blood glucose (FBG), urinary microalbumin (UMA), blood urea nitrogen (BUN), and serum creatinine (Scr) were significantly higher in the model group (P<0.05). Compared to the model group, the BUN, UMA, and Scr levels were significantly lower in the salidroside group (P<0.05). Compared to the salidroside group, the UMA, BUN, and Scr levels were significantly higher in the salidroside+NLRP3 activator group (P<0.05). HE staining and transmission electron microscopy revealed that renal tissue pathological changes in the salidroside group were significantly reduced than the model group, and aggravated in the salidroside+NLRP3 activator group. Compared to the control group, serum IL-1β and IL-18 levels were significantly higher in the model group (P<0.05) ; these levels were significantly lower in the salidroside group compared to the model group (P<0.05), and higher in the salidroside+NLRP3 activator group compared to the salidroside group (P<0.05). Compared to the control group, the expression of Caspase-1, GSDMD, NLRP3, and TGF-β1 proteins was significantly higher in the model group (P<0.05) ; it was significantly lower in the salidroside group compared to the model group (P<0.05), and higher in the salidroside+NLRP3 activator group compared to the salidroside group (P<0.05) .
Salidroside exerted therapeutic effects on DKD rats in a hypoxic environment without reducing blood glucose and lipid levels, this effect may be related to the inhibition of NLRP3, affecting the NLRP3/IL-1β/TGF-β1 signaling pathway, ultimately improving podocyte pyroptosis injury.
Respiratory problems in chronic obstructive pulmonary disease (COPD) patients are prone to poor sleep quality, anxiety and depression, but they are often ignored by medical staff and patients themselves. Understanding the sleep quality, anxiety and depression symptoms of patients with COPD and their influencing factors can help to improve the quality of life of patients, however, there are few relevant studies.
To investigate the sleep quality, anxiety and depression of patients with COPD and explore the influencing factors.
Convenience sampling was used to recruit COPD patients who visited the Department Respiratory Diseases and Critical Care Medicine of seven hospitals in Anhui Province from August to November 2022. Demographic characteristics, dyspnea grade, airflow restriction severity, risk of malnutrition, physical activity level, vaccination, and acute exacerbations in the last 1 year were collected. The Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS) were used to evaluate the sleep quality and anxiety and depression symptoms of COPD patients, and the influencing factors were analyzed by multivariate Logistic regression.
A total of 248 patients with COPD were investigated, among which the incidence of poor sleep quality was 60.9% (151/248), only 8.9% (22/248) of the patients thought they had good sleep quality, and more than half of the patients actually had insufficient sleep time (54.4%) or low sleep efficiency (60.1%). 29.4% (73/248) of COPD patients had at least one of the symptoms of anxiety or depression, of which 35 had anxiety symptoms, 61 had depression symptoms, and 23 had both anxiety and depression symptoms. Multivariate Logistic regression analysis showed that older ages (OR=1.052, 95%CI=1.018-1.086) and risk of malnutrition (OR=3.393, 95%CI=1.855-6.206) were risk factors for poor sleep quality in COPD patients. Regular physical activity was a protective factor for poor sleep quality in COPD patients (OR=0.450, 95%CI=0.242-0.834) (P<0.05). Acute exacerbations ≥2 times (OR=2.220, 95%CI=1.093-4.510) and malnutrition risk (OR=1.961, 95%CI=1.044-3.683) were risk factors for anxiety and depression symptoms in COPD patients (P<0.04). In COPD patients, PSQI score was positively correlated with HADS-A (rs=0.413) and HADS-D score (rs=0.430), and there was a positive correlation between HADS-A score and HADS-D score (rs=0.719, P<0.05) .
The incidence of poor sleep quality, anxiety and depression symptoms was high in COPD patients, and age, malnutrition risk, regular physical activity and number of acute exacerbations in the past year are important influencing factors. Medical staff, family members and patients themselves should improve the awareness of sleep quality, anxiety and depression, and actively carry out screening and intervention work for key patients to improve the sleep quality and mental health of patients.
In the current rehabilitation environment, emotional issues and cognitive dysfunctions in stroke patients are often overshadowed by physical, speech, and swallowing difficulties, leading to their underestimation in clinical rehabilitation. This oversight can result in adverse outcomes, impacting the overall success of rehabilitation. Currently, clinical treatments primarily rely on pharmacotherapy to alleviate symptoms, which has limited effectiveness and can cause a range of adverse reactions.
To observe the efficacy of precision exercise prescriptions on anxiety, depression, and cognitive functions in stroke patients and to preliminarily analyze the underlying mechanisms of action.
A total of 84 stroke patients hospitalized in the Rehabilitation Department of Changzhou Dean Hospital from January 2022 to March 2023 were selected. They were randomly divided into a control group (42 patients) and an experimental group (42 patients). The control group received standard rehabilitation treatment, while the experimental group received precision exercise prescriptions based on cardiopulmonary exercise testing (CPET) results in addition to standard rehabilitation, over 12 weeks. The Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Mini-mental State Examination (MMSE) scores, and Homocysteine (Hcy) levels were compared before and after rehabilitation training in both groups. A Pearson correlation analysis was conducted between pre-rehabilitation Hcy levels and SAS, SDS, MMSE scores.
All 42 patients in the experimental group completed the CPET and the 12-week precision exercise prescription rehabilitation without any adverse events. Before rehabilitation training, there were no statistically significant differences in SAS, SDS, MMSE scores, and Hcy levels between the two groups (P>0.05). After rehabilitation training, the scores of SAS, SDS, and Hcy levels in the experimental group were significantly lower compared to pre-treatment values (P<0.05), and which were significantly lower than those of the control group (P<0.05). The MMSE score in experimental groups increased significantly after interventions compared to pre-treatment value (P<0.05), and it was significantly higher than that of the control group (P<0.05). There were no significant differences in SAS, SDS, MMSE scores, and Hcy levels before and after rehabilitation training in the control group (P>0.05). Pearson correlation analysis revealed a positive correlation between Hcy levels and SAS, SDS scores (r-values of 0.420 and 0.507, respectively, P<0.05) and no correlation with MMSE scores (r=0.079, P=0.473) .
Our findings suggest that precision exercise prescriptions significantly improve anxiety, depression, and cognitive functions in stroke patients, suggesting their potential as a novel therapeutic approach in clinical applications. Hcy may be one of the mechanisms through which precision exercise prescriptions improve anxiety and depression in stroke patients. Further research is needed to determine whether Hcy is related to the improvement of cognitive functions through this prescription.
Chronic non-specific low back pain (CNLBP) has become one of the common causes of limited activity, which seriously threatens the physical and mental health and quality of life of patients. According to certain studies, sensitivity and tension in the myofascial tissue play an important role in chronic pain disorders. By releasing fascial tension, myofascial release theropy (MFR) is primarily used to relieve pain; however, there is a lack of high-quality clinical evidence to support this application.
To investigates the effectiveness of MFR in CNLBP cases treated non-surgically.
From January to December 2022, 56 patients with CNLBP were recruited as study subjects by Chengdu Sports Institute Sports Hospital. The patients were then divided into two groups using a randomised number table. The MFR group received MFR intervention (lumbar-abdominal MFR intervention) and the patients in the control group (CG group) received pseudo-MFR intervention (pseudo-MFR intervention in the same area) for the duration of 4 weeks, once a week for 20 minutes each time. The following variables were measured: Visual Analogue Scale (VAS) scores, Activities of Daily Living (ADL) scores, Oswestry Dysfunction Index (ODI), lumbar joint mobility[including anterior lumbar flexion (ALF), posterior lumbar extension (LR) and lumbar spine rotation (LSR) on both sides], scores on the SAS, and changes in tumour necrosis factor α (TNF-α) .
A total of 56 subjects were enrolled in this study. Of these, 8 cases were lost, 8 cases were automatically withdrawn and 40 cases -20 in the MFR group and 20 in the CG group eventually completed follow-up. There were no significant difference in VAS scores, ADL scores, ODI scores, ALF scores, SAS scores, SDS scores and TNF-α level between two groups before intervention (P>0.05). LR and LSR in MFR group were lower than those in CG group before intervention (P<0.05). After 4 weeks of intervention, VAS, ODI, SAS, SDS scores and TNF-α levels in MFR group were lower than those in CG group, ADL scores were higher than those in CG group, ALF, LR, LSR were higher than those in CG group (P<0.05). After 4 weeks of intervention, VAS, ODI, SAS, SDS scores and TNF-α levels in MFR group were lower than before intervention, ADL scores were higher than before intervention, ALF, LR, LSR were higher than before intervention (P<0.05) .
These results highlight the importance of MFR has been shown to have a better safety profile in patients with CNLBP, lowering the pain threshold, increasing lumbar joint mobility and improving negative psychological states such as anxiety and depression.
Stroke is a chronic condition that seriously impairs human health. The correlation between rainfall and onset of stroke remains unclear.
To analyze the correlation between rainfall and stroke admissions in Nanchang City, and to provide scientific references for developing a comprehensive prevention and treatment strategy for stroke.
Stroke admission data from Nanchang City (2015-2019) from the digital-related group (DRG) system of the Jiangxi Provincial Health Commission Information Center were collected. In addition, atmospheric pollutant data from the national urban air quality real-time release platform and meteorological data from the Nanchang meteorological base station were collected. Basic characteristics of stroke admission patients, air pollutants, and meteorological factors were analyzed. Spearman rank correlation analysis was performed to identify the correlation of case number of stroke admissions with air pollutants and atmospheric factors. Distributional lag nonlinear model was used to explore the linkage between rainfall and stroke admissions. Stratified analysis was conducted based on gender and age (<65 years old and ≥65 years old), and lag represented the lagging days.
From 2015 to 2019, there were 79 523 hospitalized patients with stroke in Nanchang City, of which 49 072 (61.71%) were males and 48 092 (60.48%) were ≥65 years old, accounting for a large proportion. The number of stroke admissions in winter (December to February) and spring (March to May) were 20 065 (25.23%) and 20 358 (25.60%), respectively. There was a nonlinear relationship between rainfall and stroke admission, and there was a certain lag effect. The RR values of lag1 and lag2 for the effect of rainfall on stroke admission was both 1.009, and 95%CI were 1.000-1.019 and 1.001-1.016, respectively. Stratified analysis showed that the main effect of higher rainfall on the number of male stroke admissions was lag6, RR value was 1.003; the main effect on the number of hospital admissions for female stroke was lag1 and lag2, with RR values of 1.018 (95%CI=1.004-1.031) and 1.020 (95%CI=1.009-1.031), respectively. The main effects on the number of hospitalizations for ischemic stroke under 65 years of age were lag1 (RR=1.016, 95%CI=1.003-1.030), and lag2 (RR=1.018, 95%CI=1.007-1.029) .
Short-term exposure to higher rainfall can increase the risk of stroke hospitalization, and women and people under 65 years of age are more sensitive to rainfall exposure, and protection should be strengthened for this group of people.
Chronic atrophic gastritis (CAG) with intestinal metaplasia (IM) is an independent risk factor for gastric cancer. Long-term inflammation and oxidative stress response stimulate the physical and mental state of patients. Under the modern medical model, proton pump inhibitors and gastric mucosal protective agents are increasingly unable to meet the high drug resistance of patients. It is urgent to seek effective new Chinese medicine treatments and multiple methods to treat CAG and IM.
To evaluate the clinical efficacy and safety of modified Piwei Peiyuan Decoction combined with acupuncture in the treatment of CAG with IM.
From January 2022 to September 2023, 202 patients with CAG and IM diagnosed by gastroscopy and pathological examination in the Department of Spleen and Stomach, the Center for Preventive Treatment of Disease, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine and the Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine were selected. The patients were divided into control group (n=67), treatment group A (n=68) and treatment group B (n=67) by random number table method. All patients participated in 6 weeks of treatment: (1) Control group: aluminum magnesium suspension combined with folic acid tablets (3 times/d) ; (2) Treatment group A: to add and subtract syndrome types of Piwei Peiyuan Decoction (2 times/d) ; (3) Treatment group B: Piwei Peiyuan Decoction (the same as group A) combined with acupuncture (1 time/d), with Zusanli, Liangqiu, Gongsun, Neiguan, Zhongwan as the main points, according to the syndrome type selection of acupoints. Before and 6 weeks after treatment, OLGA, OLGIM staging, gastric mucosal pathological efficacy, gastric mucosal pathological score, clinical symptom score, PRO scale score, drug-related adverse events (AE) and adverse drug reactions (ADR) were recorded.
A total of 192 patients completed the 6-week course of treatment (62 in the control group, 66 in the treatment group A, and 64 in the treatment group B). The effective rate of the control group was 48.39% (30/62), the effective rate of the treatment group A was 69.70% (46/66), and the effective rate of the treatment group B was 71.88% (46/64). There was a statistically significant difference in the effective rate among the three groups (χ2=9.144, P=0.01). After treatment, the gastric mucosal pathological score, clinical symptom score and PRO scale score in the three groups were lower than those in the same group before treatment (P<0.05). Pathological score of gastric mucosa: the scores of chronic inflammation, atrophy and IM in treatment group A and treatment group B were lower than those in control group, and the scores of active inflammation and dysplasia were higher than those in control group (P<0.05). Clinical symptom score: the scores of epigastric fullness and epigastric pain in treatment group A and treatment group B were lower than those in control group (P<0.05). The PRO scale score: the treatment group A and the treatment group B were lower than the control group in acid reflux, dyspepsia, defecation, psychological state, systemic symptoms and total score (P<0.05). There was no significant difference in the incidence of AE and ADR among the three groups (P>0.05) .
The overall clinical efficacy of Piwei Peiyuan Decoction combined with acupuncture is better than that of aluminum magnesium suspension combined with folic acid tablets, which is better than that of traditional antacids and gastric mucosal protective agents.
Metabolic associated fatty liver disease (MAFLD) is more prevalent than non-alcoholic fatty liver disease (NAFLD), leading to the identification of a variety of metabolically complex fatty liver diseases. The serum uric acid/creatinine ratio (SUA/Cr) is a new biomarker discovered after renal function-normalized SUA. At present, there have been few studies on the relationship between SUA/Cr and MAFLD.
To explore the correlation of SUA/Cr with MAFLD, and its predictive value for MAFLD.
We enrolled 2 288 individuals who visited the Physical examination Center of the Affiliated Hospital of Inner Mongolia Medical University in February to June 2023. Venous blood samples were collected for laboratory tests, and abdominal ultrasonography was used to examine the liver condition. Based on the results of abdominal ultrasonography and the diagnostic criteria for MAFLD, the subjects were divided into the MAFLD group (n=945) and non-MAFLD group (n=1 343). According to SUA/Cr quartiles, the subjects were divided into Q1 group (SUA/Cr≤4.13, n=574), Q2 group (4.13<SUA/Cr≤4.84, n=573), Q3 group (4.84<SUA/Cr≤5.72, n=570), Q4 group (SUA/Cr>5.72, n=571). Spearman rank correlation analysis was used to explore the correlation between SUA/Cr and clinical data. Binary Logistic regression analysis was used to gradually explore the influencing factors of MAFLD. Receiver operating characteristic (ROC) curve was drawn, and the area under the ROC curve (AUC) was calculated to evaluate the predictive value of SUA/Cr for MAFLD.
Compared to the non-MAFLD group, the MAFLD group had higher levels of male proportion, age, waist circumference (WC), BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total cholesterol (TC), triacylglycerol (TG), low density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), homocysteine (Hcy), serum uric acid (SUA), serum creatinine (Scr), and SUA/Cr ratio (P<0.001). High-density lipoprotein cholesterol (HDL-C) in the MAFLD group was lower in the non-MAFLD group (P<0.001). In the Q4 group, the WC, BMI, ALT, GGT, SUA, TC and TG were higher than those in the Q1, Q2 and Q3 groups, the AST was higher than the Q1 and Q2 groups, the DBP, ALP and HbA1c were higher than the Q1 group, the Scr, HDL-C were lower than those in the Q1, Q2 and Q3 groups, and the age was lower than those in the Q1 and Q2 groups (P<0.05). In the Q3 group, the ALT, AST, GGT, SUA, TC and TG were higher than those in the Q1 and Q2 groups, the WC and BMI were higher than those in the Q1 group, the Scr was lower than those in the Q1 and Q2 groups, and the age and HDL-C were lower than those in the Q1 group (P<0.05). In the Q2 group, the WC, BMI, ALT, GGT, SUA, and TG were higher than those in the Q1 group, and the age and HDL-C were lower than those in the Q1 group (P<0.05). Multivariate Logistic regression analysis showed that elevated WC (OR=1.034, 95%CI=1.016-1.053), BMI (OR=1.340, 95%CI=1.266-1.418), GGT (OR=1.006, 95%CI=1.003-1.010), SUA (OR=1.002, 95%CI=1.000-1.003), TG (OR=1.319, 95%CI=1.181-1.474), and HbA1c (OR=1.348, 95%CI=1.184-1.536) were risk factors for MAFLD, while elevated HDL-C (OR=0.334, 95%CI=0.205-0.543) was a protective factor for MAFLD (P<0.05). After adjusting for confounding factors, the risk of MAFLD in Q4 group was 1.734 (95%CI=1.220-2.465, P=0.002) compared with Q1 group. SUA/Cr predicted that the area under the curve (AUC) of MAFLD was 0.607 (95%CI=0.584-0.630), with an optimal threshold value of 4.538.
The level of SUA/Cr in MAFLD group is higher compared to the non-MAFLD group. As the SUA/Cr level increased, the detection rate of MAFLD also increased. The SUA/Cr is a risk factor for MAFLD. The SUA/Cr can be used as a predictor to evaluate the risk of developing MAFLD.
As a common malignant tumor, prostate cancer (PCa) poses a significant threat to the well-being of men worldwide. The prognosis of PCa is intricately linked to the grade and stage of the tumor at the time of initial detection. Prostate specific antigen (PSA) is a key biomarker for evaluating prostate health, yet lacks specificity for prostate cancer tumors. Elevated PSA levels can also be caused by benign prostate diseases. And the indiscriminate use of biopsy resulting in overdiagnosis. Hence, the development of a prostate cancer risk prediction model based on pre-biopsy clinical indicators in patients can serve as a valuable tool for early screening of individuals with suspicious findings warranting biopsy.
To examine the individual risk factors associated with positive prostate biopsy outcomes and develop a risk assessment model for predicting positive biopsy results in PCa screening.
A total of 1 138 patients who underwent prostate biopsy in the Department of Urology, the First Affiliated Hospital of Air Force Medical University from January 2011 to June 2023 were gathered and organized. Following the exclusion of 351 cases with inadequate clinical data, the remaining 787 cases were randomly allocated into a training set and validation set in a 7∶3 ratio by R software. Patient demographics and routine biochemical test results prior to biopsy were compiled, with PCa diagnosis determined based on the outcomes of the biopsy. LASSO regression analysis in the R software was utilized to identify independent risk factors associated with the development of PCa based on biochemical indicators. Subsequently, multivariate logistic regression analysis in SPSS software was employed to construct an early screening and predictive model for PCa, with a Nomogram being generated. The model was validated according to the data of training set and validation set.
The study utilized LASSO regression analysis to identify 6 independent risk factors associated with positive prostate biopsy results, including age, total PSA (tPSA), alkaline phosphatase, serum protein level, Ca2+, and urea. Multivariate Logistic regression analysis revealed that individuals aged 60 years or older (OR=3.769, 95%CI=2.393-5.937), with tPSA levels of 10 μg/L or higher (OR=2.259, 95%CI=1.419-3.596), and alkaline phosphatase levels exceeding 45 U/L (45-<125 U/L, OR=20.136, 95%CI=4.419-91.752; ≥125 U/L, OR=45.691, 95%CI=9.199-226.951) were at increased risk for positive prostate biopsy outcomes (P<0.05). Conversely, higher levels of serum total protein (≥65 g/L, OR=0.086, 95%CI=0.031-0.236), Ca2+ (≥2.11 mmol/L, OR=0.148, 95%CI=0.054-0.403), and urea (≥9.5 mmol/L, OR=0.069, 95%CI=0.019-0.252) were found to be protective factors against positive prostate biopsy results (P<0.05). Based on the identification of 6 independent risk factors exhibiting statistically significant differences, a nomogram was constructed and a predictive model was developed. The predictive model yielded an Area under the receiver operating characteristic (ROC) curve (AUC) of 0.778 (95%CI=0.740-0.816) for PCa in the training set, with a sensitivity of 53.2% and a specificity of 85.5%. In the validation cohort, the AUC for PCa was 0.770 (95%CI=0.708-0.832), with a sensitivity of 61.2% and a specificity of 80.0%. The goodness of fit test indicated P=0.543 in the training set and P=0.372 in the validation set, demonstrating a satisfactory level of fit. The discriminant analysis (DCA) demonstrated that the high-risk threshold in the training set was below 10%, while in the validation set it was approximately 15%, indicating valuable implications for clinical practice.
This study developed a PCa nomogram risk prediction model incorporating 6 biochemical indicators, namely age, tPSA, alkaline phosphatase, serum total protein, Ca2+, and urea, prior to prostate biopsy, to effectively forecast PCa risk in patients with favorable early screening outcomes.
Fibrinogen (FIB) is often elevated in children with Henoch Schonlein purpuric nephritis (HSPN), but the correlation between FIB and renal lesions has been less studied.
To explore the correlation between FIB in children with HSPN and the International Study Group on Pediatric Kidney Disease (ISKDC) pathology grading and micropathological changes in parts of renal units, and to clarify whether FIB can assess the severity of renal injury in children with HSPN.
In total, 922 children with HSPN who were hospitalized in the First Affiliated Hospital of Henan University of Chinese Medicine in the pediatric nephrology ward and underwent kidney biopsy at the same time from December 2017 to December 2022 were collected, and the clinical information, FIB and renal pathological information during renal biopsy were summarized, and based on the FIB level, the children were categorized into group A (low) <2.38 g/L, group B (standard) 2.38-4.98 g/L, and group C (high) >4.98 g/L. The correlation between FIB and ISKDC pathological grades, glomerular mesangial hyperplasia ratio, the crescentic bodies ratio and the nature of the glomerular lesions from acute to chronic was investigated by Spearman rank correlation analysis, and the prediction of FIB on the micropathological changes of renal units was analyzed by the subject's work characteristic (ROC) curve.
Among 922 children with HSPN who had undergone renal biopsy, the FIB was (3.48±1.01) g/L. 113 cases in group A had a low FIB rate of 12.26%; 734 cases in group B had a standardized FIB rate of 79.61%; and 75 cases in group C had a high FIB rate of 8.13%. The ISKDC pathology classification was type Ⅱa in 173 cases (18.76%), type Ⅱb in 29 cases (3.15%), 466 cases (50.54%) of type Ⅲa, 232 cases (25.16%) of type Ⅲb, and 22 cases (2.39%) of type Ⅳ and above (including 2 cases of type Ⅳa, 18 cases of type Ⅳb, and 2 cases of type Ⅴ). The results of the Spearman's rank correlation analysis showed that the FIB and the grouping of the FIB of the children with HSPN were positively related to the renal pathology ISKDC grading (rs=0.146, P<0.001; rs=0.129, P<0.001). 911 (98.80%) of 922 children with HSPN were mesangial proliferative, and 655 (71.04%) had crescentic hyperplasia. Spearman rank correlation analysis showed a weak positive correlation between FIB and FIB subgroups and the rate of mesangial hyperplasia (rs=0.092, P=0.005; rs=0.096, P=0.003), and a positive correlation with the rate of crescentic bodies (rs=0.132, P<0.001; rs=0.830, P=0.012). 922 children with HSPN had glomerular acute lesions in 763 cases (82.75%), acute chronic lesions in 97 cases (10.52%), and chronic lesions in 62 cases (6.73%). In addition, FIB gradually increased with the nature of the glomerular lesions from acute to chronic (rs=0.145, P<0.001). At the same time, comparison of some renal biopsy indexes FIB in HSPN children showed statistically significant difference (P<0.05). The ROC curves showed that the FIB had the highest sensitivity for glomerulosclerosis (sensitivity=0.900, specificity=0.303), and the optimal cutoff value for FIB was 2.835 mg/L; the area under the ROC curve (AUC) of FIB for the positive prediction of tubulointerstitial fibrosis=0.623, and that of FIB for the reverse prediction of tubulointerstitial cellular granulomatous degeneration=0.641.
FIB can be used as a laboratory index reflecting the severity of renal pathological changes in patients with HSPN, can reflect the severity of renal pathological grading, is closely related to irreversible lesions according to renal microscopic indicators such as glomerular sclerosis and balloon adhesion, and can assist clinical diagnosis and treatment.
Whether considering the cumulative effect of sustained C-reactive protein (CRP) and distinguishing different aspects of depressive symptoms may be the reasons for the inconsistent conclusions of previous studies on the association between CRP and depressive symptoms among middle-aged and older adults. The relationship between cumulative effects of CRP elevations and different aspects of depressive symptoms in middle-aged and older adults in China is not well understood.
This study aims to examine the relationship between cumulative episodes of CRP elevations over two successive determinations and depressive symptoms, as well as somatic and non-somatic retardation, among Chinese middle-aged and older adults.
This study used public data from the 2011-2018 Chinese Health and Retirement Longitudinal Study (CHARLS) and included 3 868 subjects. They were categorized based on the frequency of CRP elevations over two consecutive measurements: "elevated on zero occasion" (n=2 918), "elevated on one occasion" (n=763), and "elevated on two occasions" (n=187). Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CESD-10) in 2011, 2015, and 2018, capturing both somatic and non-somatic dimensions. Multiple linear was used to explore the associations between cumulative episodes of CRP elevations over two successive determinations with depressive symptom scores in 2018, as well as the scores of somatic and non-somatic components separately. Multivariate Logistic regression was used to investigate the effects of cumulative episodes of CRP elevations on the risk of depressive symptoms in 2018.
The results of multiple linear regression analysis showed that after adjusting for all covariates, elevated on two occasions compared with elevated on zero occasion, which was an influential factor for the total score of depressive symptoms (β=1.22, P<0.05), the score of somatic depressive symptoms (β=0.51, P<0.05) and the score of non-somatic symptoms (β=0.71, P<0.05). Logistic regression analysis showed that after adjusting for all covariates, elevated on two occasions were associated with a higher risk of depressive symptoms than elevated on zero occasion (OR=1.64, 95%CI=1.18-2.29) .
Among Chinese middle-aged and older adults, there is a positive association between cumulative effects of CRP elevations and depressive symptoms, encompassing both somatic and non-somatic retardation. Addressing chronic inflammation and treating chronic inflammatory diseases promptly may help mitigate depression risk.
There is a close association between obstructive sleep apnea-hypopnea syndrome (OSAHS) and stroke. The coexistence of the two diseases not only affects the rehabilitation process of patients, prolongs their hospitalization time, but also may increase the risk of death. At present, there is still a lack of clinical research on continuous positive airway pressure (CPAP) combined with respiratory training for stroke patients with OSAHS.
To examine the impact of threshold inspiratory muscle training (TIMT) in conjunction with CPAP on sleep status, pulmonary function, and respiratory muscle strength in stroke patients with OSAHS.
Sixty-nine patients with stroke and OSAHS who met the enrollment criteria were selected from the Second Affiliated Hospital of Zhengzhou University from April 2022 to August 2023. The patients were divided into experimental group (n=35) and control group (n=34) by random number table method. The control group received CPAP and conventional treatment, and the experimental group received TIMT on this basis for 6 weeks. The sleep status, lung function and respiratory muscle function of the two groups were compared before and after intervention.
Six weeks after the intervention, the mean blood oxygen saturation (SpO2), proportion of deep sleep (proportion of N3 sleep in total sleep time), minimum arterial oxygen saturation (LSaO2), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), one-second rate (FEV1/FVC), maximum expiratory pressure (MEP) and maximum inspiratory pressure (MIP) were all higher than those before intervention in the 2 groups (P<0.05) ; After 6 weeks of intervention, SpO2, proportion of deep sleep (proportion of N3 sleep in total sleep time), LSaO2, FEV1, FVC, FEV1/FVC, MEP and MIP in experimental group were higher than those in control group (P<0.05). Sleep apnea hypopnea index (AHI), oxygen loss index (ODI), arousal index and Epworth lethargy scale (ESS) scores in the 2 groups were lower than those before intervention (P<0.05). After 6 weeks of intervention, the ODI, arousal index and ESS scores of experimental group were lower than those of the control group (P<0.05) .
TIMT combined with CPAP can significantly improve the sleep disorder of stroke patients with OSAHS, and improve arterial oxygen partial pressure, respiratory muscle strength and pulmonary function.
Dysphagia, a prevalent geriatric syndrome, has been witnessing an upward trend in incidence rates, potentially leading to severe complications like aspiration pneumonia and asphyxia. Despite its significance, research on the prevalence and determinants of dysphagia among community-dwelling elderly remains scarce.
This study aims to ascertain the prevalence of dysphagia among Shanghai's elderly community by identifying influencing factors and analyzing occurrence rates and determinants across different age brackets.
Employing a cross-sectional survey approach, the study was conducted from July 2022 to May 2023. Using convenience sampling, the study involved 358 individuals aged 60 and above, selected from the outpatient and home care services of five community health service centers in Huangpu, Baoshan and Fengxian Districts of Shanghai. Demographic data were collected, and measurements of the Appendicular Skeletal Muscle Index (ASMI), grip strength, and walking speed were taken. The Eating Assessment Tool-10 (EAT-10) was utilized to assess the risk of dysphagia among the elderly.
Out of the 358 community-dwelling elderly individuals surveyed, 80 (22.3%) exhibited symptoms of dysphagia (EAT-10≥3) (dysphagia group). Multivariate Logistic regression analysis identified advanced age (≥80 years) (OR=18.484, 95%CI=3.571-95.679), depressive state (OR=4.135, 95%CI=1.280-13.364), and a history of choking (OR=13.650, 95%CI=4.345-42.877) as significant risk factors for dysphagia (P<0.05). Conversely, a high Barthel Index (OR=0.891, 95%CI=0.832-0.953) and a robust ASMI (OR=0.330, 95%CI=0.199-0.547) emerged as protective factors (P<0.05). When stratified by age, the prevalence rates of dysphagia were 5.0% (6/119), 11.1% (16/144), and 61.1% (58/95) for the age groups 60-69, 70-79, and ≥80 respectively, with statistically significant differences (P<0.05). Significant disparities were noted between dysphagia and non-dysphagia groups in terms of BMI, ASMI, and depression status for ages 60-69 (P<0.05), grip strength, calf circumference, depression, Barthel Index, and choking history for ages 70-79 (P<0.05), and ASMI, grip strength, walking speed, Barthel Index, MMSE scores, and choking history for ages ≥80 (P<0.05). Within the dysphagia cohort, ASMI and grip strength in the 70-79 and ≥80 age groups were lower compared to the 60-69 age group (P<0.05). The walking speed of individuals aged ≥70 was reduced relative to those aged 60-69 (P<0.05). Additionally, individuals aged ≥80 showed a higher choking incidence and scored lower on the Barthel Index and MMSE than those aged 60-79 (P<0.05) .
The prevalence of dysphagia among community-dwelling elderly in Shanghai is notably high and progressively increases with age, with a corresponding rise in influencing factors. It is imperative to intensify dysphagia screening, particularly among the elderly with depressive symptoms or a history of choking. Enhancing muscle mass and self-care capabilities, coupled with age-specific preventive measures, can substantially alleviate the disease burden and improve prognoses.
Locally advanced gastric cancer mainly includes stage Ⅲ gastric cancer, which is mainly treated with comprehensive therapy. Postoperative recurrence is a key factor affecting the prognosis of patients.
To explore the influencing factors of long-term prognosis in patients with stage Ⅲ gastric cancer undergoing D2 radical surgery and adjuvant chemotherapy.
Gastric cancer patients who underwent D2 radical surgery and adjuvant chemoradiotherapy were collected from the Department of Radiotherapy at Zhongshan Hospital affiliated to Fudan University from 2009 to 2014. They were pathologically diagnosed with stage Ⅲ gastric cancer according to the International Union of Cancer (UICC) and American Cancer Federation (AJCC) 8th edition TNM staging system for gastric cancer. All postoperative patients were followed up every 3 months in the first year, every 6 months for the following 2 years, and once a year thereafter. The deadline for follow-up is December 15, 2021. Survival rates of subgroups were compared using Log-rank tests.The influencing factors of overall survival (OS) and disease-free survival (DFS) were compared using Cox proportional hazards regression analysis, and the prediction of clinicopathological features were analyzed by Nomogram. Comparison of survival differences among patients with different pTNM stagings, age, metastatic lymph node radios (LNR), and gastrectomy methods using Kaplan-Meier method.
A total of 135 qualified patients were included, with a median follow-up time of 10.48 years. Within 5 years, there were 70 cases of recurrence and 62 deaths. The 5-year DFS rate and OS rate were 48.1% (65/135) and 54.1% (73/135), respectively; Within 10 years, there were 74 cases of recurrence and 74 deaths. The 10-year DFS rate nd OS rate were both 45.2% (61/135). The Log-rank test results showed that there was a statistically significant difference in 5-year survival rates among patients with different pTNM stagings, pT stagings, LNRs, cancer nodules, tumor locations, and gastrectomy methods (P<0.05). The 10-year survival rates of patients with different pTNM stagings, pT stagings, LNRs, nerve infiltrations, and gastrectomy methods were compared, and the differences were statistically significant (P<0.05). The results of multivariate Cox proportional hazards regression analysis showed that pTNM staging (Stage ⅢA, OS: HR=0.40, 95%CI=0.19-0.83; DFS: HR=0.40, 95%CI=0.19-0.92), LNR (>50%, OS: HR=1.74, 95%CI=1.03-2.94; DFS: HR=1.73, 95%CI=1.02-2.94), and gastrectomy method (total gastrectomy, OS: HR=2.07, 95%CI=1.22-3.50; DFS: HR=2.02, 95%CI=1.20-3.41) were independent influencing factors for OS and DFS in patients with stageⅢ gastric cancer undergoing D2 radical surgery with adjuvant chemotherapy (P<0.05), while age (≤ 40 years, HR=2.19, 95%CI=1.06-4.53) was an independent influencing factor for OS. Moreover, nomogram indicated that age, pTNM staging, LNR, and gastrectomy method have good predictive effects on the prognosis. For recurrence, 10 cases (7.4%) experienced local recurrence (recurrence of anastomotic sites and lymph nodes within the radiation field), 35 cases (25.9%) experienced abdominal and pelvic dissemination of implants, and 37 cases (27.4%) experienced distant metastasis (including lung, liver, bone, brain and other organs) ; Some patients had two or more types of recurrence. The postoperative survival curves of stageⅢ gastric cancer patients with different pTNM stagings, age, LNRs, and gastrectomy methods were compared, and the differences were statistically significant (P<0.05) .
Most patients with stageⅢ gastric cancer who undergo adjuvant chemoradiotherapy after D2 radical surgery experience recurrence or death within 5 years. pTNM staging, LNR, and gastrectomy method are factors that affect the prognosis of these patients.
Depression is a common psychiatric disorder with limited treatment options. Deep transcranial magnetic stimulation (dTMS), as a new non-invasive neuromodulation technique, has been utilized in the treatment of major depressive disorder (MDD), but there is less evidence from clinical studies.
To explore the clinical efficacy of dTMS combined with escitalopram oxalate (Esc) in the treatment of depression, and provide further reliable data reference for dTMS in the treatment of depression patients.
A total of 73 patients with depression who attended Department of Psychiatry, Affiliated Hospital of Guizhou Medical University from December 2021 to January 2023 were selected as the study subjects and divided into the control group (n=35) and combined treatment group (n=38) according to the random number table. Patients in the control group were given Esc ( 10 mg per day in the first week and 20 mg per day from the second week for 2 consecutive weeks). The combined treatment group received the treatment of dTMS (left DLPFC as the stimulation target, 18 Hz, 120%MT, 1 980 times per day for 2 weeks, 10 times in total) based on the same treatment for the control group. The depressive symptoms and cognitive improvement of patients in the two groups were evaluated before and after the two weeks of treatments by Hamilton depression scale (HAMD), Beck Scale for Suicide Ideation (BSS), Montreal Cognitive Assessment Scale (MoCA) and the mean oxygenated hemoglobin (oxy-Hb) concentration in the prefrontal cortex measured by functional near-infrared spectroscopy (fNIRS) based on the verbal fluency text (VFT) task.
The actual completion of the trial was 30 cases in the control group and 31 cases in the combined treatment group. After treatment, the HAMD and BSS scores of the combined treatment group were lower than those of the control group, and the MoCA score was higher than that of the control group (P<0.05). After treatment, the HAMD and BSS scores of patients in the two groups were lower than those before treatment, and the MoCA score was higher than that before treatment (P<0.05). There was no significant activation of the prefrontal cortex after treatment in both groups. The improvement of depression symptoms and cognitive function in the combined treatment group was better than that in the control group.
The combination of dTMS and Esc can improve the depressive symptoms and cognitive function better than Esc treatment alone in depression patients.
Acute pancreatitis (AP) is one of the common gastrointestinal emergencies, and the disease progression of moderately severe and severe AP is rapid. Early and accurate identification is crucial for effective intervention and prognosis assessment. there is still a lack of effective and simple predictive indicators.
To investigate the early dynamic changes and predictive value of the systemic inflammation response index (SIRI) in patients with AP.
A total of 221 AP patients who met the inclusion and exclusion criteria at the Department of Gastroenterology, Beijing Tiantan Hospital, Capital Medical University, were included as study subjects from August 2020 to March 2023. According to the revised 2012 Atlanta criteria, patients were categorized into mild group (MAP group, mild acute pancreatitis) and non-mild group (non-MAP group, including moderate severe and severe acute pancreatitis). The SIRI values (SIRI 0 h, SIRI 48 h) and C-reactive protein (CRP) levels (CRP 0 h, CRP 48 h) during admission and within 48 hours of admission for the patients were collected by reviewing cases. The receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was calculated to analyze the predictive value of SIRI for non-MAP and compare it with CRP as a common clinical indicator of inflammation.
A total of 221 AP patients were finally included, 102 with MAP and 119 with non-MAP. SIRI 0 h and SIRI 48 h were higher in patients in the non-MAP group than in the MAP group (P<0.001). The ROC curve showed that the AUC for SIRI 0 h and SIRI 48 h in predicting non-MAP were 0.685 (95%CI=0.615-0.756) and 0.753 (95%CI=0.689-0.816), respectively, with no significant difference with CRP [0.607 (95%CI=0.533-0.681) and 0.752 (95%CI=0.687-0.817) ] during the corresponding time intervals (Z=1.67, P=0.095; Z=0.02, P=0.981). The optimal cut-off value for SIRI 48h to predict non-MAP was 2.49, with sensitivity, specificity, positive predictive value, and negative predictive value of 81.51%, 58.82%, 69.78%, and 73.17%, respectively.
SIRI is an affordable and readily available test that can be used as an indicator for assessing the severity of early-stage AP.
The treatment of coronary microvascular disease (CMVD) has always been the focus of non-coronary obstructive ischemic heart disease. Adenosine injection and adenosine disodium triphosphate (ATP) injection, which are common clinical loading drugs to determine coronary flow reserve (CFR) and evaluate CMVD, are related but significantly different. ATP is the precursor of adenosine, with low price and similar vasodilatory mechanism to adenosine, and is often substituted for adenosine in clinical practice, but its potential adverse effects are ignored.
To compare the incidence of adverse reactions in the assessment of coronary microvascular disease by adenosine load and adenosine disodium triphosphate load.
A total of 170 patients who visited the Department of Cardiology of Shaanxi Provincial People's Hospital for typical angina pectoris and underwent coronarography/Coronary CT angiography (CTA) to determine the residual stenosis diameter of each branch coronary artery <50% during June 2019 to July 2020 were selected and divided into the adenosine group (n=88) and ATP group (n=82) based on random number table method. CFR was determined by adenosine injection loading in the adenosine group and by ATP loading in the ATP group. Blood pressure, heart rate, scanning time and adverse reactions of patients were recorded during the detection process.
The incidence of adverse reactions of chest tightness [61.0% (50/82) vs 20.4% (18/88) ], dizziness [72.0% (59/82) vs 31.8% (28/88) ], headache [68.3% (56/82) vs 11.4% (10/88) ], gastrointestinal discomfort [13.4% (11/82) vs 4.5% (4/88) ], palpitation [69.5% (57/82) vs 5.7% (5/88) ], shortness of breath [40.2% (33/82) vs 2.3% (2/88) ], profuse sweating [28.0% (23/82) vs 3.4% (3/88) ], hot flush [19.5% (16/82) vs 2.3% (2/88) ] and facial flushing [13.4% (11/82) vs 4.5% (4/88) ] in patients in the ATP group were higher than those in the adenosine group (P<0.05). There was no significant difference in the incidence of neuroticism, tinnitus, dry throat and neck discomfort between the two groups (P>0.05) .
Compared with ATP loading, adenosine loading has a lower incidence of adverse reactions determine CFR.
The heterogeneity of myelodysplastic syndromes (MDS) is strong, with poor efficacy of existing therapeutic regimens and large individual differences in patient prognosis. B-cell lymphomato-2 (Bcl-2) protein is highly expressed in patients with myeloid tumors, which has been proved by previous to be associated with disease progression, chemotherapy resistance, and shortened overall survival. The Bcl-2 inhibitor Veneckla (VEN) is approved for elderly patients with newly diagnosed acute myeloid leukemia (AML) who are not eligible for intensive therapy, and there is less data on its use in MDS patients. The difference in Bcl-2 expression in MDS patients and its correlation with the efficacy and prognosis of VEN therapy haven't been reported.
To analyse the expression of Bcl-2 protein in MDS patients and assess its correlation with the efficacy and prognosis of VEN treatment.
The clinical data of 71 patients with MDS admitted to Sichuan Academy of Medical Sciences·Sichuan Provincial People's Hospital from July 2018 to December 2022 were retrospectively analyzed. Baseline data of patients including gender, age, blood routine, blood biochemistry, bone marrow hemocytology, flow cytometry, chromosome karyotype, myeloid gene mutation, fusion gene mutation and MDS-EB typing were collected. The expression of Bcl-2 protein was detected by immunohistochemical staining. According to the modified International Prognostic Score System (IPSS-R), the patients were divided into 5 risk levels of very low risk (0 case), low risk (1 case), medium risk (7 cases), high risk (40 cases) and very high risk (23 cases). Patients with bone marrow Bcl-2 positivity≥10% were defined as Bcl-2 positive and<10% as Bcl-2 negative. Patients were divided into the positive group (n=38) and negative group (n=33). Of 63 patients with high-risk and very high-risk MDS, 38 were treated and evaluated for efficacy, including 28 patients who received VEN combined with azacitidine (VA combination regimen) and 10 patients who received hypomethylated drugs (HMA, including azacitidine or decitabine) as monotherapy. The patients were followed up until 2022-12-30. Kaplan-Meier curve was plotted to analyze the overall survival time (OS) of different patients, and Log-rank test was used for comparison. Univariate Cox regression model was used to analyze the influencing factors of patients' OS.
The proportions of fusion gene mutation and nuclear myeloid phosphoprotein 1 (NPM1) gene mutation in the positive group were higher than those in the negative group, and the difference was statistically significant (P<0.05). Of the 10 patients who received HMA monotherapy, 1 was Bcl-2 negative and 9 were Bcl-2 positive, after 14 days of treatment, 4 of them (40.0%) achieved composite complete response (CR/mCR). Of the 28 patients receiving the VA combination regimen, 12 were Bcl-2 negative and 16 were Bcl-2 positive, and after 14 days of treatment, 20 (71.4%) patients receiving the VA combination regimen achieved CR/mCR. There was no significant difference in CR/mCR ratio between the two treatment regimens (P=0.087). The median overall survival time (mOS) for patients with VA combination therapy was 6.9 months, with a mOS of 2.9 months for Bcl-2 negative patients and 7.4 months for Bcl-2 positive patients. There was no significant difference in survival rate between Bcl-2 positive patients and Bcl-2 negative patients (χ2=2.075, P=0.150). The mOS of Bcl-2 positive patients receiving HMA monotherapy was 4.3 months, and there was no significant difference in the survival rate comparing with Bcl-2 positive patients receiving VA combination regimen (χ2=0.824, P=0.364). Univariate Cox regression model analysis showed that age, Bcl-2 protein expression, mutant gene number, chromosome karyotype, MDS-EB typing, IPSS-R risk, and efficacy were not the influencing factors for OS in patients treated with VA combination regimen (P>0.05) .
Bcl-2 protein contributes to MDS fusion gene mutation and myeloid gene mutation; Bcl-2 positive expression was not associated with the survival of MDS patients. There was no difference in survival rate between Bcl-2 positive and Bcl-2 negative patients who received the VA combination regimen.
Patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) face a significant risk of long-term major adverse cardiovascular events (MACEs). Accurate early risk stratification is crucial for managing post-PCI MACEs in STEMI patients, as highlighted in clinical guidelines. Existing risk scoring systems, including the Age, Creatinine, and Ejection Fraction (ACEF) score, Thrombolysis in Myocardial Infarction (TIMI) score, Zwolle score, Primary Angioplasty in Myocardial Infarction (PAMI) score, and Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) score, vary in their predictive utility for the long-term prognosis post-PCI in STEMI patients.
This study aims to analyze the risk factors for long-term MACEs post-PCI in STEMI patients in China and compare the predictive value of the commonly used ACEF, TIMI, Zwolle, PAMI, and CADILLAC risk scoring systems.
A retrospective cohort of 687 STEMI patients who underwent their first PCI between June 2016 and June 2020 at Gansu Provincial Hospital was selected. Patient demographics, laboratory, and imaging results were collected, and risk scores were assigned using the ACEF, TIMI, Zwolle, PAMI, and CADILLAC systems. Patients were followed up annually via phone or clinic visits until August 2023, with a focus on the occurrence of MACEs. Multivariable Logistic regression analysis was used to explore the factors influencing the occurrence of MACEs post-PCI. Receiver operating characteristic (ROC) curves for the different risk scoring systems were plotted, and their areas under the curve (AUC) were compared using the DeLong test.
Out of the 687 patients who underwent PCI, 44 were excluded due to incomplete data, leaving 643 for analysis. The median follow-up period was 37 (range 25-49) months. By the end of the follow-up, 134 patients had experienced MACEs, representing a 20.8% incidence rate. The MACEs group differed significantly from the non-MACEs group in terms of age, hospital stay duration, Killip class, N-terminal pro b-type natriuretic peptide, fibrinogen, anemia, left ventricular ejection fraction, estimated glomerular filtration rate, and creatinine levels (P<0.05). Multivariable Logistic regression revealed prolonged hospital stay (OR=1.071, 95%CI=1.012-1.134, P=0.018), elevated creatinine (OR=1.018, 95%CI=1.006-1.030, P=0.003), and increased fibrinogen (OR=1.226, 95%CI=1.066-1.409, P=0.004) as risk factors for MACEs, while higher left ventricular ejection fraction (OR=0.980, 95%CI=0.960-1.000, P=0.045), mild (OR=0.377, 95%CI=0.151-0.938, P=0.036), and moderate regurgitation (OR=0.164, 95%CI=0.051-0.522, P=0.002) were protective. The ACEF, TIMI, Zwolle, PAMI, and CADILLAC scores were significantly higher in the MACEs group (P<0.05). The ROC curves for predicting MACEs post-PCI in STEMI patients showed no significant differences among the five risk scoring systems (P>0.05) .
Hospital stay duration, creatinine levels, fibrinogen, left ventricular ejection fraction, and valvular regurgitation status are significant factors affecting the occurrence of long-term MACEs post-PCI in STEMI patients. While all five risk scoring systems—ACEF, TIMI, Zwolle, PAMI, and CADILLAC—can predict the occurrence of long-term MACEs in these patients, the CADILLAC score is recommended for its distinctiveness and sensitivity.
Diabetic foot (DF) is one of the most serious chronic complications in patients with diabetes. There is an incidence of DF of 15% in China, with a poor prognosis, an amputation rate of 22%, and a mortality rate of 11%, which greatly reduces the quality of life and life expectancy of patients with DF. DF wound healing may benefit from vitamin D, however, sufficient clinical studies are lacking to confirm this claim.
To explore the correlation between serum 25 (OH) D3 and DF wound healing.
A nested case-control study method was used to select DF patients with Wagner grading 2-4 who were hospitalized in the Affiliated Hospital of Zunyi Medical University from 2020 to 2021. The patients were discharged from the hospital and followed up for 3 months, and 55 patients whose DF wounds still had not healed were selected as the case group. As the control group, 110 patients whose DF wounds healed within 3 months of discharge were matched 1∶2 according to their age, gender, and Wagner grade with the patients in the case group. In the early stages of treatment, 2 mL of venous blood was obtained and serum 25 (OH) D3 levels were determined before vitamin D supplementation. Detailed basic data, biochemical and imaging indices of the patients were collected, including general demographics (age, gender, place of residence, education), BMI, diabetes duration and family history, hospitalization duration, lifestyle habits (alcohol consumption, smoking status), history of hypertension and Wagner classification. The biochemical parameters included 25 (OH) D3, glycosylated hemoglobin (HbA1c), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). An MRI was performed to determine if the patient had osteomyelitis. Logistic regression was used to analyze the relationship between different 25 (OH) D3 levels and DF wound healing.
The duration of diabetes in the case group was longer than that in the control group (P<0.001), the proportion of patients with a family history of diabetes was less than that in the control group (P=0.046), and the serum 25 (OH) D3 levels was lower than that in the control group (P<0.001) ; There was a statistically significant difference in the comparison of smoking status between the patients in the case group and the control group (P<0.001). Comparison of age, gender, residence, BMI, length of hospital stay, education level, alcohol consumption, proportion of patients with a history of hypertension, Wagner grade, incidence of osteomyelitis, HbA1c, ESR, and CRP between the two groups showed no statistically significant difference (P>0.05). Once age, gender, place of residence, education, BMI, alcohol consumption, smoking, history of hypertension, family history of diabetes mellitus, diabetes duration, length of hospitalization, Wagner grade, osteomyelitis, HbA1c, ESR, and CRP have corrected for, patients with serum 25 (OH) D3 levels of 20 to <30 ng/mL, 10 to <20 ng/mL, and <10 ng/ mL, the risk of diabetic foot wound non-healing was 1.30 times (95%CI=1.12 to 1.63), 2.01 times (95%CI=1.55 to 2.80) and 2.29 times (95%CI=1.66 to 3.92) higher than that of patients with serum 25 (OH) D3 levels≥30 ng/mL, respectively.
Serum 25 (OH) D3 levels <30 ng/mL is an independent risk factor for DF wound nonhealing.
The prevalence of diabetes and cardiovascular diseases in China has been increasing annually, and it has been demonstrated that diabetes can exacerbate the adverse effects of cardiovascular diseases through nutritional and inflammatory pathways. The prognostic nutritional index (PNI) is a marker of immunonutrition that reflects the inflammation, immune status and nutritional status of an individual. Due to its advantages of simplicity, rapidity, accessibility, and reliability, research on PNI has been increasing, yet its role in cardiovascular diseases has been less explored.
To investigate the relationship between PNI and major in-hospital adverse cardiovascular events (MACE) in patients with acute ST-elevation myocardial infarction (STEMI) complicated by type 2 diabetes mellitus (T2DM) following percutaneous coronary intervention (PCI) .
A retrospective analysis of 1 053 STEMI patients with T2DM who underwent PCI at the First Affiliated Hospital of Xinjiang Medical University from January 2015 to June 2023 was conducted. The patients were divided into the MACE (n=177) and non-MACE (n=876) groups according to the occurrence of MACE during hospitalization, and further categorized into the high PNI (n=686) and low PNI (n=367) groups according based on the cutoff value of PNI to predict the occurrence of in-hospital MACE after PCI in patients with STEMI and T2DM. Univariate and multivariate Logistic regression analyses identified factors influencing in-hospital MACE after PCI in patients with STEMI and T2DM. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of PNI for in-hospital MACE, and the area under the curve (AUC) was calculated. Pearson correlation analysis or Spearman rank correlation analysis was used to explore the correlation between PNI and cardiovascular disease risk factors.
The differences between the MACE and non-MACE groups in gender, age, history of hypertension, serum glucose, Killip classification, lactate dehydrogenase, heart rate, myoglobin, creatine kinase-MB isoenzyme (CK-MB), white blood cell count, brain natriuretic peptide (BNP), PNI, Global Registry of Acute Coronary Events (GRACE) score, hemoglobin, platelet count, lymphocyte count, albumin, total protein, creatinine, urea nitrogen and triacylglycerol were statistically significant (P<0.05). The results of multivariate Logistic regression analysis showed that elevated serum glucose (OR=1.055, 95%CI=1.002-1.112, P=0.044) and higher GRACE score (OR=1.034, 95%CI=0.876-0.939, P<0.001) were risk factors for in-hospital MACE, while increased PNI (OR=0.907, 95%CI=1.017-1.050, P<0.001) was a protective factor. The AUC of PNI for predicting in-hospital MACE was 0.734 (95%CI=0.694-0.773). A predictive model was constructed by Logistic regression analysis, and the model predicted an AUC of 0.791 (95%CI=0.753-0.858) for the occurrence of in-hospital MACE after PCI in patients with STEMI complicated by T2DM. The low PNI group showed higher incidence of MACE and proportion of intra-aortic balloon counterpulsation, longer hospitalization duration, higher levels of serum glucose, troponin T, CK-MB, myoglobin, BNP, C-reactive protein, creatinine, and urea nitrogen than those in the high PNI group; and lower optical coherence tomography ratio, total cholesterol, triacylglycerol, HDL-C, and hemoglobin levels than those in the high PNI group (P<0.05). The results of correlation analysis showed that PNI was positively correlated with hemoglobin, HDL-C, total cholesterol, and triacylglycerol (P<0.05) ; PNI was negatively correlated with serum glucose, creatinine, urea nitrogen, BNP, troponin T, CK-MB, myoglobin, and C-reactive protein (P<0.05) .
PNI is an independent predictive factor for in-hospital MACE in STEMI patients with T2DM after PCI, which can serve as an auxiliary indicator for monitoring patients' immunonutritional status and predicting their short-term prognosis.
Adolescent non-suicidal self-injury has become an increasingly serious mental health problem, and its course is protracted, causing serious burdens to patients, families and society. Intervention of non-suicidal self-injury in adolescents requires a comprehensive intervention model, and the practice of online intervention management in China is still in its infancy.
To investigate the intervention effect of "Internet+" dialectical behavior therapy (DBT) on suicidal ideation, cognitive emotion regulation, and alleviation of depression in adolescent patients with non-suicidal self-injury.
A total of 120 adolescent patients with non-suicidal self-injury who were discharged from the Second Affiliated Hospital of Xinxiang Medical University from May 2021 to May 2022 were selected and randomly divided into the control group (n=60) and intervention group by randomized controlled single-blind method (n=60). The control group received drug intervention, telephone follow-up and psychological counseling, the intervention group implemented a one-year "Internet+" DBT training based on the control group, which was divided into 4 modules of mindfulness training, interpersonal effectiveness training, emotion regulation training and pain tolerance training. Before the intervention, 6 months and 12 months after the intervention, the Self-rating Idea of Suicide Scale (SIOSS), Chinese version of Cognitive Emotion Regulation Questionnaire, (CERQ-C) and Montgomery and Asberg Depression Rating Scale (MADRS) were used to evaluate the suicidal ideation, cognitive emotion regulation, and depression status of the two groups of patients. Repeated measures analysis of variance was used to compare the health status of the two groups at different time points.
Finally, 57 cases in the control group and 55 cases in the intervention group completed the study. There was an interaction between group and time on SIOSS, CERQ-C, and MADRS scores (P<0.05) ; the main effect of group on SIOSS, CERQ-C, and MADRS scores was significant (P<0.05), and the main effect of time on SIOSS, CERQ-C, and MADRS scores was significant (P<0.05). Among them, the difference was statistically significant when comparing the SIOSS, CERQ-C, and MADRS scores before and after intervention within the intervention group (P<0.001) ; there was no significant difference in positive refocus, refocusing on planning, positive reappraisal, rational analysis, catastrophizing, and blaming others dimensions in the SIOSS scores, MADRS scores, and CERQ-C scores before and after intervention within the control group (P>0.001). The difference was statistically significant when comparing the self-blame, acceptance, and contemplation dimensions of the CERQ-C scores before and after intervention within the control group (P<0.001) .
The "Internet+" DBT intervention model can effectively reduce the suicidal ideation of adolescent patients with non-suicidal self-injury, improve the level of emotional control, relieve depression, and improve the quality of life and social function of patients.
Differentiated thyroid carcinoma (DTC) with distant metastasis generally forecasts a poor prognosis. Timely diagnosis and effective treatment of distant metastasis are pivotal and challenging in clinical practice. Serum thyroglobulin (Tg) is a marker for monitoring tumor residue or recurrence/metastasis post-surgery and post-131I therapy in DTC. Thyroglobulin antibodies (TgAb) are autoantibodies against Tg that can potentially interfere with Tg measurement. Presently, literature on 131I treatment of TgAb positive DTC with distant metastasis is sparse.
To investigate the efficacy of 131I therapy in TgAb positive DTC with distant metastasis.
A retrospective analysis was conducted on clinical data of 189 DTC patients treated with 131I from January 2017 to January 2022 at the People's Hospital of Zhengzhou University. Pre-treatment and follow-up measurements of thyroid-stimulating hormone (TSH), Tg, and TgAb were collected. Patients were categorized into TgAb positive (29 cases) and TgAb negative (160 cases) groups. The efficacy of 131I therapy was evaluated. Serum thyroid hormones and routine blood tests were conducted 6-8 weeks post-131I therapy, followed by biannual or annual follow-ups including serum thyroid hormones, Tg, TSH, TgAb, thyroid peroxidase antibodies (TPOAb), neck ultrasound, and CT scans of metastatic sites.
Statistical significance (P<0.05) was observed in the comparison of distant metastatic sites, TPOAb, and pre-first 131I therapy TgAb levels between the TgAb positive and negative groups. In the TgAb positive group, disease was controlled in 14 patients (48.2%), while 15 patients (51.8%) showed disease progression; in the TgAb negative group, 127 patients (79.4%) showed disease control and 33 patients (20.6%) showed progression. The rate of disease progression in the TgAb positive group was significantly higher than in the TgAb negative group (χ2=7.148, P=0.008) .
The rate of disease progression in serum TgAb positive DTC with distant metastasis is significantly higher than in TgAb negative patients; differences in metastatic sites, TPOAb, and pre-first 131I therapy TgAb levels were observed between the groups.
Venous thromboembolism (VTE) has become the third most common cardiovascular disease after ischemic heart disease and stroke. Since the official launch of the National Programme for Prevention and Management of Pulmonary Embolism and Deep Vein Thrombosis in 2018, medical personnel have paid more attention to VTE, and the screening rate of VTE has also increased significantly. However, epidemiological investigations related to VTE are mostly limited to single center studies. There is still a lack of large-scale survey data on the prevalence of VTE involving different levels and properties of medical institutions.
To understand the prevalence and epidemiological characteristics of VTE in Jiaxing, and provide a basis for further prevention and treatment of VTE in this region.
A total of 731 755 discharged patients diagnosed with VTE from all secondary and above medical institutions in Jiaxing City in 2021 were included as the study subjects. General patient data and disease diagnosis-related grouping indicators reflecting the number of patients admitted to the hospital and the difficulty of diagnosis and treatment techniques were collected. Multiple linear regression analysis was used to explore influencing factors of the number of VTE patients in hospitals.
According to inclusion and exclusion criteria, a total of 10 758 VTE patients were diagnosed. The median age of patients was 71 (62, 79) years. The number of VTE patients in general hospital was the highest, which amounting to 9 732 cases (90.46%), while the number of VTE patients in psychiatric hospital was the lowest at 53 cases (0.49%). The number of VTE patients in tertiary hospitals was higher than that in secondary hospitals [7 929 (73.70%) vs. 2 829 (26.30%) ]. The proportion of VTE patients in general hospital was the highest at 1.85%, and the lowest in maternal and child health hospital at 0.10%. The proportion of VTE patients in tertiary hospitals was higher than that in secondary hospitals, at 1.80% and 0.97%, respectively. The prevalence of VTE in different age groups was statistically significant (χ2=32 383.098, P<0.001). The prevalence of VTE in the high age group was higher than that in the low age group (P<0.05) when comparing the prevalence of VTE between different age groups (P<0.05). The prevalence of VTE in males aged 15-44 years was significantly higher than that in females, with statistical significant difference (P<0.001). Surgical treatment was the first risk factor in the distribution of VTE patients, followed by the presence of malignant tumors. The results of linear regression analysis showed that weight (RW) ≥2 cases was the factor influencing the number of VTE patients (P<0.001), and the number of VTE cases increased by 0.363 for each increase in the number of cases with RW≥2 cases.
The prevalence rate of VTE in Jiaxing is 199.2 per 100 000 population, and the disease burden of VTE in Jiaxing has reached or even exceeded western countries. The main risk populations of VTE were elderly patients who have received surgical treatment, with malignant neoplasm, etc. The level of prevention and treatment of VTE in general hospitals in this region should be further improved. In addition, the participation and attention to the standardized prevention and treatment of VTE in traditional Chinese medicine hospitals, maternity and child health care hospitals and psychiatric hospitals should be enhanced.
International Mission on Prognosis and Analysis of Clinical Trial (IMPACT) and Corticosteroid Randomisation after Significant Head Injury (CRASH) are internationally influential prognostic models for traumatic brain injury (TBI), which need to be continuously developed, improved and continuously verified externally to ensure generalizability to different settings.
To verify and compare the prognostic evaluation values of IMPACT and CRASH simultaneously in TBI population in China.
A total of 210 TBI patients treated in Zhengzhou Central Hospital Affiliated to Zhengzhou University from 2017 to 2019 were retrospectively selected as the study objects, and the basic information of the included patients was collected. The 14-day survival and 6-month Glasgow prognostic score (GOS) of the patients were followed up until June 2021, with a termination event of loss of follow-up. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive efficacy of IMPACT and CRASH models in TBI patients, and the area under ROC curve (AUC) was calculated. Brier score was used to evaluate the calibration degree of the model.
The average age of the patients was (54.0±17.4) years. The ROC curves of the IMPACT model and CRASH model to predict the prognosis of TBI patients were plotted, respectively, and the results showed that the AUCs of IMPACT core model, CT model and laboratory model to predict the poor prognosis of GOS in TBI patients at 6 months was 0.807 (95%CI=0.747-0.866, P<0.001), 0.843 (95%CI=0.789-0.897, P<0.001), 0.845 (95%CI=0.793-0.897, P<0.001), Brier scores were 0.179, 0.164, 0.161, respectively; the AUCs of IMPACT core model, CT model and laboratory model predicting 6-month death in TBI patients were 0.868 (95%CI=0.816-0.919, P<0.001), 0.896 (95%CI=0.851-0.941, P<0.001), 0.892 (95%CI=0.850-0.935, P<0.001), and Brier scores were 0.151, 0.144 and 0.136, respectively. The AUCs of CRASH basic model and CT model to predict the poor prognosis of GOS in TBI patients at 6 months was 0.747 (95%CI=0.682-0.813, P<0.001) and 0.766 (95%CI=0.703-0.829, P<0.001) ; Brier scores were 0.306 and 0.308, respectively. The AUCs of CRASH basic model and CT model for predicting 14-day death of TBI patients were 0.791 (95%CI=0.723-0.860, P<0.001) and 0.797 (95%CI=0.728-0.865, P<0.001), the Brier scores were 0.348 and 0.383, respectively.
For the prognosis of TBI patients, the IMPACT model showed better overall predictive capacity than the CRASH model.
After infection with SARS-CoV-2, the body will experience symptoms such as hyposthenia, fatigue, and accelerated heart rate for a period of time. Current research institutions do not have a clear description of the persistent symptoms and causes of corona virus disease 2019 (COVID-19) .
To explore the correlation between the characteristics of fatigue and its related symptoms during the recovery period of COVID-19, and provide data reference for the scientific control of COVID-19.
The survey of COVID-19 was conducted in urban and rural areas of Guangzhou, Wuhan and Zhengzhou from December 2022 to February 2023, a total of 750 questionnaires were distributed and 732 questionnaires were recovered, with an effective rate of 97.6%. Among the 732 respondents, 356 were males (48.63%) and 376 were females (51.37%) ; the average age was (35.2±16.0) years. There were 526 infected individuals and 206 uninfected individuals. The infections and clinical symptoms of the respondents were statistically analyzed by using questionnaires, and the subjective fatigue level was measured using the Fatigue Scale-14 (FS-14), and the measurement results were analyzed for differences. Pearson correlation analysis was used to explore the correlation between clinical characteristics and fatigue levels in COVID-19, and binary Logistic regression analysis was used to explore the risk factors for fatigue in COVID-19.
Fever was the most common symptom of COVID-19, accounting for 88.97% (468/526), the average maximum fever temperature in febrile patients was (38.96±1.35) ℃. The physical fatigue and overall fatigue scores of infected individuals were higher than those of uninfected individuals (P<0.05). The scores of physical fatigue, mental fatigue and overall fatigue of female infected individuals were higher than those of male infected individuals (P<0.05). Pearson correlation analysis showed that the total fatigue score of FS-14 was positively correlated with the maximum fever temperature (r=0.192, P<0.001), fever duration (r=0.299, P<0.001) and physical recovery time (r=0.358, P<0.001). The results of binary Logistic regression analysis showed that fever (OR=1.215, 95%CI=1.029-1.434, P=0.022), the accelerated heart rate (OR=7.325, 95%CI=1.671-32.114, P=0.008), and ocular pain (OR=3.298, 95%CI=1.251-8.696, P=0.016) were risk factors for fatigue above moderate in COVID-19 during recovery period.
The fatigue symptoms of COVID-19 are obvious during the recovery period, with females had higher levels of fatigue than males. Accelerated heart rate, ocular pain, and elevated maximum fever temperature may be risk factors for fatigue above moderate in COVID-19 during recovery period.
Hepatocellular carcinoma (HCC) is the main pathological type of primary liver cancer (PLC) and is closely associated with Hepatitis B virus (HBV) infection. HCC in its early stages often presents no significant symptoms and is usually discovered at an advanced stage with liver, portal vein, or other site metastases, leading to a poor prognosis. Regular screening and early diagnosis in high-risk populations in the early stages of the disease are of great significance for clinical treatment and prognosis.
To explore the application value of oligosaccharides and alpha-fetoprotein (AFP) in the risk population and patients of HBV-related HCC, providing a reference for clinical diagnosis.
The study included 165 chronic HBV infection patients treated at the First Affiliated Hospital of Soochow University from January to November 2022, comprising 123 non-HCC and 42 HCC patients. Patient data (age, gender, cirrhosis status), laboratory indices[total bilirubin (TB), albumin (ALB), platelet count (PLT), AFP]were collected through electronic medical records, and a liver cancer risk prediction model score for chronic liver disease patients (aMAP score) was calculated, along with oligosaccharide marker test results (G-Test). HCC patients were classified as the HCC group (42 cases), and non-HCC patients were divided based on aMAP scores into low-risk (<50 points, 40 cases), medium-risk (50-60 points, 44 cases), and high-risk (>60 points, 39 cases) groups. Receiver operating characteristic (ROC) curves were plotted to analyze the efficacy of AFP, G-Test, and their combined diagnosis of HCC, calculating the area under the ROC curve (AUC), and the DeLong test was used to compare the differences between combined and single indicator AUCs. Kappa consistency tests were used to analyze the consistency of AFP and G-Test with clinical diagnostic results.
In patients with HCC, levels of AFP and G-Test were higher compared to those in the low-risk, medium-risk, and high-risk groups (P<0.05). Additionally, age and the proportion of liver cirrhosis were higher than those in the low-risk and medium-risk groups, ALB levels was lower than that of low risk group and medium risk group and TB levels were lower than those in the high-risk group, while PLT was lower than that in the low-risk group (P<0.05). In the high-risk group, patients exhibited higher age, TB, and G-Test levels compared to the low-risk and medium-risk groups, whereas ALB and PLT levels were lower than those in the low-risk and medium-risk groups, and the proportion of liver cirrhosis was higher than that in the low-risk group (P<0.05). Patients in the medium-risk group showed higher age and liver cirrhosis proportion compared to the low-risk group, and PLT was lower than that in the low-risk group (P<0.05). The AUCs for diagnosing HCC using AFP and G-Test were 0.796 (95%CI=0.706-0.886, P<0.001) and 0.878 (95%CI=0.813-0.943, P<0.001), respectively. The AUC for the combined diagnosis was 0.901 (95%CI=0.844-0.957, P<0.001). DeLong test results showed that the AUC for combined diagnosis was higher than AFP alone (Z=2.104, P=0.035). Consistency analysis showed that the concordance rate of AFP with clinical diagnosis was 84.8% (140/165), with moderate consistency (Kappa=0.539, P<0.001), and for G-Test, it was 89.5% (145/165), indicating higher consistency (Kappa=0.704, P<0.001). The AUC of G-Test in diagnosing AFP-negative HCC was 0.895 (95%CI=0.839-0.952, P<0.001) .
Oligosaccharide chain markers can be used as a complementary detection marker for AFP-negative HCC patients as a potential serum biomarker with better diagnostic efficacy than AFP in patients with HBV-related HCC.
Early diagnosis of acute kidney injury (AKI) in neonates is difficult with a high mortality rate. However, there is currently a lack of research on severe neonatal asphyxia complicated with AKI.
To investigate the risk factors and short-term prognosis of neonatal asphyxia complicated with AKI, and analyze the predictive value of related factors, so as to take measures to reduce the occurrence of AKI and improve the success rate of resuscitation of the neonates.
A total of 172 neonates with severe asphyxia who were hospitalized in the Neonatal Intensive Care Unit of the First Affiliated Hospital of Bengbu Medical College from January 2016 to January 2023 were included as the study subjects and divided into AKI group (n=43) and non-AKI group (n=129) according to whether the neonates were complicated with AKI. Clinical data and laboratory results were collected, and the short-term prognosis (survival or death during hospitalization) of the children with AKI was recorded. Multivariate Logistic regression analysis was used to explore the influencing factors of severe neonatal asphyxia complicated with AKI, and receiver operating characteristics (ROC) curve was used to explore the predictive value of related indicators for severe neonatal asphyxia complicated with AKI.
Gestational age, birth weight, 5-min Apgar score and platelet count in AKI group were lower than those in non-AKI group, and the proportions of coma, invasive mechanical ventilation and combined respiratory failure, cystatin C (Cys C) were higher than those in non-AKI group, with statistically significant difference (P<0.05). Multivariate Logistic regression analysis showed that 5-min Apgar score (OR=1.553, 95%CI=1.193-2.021, P=0.001), invasive mechanical ventilation (OR=2.965, 95%CI=1.021-8.611, P=0.046) and blood Cys C value (OR=0.231, 95%CI=0.109-0.487, P<0.001) were the influential factors for severe neonatal asphyxia complicated with AKI. ROC curve analysis showed that the AUC of blood Cys C for predicting AKI was 0.777 (95%CI=0.701-0.854, P<0.05), and the AUC of 5-min Apgar score for predicting AKI was 0.792 (95%CI=0.715-0.869, P<0.05). The hospitalized mortality was 51.2% (22/43) in AKI group and 21.7% (28/129) in non-AKI group, and the mortality in AKI group was higher than that in non-AKI group, the difference was statistically significant (χ2=13.572, P<0.001) .
Low 5-min Apgar score, invasive mechanical ventilation, and high postnatal blood Cys C can increase the risk of AKI in neonates with severe asphyxia. Postnatal blood Cys C and 5-min Apgar Score are reliable predictor of neonatal asphyxia complicated with AKI.
In recent years, the prevalence of degenerative spinal deformity (DSD) has been increasing annually. Patients have to live with DSD for a long time from the onset of disease until surgical intervention is required, and self-management during this period is crucial for the development and progression of DSD. However, the current status and influencing factors of self-management in DSD patients remain unclear, making it difficult to tailor effective intervention measures.
To investigate the current status and influencing factors of self-management in patients with DSD, so as to provide a clinical reference for the development of targeted intervention programs.
A total of 200 patients with DSD who attended the Department of Orthopedics in the First Affiliated Hospital of Army Medical University from June 2020 to December 2022 using a convenience sampling method to conduct questionnaire survey. The demographic information, Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI) score, Medical Outcomes Study Social Support Survey (MOS-SSS) score, and Chronic Disease Self-management Behavior Scale score were collected. Multiple linear regression were used to analyze the influencing factors of chronic disease self-management behaviors of patients.
A total of 191 (95.5%) valid questionnaires were recovered. The average age of the patients was (62.6±11.6) years, including 144 cases (75.4%) of scoliosis, 37 cases (19.4%) of kyphosis and 10 cases (5.2%) of lateral kyphosis. The total score of self-management behaviors was (22.94±11.97). The standardized scores for each dimension of self-management behaviors were cognitive symptom management (26.27±15.83), doctor-patient communication (23.53±16.27) and exercise (18.42±11.00) in descending order. The results of correlation analysis showed that age, BMI, monthly per capita household income, education level, smoking history, function disorder and medical social support were significantly correlated with the scores of each dimension and total score of Chronic Disease Self-management Behavior Scale (P<0.05). The multiple linear regression analysis results showed that medical social support, education level, monthly per capita household income, and bone mineral density were influencing factors of Chronic Disease Self-management Behavior Scale scores (P<0.05) .
The level of self-management behavior in patients with DSD is low. Medical social support, education level, economic level, and bone mineral density are the main influencing factors of self-management behaviors. Healthcare providers should improve self-management behaviors of DSD patients in clinical practice to help them manage their diseases effectively by strengthening education and enhancing social support.
Subclinical Cushing's syndrome (SCS) is a common subtype of adrenal incidentaloma. There are few reports on the correlation between hyperglycemia and hypercortisone secretion and its postoperative change in SCS patients.
To assess the pre- and post-surgical prevalence of hyperglycemia in patients with SCS secondary to adrenal incidentaloma.
The data of 202 patients who consulted in respiratory department of endocrinology, renhe hospital affiliated to shanghai university (shanghai baoshan district renhe hospital). Participants included 36 SCS patients, 41 patients with Cushing's syndrome due to adrenal tumor (CSA), 47 with nonfunctional adrenal tumor (NAT), and 53 controls. OGTT was performed in all of them, and based on the results, HOMA-IR, the area under the curve of blood glucose (AUCGlu) and insulin (AUCIns) were calculated, and plasma cortisol and urinary free cortisol and plasma ACTH were measured, then the values of the parameters were compared between controls and patients. Surgical treatment was given to SCS and CSA patients. The association of hormone and glucose metabolism parameters was assessed using Pearson correlation analysis.
The prevalence of hyperglycemia in SCS, CSA and NAT patients before surgery and in controls was 41.7%, 51.2%, 25.5%, and 24.5%, respectively. The HbA1c, 2-hour post-load insulin (2 hPIN), AUCGlu and AUCIns in SCS patients were higher than those of controls (P<0.05). CSA patients had higher fasting insulin, AUCIns and HOMA-IR than SCS patients, NAT patients and controls (P<0.05). CSA patients had higher HbA1c, fasting plasma glucose (FPG), 2-hour post-load plasma glucose (2 hPPG), 2 hPIN and AUCGlu than NAT patients and controls (P<0.05). After controlling for sex and age, in SCS patients, HbA1c was positively associated with cortisol measured at 8: 00 and 16: 00 on the day after admission, and 24-hour urinary free cortisol (r=0.68, 0.657, 0.522, P<0.05), and so was 2 hPPG (r=0.569, 0.544, 0.369, P<0.05) ; FPG was positively associated with cortisol measured at 8: 00 on the day after admission (r=0.434, P<0.05) ; AUCGlu was positively associated with cortisol measured at 8: 00 and 16: 00 on the day after admission (r=0.397, 0.409, P<0.05). In CSA group, HbA1c was positively associated with cortisol measured at 8: 00 on the day after admission (r=0.748, P<0.05), and so was FPG, 2 hPPG, AUCGlu, and 2 hPIN (r=0.631, 0.669, 0.602, 0.319, P<0.05). HbA1c was also positively associated with cortisol measured at 16: 00 on the day after admission (r=0.674, P<0.05), and so was FPG, 2 hPPG, AUCGlu, (r=0.655, 0.640, 0.624, P<0.05). Plasma cortisol and 24-hour urinary free cortisol decreased in SCS and CSA patients after surgery (P<0.05). 2 hPIN and AUCIns decreased in SCS patients after surgery (P<0.05). FIN, 2 hPIN, AUCGlu, AUCIns and HOMA-IR decreased in CSA patients after surgery (P<0.05). The postsurgical prevalence of hyperglycemia SCS and CSA patients was 33.3% and 39.0%, respectively.
The high prevalence of hyperglycemia may be related to high secretion of glucocorticoid in SCS patients, and the hyperglycemic condition was improved after surgical treatment.
The most effective prevention strategy for atherosclerotic cardiovascular disease (ASCVD) is primary management, with the core measure of risk assessment. The existing prediction models for ASCVD for the elderly are not able to guide TCM primary management well. Therefore, it is necessary to integrate TCM elements into the development of prediction models to guide the primary management of ASCVD with combined traditional Chinese and western medicine.
To construct and validate the ASCVD prediction model for the elderly based on TCM constitution.
A total of 1 418 elderly people who underwent physical examination at Huayuan Street Community Health Service Center, Chentangzhuang Street Community Health Service Center, Xiangyang Road Street Community Health Service Center and Daqiuzhuang Town Central Health Center in 2017 were included as the study subjects. General data of the study subjects were collected and constitution identification was performed. The incidence of ASCVD (clinical outcome) was followed up from 2017 to 2022. The follow-up will end at 2022-11-30. The data of the subjects were randomly divided into a training set (n=1 127) and validation set (n=291) according to 8∶2. In the training set, the conventional ASCVD prediction model for the elderly (model 1) and the conventional ASCVD+constitution prediction model for the elderly (model 2) were constructed by using the forward stepwise method. The nomogram of ASCVD prediction model for the elderly based on TCM constitution was plotted. The calibration curve was plotted and the Hosmer-Lemeshow goodness of fit test was performed to determine the calibration of the model. The receiver operating characteristic curve was plotted and the area under the curve (AUC) was calculated to determine the discrimination of the model. AUC, Net Reclassification Index (NRI), Integrated Discrimination Improvement (IDI), and Decision Curve Analysis (DCA) were used to compare model 2 with model 1 to evaluate the improvement efficacy of model 2.
There was no significant difference in the general data between the training set and validation set (P>0.05). The results of multivariate analysis showed that model 1 included 7 predictors of gender, age, waist circumference, systolic blood pressure, triacylglycerol (TG), BMI, systolic blood pressure×hypertension medication history. model 2 included 8 predictors of gender, age, waist circumference, systolic blood pressure, TG, BMI, systolic blood pressure×hypertension medication history, and constitution type. Hosmer-Lemeshow goodness-of-fit test showed good fit of model 2; Delong test results showed that AUC of model 2 was higher than that of model 1 (Z=2.741, P=0.006), NRI=0.511 (95%CI=0.359-0.663, P<0.001), IDI=0.038 (95%CI=0.024-0.051, P<0.001), suggesting that the addition of constitution predictors could improve the accuracy of model prediction. The clinical utility comparison results showed that the net benefit of model 2 to predict severe ASCVD events in the elderly was better than model 1 at a threshold probability of 5% to 74%.
In this study, a ASCVD prediction model for the elderly was constructed including 8 predictor variables of gender, age, waist circumference, systolic blood pressure, TG, BMI, systolic blood pressure×hypertension medication history, and constitution type. After testing, the differentiation and calibration performed well, which was better than the conventional prediction model, and can be applied to the individualized risk assessment of ASCVD in the elderly and guide the primary management of ASCVD with combined traditional Chinese and western medicine.
With the change of disease spectrum and the development of modern medical model, traditional Chinese medicine (TCM) is playing an important role in disease prevention, health care and rehabilitation. It is necessary to further promote the development of prevention of disease in TCM and vigorously promote the unique role of TCM in maintaining and promoting people's health. However, popularization and education of the concept of prevention of disease in TCM among community residents remains unclear.
To understand the overall awareness, trust, and adoption behavior of prevention of disease in TCM of community residents in Guangzhou, and explore the influencing factors of community residents' trust in prevention of disease in TCM services.
From April to August 2022, a stratified cluster sampling method was used to interview 652 community residents from 12 streets in 4 administrative regions of Guangzhou city based on geographic location (central city, urban-rural areas, and suburbs) and economic factors by questionnaires. The survey included residents' basic information, awareness and access to knowledge of prevention of disease in TCM, as well as their demand, utilization and trust in it. The influencing factors of community residents' trust in prevention of disease in TCM services were explored by binary Logistic regression analysis.
Among the 652 community residents, 67.79% (442/652) were aware of prevention of disease in TCM, 77.91% (508/652) trusted prevention of disease in TCM services, 69.63% (454/652) had received traditional TCM physiotherapy, and only 6.59% (43/652) had received prevention of disease in TCM services more than 4 times in the past year. Univariate correlation analysis showed that age (χ2=9.218), household type (χ2=19.356), marriage status (χ2=2.490), occupation (χ2=17.889), and medical insurance payment type (χ2=13.516) were influencing factors of residents' trust in prevention of disease in TCM services. Binary Logistic regression analysis showed that household type (non-agricultural, agricultural to resident, and non-agricultural to resident) was an influential factor for community residents' trust in prevention of disease in TCM services (OR=2.646, 5.593, 10.502) .
The overall awareness (67.79%) and trust (77.91%) of prevention of disease in TCM among community residents in Guangzhou are relatively high, but the actual number of services received is insufficient, with a phenomenon of knowledge-attitude-practice separation. Community residents with non-agricultural household type have a higher level of trust, while those with agricultural household type have a lower level of trust. During popularization and services of prevention of disease in TCM, it is necessary to fully utilize the residents' preferred forms, as well as to target specific groups, so as to cultivate the health habits of prevention of disease in community residents.
Accessory breast plasma cell mastitis (PCM) is uncommon in clinical practice with rare reports.
To investigate the clinical characteristics, diagnostic methods and the traditional Chinese medicine (TCM) clinical efficacy of accessory breast PCM.
The clinical diagnosis and treatment data of 15 patients with accessory breast PCM admitted to Beijing Hospital of Traditional Chinese Medicine, Capital Medical University from January 2017 to December 2021 were analyzed retrospectively, the general information, diagnostic methods, treatment methods and outcomes of 15 cases with accessory breast PCM were summarized.
A total of 15 female patients of childbearing age with accessory breast PCM were included in this paper, with onset within 2-5 years after pregnancy. The etiology was complex and the course of accessory breast PCM was protracted, which was similar to breast PCM in pathogenetic characteristics, using pathological examination results as gold standard for diagnosis. After the combination of internal and external treatment of TCM, the symptoms of 15 patients were relieved, local lesions disappeared, and there was no recurrence after six months of follow-up.
Accessory breast PCM is rare in clinical practice, which is easy to be misdiagnosed or missed, and difficult to be treated clinically. The combination of internal and external treatment of TCM has a significant effect on accessory breast PCM.
The prevalence of atrial fibrillation (AF) has continued to rise globally in recent years, and AF increases the risk of stroke, heart failure, myocardial infarction, chronic kidney disease, and other diseases. Studies have identified hypertension, diabetes, smoking, obstructive sleep apnea, obesity and sedentary lifestyle as risk factors for AF. And most of these factors are within the scope of the "Life's Essential 8" (LE8) proposed by the American Heart Association.
To investigate the relationship between cardiovascular health (CVH) score based on the LE8 and AF.
A study was conducted in which 91 131 employees of Kailuan Group in Tangshan, Hebei Province were selected for physical examination from June 2006 to October 2007, and the LE8 score was evaluated according to the algorithm developed by the American Heart Association, and combined with the actual situation of the Kailuan study to form the Kailuan study version of LE8, including 4 health behaviors (diet, physical activity, tobacco exposure, and sleep) and 4 health factors (BMI, blood lipids, blood glucose, and blood pressure). The study subjects were divided into the three groups of the low CVH group (n=8 407) with a LE8 score less than 50, the medium CVH group (n=73 493) with a LE8 score of 50 or more but less than 80, and the high CVH group (n=9 231) with a LE8 score of 80 or more. The follow-up visit was performed per year with the time of the study subject's first Kailuan physical examination as the starting point, the occurrence of AF as the endpoint event, the end of AF and follow-up (2020-12-31) as the endpoint time. Kaplan Meier survival curve was used to analyze the cumulative incidence of new-onset AF in different groups, and log rank test was used to compare the differences between groups; Cox proportional hazards regression analysis was used to investigate the impact of different LE8 score groups and single factor scores on the risk of new-onset AF.
There were significant differences in age, gender, education level, monthly per capita household income, history of alcohol consumption, and LE8 scores among the three groups of subjects (P<0.001). During follow-up, 1 088 cases of new-onset AF were identified, including 133 cases (1.58%) in the low CVH group, 883 cases (1.20%) in the medium CVH group, and 72 cases (0.78%) in the high CVH group. The median follow-up time was 15.0 (14.7, 15.2) years; there was statistically significant difference in the comparison of cumulative incidence rate of new-onset AF in the three groups (P<0.000 1). Cox proportional hazards regression analysis after adjusting for age, gender, education level, monthly per capita household income, and history of alcohol consumption showed that, compared with the low CVH group, both the medium CVH group (HR=0.697, 95%CI=0.579-0.841, P<0.001) and the high CVH group (HR=0.609, 95%CI=0.454-0.816, P=0.001) reduced the risk of new-onset AF. An increase in LE8 score could reduce the risk of new-onset AF (HR=0.859, 95%CI=0.804-0.918, P<0.001). The individual factors of LE8, including BMI score (HR=0.762, 95%CI=0.717-0.809, P<0.001) and blood pressure score (HR=0.824, 95%CI=0.776-0.876, P<0.001), were negatively correlated with the risk of new-onset AF.
The LE8 score of CVH is negatively correlated with the risk of new-onset AF, and the individual factors of LE8, including BMI score and blood pressure score, are negatively correlated with the risk of new-onset AF.
