Sleep quality is an important influence on arteriosclerosis (AS), but the category characteristics of sleep quality need to be further explored, and the association of each category with AS has not been clarified.
To explore the potential categories of sleep quality and analyze the association with AS, providing reference for refining individualized prevention strategies for AS.
The data of this study were obtained from the baseline survey of the "Follow-up Study of Sleep Characteristics and Chronic Diseases in the Middle-aged and Elderly Population in Guizhou Province", which was conducted from March to November 2022. Field questionnaires, physical examination and laboratory tests were conducted by uniformly trained investigators and professionals. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality problems, and latent class analysis (LCA) was performed using the scores of each dimension. Modified Poisson regression was used to analyze the association between sleep quality categories and AS. Stratification analysis was also conducted by gender, age and sleeping late.
A total of 1 059 adults were included and a total of 558 patients with AS were detected, with a detection rate of 52.69%. Four sleep quality categories were identified via the LCA, including good sleep type (category 1, n=458), sleep deprivation with poor nighttime sleep quality (category 2, n=248), inefficient and insufficient sleep type (category 3, n=238), and multiple sleep problems type (category 4, n=115). The risk of AS was higher in the category 3 population than in category 1 (PR=1.14, 95%CI=1.00-1.30). Subgroup analyses revealed that in the female population, the risk of AS was higher in category 3 and category 4 compared to category 1, with PR=1.44 (95%CI=1.11-1.86) and 1.41 (95%CI=1.06-1.90). In addition, association between sleep quality categories and AS in the male population was not statistically significant. Compared with in category 1, higher risk of AS was detected in category 4 in the late-sleeping population and in category 3 in the non-late-sleeping group, with PR=1.26 (95%CI=1.02-1.56) and 1.20 (95%CI=1.00-1.43), respectively. No statistically significant difference in AS risk were found between category 2 and category 1 (P>0.05) .
Four categories characterizing sleep quality were identified among adults aged 40 to 65 years, each showing different associations with AS. Classification of sleep problems should be combined into individual interventions for better prevention against AS, especially for women and late sleepers.
Cognitive impairment is one of the serious risk factors affecting the quality of life in the elderly. Some studies have found an association between frailty and cognitive function, but research on mediating and moderating effects between the two is relatively scarce.
To explore the influence of frailty on cognitive function, and to investigate the mediating role of activities of daily living and depressive symptoms between frailty and cognitive function. Additionally, the moderating effect of social participation will be analysed.
Using data from the 2018 China Longitudinal Healthy Longevity Survey (CLHLS), 8 173 individuals aged 65 and older were selected to obtain relevant information on frailty, cognitive function, activities of daily living, depressive symptoms, social participation, and demographic data among the elderly. The differences in cognitive function among elderly individuals with different characteristics were analyzed. Pearson correlation analysis was employed to investigate the interrelationships between the variables. Stratified regression was utilised to examine the impact of frailty on cognitive function. The Process macro programme was used to test the chain mediating role of activities of daily living and depressive symptoms between frailty and cognitive function, and the moderating effect of social participation within it.
Of the 8 173 participants, 1 769 (21.6%) had cognitive impairment and all variables were correlated. Stratified regression analyses showed frailty negatively predicts cognitive function (B=-2.862, P<0.001). The results of the chain-mediated effects analysis showed that the activities of daily living (B=-1.713, 95%CI=-1.944 to -1.498) and depressive symptoms (B=-0.435, 95%CI=-0.531 to -0.345) mediated the link between cognitive function and frailty to some extent. The interaction term between frailty and social participation (B=1.140, 95%CI=0.822 to 1.457) as well as the interaction term between depression and social participation (B=0.113, 95%CI=0.015 to 0.211) both significantly and positively predicted cognitive function, while the interaction term between activities of daily living and social participation was negatively correlated with cognitive function (B=-0.413, 95%CI=-0.560 to -0.266) .
Social participation moderated the direct and indirect effects of activities of daily living and depressive symptoms on the relationship between frailty and cognitive function. The findings indicate that interventions targeting older people's mental health and enhancing the quality of social relationships may facilitate the dissolution of the correlation between frailty and cognitive impairment.
Chronic obstructive pulmonary disease (COPD) patients often present with multiple comorbidities, which increase the complexity of treatment and the healthcare of burden. While comorbidities significantly impact the management of COPD patients, existing research primarily focuses on individual comorbidities, lacking systematic analysis of multiple comorbidity patterns and hospitalization costs.
To investigate the comorbidity characteristics and patterns in patients with COPD, analyzing how different features and comorbidity patterns affect hospitalization costs. The findings will provide a basis for personalized health management and resource allocation for COPD patients.
A retrospective analysis was conducted on 5 061 inpatients diagnosed with COPD at the First Affiliated Hospital, Guangzhou Medical University from 2020 to 2023. Systematic clustering analysis was employed to construct dendrograms, identifying comorbidity patterns among COPD patients. Multiple group comparisons were performed to assess the basic characteristics of these patterns, then multiple linear regression analysis was utilized to evaluate the impact of each comorbidity pattern on total hospitalization costs, western medicine costs, and antibacterial medication costs.
There are a total of 4 343 patients with COPD, and the comorbidity was 85.81%. Systematic clustering analysis identified six comorbidity patterns among COPD patients: cardiovascular and metabolic diseases, hepatorenal diseases, digestive system diseases, arthropathy diseases, cancer and respiratory system diseases. There were significant differences in sex, age, BMI and smoking history among patients with 6 comorbidity models (P<0.05). Multiple linear regression analysis revealed that BMI, cancer pattern, and respiratory system diseases pattern all had impacts on total hospitalization costs, western medicine costs and antibacterial medication costs (P<0.05), with the respiratory system diseases pattern having the most substantial impact on total hospitalization costs (β=0.125, P<0.001) .
Comorbidity patterns in COPD can be categorized into six clusters. BMI, cancer pattern and respiratory system diseases pattern are the primary factors influencing hospitalization costs.
Frailty and metabolic syndrome (MetS) are both common geriatric conditions and may have potentially important links in terms of risk factors, body composition and metabolic mechanisms, which could jointly affect the prognosis of older patients with gastric cancer. Clearly distinguishing the characteristics of the two syndromes and elucidating their intrinsic relationship can help to develop precise and targeted preoperative management strategies.
To compare the characteristics of preoperative frailty and MetS in older patients with gastric cancer, focusing on general information, blood indicators and body compositions, then analyze their correlation.
A total of 286 patients aged 60 to 80 years who were admitted to the Gastrosurgery Department of the Jiangsu Province Hospital for gastric malignancy from August 2021 to August 2022 were included and divided into the four groups: the frailty group (n=45), the MetS group (n=58), the frailty+MetS group (n=12) and the normal group (n=171) based on the presence of frailty and MetS, and the clinical indicators of these groups were compared. With frailty as the dependent variable, Logistic regression analysis was conducted to investigate the correlation of MetS and the diagnostic indicators with preoperative frailty.
Statistically significant differences were observed among the four groups in terms of age, comorbidities, Nutritional Risk Screening 2002 (NRS2002) scores>3, fasting blood glucose, triglyceride, high-density lipoprotein cholesterol (HDL-C), C-reactive protein (CRP), hemoglobin, albumin, height, body mass, waist circumference, BMI, fat content, fat mass index, body fat percentage, visceral fat area, skeletal muscle content, skeletal muscle mass index, limb skeletal muscle mass index, muscle percentage, fat to muscle ratio and muscle to fat ratio (P<0.05). Multivariate Logistic regression analysis showed that age (OR=1.115, 95%CI=1.046-1.190), history of smoking (OR=2.156, 95%CI=1.134-4.096), NRS2002 score>3 (OR=2.359, 95%CI=1.159-4.802), CRP (OR=1.038, 95%CI=1.003-1.073) and central obesity (OR=0.405, 95%CI=0.183-0.896) were the risk factors for frailty in older patients with gastric cancer (P<0.05) .
The frailty group showed advanced age, elevated levels of inflammation and increased nutritional risk, along with an overall decline in fat and muscle composition. The MetS group showed increased comorbidities, elevated inflammation and albumin levels, abnormal markers of glycolipid metabolism, and overall increased fat and muscle composition. The frailty+MetS group had increased comorbidities, abnormal fasting blood glucose and HDL-C levels with increases only in fat-related components but no significant changes in muscle components. Thus, frailty was not significantly associated with MetS in this study.
Preeclampsia (PE) is a life-threatening multisystemic disorder that significantly endangers maternal and fetal health.
To investigate the association between CCND1 (Cyclin D1) and CCNE1 (Cyclin E1) gene polymorphisms, as well as their interactions with the risk of PE, and provide scientific evidence for its pathogenesis.
A case-control study was conducted. From October 2020 to October 2023, pregnant women diagnosed with PE were recruited from the Xiangya Third Hospital of Central South University and the Hunan Provincial Maternal and Child Health Hospital as the case group (n=202), while pregnant women with normal blood pressure were recruited as the control group (n=400). Multivariate Logistic regression analyses were performed to evaluate the association between CCND1 and CCNE1 gene polymorphisms and the risk of PE, with adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) calculated. Interaction analysis was performed to investigate the association between gene-gene interactions and PE risk. Functional annotation of single nucleotide polymorphisms (SNP) was performed using the 3DSNP database.
Multivariate Logistic regression analysis revealed that pregnant women with the CT/TT genotype at CCND1 rs1352075 had a lower risk of PE compared to CC genotype (dominant model: aOR=0.44, 95%CI=0.20-0.96). Pregnant women with the GG genotype at CCNE1 rs3218070 had a higher risk of PE compared to CC/GC genotype (recessive model: aOR=4.31, 95%CI=1.16-16.04). Analysis based on the 3DSNP database revealed a higher proportion of cellular regulatory factors related to vascularization and placentation in the open chromatin regions at rs1352075 and rs3218070 binding sites. Interaction analysis showed that the additive interaction between rs1352075 and rs3218070 was not significantly associated with PE risk.
The CCND1 rs1352075 locus harboring the CC genotype and the CCNE1 rs3218070 locus harboring the GG genotype may be associated with an elevated risk of developing PE.
Axillary lymph node metastasis in breast cancer is an important factor in assessing disease progression and prognosis, and there is an urgent need for non-invasive and accurate methods to assess axillary lymph node status. In recent years, the integration of artificial intelligence and medical imaging technology has shown great potential. Among them, S-Detect technology, with its powerful image analysis capability, combined with the accurate quantitative assessment of virtual touch tissue imaging quantification (VTIQ) technology, provides new possibilities for the prediction of axillary lymph node metastasis in breast cancer.
To explore the value of the conventional ultrasound-based artificial intelligence S-Detect combined with VTIQ technique to predict axillary lymph node metastasis in breast cancer.
Data of 148 female breast cancer patients (166 masses in total) who underwent surgery at the First Affiliated Hospital, Shihezi University from February 2022 to February 2024 were retrospectively collected and divided into metastatic group (n=61) and non-metastatic group (n=105) based on axillary lymph node pathology results. All patients underwent routine ultrasound, VTIQ and S-Detect examinations before surgery. Univariate and multivariate Logistic regression analyses were used to explore the influence of each observational index on axillary lymph node metastasis, screen meaningful indexes and establish a Logistic regression prediction model. The predictive value of the model was evaluated by the ROC curve.
The results of multivariate Logistic regression analysis showed that breast cancer mass border (OR=0.619, 95%CI=0.540-0.693), margin (OR=0.563, 95%CI=0.484-0.640), calcification (OR=0.559, 95%CI=0.480-0.636), aspect ratio (OR=0.540, 95%CI=0.461-0.617) and SWVmean (OR=0.794, 95%CI=0.725-0.853) were independent influences in predicting axillary lymph node metastasis in breast cancer (P<0.05). Logistic equations were constructed: Logistic (P) =-14.293+1.664×border+1.315×margin+1.757×calcification+1.341×aspect ratio+1.196×blood flow classification+0.736×SWVmax-3.942×SWVcentre+0.710×SWVmean. The AUC of this joint prediction model was 0.902 (95%CI=0.847-0.943), which was greater than the AUCs of each independent influencing factor (all P<0.05), and the AUC values of the joint prediction model were greater than the AUCs of the independent prediction models of conventional ultrasound (AUC=0.605, 95%CI=0.526-0.680), S-Detect (AUC=0.672, 95%CI=0.595-0.743), and VTIQ (AUC=0.794, 95%CI=0.725-0.853). The agreement between this joint prediction model and pathological results was good (Kappa=0.732, P<0.05) .
The prediction model constructed by combining S-Detect and VTIQ techniques based on conventional ultrasound has certain clinical predictive value for axillary lymph node metastasis in breast cancer.
Ergothioneine is associated with the severity of cognitive impairment in Alzheimer's patients, and it has neuroprotective effects. However, whether it can improve cognitive dysfunction in rats with vascular dementia (VD) is indistinct, and the specific mechanism is still unclear.
To investigate the effect of ergothioneine on cognitive dysfunction in VD rats by activating NRF2/HO-1 signaling pathway.
From August 2021 to September 2023, 48 adult male SD rats were selected and randomly assigned to four groups (n=12/pergroup) : control, model, ergothioneine and ergothioneine + NRF2 inhibitor (ML385). The VD rat model was replicated by permanent ligation of bilateral common carotid arteries. Two weeks before VD replicated, ergothioneine rats was intraperitoneally injected with 2 mg/kg of ergothioneine daily for 4 weeks. And ergothioneine + ML385 group receiving ergothioneine 2 mg/kg and ML385 30 mg/kg daily for 4 weeks before VD operation. The effects of ergothioneine on cognitive dysfunction in VD rats were detected by Morris water maze test, HE staining and TUNEL staining. The level of various proteins was measured utilizing Western blotting. Oxidative stress factors level and inflammatory factors level were tested with ELISA.
The model was successfully established. VD model group had longer escape latency and less residence time than control group (P<0.05). The number of neurons in rat hippocampal tissue decreased, the cells atrophied, the morphology was abnormal, and the nuclei were deeply stained. VD model group had more neurons apoptosis rate in brain tissue than control group (P<0.05). Decreased NRF2, HO-1, NQO1, SOD and GSH-Px levels were observed in VD model group (P<0.05). Increased MDA, IL-1β, IL-6 and TNF-α were also observed in VD model group (P<0.05). Ergothioneine group had shorter escape latency and more residence time than VD model group (P<0.05). The pathological degree hippocampal tissue reduced, and ergothioneine group had more neurons apoptosis rate in brain tissue than VD model group (P<0.05). Increased NRF2, HO-1, NQO1, SOD and GSH-Px levels were observed in ergothioneine group (P<0.05). Decreased MDA, IL-1β, IL-6 and TNF-α were also observed in ergothioneine group (P<0.05). Compared with ergothioneine group, the escape latency of rats in the ergothioneine + ML385 group was prolonged, the percentage of residence time in the target quadrant was decreased (P<0.05). The hippocampus was seriously damaged, and the apoptosis rate of brain neurons was increased (P<0.05). NRF2, HO-1, NQO1, SOD and GSH-Px levels were decreased (P<0.05). MDA, IL-1β, TNF-α and IL-6 levels were increased (P<0.05) .
Ergothioneine can improve cognitive dysfunction in VD rats by activating NRF2/HO-1 signaling pathway.
Under the process of improving the capacity of primary health services, promoting hierarchical diagnosis and treatment, and realising the integration of medicine and prevention, the state has introduced a series of policies to support the cultivation of general practitioners, and to promote the rational distribution of general practitioners' resources. However, at the present stage, the study on the equilibrium of the distribution of general practitioners is still not comprehensive enough, and lacks the attention to both primary health care and disease prevention.
To set up indicators more comprehensively on the basis of previous studies to evaluate the characteristics and equilibrium of the distribution of general practitioners between provinces in China, and to provide theoretical support for the optimal distribution of general practitioner resources.
We collected data from the 2018-2022 China Health Statistics Yearbook, the 2018-2022 China Statistics Yearbook, and the 2021 China Urban Statistics Yearbook from the websites of the National Health Commission, the National Bureau of Statistics, and offline libraries in April 2023, measured interprovincial general practitioner distribution on an absolute level using five indicators: general practitioners per 10 000 population, general practitioners per 10 square kilometres, the general practitioner-inhabitant disposable income ratio, the general practitioner-primary care institution ratio, and the general practitioner-disease prevention institution ratio, combined with descriptive statistics; The GINI coefficient of the five dimensions of population, area, income, primary health care and disease prevention, combined with the Lorenz curve, were used to preliminarily evaluate the provincial relative distribution gap of general practitioners; Further measured the equilibrium of the distribution of the number of general practitioners among provinces by using the five dimensional DAGUM decomposition GINI coefficient, including inter-group GINI coefficient, intra-group GINI coefficient and inter-group GINI coefficient within each region, combined with the analysis of the agglomeration degree of population and area.
During 2017 to 2021, the number of general practitioners in China had been growing rapidly. In 2021, the average number of general practitioners per 10 000 population was 2.93, the median was 2.80, and the standard deviation was 0.87; The GINI coefficient of the five-year population dimension was (0.195±0.047), the area dimension was (0.608±0.019), the income dimension was (0.401±0.015), the primary health care dimension was (0.318±0.058), and the disease prevention dimension was (0.393±0.033) ; The annual Lorentz curve of the population dimension deviated slightly from the 45° line, the area dimension and income dimension deviated significantly, and the Lorentz curve of the primary health care dimension and disease prevention dimension deviated moderately; In the result of DAGUM decomposition GINI coefficient, the contribution rate of GINI coefficient between groups was (59.863%±8.785%), the gap between groups was the main reason for the overall gap, and the hypervariable density was (25.959%±10.052%), and the gap within each regional group could not be ignored. Further decomposition results showd that within the region the inter-group GINI coefficient in the area dimension of East China and North China were higher, 0.570 and 0.504, respectively, and the inter-group GINI coefficient of the income dimension in North China was higher, 0.413, and the gap was mainly from Beijing, Tianjin, and Shanghai and the other provinces in the region; The results of agglomeration analysis showd that the values of Qinghai, Henan, Anhui, Guangdong and Jilin provinces were closer to the reasonable value 1, the values of other provinces were different, but they were close to 1 except for Tianjin, Shanxi, Inner Mongolia, Fujian, Hubei, Ningxia and Xinjiang provinces.
In absolute terms, the number of general practitioners in China has reached the established development goal. The construction of general practitioners has made remarkable achievements, but the relative number gap between provinces is still large. Although the polarization of agglomeration degree is improving, it still exists. The equilibrium of the distribution of general practitioners needs to be further optimized. We should continue to strengthen the training efforts to promote the growth of the number of general practitioners, At the same time, we should rely on information technology to encourage cross regional assistance and resource sharing.
With the global population aging at an accelerating rate, the rapid growth of the elderly population in China presents a series of health challenges, particularly in the management of chronic conditions such as hypertension, diabetes, and dyslipidemia. Residents of original residential communities, a unique social unit within the urbanization process, experience a higher prevalence of comorbidities related to these conditions. This underscores the urgent need for effective and comprehensive management strategies. Family function plays a critical role in the management of chronic diseases. For patients with the hypertension, diabetes, and dyslipidemia, family support is not only crucial for improving treatment outcomes but also a key factor in enhancing overall quality of life.
This study aims to investigate the prevalence of comorbidities and family function among older people of original residential communities of Guangzhou with hypertension, diabetes, and dyslipidemia.
The survey was based on the annual health examination services for patients with hypertension and type 2 diabetes, in accordance with the National Basic Public Health Service Standards (Third Edition). Stratified random sampling was used to conduct a questionnaire survey with the APGAR scale among patients of comorbidities of hypertension, diabetes, and dyslipidemia over 60 years old in Panyu District, Guangzhou, between January and June 2023. To explore the multimorbidity and family functioning status of original residential communities of Guangzhou and its associated factors.
A total of 2 507 patients were surveyed. Among them, 202 patients (8.1%) had only one condition, 1 712 patients (68.3%) had two conditions, and 593 patients (23.7%) had all three conditions. Statistically significant differences (P<0.05) were observed in the types of conditions present based on variables such as gender, place of residence, number of household members with hypertension, diabetes, and dyslipidemia, BMI, exercise habits, fasting blood glucose levels, lipid profiles, and family function score. The prevalence ratio for hypertension, dyslipidemia, and diadetes was 2.4∶2.4∶1. Among the comorbidity patterns, hypertension combined with diadetes was the most common (1 404 cases, 56.0%), followed by patients with all three conditions (593 cases, 23.7%). No statistically significant differences (P>0.05) were found in the distribution of different comorbidity patterns between genders or across age groups. The mean total family function score was (7.63±1.83). Significant differences (P<0.05) were found in the partnership, affection, and resolve sub-scores, as well as in the total family function scores, among patients with different disease patterns. Multivariate linear regression analysis identified gender (female: β=-0.148, t=-2.275, P=0.023), place of residence (apartment complex: β=-0.155, t=-2.402, P=0.016), and fasting blood glucose levels (abnormal glucose: β=-0.045, t=-2.465, P=0.014) as risk factors for lower total family function scores. On the other hand, the number of family members with hypertension, diabetes, and dyslipidemia (two or more: β=0.174, t=2.356, P=0.026) and the type of disease patterns ("comorbidity of two conditions": β=0.193, t=2.586, P=0.010; "comorbidity of all three conditions": β=0.342, t=3.248, P=0.001) were identified as protective factors for higher total family function scores.
Elderly patients with the hypertension, diabetes, and dyslipidemia in original residential community of Guangzhou metropolitan predominantly exhibit "a comorbidity of two conditions" pattern with generally good family function. Gender, place of residence, the number of family members with hypertension, diabetes, and dyslipidemia, type of diseases and fasting blood glucose are key influencing factors of family function.
With the continuous development of the concept and practice of "patient-centered" medical and health service, the traditional family doctor contract service model, which focuses on single-disease treatment and management, cannot effectively meet the service needs of patients with multiple chronic diseases.
To explore that preference of patients with hypertension and type 2 diabetes for family doctor contract service in Hainan Province, and to provide empirical evidence for optimizing the contract service plan of family doctor.
A multi-stage stratified random sampling method was used to conduct a questionnaire survey from July 2023 to February 2024. The service preference of family doctors with hypertension and type 2 diabetes comorbid patients in Hainan Province was measured by discrete choice experiment (DCE). The set preference attributes were institutional nature, implementation environment, doctor's title, service mode, medication guidance and out-of-pocket expenses, service content attribute. A mixed Logit model was constructed with Python 3.11.7 software for preference analysis.
A total of 581 questionnaires were sent out, and 558 were valid, with an effective recovery rate of 96.0%. Six attributes, including institutional nature, implementation environment, doctor's title, service mode, medication guidance and out-of-pocket expenses, had significant effects on patients' preference for family doctor contracted service (P<0.05). The service content attribute had no significant effect (P>0.05). Patients with HTN-T2DM prefer to choose government-run institutions, door-to-door service, priority referral, senior doctor title, 50 yuan/month and 2 weeks medication guidance.
The institutional nature being government-run is the most highly valued attribute for patients. Home visit services and priority referral are important attributes that influence the preference for family doctor contracted services. It is suggested that a personalized family doctor contract service plan based on the preferences of patients with chronic diseases and comorbidities be formulated with a patient-centered approach to promote the high-quality development of family doctor contract services.
Cardiovascular disease (CVD) is a global health problem, and it is not known whether socioeconomic status (SES) and healthy lifestyle (HL) have an impact on CVD onset.
To understand the relationship between SES, HL and CVD, and to provide a basis for the prevention and control of CVD in the population.
A multi-stage cluster random sampling method was employed to select 9 280 residents aged 18 and above from 12 counties and districts in Guizhou Province as the baseline sample in 2010. In 2016-2020 follow the cohort, face to face interview by unified training and qualified personnel, including basic situation, lifestyle (smoking, drinking, vegetables and vegetables, etc.), previous disease history, according to the survey was divided into CVD group (123) and non-CVD group (4 025) ; we used COX proportional hazard regression models were used to analyze the effect of SES and HL on CVD incidence. Additionally, an accelerated failure time model was utilized to assess the impact of different SES and HL at the time of CVD onset.
After excluding baseline CVD patients, lost-to-follow-up and missing information, the valid sample size included in the analysis was 4 148, CVD onset 123, and the incidence density was 4.13 / 1 000 person-years. The results of multivariate analysis showed that compared with low SES (≤7 points), the risk of CVD in high SES (>7 points) decreased by 40.60% (HR=0.594, 95%CI=0.402-0.878). Compared with 6 HL populations, the population with 8 and 9 HL decreased by 44.40% (HR=0.556, 95%CI=0.320-0.968) and 49.20% (HR=0.508, 95%CI=0.284-0.912). Compared with the population in the low SES group and with HL ≤ 6 conditions, there was no statistically significant risk of CVD incidence in the population in the low SES group with HL of 7, 8, or ≥ 9 conditions (P>0.05) ; those with high SES (>7 points) and HL of 8 or 9 decreased CVD risk by 61.80% (HR=0.382, 95%CI=0.163-0.894) and 70.20% (HR=0.298, 95%CI=0.119-0.748, respectively), showing a decreasing trend. The results of the accelerated failure time model showed that those with high SES (>7 points), those with 8 species and 9 HL were delayed by 1.148 years (95%CI=0.049-2.287) and 1.407 (95%CI=0.227-2.588) .
Different SES and HL are negatively associated with CVD onset; in high SES population, the duration of CVD onset increases with increasing HL species. Low SES population is the key population of CVD prevention and control in Guizhou Province, so measures should be taken to improve their health literacy, and the health education and health promotion of CVD should be carried out accordingly.
In the context of the general implementation of online and offline blended teaching mode in China's high schools, it was necessary to understand the changes in body mass index (BMI), dietary knowledge acquisition level and sedentary time of high school students. However, there was a lack of multicenter, large-sample studies focusing on the relationship between the three.
To understand the BMI, dietary knowledge acquisition level and sedentary time of high school students in China, and to analyze their influencing factors, in order to provide empirical evidence for the promotion of physical and mental health development of high school students.
From January to March 2019, 6 213 high school freshmen and sophomores were selected as study subjects in 23 provinces in seven regions of China, namely east China, south China, north China, central China, northwest China, southwest China and northeast China, by using stratified random whole cluster sampling method. A self-designed questionnaire was used to conduct the survey, which involved 4 parts: students' personal and family information, BMI, dietary pagoda knowledge test (DPKT), and sedentary time. A total of 6 038 valid questionnaires were collected, and the effective recovery rate of the questionnaires was 98.35%.
Comparison of BMI among high school students with different regions, provinces, grades, number of family members, and father's education showed statistically significant differences (P<0.05). Comparison of DPKT among high school students with different regions, provinces, number of family members, annual income of the family, father's education, and mother's education showed statistically significant differences (P<0.05). Comparison of sedentary time among high school students with different regions, provinces, urban/rural distributions, age, family population, annual family income, father's education, mother's education, the difference is statistically significant (P<0.05). The results of the multiple linear regression analysis indicate that BMI (β=-0.05), sedentary time (β=0.07), family size (β=0.03), father's education level (β=0.05), and family income (β=0.05) were influencing factors of DPKT scores among high school students (P<0.05). Additionally, DPKT scores (β=0.07), family size (β=-0.03), and father's education level (β=0.04) were influencing factors of sedentary time among high school students (P<0.05) .
The median BMI levels of high school students in urban and rural areas in seven regions of China were generally in the normal range, but the overall dietary knowledge acquisition level were low, and the problem of overall longer sedentary time was prominent. Dietary dietary knowledge acquisition level and sedentary time were the most influential factors on each other, and father's education was the main social factor influencing dietary DPKT score and sedentary time.
With the acceleration of population aging, chronic disease comorbidities have become a major public health problem threatening the health of the elderly. There is a close correlation between chronic disease comorbidity and activity of daily living (ADL). However, there are few studies on the influence of chronic disease comorbidity and comorbidity pattern on ADL.
To understand the impact of chronic disease comorbidity on ADL, to provide a reference for improving the quality of life of the elderly.
From June to July 2022, a multi-stage stratified random cluster sampling method was used to conduct a face-to-face household survey among 20 821 residents in 4 counties of Ningxia Hui Autonomous Region, including demographic characteristics, chronic diseases, and ADL impairment. In this study, 4 362 elderly people (≥60 years) were included as subjects. Potential category analysis was used to determine comorbidity patterns, and Logistic regression was used to analyze the effects of chronic disease comorbidity and different comorbidity patterns on activities of daily living.
The prevalence of chronic diseases among the elderly included was 62.52% (2 727/4 362), the prevalence of comorbidities was 23.75% (1 036/4 362), the ADL damage rate was 18.36% (801/4 362). Five comorbidity patterns were identified based on the latent category analysis, namely the coronary heart disease comorbidity group, the rheumatoid arthritis comorbidity group, the diabetes comorbidity group, the hypertension comorbidity group, and the multisystem disease comorbidity group. Adjusting for factors such as gender, age, educational level, marital status, occupation, annual per capita household income, smoking, alcohol consumption, exercise status, and self-rated health status, elderly people with comorbidity had 1.909 times (95%CI=1.581-2.305, P<0.05) risk of impaired ADL than those without comorbidity, older adults in the rheumatoid arthritis comorbidity group had a higher risk of impaired ADL than those in the coronary heart disease comorbidity group [OR (95%CI) =1.834 (1.245-2.701), P<0.05] .
Older adults with chronic comorbidities have a higher risk of ADL impairment than older adults without chronic comorbidities. There are differences in the risk of ADL impairment among the elderly with different comorbidity patterns of chronic diseases. The risk of ADL impairment in the elderly in the comorbidity group of rheumatoid arthritis is higher than that in the comorbidity group of coronary heart disease. Therefore, there is an urgent need to pay more attention to elderly people with chronic disease comorbidities, appropriate measures should be taken to improve their health and improve their quality of life.
In comparison to single chronic disease, multimorbidity significantly increase patients' hospitalization spending, economic burdens, and even the risk of poverty due to illness. Currently, the hospitalization spending and associated factors of patients with multimorbidity in rural primary health care facilities in our country still remain unclear, which hampers effective decrease in disease burden of multimorbidity among rural inhabitants.
This study aims to understand the hospitalization spending and associated factors of patients with multimorbidity in rural township health centers in Guangxi.
The study employed a combination of multiple-phased stratified sampling and cluster sampling, and randomly sampled 2 rural township health centers from five cities of Guangxi respectively, including Nanning, Wuzhou, Liuzhou, Yulin, and Guigang. The de-identified health records of all inpatients with multimorbidity admitted between Jan 1th, 2021 and Jun 30th, 2023 of 10 sampled township health centers in total were collected (n=9 330). The average expenditure per hospitalization and the hospitalization expenditure per capita for various number of co-existing chronic diseases and for prevalent multimorbidity patterns were compared, and multivariate unordered Logistic regression analysis was used for identification of factors associated with the average expenditure per hospitalization and the hospitalization expenditure per capita of patients with multimorbidity.
The average expenditure per hospitalization for 9 330 patients with multimorbidity was 3 063.0 (2 384.5, 3 836.3) yuan, and the hospitalization expenditure per capita was 4 175.0 (2 704.0, 7 966.7) yuan. The patients with ≥5 co-existing chronic diseases demonstrated the highest levels of average expenditure per hospitalization and hospitalization expenditure per capita, as 4 535.7 (3 718.3, 5 288.2) yuan and 11 897.7 (6 536.5, 21 940.2) yuan, followed by those with 4 co-existing chronic diseases and the second highest levels as 3 894.2 (3 178.0, 4 562.2) yuan and 9 474.3 (4 854.9, 15 178.4) yuan, those with 3 co-existing chronic diseases and the third highest levels as 3 306.9 (2 649.5, 3 976.3) yuan and 4 926.0 (3 180.6, 8 793.8) yuan, and those with 2 co-existing chronic diseases and the lowest levels as 2 699.8 (2 075.4, 3 290.7) yuan and 3 196.0 (2 264.1, 5 292.3) yuan. The multimorbidity patterns ordered by prevalence were not identical to those by the level of hospitalization expenditure among patients with 2, 3, 4, ≥5 co-existing chronic diseases. The results of multivariate unordered Logistic regression analysis showed multiple factors, including age, ethnic group, vocation, medical insurance type, smoking history, BMI, number of co-existing chronic diseases, and hospitalization frequency, correlated with the average expenditure per hospitalization (P<0.05) ; similar factors, including gender, age, ethnic group, education level, marital status, medical insurance type, smoking history, and number of co-existing chronic diseases, were associated with the hospital expenditure per capita (P<0.05) .
The hospitalization spending of patients with multimorbidity positively correlates with number of co-existing chronic diseases in township health centers in Guangxi, and only one chronic disease added can lead to significant increases in both the average expenditure per hospitalization and the hospital expenditure per capita. Multimorbidity patterns with high prevalence were not identical to those with high hospitalization spending. Factors influencing hospitalization spending due to multimorbidity interact with each other intricately, emphasizing the need for comprehensive, multifaceted strategies to improve hospitalization spending of multimorbidity in rural areas and to reduce economic burden of multimorbidity amid rural residents.
Type 2 diabetes mellitus (T2DM) among the elderly has become a significant public health problem both globally and in China, affecting population health. It is extremely urgent to clarify the related disease burden.
To assess the disease burden of T2DM among the elderly population globally and in China from 1990 to 2021, project future trends, and offer insights to inform public health and medical decision-makings.
Data on incidence and mortality burdens of individuals aged 60 years and above with T2DM in China and around the world were extracted from the global Burden of Disease (GBD) 2021 database. Age-standardized incidence and mortality rates were estimated based on the GBD 2021 standard population. Joinpoint regression was utilized to calculate the average annual percentage change (AAPC) for assessing disease burden trends. Subgroup analyses were performed based on age and sex, and decomposition analysis was performed to examine how aging, population growth, and epidemiological changes impacted disease burden. Bayesian models were employed to forecast prevalence and mortality between 2022 and 2035.
In 2021, the global incidence of T2DM stood at 6 047 049, while in China, it reached 800 764, representing increases of 178.68% and 220.28%, respectively, compared to the incidence in 1990. Over the period from 1990 to 2021, the global age-standardized incidence rate exhibited a significant overall upward trend (AAPC=1.21%, P<0.001), whereas the trend in China was not statistically significant (AAPC=0.29%, P=0.189). The number of deaths among elderly T2DM patients in 2021 in the global and Chinese populations was 1 304 150 and 149 972, respectively, marking increases of 164.68% and 197.98% compared to the number of deaths in 1990. Throughout the same period, the global age-standardized mortality rate displayed a consistent upward trend (AAPC=0.32%, P<0.001), while the trend in China remained relatively stable (AAPC=0.01%, P=0.922). Notably, the number of incidence and mortality for female in 1990 and 2021, globally and in China, exceeded those of males. Meanwhile, the 60-64 age group had the highest proportion of incidences in 2021, while the 70-74 age group had the highest proportion of deaths. Population growth emerged as the primary influencer driving the rise in incidence and mortality in elderly T2DM patients in both global and Chinese populations, as revealed by decomposition analysis. The projection indicates a continued increase in the incidence and mortality of elderly T2DM patients worldwide and in China from 2022 to 2035.
The persistent heavy burden of incidence and mortality among elderly individuals with T2DM in both global and Chinese populations necessitates urgent reinforcement and formulation of more effective public health policies and clinical prevention and control strategies to alleviate the fundamental burden associated with this demographic.
The ratio of blood urea nitrogen (BUN) to serum albumin (ALB) (BAR) is an emerging biomarker that has been recently recognized to associate with adverse outcomes in a variety of cardiorespiratory disorders. However, the relationship between BAR and carotid plaque in patients with coronary heart disease (CHD) is currently unclear.
To investigate the correlation between BAR and carotid plaque in CHD patients.
Admission medical data of CHD patients hospitalized in six hospitals in Tianjin from January 2014 to September 2019 were retrospectively analyzed. BAR was calculated by dividing BUN by ALB. Logistic regression analysis was used to evaluate the correlation of BAR with the occurrence, number and characteristics of carotid plaque in CHD patients before and after adjusting for confounding factors. Drew a receiver operating characteristic (ROC) curve for diagnosing the risk of carotid plaque occurrence using BAR, and calculate the area under the ROC curve (AUC) .
A total of 10 808 cases of CHD were included. Among them, 8 158 cases suffered from carotid plaque with a prevalence of 75.5%. The data of 10 808 CHD cases were divided into four groups by quartiles of BAR (Q1, Q2, Q3, Q4) for baseline analysis: Q1 ≤ -0.395 4, -0.395 4< Q2 ≤ -0.158 7, -0.158 7 < Q3 ≤0.132 4, and Q4 > 0.132 4. Compared with Q1, the correlation between BAR and carotid plaque formation was more significant in Q4 after multivariate adjustment (OR=1.512, 95%CI=1.273-1.795, P<0.001). The AUC for diagnosing the risk of carotid plaque in CHD patients with BAR is 0.612 (95%CI=0.600-0.624). The correlation between BAR and plaque was more significant in the female population. (OR=1.583, 95%CI=1.260-1.989, P<0.001), the correlation between BAR and plaque was more significant in the older age group (OR=1.810, 95%CI=1.459-2.246, P<0.001). The significant correlation between BAR and carotid plaque was not affected by diseases such as hypertension, hyperlipidemia and diabetes.
High-level BAR is associated with carotid plaque formation, and which is more significant in women and middle-aged and elderly people. High-level BAR is helpful in an early identification of carotid plaque formation in CHD patients, thus avoiding the occurrence of major adverse cardiovascular events (MACEs) .
The incidence and prevalence of chronic kidney disease (CKD) remain high. Hypertension and diabetes frequently coexist and jointly accelerate the progression of kidney disease. The lipid accumulation product index (LAPI) is a novel indicator for predicting cardiovascular disease and abnormalities in glucose metabolism, and its relationship with CKD warrants further investigation.
This study aimed to investigate the relationship between LAPI and the risk of developing CKD in patients with hypertension and abnormal glucose metabolism.
A retrospective cohort of 2 033 patients with hypertension and abnormal glucose metabolism admitted to the Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region from January 2012 to May 2019 was enrolled. General patient information and laboratory test indicators were collected. The LAPI was calculated, and the population was divided into four groups based on LAPI quartiles: Q1 (LAPI≤44.03, n=509), Q2 (44.03<LAPI≤64.68, n=508), Q3 (64.68<LAPI≤98.90, n=508), and Q4 (LAPI>98.90, n=508). Patients were followed up, with the endpoint event being CKD. Kaplan-Meier curves were used to analyze the cumulative incidence of CKD at different LAPI levels, and the Log-rank test was used to compare differences. Multivariate Cox regression models were employed to analyze the relationship between LAPI and CKD. Restricted cubic splines were fitted to the multivariate Cox regression model to explore the dose-response relationship between LAPI and CKD. Subgroup analysis and sensitivity analysis were conducted to test the stability of the relationship between LAPI and CKD.
Significant differences were observed in age, gender, BMI, waist circumference, heart rate, diastolic blood pressure, smoking, alcohol consumption, uric acid, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, glycated hemoglobin, fasting blood glucose, use of calcium channel blockers, and hypoglycemic treatment among the 4 groups (P<0.05). Log-rank test results indicated that the cumulative risk of CKD increased with elevating LAPI levels (χ2=14.48, P<0.001). Multivariate Cox regression analysis revealed that for each standard deviation increase in LAPI, the hazard ratio (HR) for CKD increased by 12.5% (HR=1.125, 95%CI=1.035-1.223, P=0.005) ; compared to the Q1 group, the Q4 group had a 54.9% higher risk of CKD (HR=1.549, 95%CI=1.129-2.125, P=0.007). Restricted cubic spline regression analysis showed that LAPI>65.59 was a risk factor for CKD (P=0.007). Interaction and subgroup analyses revealed that the association between LAPI and the risk of developing CKD remained stable.
In patients with hypertension and abnormal glucose metabolism, a higher LAPI in the early stages increases the risk of developing CKD.
Type 2 diabetes (T2DM) and metabolism-associated fatty liver disease (MAFLD) interact with each other, and the coexistence of the two further increases the risk of adverse outcomes such as cardiovascular disease (CVD) and liver fibrosis. Therefore there is a need for MAFLD screening and liver fibrosis risk stratification in patients with T2DM, especially those with multiple cardio-metabolic risks.
To investigate the clinical metabolic characteristics of T2DM patients with different risk of liver fibrosis and CVD risks.
A total of 1 425 T2DM patients admitted to our department from July 2020 to June 2023 were included in the study. All patients underwent liver transient elastography (FibroTouch) examination. According to the 2023 American Diabetes Association (ADA) Standards of Medical Care in Diabetes, the population is classified based on the FIB-4 index and liver stiffness measurement (LSM) into three groups: low-risk group (n=1 235), intermediate-risk group (n=110), and high-risk group (n=80). The clinical characteristics among the groups were compared, and the Framingham Risk Score (FRS) was utilized to assess the 10-year risk of CVD. Furthermore, the different populations at varying risks of liver fibrosis were stratified based on CVD risk into three groups: Low-CVD Low hepatic risk Group (n=214), High-CVD Low hepatic risk Group (n=1 021), High-CVD High hepatic risk Group (n=178), Low-CVD High hepatic risk Group (n=12). The clinical characteristics of T2DM patients were compared in the first 3 groups.
The results showed that inclusion 5.6% of the 1, 425 patients with T2DM were at high risk of liver fibrosis.Age, alanine aminotransferase (ALT), direct bilirubin (DBIL), glycosylated hemoglobin (HbA1c), fat attenuation parameter (UAP), LSM, FIB4, muscle mass loss, diabetic peripheral neuropathy, lipid-lowering therapy were higher in patients in the high-risk group than in the low-risk group of hepatic fibrosis, and platelets (PLT), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and skeletal muscle mass index (SMI) were lower than those in the low-risk group for liver fibrosis, and aspartate aminotransferase (AST) and diabetic retinopathy were higher than those in the low-risk group for liver fibrosis and the intermediate-risk group for liver fibrosis (P<0.05). Stratified analysis showed that T2DM patients with age>60 years, HbA1c>9%, abnormal liver enzymes, and combined muscle mass loss were at higher risk of liver fibrosis (P<0.05). Comparison of the incidence of CVD risk in patients with different risks of liver fibrosis showed a progressive increase in the incidence of high CVD risk as the risk of liver fibrosis increased (χ2trend=35.900, P<0.001). Age, AST, DBIL, UAP, LSM, FIB4, FRS, diabetic peripheral neuropathy, and lipid-lowering therapy were higher and PLT was lower in patients in the High-CVD High hepatic risk Group than in the the Low-CVD Low hepatic risk Group and the High-CVD Low hepatic risk Group (P<0.05) .
Patients with T2DM are at high risk of developing liver fibrosis and CVD, in which advanced age, poor glycemic control, combination of multiple diabetic complications, liver enzyme abnormalities, increased hepatic lipid deposition, or decreased muscle mass increase the risk of CVD and hepatic fibrosis, and early monitoring and preventive management should be strengthened in this group of patients.
Arteriovenous fistula is the primary vascular access for patients on maintenance hemodialysis. Mean platelet volume (MPV) is a biomarker for cardiovascular events and MPV has been identified as an independent risk factor for myocardial infarction, stroke, and venous thromboembolism. Whether MPV is a risk factor for vascular access events in patients with maintenance hemodialysis (MHD) is unclear.
To explore the correlation between MPV levels and the risk of vascular access events in MHD patients.
343 patients who underwent MHD at the Blood Purification Center of the Fourth Hospital of Hebei Medical University from September 1st to 15th, 2020 were selected for the study. The follow-up cutoff was 2021-09-15, and the endpoint events were the occurrence of a vascular access event (stenosis or thrombosis of the arteriovenous fistula) or the patient's death. Patients were categorized into 4 groups according to the quartiles of MPV values of the included patients: group Q1 (MPV: 6.1-8.1 fL), group Q2 (MPV: 8.2-8.8 fL), group Q3 (MPV: 8.9-9.6 fL), and group Q4 (MPV: 9.7-14.1 fL). The general conditions, laboratory tests, incidence of arteriovenous fistula thrombosis and stenosis, and other relevant data of MHD patients in the 4 groups were compared. Kaplan-Meier survival curves were used to analyze the incidence of vascular access events in MHD patients, and Log-rank test was used for comparison between groups. The correlation between MPV and the risk of vascular access events in MHD patients was analyzed using multiple Cox proportional risk regression models, and further subgroup analyses were performed based on stratified characteristics.
Vascular access events occurred in 60 (17.5%) of 343 MHD patients, and the incidence rates of vascular access events in MHD patients in the Q4, Q3, Q2, and Q1 groups were 33.7% (29/86), 17.8% (16/90), 12.2% (10/82), and 5.9% (1/85), respectively. The results of the Kaplan-Meier survival curve analyses showed that, when comparing the incidence rates of vascular access events in the 4 groups of MHD patients, the difference was statistically different (χ2=25.693, P<0.05). After correcting for confounders, elevated MPV levels remained a risk factor for the risk of vascular access events in MHD patients (HR=1.59, 95%CI=1.28-1.97, P<0.001). Subgroup analyses showed no interaction between subgroups except for the diabetes subgroup (Pinteraction>0.05) .
Elevated MPV levels may be a risk factor for the risk of vascular access events in patients with MHD, providing a reference index for clinicians to predict the risk of vascular access events.
With the increasing incidence of hyperhomocysteinemia (HHcy) and hypertension in high-altitude regions, the relationships among homocysteine (Hcy), polymorphisms of Hcy metabolizing enzyme genes, blood pressure, and oxidative stress levels remain unclear. Exploring these correlations may provide new diagnostic and therapeutic insights for H-type hypertension in high-altitude areas.
To analyze the impact of altitude on polymorphisms of Hcy metabolizing enzyme genes, compare differences in blood pressure, Hcy levels, and oxidative stress levels among different genotypes, and explore the correlations between Hcy levels and blood pressure as well as oxidative stress.
From July 2023 to July 2024, 60 hypertensive patients (high-altitude hypertension group) and 30 healthy subjects (high-altitude healthy group) from the Yushu region (altitude: 3 800-4 200 m) were recruited from the Affiliated Hospital of Qinghai University. Additionally, 60 hypertensive patients (low-altitude hypertension group) and 30 healthy subjects (low-altitude healthy group) from the Xining region (altitude: 2 260 m) were included in the study. Baseline information and laboratory test results were collected from the subjects, and polymorphisms of Hcy metabolizing enzyme genes were detected. Pearson correlation tests were used to investigate the correlations among Hcy, blood pressure, serum oxidized glutathione (GSSG), nitric oxide (NO), and superoxide dismutase (SOD) levels.
There were no significant differences in age, gender, BMI, smoking history, drinking history, medication history, family history of hypertension, or ethnicity among the groups (P>0.05). The high-altitude hypertension group had higher Hcy, systolic blood pressure (SBP), diastolic blood pressure (DBP), and GSSG levels, and lower NO and SOD levels compared to the high-altitude healthy group and the low-altitude hypertension group (P<0.05). The high-altitude healthy group had higher SBP, DBP, and GSSG levels, and lower SOD levels compared to the low-altitude healthy group (P<0.05). The low-altitude hypertension group had higher Hcy, SBP, DBP, and GSSG levels, and lower SOD levels compared to the low-altitude healthy group (P<0.05). There was a significant difference in the genotype frequency of the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism between the hypertension groups at different altitudes (P<0.05), but no significant differences in the genotype frequencies of the MTHFR A1298C and methionine synthase reductase (MTRR) A66G polymorphisms (P>0.05). There were no significant differences in the genotype frequencies of the MTHFR C677T, MTHFR A1298C, and MTRR A66G polymorphisms between the healthy groups at different altitudes (P>0.05). Among the 120 hypertensive patients, 56 (46.67%) had the CC genotype, 43 (35.83%) had the CT genotype, and 21 (17.5%) had the TT genotype at the MTHFR C677T locus; 62 (51.67%) had the AA genotype, 51 (42.50%) had the AC genotype, and 7 (5.83%) had the CC genotype at the MTHFR A1298C locus; 62 (51.67%) had the AA genotype, 48 (40.00%) had the AG genotype, and 10 (8.33%) had the GG genotype at the MTRR A66G locus. At the MTHFR C677T locus, the TT genotype was associated with higher Hcy, SBP, NO, and SOD levels and lower GSSG levels compared to the CT and CC genotypes, and the CT genotype was associated with higher Hcy, SBP, NO, and SOD levels and lower GSSG levels compared to the CC genotype (P<0.05). At the MTHFR A1298C locus, the CC genotype was associated with higher Hcy levels and a higher proportion of HHcy compared to the AC and AA genotypes, and the AC genotype was associated with higher Hcy levels and a higher proportion of HHcy compared to the AA genotype (P<0.05). At the MTRR A66G locus, the GG genotype was associated with higher Hcy, NO levels, and a higher proportion of HHcy compared to the CC and AG genotypes, and the AG genotype was associated with higher Hcy, NO levels, and a higher proportion of HHcy compared to the CC genotype (P<0.05). Patients with HHcy had higher DBP and GSSG levels and lower NO and SOD levels compared to non-HHcy patients. Correlation analysis showed that Hcy was positively correlated with DBP and GSSG and negatively correlated with NO and SOD in hypertensive subjects, and NO was negatively correlated with DBP (P<0.05) .
Hypertensive patients in high-altitude regions have higher blood pressure and oxidative stress levels compared to those in low-altitude regions. However, the genotype distribution of the MTHFR C677T polymorphism tends towards the normal type, with a lower proportion of mutant genotypes that lead to increased Hcy levels, which deviates from traditional views. The relationship between polymorphisms of Hcy metabolizing enzyme genes and Hcy and blood pressure levels remains unclear, and further exploration is needed in the future.
Atherosclerosis (AS) is the main pathological basis of cardiovascular disease and is characterized by vascular endothelial inflammation, thus targeting inflammation-related mechanisms is the key to prevention and treatment of AS.
To investigate the effect of the hexosamine biosynthesis pathway (HBP) on adhesion molecules and its regulatory role in vascular endothelial inflammation.
From August to December 2022, 24 SPF grade C57BL/6 female mice were divided into control group, DON group, HFD group, HFD+DON group according to randomized block design method using body weight stratification. Serum and aortic tissue from the mice were collected after 15 weeks of corresponding intervention measures in each group of mice. The lipid levels of mice were detected using biochemical kits before and after intervention, pathological changes in the aortic root were detected by HE staining, and the expression levels of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) were detected by immunofluorescence staining, ELISA and Western blot.
After 15 weeks of intervention, compared with the control group, the levels of LDL-C and TC were increased significantly in the HFD group, while HDL-C was reduced significantly (P<0.05) ; There was no change in the lipid levels between the HFD group and the HFD+DON group (P>0.05). HE staining results showed that the vascular intima was thickened, the morphology of vascular smooth muscle was abnormal, the structure was disorganized, and a large number of foam cells were seen in HFD group. The smooth muscle cells of mice were neatly aligned, the endothelial cell layer was continuous, the number of foam cells was reduced significantly, and the cell gap was normal basically in the HFD+DON group. The results of immunofluorescence staining, ELISA and Western blot showed that the expression of ICAM-1 and VCAM-1 was down-regulated in the HFD+DON group compared with the HFD group.
Inhibition of HBP can down-regulate the expression of ICAM-1 and VCAM-1, and play a role in improving vascular endothelial inflammation.
The majority of caregivers of left-behind children in rural China are their mothers and grandmothers. The mental health of children's caregivers is one of the significant factors affecting the early development of children. Currently, there is a lack of research and comparison on the factors influencing depression among mothers and grandmothers of left-behind children in rural China.
To investigate the determinants of depression among female caregivers of left-behind children in rural China.
Data were collected from the baseline survey of the Home Visit Intervention Evaluation Segment of the Health and Development Promotion Program for Left-behind Children, conducted by UNICEF from April to July in 2018. The villages were selected through multi-stage stratified sampling. 1 or 2 towns were chosen as program towns in each of the 5 impoverished counties in 5 provinces. Villages in program towns were stratified by number of under-3-year-old children except Pingshan, where all villages from the program town were included. Three villages were randomly selected in each stratum as intervention villages, matched with control villages of similar number of under-3-year-old children, socioeconomic status and the distance from county. Ultimately 113 villages in 27 towns were included in the survey. This study focused on the mothers and grandmothers of left-behind children under 3. Questionnaire was used to collect the data of left-behind children under 3 years old and their main caregivers participating in the survey, and Zung Self-rating Depression Scale (ZSDS) was used to assess the depression status of caregivers. Multivariate Logistic regression was used to analyze the determinants of depression in the main caregivers of left-behind children.
A total of 728 subjects were included in this study, including 282 mothers and 446 grandmothers. The overall incidence of depressive symptoms was 32.8% (239/728) . The prevalence of depression among mothers and grandmothers of left-behind children was 29.8% (84/282) and 34.8% (115/446) respectively, with no statistical significance between two groups (P>0.05) . Multivariate Logistic analysis revealed that for mothers, caring for 1-year-old children (OR=2.041, 95%CI=1.065-3.913) , 2-3-year-old children (OR=2.128, 95%CI=1.023-4.425) , and experiencing caregiving stress (OR=4.043, 95%CI=2.152-7.594) were risk factors for depression (P<0.05) . A mean communication time ≥10 minutes per time with absent fathers (OR=0.396, 95%CI=0.175-0.898) was a protective factor against maternal depression (P<0.05) . For grandmothers, looking after girls rather than boys (OR=0.506, 95%CI=0.331-0.772) was a protective factor for depression (P<0.05) . Conversely, being 60 years or older (OR=1.879, 95%CI=1.082-3.261) , self-rated health status affecting caregiving (OR=2.402, 95%CI=1.364-4.231) and children's mothers cumulative longer absence from home (OR=2.468, 95%CI=1.059-5.751) were the risk factors for depression (P<0.05) .
The incidence of depression among female caregivers of left-behind children in rural China is high. Mothers and grandmothers, as the primary caregivers of most left-behind children, experience different factors affecting depression. Older children, high caregiving stress are risk factors for maternal depression, whereas greater communication with the children's fathers is protective factor for maternal depression. Grandmothers face a higher risk of depression when advanced age, self-report health status affacts caregiving, and children's mothers are absent from home for extended period, while caring for a granddaughter is a protective factor against grandmother's depression.
Homocysteine (Hcy) levels are strongly associated with vascular health problems like stroke, and early identification and screening for hyperhomocysteinemia (HHcy) is crucial for stroke prevention. However, lack of systematic epidemiological data on the relationship between Hcy and stroke in Hebei Province, China, and insufficient comprehensive studies on HHcy and other risk factors limit the development of effective prevention and control strategies.
To investigate the correlation between Hcy and stroke in people aged 40 years and over in Hebei Province, thus providing scientific basis for the development of accurate stroke prevention and control strategies.
On the basis of the China National Stroke Screening Survey from January 2018 to December 2020, 92 942 permanent residents aged 40 and above were sampled from 49 monitoring sites in 9 cities of Hebei Province by multi-stage cluster sampling method. The correlation between Hcy and stroke was investigated by unconditional Logistic regression analysis, and stratified analysis was performed based on age and sex. At the same time, the combined effects of Hcy and other factors on stroke were further studied.
The prevalence of stroke among people aged 40 years and above in Hebei Province was 4.51% (4 196/92 942) , and the prevalence of high Hcy was 36.25% (33 692/92 942) . The prevalence of stroke in people with high Hcy levels was significantly higher than that in people with normal Hcy levels (P<0.05) . Stratified by Hcy quartiles, the prevalence of stroke tended to increase as Hcy levels gradually increased (χ2 trend=367.310, P<0.05) . The results of stratification analysis showed that in two age groups (40-59 years old and ≥60 years old) , the prevalence of stroke was significantly higher in people with high Hcy levels than in people with normal Hcy levels (P<0.05) . With the incremental increase of Hcy levels from Q1 to Q4, the prevalence of stroke in people with 40-59 and ≥60 years old showed an incremental trend (the trend χ2 values were 109.213, and 75.653, respectively, P<0.05) . The prevalence of stroke was significantly higher in both males and females with high Hcy levels than normal Hcy levels (P<0.05) , and the prevalence of stroke in both males and females showed an increasing trend as the Hcy level increased from Q1 to Q4 (the trend χ2 values were 197.115, and 117.406, respectively, P<0.05) . There was a positive additive interaction but no multiplicative interaction between high Hcy and hypertension (RERI=0.41, AP=0.08, SI=1.12, P<0.05) , and a negative additive (RERI=-0.30, AP=-0.25, SI=0.41, P<0.05) and negative multiplicative (OR=0.77, 95%CI=0.64-0.92, P<0.05) interactions. No interaction was found with diabetes or alcohol consumption.
The prevalence of high Hcy exceeded 36% in people over 40 years of age in Hebei province, and the prevalence of stroke increased with higher Hcy levels, especially across age and gender. The risk of stroke was increased when high Hcy coexisted with hypertension, whereas there was a negative interaction between high Hcy and smoking, with an antagonistic effect when the two exposure factors coexisted that altogether reduced the risk of stroke. However, it should be emphasized that the reduced risk does not mean that the harms of these two factors alone can be ignored, and that high Hcy and smoking are still important risk factors for stroke. Therefore, people at high risk of stroke should have their Hcy levels monitored regularly, and should take targeted measures to control their blood pressure, improve healthy lifestyles, and take folic acid and B vitamins supplements to reduce the overall risk of stroke.
The motoric cognitive risk (MCR) is a new method for identifying the preclinical stage of dementia and represents the earliest stage of cognitive impairment. Cold is a common pathogenic factor for both coronary artery disease and cognitive impairment. Studying the key characteristics and influencing factors of MCR in hospitalized patients with coronary artery disease in the frigid zone can provide a scientific basis for preventing and controlling coronary artery disease combined with MCR in the frigid zone and formulating targeted intervention measures.
To clarify the occurrence of MCR in the population with coronary artery disease in the frigid zone and analyze its key influencing factors.
This study was a cross-sectional survey. Convenience sampling was used to select patients hospitalized in the Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University and diagnosed with coronary artery disease from September to December 2023. A self-designed questionnaire was used to investigate sociodemographic data and lifestyle, and handgrip strength was measured. Standardized electronic medical records were reviewed to obtain clinical data, and psychological scales were used to measure relevant psychological indicators of patients. MCR was identified based on subjective cognitive complaints, slow gait, no mobility impairment, and no diagnosis of dementia. Binary Logistic regression analysis was used to explore the influencing factors of MCR in patients with coronary artery disease in the frigid zone.
A total of 413 patients were included in this study, and the incidence of MCR was 13.80% (57/413) . Binary Logistic regression analysis showed that polypharmacy (OR=2.142, 95%CI=1.151-3.987) , cardiometabolic co-morbidities (OR=3.730, 95%CI=1.059-13.143) , apathy (OR=2.305, 95%CI=1.239-4.287) , PCI (OR=2.861, 95%CI=1.461-5.602) , neutrophil count (OR=2.803, 95%CI=1.302-6.034) , and handgrip strength[Q2 (17.7-26.2 kg) : OR=0.362, 95%CI=0.160-0.814; Q3 (26.4-34.4 kg) : OR=0.349, 95%CI=0.156-0.831; Q4 (34.5-70.6 kg) : OR=0.259, 95%CI=0.105-0.639] were the influencing factors of MCR in patients with coronary artery disease (P<0.05) .
The incidence of MCR in patients with coronary artery disease in the frigid zone is higher than that in the community population, at 13.80%. The risk factors associated with MCR suggest that medical staff should conduct early screening and follow-up for patients who have undergone PCI treatment, have apathy, have diabetes, and have a history of stroke, and provide long-term standardized drug management. Further exploration of the correlation mechanism between MCR and coronary artery disease, with a focus on the inflammatory pathway characterized by elevated neutrophil counts and the muscle and neural regulatory mechanisms, is expected to open up new avenues for in-depth research in this field.
The lack of disease self-management awareness in patients after percutaneous coronary intervention (PCI) affects the prognosis, and the prognosis of patients with diabetes is worse. The establishment of chronic disease follow-up system and the collaborative management of the two diseases become the key to the rehabilitation of patients.
To construct a comorbidity follow-up model for patients with coronary heart disease complicated with diabetes after PCI based on the theory of chronic disease self-management and CICARE communication model, and to explore the application effect.
From January to April 2022, literature review, semi-structured interviews and expert correspondence were used to constructed a comorbidity follow-up model for patients with coronary heart disease complicated with diabetes after PCI. Patients with coronary heart disease complicated with diabetes who received PCI in the Department of Cardiology of Chu Hsien-I Memorial Hospital, Tianjin Medical University from May to December 2022 were selected as research subjects. They were divided into two groups by using the random number table method. The control group (77 cases) received routine follow-up, and the test group (78 cases) received comorbidity follow-up model. The scores of Coronary Heart Disease Self-management Scale (CSMS) and other outcome indicators were compared between the two groups before discharge, 3 months and 6 months after discharge.
The positive coefficients of experts in the two rounds of expert correspondence were both 100%, the authority coefficient was 0.87, and the coordination coefficient was 0.310 and 0.334, respectively (all P<0.001) . The comorbidity follow-up model included three dimensions, 11 modules and 30 contents. Finally, 64 patients in each group completed the follow-up. There was an interaction between group and time on the scores of CSMS (F=150.504, P<0.001) . The scores of CSMS at 3 months and 6 months after discharge were higher than those before discharge (P<0.001) , and the scores of the test group were higher than those of the control group (P<0.05) . After 6 months, the BMI of the test group was lower than that of the control group (P<0.05) .
The constructed comorbidity follow-up model after PCI was scientific and effective, which can improve the self-management behavior of patients after PCI and reduce BMI.
Inflammatory bowel disease (IBD) patients suffer from recurrent and prolonged disease episodes, resulting in a high disease burden, which seriously affects patients' quality of life. Different types of disease burden have different impacts on the health status of patients, however, the current distribution of disease burden types in IBD patients and their influencing factors are not clear and need to be further explored.
To explore the potential profiles of disease burden in patients with IBD, and to analyze the influencing factors of different potential profiles.
Convenience sampling method was used to select 241 IBD patients from Tenth People's Hospital, Tongji University from June to October 2023. General information questionnaire, Chinese version of the Inflammatory Bowel Disease Disk Scale, and Psychological Resilience Scale were used to conduct the survey. Potential profile analysis was categorized the burden of disease for IBD patients, and multiple Logistic regression was explored the differences in the characteristics of different categories of patients.
A total of 250 questionnaires were distributed in this study and 241 valid questionnaires were recovered, with a valid questionnaire recovery rate of 96.4%. The disease burden characteristics of IBD patients could be categorized into 3 potential profiles: high burden-disease coping difficulties type (n=147, 61.0%) , medium burden-perceived pain and image type (n=75, 31.1%) , and low burden-psycho-emotional type (n=19, 7.9%) . The results of multiple Logistic regression analysis showed that the high burden-disease coping difficulties type was compared with the low burden-psycho-emotional type, patients with unstable jobs and high education level were easily categorized into high burden-disease coping difficulties type, while patients with high annual income, long disease duration, no complications and favorable psychological resilience were easily categorized into low burden-psycho-emotional type. Comparing the medium burden-perceived pain and image type with the low burden-psycho-emotional type, the older the patients, the higher the literacy level, the higher the number of follow-ups, and the lack of surgical experience were easily categorized into the medium burden-perceived pain and image type, and the patients with high annual income, long disease duration, no complications, and favorable psychological resilience were easily categorized into the low burden-psycho-emotional type. Comparing the medium burden-perceived pain and image type with the high burden-disease coping difficulties type patients who were married, had no regular job, and had long disease duration were likely to be categorized in the high burden-disease coping difficulties type, whereas patients who had a high number of follow-ups and no surgical treatment were likely to be categorized in the medium burden-perceived pain and image type (P<0.05) .
The disease burden of IBD patients has a distinct categorical profile and is divided into three potential profiles: high burden-disease coping difficulties type, medium burden-perceived pain and image type, and low burden-psycho-emotional type, which are influenced by age, marital status, job status, education level, annual income, disease duration, frequency of follow-up, surgical experience, complications, and level of psychological resilience. Healthcare professionals should pay attention to identifying the disease burden levels of different patients, focusing on high-burden patients, strengthening IBD symptom management and psychological interventions, and improving patients' disease coping ability and psychological resilience levels to reduce their disease burden.
Intracranial arterial negative remodeling refers to stenotic changes in the large intracranial arteries and is a potential indicator of accelerated atherosclerosis in the vessel wall. If left untreated, this condition can lead to serious cardiovascular and cerebrovascular diseases such as stroke and myocardial infarction. However, research on the influencing factors of intracranial arterial negative remodeling is still limited.
To explore the relationship between blood pressure variability (BPV) , the systemic immune-inflammation index (SII) , and intracranial arterial negative remodeling in patients with cerebral small vessel disease (CSVD) , and to establish a predictive model.
A total of 110 patients with CSVD admitted to the Second Affiliated Hospital of Zhengzhou University between September 2022 and March 2024 were enrolled in the study. Based on imaging examinations, the brain arterial remodeling (BAR) score was calculated, and the patients were divided into two groups: the intracranial arterial negative remodeling group (BAR score <-1 standard deviation, 17 cases) and the non-negative remodeling group (BAR score ≥-1 standard deviation, 93 cases) . Clinical data were collected, and dynamic blood pressure monitoring was conducted. Multivariate Logistic regression analysis was performed to identify factors that may contribute to intracranial arterial negative remodeling in CSVD patients. The predictive value of these factors for intracranial arterial negative remodeling was evaluated using receiver operating characteristic (ROC) curve analysis. Additionally, a nomogram predictive model was constructed and its clinical utility was assessed.
There were statistically significant differences between the intracranial arterial negative remodeling group and the non-negative remodeling group in terms of history of hypertension, SII, 24-hour systolic blood pressure standard deviation (24 hSSD) , and 24-hour systolic blood pressure coefficient of variation (24 hSCV) (P<0.05) . Multivariate Logistic regression analysis revealed that a history of hypertension (OR=23.192, 95%CI=1.029-522.644, P=0.048) , SII elevated (OR=1.005, 95%CI=1.000-1.010, P=0.041) , and 24 hSSD elevated (OR=3.510, 95%CI=1.155-10.671, P=0.027) were risk factors for intracranial arterial negative remodeling in CSVD patients. The area under the ROC curve (AUC) for SII and 24 hSSD in predicting intracranial arterial negative remodeling was 0.797 (95%CI=0.670-0.924, P<0.001) and 0.933 (95%CI=0.885-0.980, P<0.001) , respectively. Based on SII and 24 hSSD, a nomogram predictive model was developed to predict the occurrence of intracranial arterial negative remodeling in CSVD patients. Internal validation showed that the ideal curve closely matched the predictive curve.
Elevated SII and 24 hSSD are risk factors for intracranial arterial negative remodeling in CSVD patients and have a certain predictive value for its occurrence. Reducing SII and 24 hSSD may have clinical value in preventing the onset of intracranial arterial negative remodeling.
The majority of cervical adenocarcinomas are caused by human papilloma virus (HPV) infection, and only about 10%-15% are unrelated to HPV infection. However, there are few comparative studies of HPV-related and non-HPV-related cervical adenocarcinomas, and few studies have investigated the prognostic risk factors of cervical adenocarcinoma.
To investigate the clinicopathological features and prognostic factors of human papillomavirus-associated (HPVA) and human papillomavirus-independent adenocarcinoma (HPVI) .
A total of 227 cases of cervical adenocarcinoma diagnosed and treated by the Department of Female Tumor, Shanxi Provincial Cancer Hospital from January 2017 to September 2021 were selected, including 47 cases (20.7%) of HPVI and 180 cases (79.3%) of HPVA. The clinicopathological characteristics of the patients were collected, and the patients were followed up until September 30, 2020. Records of the patient's overall survival (OS) and time progression-free surial (PFS) .
Log-rank analysis showed that patients with age of onset≥50 years, maximum tumor diameter ≥4 cm, HPVI, FIGO stageⅡ-Ⅳ, cervical invasion depth ≥1/2, lymph node metastasis, vascular tumor thrombus, nerve invasion, uterine body invasion and ovarian metastasis had higher recurrence and metastasis rates and death rates (P<0.05) . Cox multivariate regression analysis showed that age of onset (HR=1.056, 95%CI=1.021-1.091) , tumor size (HR=1.266, 95%CI=1.006-1.594) , pathological type (HR=2.060, 95%CI=1.073-3.956) , vascular invasion (HR=4.986, 95%CI=2.478-10.032) , nerve invasion (HR=5.632, 95%CI=2.159-14.687) were influencing factors for progression-free survival. Age of onset (HR=1.056, 95%CI=1.021-1.093) , tumor size (HR=4.147, 95%CI=1.384-12.424) , pathological type (HR=4.371, 95%CI=1.602-11.925) , FIGO stage (HR=1.748, 95%CI=1.057-2.889) , vascular invasion (HR=8.054, 95%CI=3.905-16.608) and nerve invasion (HR=3.842, 95%CI=1.147-12.872) were independent poor prognostic factors for overall survival of cervical adenocarcinoma (P<0.05) .
Compared with HPV-related cervical adenocarcinoma, non-HPV-related cervical adenocarcinoma has worse clinicopathological features and prognosis. More attention should be paid to cervical adenocarcinoma, especially non-human papillomavirus associated adenocarcinoma.
Breast cancer is a hormone receptor-dependent malignant tumor, and the dynamical changes of estradiol (E2) play a critical role in the development of breast cancer. The classical case-cohort design completely ignores the information of non-selected samples, which could easily lead to biased estimating.
To explore the effect of dynamical changes of E2 levels on the survival prognosis in breast cancer patients, and evaluate the superiority of improved case-cohort design.
In this study, we selected 8 226 patients who were diagnosed as breast cancer by pathological examination at the Affiliated Cancer Hospital of Xinjiang Medical University from 2015 to 2019, by using the time of patient diagnosis as the follow-up start date, and defining the death of patients due to breast cancer as the outcome event. The follow-up end date was December 31, 2021. The demographic characteristics, immunohistochemical indicators, clinicopathological characteristics and survival status of patients were gathered, and their serum E2 levels were longitudinally monitored. Based on the classical case-cohort design, the improved case-cohort design was achieved by incorporating survival data from patients outside of the case-cohort sample. Under the classical and improved case-cohort designs, linear mixed effects model and Cox proportional risk model were used to fit the longitudinal data (longitudinal submodel) and survival data (survival submodel) of breast cancer patients, respectively, and two joint models for longitudinal and time-to-event data were further established. Moreover, Markov Chain Monte Carlo algorithm was used to estimate the parameters of two joint models. The area under the receiver operating characteristic curves (AUC) and prediction errors (PE) were further applied to compare the discrimination and calibration of two joint models under the classical and improved case-cohort designs.
Based on the inclusion and exclusion criteria, a total of 895 breast cancer patients were included in the full cohort, of which 53 patients died of breast cancer. The median follow-up time for patients was approximately 28 months. The samples of classical case-cohort design were concluded two parts: one was one quarter of the patients selected from the full cohort as a random subcohort, the other was patients who died during the follow-up period outside the random subcohort, of which included survival data from 236 patients and 1 062 measurements of E2 levels. Moreover, on the basis of the classical case-cohort design, the survival data of breast cancer patients who were outside of the classical case-cohort samples and survived during the follow-up period (G4) were included as the samples of the improved case-cohort design that included survival data from 895 patients, 1 062 measurements of E2 levels from 236 patients (in which it was assumed that there were 2 958 longitudinally missing measurements of E2 levels) . The results of two joint models under classical and improved case-cohort designs both revealed that dynamical change of E2 levels was identified as the influencing prognostic factors for breast cancer patients. For one-unit longitudinal increment of lg (E2) , the mortality risks for patients would increase by about 23% (HR=1.23, =1.015) and 8% (HR=1.08, =1.020) , respectively. Moreover, the joint model under the improved case-cohort design showed better discrimination and calibration (AUC=0.706-0.962, PE=0.001 2-0.010 8) .
The longitudinal increment of E2 levels could cause a decrease of the survival probability for breast cancer patients. The joint model under case-cohort design could both analyze longitudinal and survival data, and the improved case-cohort design would be superior to that of the classical case-cohort design.
The elderly population in our country is large and growing rapidly, and depression is a common emotional disorder and mental health problem among the elderly population. The mental health of the female elderly population is increasingly becoming a focus of social concern.
To explore the influencing factors of depression symptoms in the female elderly population from a multi-level and comprehensive perspective of health ecology, and provide theoretical basis for identifying and intervening in depression symptoms in the elderly female population in China.
In January 2024, we extracted for the 2020 survey data from the China Health and Retirement Longitudinal Survey (CHARLS), and a group of female elderly adults aged 60 years and above were selected for the study (n=4 594). Based on the health ecology model, the influencing factors were divided into five levels: personal characteristics layer, behavioural characteristics layer, interpersonal network layer, living and working conditions layer, and policy environment layer. The χ2 test and binary Logistic regression model were used to explore the influencing factors of depression symptoms and to establish a health ecology model of depression symptoms in the Chinese female elderly population.
The detection rate of depression symptoms in the Chinese female elderly population was 48.06% (2 208/4 595). Logistic regression analysis showed that age of ≥80 years (OR=0.601, 95%CI=0.449-0.804), sleep duration of≥6 h (OR=0.561, 95%CI=0.493-0.639), satisfaction with life (OR=0.256, 95%CI=0.199-0.330), better self-rated physical health (OR=0.459, 95%CI=0.395-0.533), urban household registration (OR=0.717, 95%CI=0.603-0.853), satisfaction with children (OR=0.666, 95%CI=0.472-0.940), education level of junior high school and above (OR=0.712, 95%CI=0.582-0.871), family income >50 000 yuan (OR=0.822, 95%CI=0.704-0.959) and the per capita GDP of the city is 50 000 to 100 000 yuan (OR=0.841, 95%CI=0.730-0.970) were the protective factors for the development of depression symptoms in the Chinese female elderly population (P<0.05). Having become disabled (OR=1.786, 95%CI=1.556-2.050), suffering from chronic diseases (OR=1.159, 95%CI=1.014-1.324), central region (OR=1.298, 95%CI=1.107-1.522) and western region (OR=1.407, 95%CI=1.183-1.675) were the risk factors for depression symptoms in the Chinese female elderly population (P<0.05) .
The detection rate of depression symptoms in the Chinese female elderly population is relatively high, and there are many influencing factors, including: age in the personal characteristics layer; sleep time, satisfaction with life, self-related of physical health, disability, and chronic disease in the behavioral characteristics layer; household registration type, satisfaction with children, and geographical distribution in the interpersonal network layer; education and family income in the living and working conditions layer; the per capita GDP of the city in the policy environment layer. Effective intervention measures should be taken at all layers, targeting key populations, in order to reduce the incidence of depression symptoms among the Chinese elderly women.
Lipid metabolism of middle-aged and older adults may be influenced by decreased sleep efficiency, but their association still needs to be analyzed in-depth.
To analyze the association between sleepefficiency (SE) and different lipid indexes in people aged 40-65, and to explore the mediating role of central obesity in the association between SE and lipid to provide reference for exploring the pathway of dyslipidemia caused by SE and its prevention and treatment.
From March to November 2022, the subjects who met the inclusion and exclusion criteria for physical examination in the physical examination center of Fuquan First People 's Hospital were investigated, including face-to-face questionnaire survey, physical examination and laboratory index detection. The minimum control variable set that needs to be adjusted to identify the association between SE and dyslipidemia through directed acyclic graph (DAG) was: age, gender, smoking, drinking, family income, exercise and education level. Non-conditional binary Logistic regression analysis was used to explore the association between SE and different dyslipidemia indicators.
A total of 1 095 subjects were included in this study and were divided into two groups according to the presence or absence of dyslipidemia. There were statistically significant differences in gender, smoking, drinking, exercise, waist circumference, hip circumference and waist-hip ratio between the two groups (P<0.05). After adjusting control variables, higher risk hypertriglyceridemia was observed in the group with low SE than high SE group (OR=1.35, 95%CI=1.03-1.77), there was no statically significant association between SE and other lipid indexes. Mediation effect analysis showed that WHR had a partial mediating effect in the association between SE and hypertriglyceridemia (β=0.019, 95%CI=0.005-0.034), WHR played a masking effect on the association between SE and low high-density lipoprotein cholesterol .
Central obesity may be an important pathway in the association between low SE and hypertriglyceridemia.
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, and the prevalence of NAFLD in China has continued to increase over the past 20 years. Some cohort studies have confirmed the causal relationship between NAFLD and dysglycaemia, but the temporal relationship between the two remains unclear.
To analyse the bidirectional time-series association between NAFLD and dysglycemia using cross-lagged panel models with the Beijing Health Management Cohort as the study population.
Based on the Beijing Health Management Cohort Study, follow-up data were collected from 2016 to 2021, with one follow-up visit per year, including questionnaire and physical examination information. According to the pre-established inclusion and exclusion criteria, 44 838 study subjects were finally included. A cross-lagged panel model was constructed using hepatic steatosis (HS) and fasting plasma glucose (FPG) as surrogate indicators of NAFLD and dysglycaemia, and stratified by gender and BMI to explore the temporal relationship between NAFLD and dysglycaemia in different populations.
(1) In the total population, the cross-lagged path coefficient βbaseline HS→follow-up FPG was statistically significant (P<0.05) at 0.009 (95%CI=0.002-0.016) ; however, the cross-lagged path coefficient in the opposite direction was not statistically significant (P>0.05). (2) In women, the cross-lagged path coefficients in both directions were statistically significant (P<0.05) with βbaseline HS→follow-up FPG of 0.025 (95%CI=0.015-0.035), and βbaseline FPG→follow-up HS of 0.026 (95%CI=0.014-0.038) ; in men, the cross-lagged path coefficients in both directions were not statistically significant (P>0.05). (3) Among those with BMI≥25.0 kg/m2, the cross-lagged path coefficient βbaseline HS→follow-up FPG was statistically significant (P<0.05) at 0.114 (95%CI=0.103-0.125) ; however, the cross-lagged path coefficients in the opposite direction were not statistically significant (P>0.05) ; and among those with BMI <25.0 kg/m2, the cross-lagged path coefficients in both directions were statistically significant (P>0.05). Cross-lagged path coefficients were statistically significant (P<0.05), with βbaseline HS→follow-up FPG of 0.101 (95%CI=0.092-0.111) and βbaseline FPG→follow-up HS of 0.021 (95%CI=0.012-0.031) .
There was a unidirectional temporal relationship from NAFLD to dysglycaemia in the total population and in the population with BMI≥25.0 kg/m2; and there was a bidirectional temporal relationship between NAFLD and dysglycaemia in the female population and in the population with BMI<25.0 kg/m2, which provides clues for adopting the treatment idea of co-prevention of the two disorders, NAFLD and dysglycaemia, in clinical practice.
Childhood trauma is a risk factor for suicidal ideation in patients with depressive disorder, and plasma vitamin D level is also related to suicidal ideation. However, there is still insufficient research on the relationship between them in adolescent patients with depressive disorder.
To explore the relationship between suicidal ideation and childhood trauma and to analyze the mediating role of depressive symptom severity and low vitamin D levels.
Adolescent patients with depressive disorder who attended Chaohu Hospital of Anhui Medical University and the Fourth People's Hospital of Hefei City in 2021 were used as the depressive disorder group (n=168), and adolescents with no history of mental illness recruited during the same period were used as the control group (n=89). Childhood trauma, depressive symptoms, and suicidal ideation were assessed using the Childhood Abuse Questionnaire (CTQ), the Current Evaluation of Depression Scale (CES-D), and the Suicidal Ideation Scale (PANSI), and plasma 25-hydroxyvitamin D[25 (OH) D] levels were also tested. Differences between adolescents with depressive disorders and control adolescents in suicidal ideation, depressive symptoms, childhood trauma, and vitamin D levels were compared; Pearson correlation analyses were used to test the correlation of scores on each scale, and the mediating roles of depression and vitamin D levels between childhood trauma and suicidal ideation were analyzed by the PROCESS macro program.
Adolescents in the depressive disorder group had higher PANSI scores, CTQ subscale scores, and total scores than those in the control group (P<0.05), and lower 25 (OH) D levels than those in the control group (P<0.5). Pearson correlation analyses showed that there were correlations between the PANSI scores and the CTQ total scores, the CES-D scores, and the 25 (OH) D levels of adolescents in the depressive disorder group (P< 0.05), and the PANSI scores of adolescents in the control group were correlated with total CTQ scores, CES-D scores (P<0.05), and no correlation with 25 (OH) D levels (P>0.05). The mediation benefit analysis showed that the CES-D score and 25 (OH) D level in the adolescent group with depressive disorder played a partial mediating role between the CTQ total score and PANSI score, with mediation effects accounting for 61.8% and 5.3%, respectively; and a partial mediating role between the CTQ affective abuse subscale score and PANSI score, with mediation effects accounting for 58.9% and 6.5%; a partial mediating role between CTQ emotional neglect subscale scores and PANSI scores, with mediating effect percentages of 67.2% and 5.6%, respectively; and a full mediating role between CTQ somatic neglect subscale scores and PANSI scores, with mediating effect percentages of 92.2% and 7.8%. None of the mediating effects of 25 (OH) D levels were significant for control adolescents; CES-D scores played a fully mediating role between CTQ total scores and PANSI scores, and between CTQ emotional maltreatment subscale scores and PANSI scores; and a partially mediating role between CTQ emotional maltreatment subscale scores and PANSI scores, with a direct effect percentage of 41.5% and a mediating effect accounted for 58.5%; the mediating effect between CTQ somatic neglect subscale scores and PANSI scores was not significant.
The severity of depressive symptoms and low vitamin D levels in patients with adolescent depressive disorder are potential mechanisms of childhood trauma leading to suicidal ideation. In view of the disorder of childhood trauma of adolescent depression in clinical should be timely and effective control and improvement of patient, improve their vitamin D levels and actively carry out mental health education, in order to reduce the occurrence of suicidal ideation, improve clinical outcomes.
Long-acting antipsychotics are one of the important choices in the maintenance treatment of patients with schizophrenia, which can effectively prevent relapse. Risperidone microspheres for injection (Ⅱ) has been improved in dosage form to maintain steady-state concentration, however there is currently a lack of study for efficacy on maintenance phase treatment.
To evaluate the efficacy and safety of risperidone microspheres for injection (Ⅱ) in the maintenance treatment for schizophrenia.
This was a single-arm, self-controlled, multicenter study. From May 2021 to May 2022, patients with schizophrenia, aged 18-65 years, were enrolled from 3 centers: Shanghai Mental Health Center, Hangzhou Seventh People's Hospital, and Suzhou Guangji Hospital. All patients switched from oral risperidone to risperidone microspheres for injection (Ⅱ) for maintenance treatment. During the treatment period, 25.0 mg, 37.5 mg or 50.0 mg were injected every two weeks, followed up for 12 weeks. At baseline, and at the end of 2, 4, 8, and 12 weeks, the social functioning was assessed using the Personal and Social Functioning Scale (PSP) ; the clinical symptoms and overall changes were assessed using the Positive and Negative Symptoms Scale (PANSS) and the Clinical Global Impression Scale (CGI) ; the health status was assessed using the European Five-Dimensional Survival Quality Inventory (EQ-5D) ; The Simpson-Angus Scale (SAS), Barnes Akathisia Rating Scale (BARS), and Abnormal Involuntary Movement Rating Scale (AIMS) were used to assess the extrapyramidal symptoms (EPS), and the laboratory indices were also collected.
A total of 71 patients were included in the study. The total PSP scores of patients at the end of the 2, 4, 8 and 12 weeks of treatment were (48.20±24.65), (49.07±25.81), (50.46±26.96), and (51.85±28.16), respectively, which were higher than the baseline (43.89±22.32) (P<0.05). The PANSS total score, positive symptom scale, negative symptom scale, and general psychopathology scale scores were reduced at the end of 12 weeks of treatment compared with baseline (P<0.05). CGI-S scores were lower than baseline (P<0.05), CGI-I scores were significantly reduced at the end of 12 weeks compared with the end of 4 weeks after treatment (P<0.01), and EQ-5D scores were higher than baseline (P<0.05). Common adverse reactions were increased prolactin, EPS, and dizziness, and no serious adverse reactions (SAE) or drop-out patients due to AE were observed.
Risperidone microspheres for injection (Ⅱ) can effectively improve the clinical symptoms of schizophrenia in the maintenance period, and it is well tolerated.
Since its implementation, residents' electronic health records have achieved phased results. The target of the filing rate in Shenzhen, Guangdong Province has been achieved, and the utilization rate has become the core index of theoptimization management of this work.
To understand the use of electronic health records of residents in Bao'an District, Shenzhen, and to analyze the influencing factors. It provides a basis for improving the utilization rate of health records and optimizing the allocation of community health resources.
As of 2022-12-31, Shenzhen Community Health Service information system had a total of 4 077 665 electronic health records of Bao 'an District residents. 403 700 electronic health records were selected by systematic sampling method, and 401 853 meeting the requirements of the study were selected for analysis.
The utilization rates of health records in 1 year, 2 years and 3 years were 59.30% (238 131/401 853), 74.90% (301 032/401 853) and 80.10% (321 853/401 853). The results of multivariate Logistic regression analysis showed that age, nationality, resident type, marital status, education level, profession, payment methods for medical expenses, duration of filing, as well as whether the health records were signed by a family doctor, the elderly, the hypertension and the diabetes were residents' electronic health records influencing factors of 1, 2 and 3 years use (P<0.05). Among them, compared with residents aged 21-45, the use rate of electronic health records in 1, 2 and 3 years was higher for residents aged 0-1, 2-3 and 4-6 years (OR>1.00, P<0.05) ; the usage rate of electronic health records for residents aged 46-60 and ≥61 years was lower in 1, 2 and 3 years (OR<1.00, P<0.05) ; compared with non-resident residents of Shenzhen, the use rate of electronic health records of residents with permanent residence in Shenzhen was higher at 1, 2 and 3 years (OR>1.00, P<0.05) ; compared with the residents participating in the basic medical insurance for urban employees, the use rate of electronic health records of residents with basic medical insurance, full self-payment and other medical expenses payment methods for urban residents was lower in 1, 2 and 3 years (OR<1.00, P<0.05) ; compared with residents with a filing period of<1 year, the use rate of electronic health records of residents with a filing period of≥1 year was lower at 1, 2 and 3 years (OR<1.00, P<0.05) ; compared with the residents without the corresponding project identification, the 1-year utilization rate of electronic health records with family doctor contract identification, elderly project identification, hypertension project identification, and diabetes project identification was higher[OR (95%CI) was 3.77 (3.70-3.84), 2.73 (2.53-2.94), 4.40 (4.11-4.72), 3.10 (2.78-3.47), P<0.05], respectively, and the 2-years and 3-years usage rates were also higher (OR>1.00, P<0.05) .
The usage rate of electronic health records among residents in Bao'an District has risen compared to previous levels, but there is still potential for further enhancement. Priority should be given to non-elderly people, middle-aged and elderly people identified by the hypertension/diabetes program, and residents who have not signed a family doctor, basic medical insurance for urban residents, payment methods for self-payment and other medical expenses, and non-household registration residents.
The aging of Chinese society has intensified, and the health of the elderly is a matter of great concern. As a densely populated and economically active area, the health of the elderly population in Huangpu District, Guangzhou City, is particularly important to the social and economic development of the local community. Therefore, regular monitoring and assessment of the health of the elderly population in Huangpu District can help identify potential health problems, prevent and control chronic diseases, and improve health literacy and self-care ability.
This study collects data on health checkups of the elderly population in Huangpu District and establishes a retrospective cohort to gain an in-depth understanding of the health status of the elderly population in the district, the influencing factors of diseases, and to provide reasonable suggestions for the development of targeted health interventions to improve the quality of life of the elderly.
Physical examination data were collected from 2019-2021 from Huangpu District, Guangzhou City, who participated in community health checkups and were≥65 years old, and the study involved basic information, history of living habits, auxiliary examinations, laboratory tests, and history of previous illnesses of the study subjects. Logistic regression analysis was performed on the influencing factors of the diseases.
A total of 17 412 study subjects were included in the analysis of this study. In the "baseline-follow-up" cohort, there were statistically significant differences (P<0.05) in the prevalence of exercise, smoking, alcohol consumption, diastolic blood pressure, BMI, waist circumference, fasting blood glucose, blood creatinine, glomerular filtration rate, triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-Ｃ), hypertension, diabetes mellitus, dyslipidemia, and chronic kidney disease (CKD). Differences in terms of were statistically significant (P<0.05). The proportion of developing hypertension, diabetes mellitus, dyslipidemia, or CKD at follow-up in the cohort population was 3.07%, 7.25%, 21.92%, and 6.00%, respectively. In participants with new-onset chronic disease at follow-up, 45.63% had comorbidities. Multifactorial logistic regression analysis: Risk factors for the prevalence of hypertension included age, pulse rate, and BMI; glomerular filtration rate and HDL-C were protective factors. Risk factors for the development of diabetes mellitus included age, systolic blood pressure, and BMI; and HDL-C was the main protective factor (P<0.05). Risk factors for dyslipidemia include systolic blood pressure. Risk factors for the development of CKD include age, systolic blood pressure, fasting blood glucose, and triglycerides (P<0.05) ; HDL-C was a protective factor (P<0.05) .
The prevalence of dyslipidemia was higher among the study population in the present study, followed by diabetes mellitus and CKD. Multiple chronic diseases predominantly suffer from both diseases. Age, systolic blood pressure, and BMI were the main risk factors for the development of chronic diseases among the elderly people who participated in the physical examination in this study. In response to the analysis, it is recommended to make full use of the health records based on the optimization of information technology, implementation of targeted interventions, leveraging community strengths as well as strengthening health education and health promotion to improve the health of the elderly.
The modified COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) has been shown to be useful to assess and monitor patients in post-COVID-19 syndrome in developed countries. However, its reliability and validity in the Chinese population remains unclear.
To translate the C19-YRSm into a Chinese version (C19-YRSm-C), and test the reliability and validity of the Chinese version.
After obtaining the approval of the translation and use authority of the C19-YRSm from MANOJ SIVAN's team at the University of Leeds, United Kingdom, the research team translated the C19-YRSm and formed the C19-YRSm-C after translation, back-translation, and cross-cultural adaptation, according to the Translation and Cross-cultural Adaptation Procedure. From May 1 to 7, 2023, a simple random sampling method was used to select post COVID-19 patients from the "Wen Juan Xing" platform sample pool as the study subjects. The General Information Questionnaire and the C19-YRSm-C were used to survey them. 13 experts were invited to evaluate the content validity of the scale. The C19-YRSm-C was subjected to item analysis, reliability and validity analysis.
A total of 512 questionnaires were distributed and 370 valid questionnaires were recovered, with a valid recovery rate of 72.3%. The results of item analysis showed that the CR values of the items ranged from 6.589 to 22.725 (P<0.001), and the item-total correlation coefficients of the scale ranged from 0.460 to 0.815 (P<0.001). For reliability, the Cronbach's α coefficient, Guttman Split-half coefficient and test-retest reliability of the C19-YRSm-C was 0.881, 0.837 and 0.833, respectively. For content validity, the item-level content validity index (I-CVI) of the C19-YRSm-C ranged from 0.692 to 1.000, and the scale-level validity index (S-CVI) was 0.914. The results of confirmatory factor analysis (CFA) showed that the fitting indicators of the initial model were undesirable. After the establishment of a covariance correlation between error variables e12 and e13 according to the indication prompts, the fitting indicators of the modified model were within the acceptable range except for the adjusted goodness-of-fit index (AGFI). The results of discriminant validity analysis showed that the differences in scores for the 4 subscales of the C19-YRSm-C among post-COVID-19 patients with different chronic disease history and cumulative number of COVID-19 showed statistically significant differences (P<0.05). The differences were statistically significant when comparing the scores of the 3 subscales in addition to other symptoms before and after COVID-19 infection (P<0.05) .
The C19-YRSm-C has good reliability and validity, with good applicability in Chinese population, which can be used to assess and monitor the rehabilitation status of post COVID-19 patients in China.
Hypertension is a common disease among residents, characterized by insidious onset, high incidence, high disability rate, low control rate, and low awareness rate, posing a significant threat to residents' health. In recent years, medical research has discovered a certain association between the lipid accumulation index (LAP) and hypertension. However, current cohort studies on the risk of hypertension incidence related to adult LAP are still limited. This research aims to explore the association between adult LAP and the incidence of hypertension through long-term follow-up observation, providing reliable scientific evidence for the prevention and control of hypertension in the population.
To investigate the relationship between lipid accumulation index in adults and the incidence of hypertension.
A baseline survey was conducted in 2010 among 9 280 individuals from 48 townships in 12 counties (districts) in Guizhou Province. Baseline information, physical examination results, and laboratory test results were collected from the participants. Follow-up surveys were conducted in 2016 and 2020. Multivariable Cox proportional hazards regression analysis was used to assess the correlation between LAP and the incidence of hypertension in the population. The Schoenfeld residual method was employed to test the proportional hazards assumption.
Ultimately, 3 774 individuals were included in this study, with 806 new cases of hypertension (21.36%) and 2 968 individuals without hypertension (78.64%). Statistically significant differences were observed between the two groups in terms of LAP, LAP distribution, gender, age, residence, occupation type, current smoking, harmful alcohol consumption, excessive oil intake, waist circumference, and triglyceride (TG) levels (P<0.05). Participants were divided into four groups based on LAP quartiles: Q1 (198 cases), Q2 (238 cases), Q3 (297 cases), and Q4 (394 cases). Multivariable Cox proportional hazards regression analysis revealed that the risk of hypertension in the Q4 group was 1.43 times that of the Q1 group (P<0.05). A non-linear dose-response relationship was observed between LAP levels and the risk of hypertension in the overall population (Pnon-linear=0.004). Subgroup analyses showed that, among males, the risk of hypertension increased in the Q3 (HR=1.67, 95%CI=1.24-2.25) and Q4 (HR=1.62, 95%CI=1.20-2.16) groups compared to the Q1 group (P<0.05). In the 18-45 and 46-60 age groups, the risk of hypertension increased in the Q4 group compared to the Q1 group (HR=1.58, 95%CI=1.20-2.09, P<0.001; HR=1.51, 95%CI=1.07-2.11, P=0.018). Among individuals primarily engaged in physical labor, the risk of hypertension increased in the Q4 group compared to the Q1 group (HR=1.28, 95%CI=1.02-1.59, P=0.030). Among individuals primarily engaged in mental labor, the risk of hypertension gradually increased with elevated LAP levels compared to the Q1 group (P<0.05) .
As a simple indicator for assessing abdominal obesity, LAP has a certain predictive effect on the risk of hypertension. Its predictive efficacy varies among different populations, with better performance in males and middle-aged and young adults. LAP can serve as a screening indicator for classifying individuals at risk of hypertension in primary healthcare or medical examination settings during health management services.
Subjective symptoms are the main reason for visiting and readmissions in elderly patients, and symptoms of elderly patients are closely related to ageing. At present, few studies have focused on the age-related changes of symptoms in elderly patients, thus reducing the targete, dynamic and prospective management of symptoms in elderly patients.
To analyze the characteristics of hospitalization, incidence of high-frequency symptoms and age-related changes for pre-elderly and elderly inpatients in recent 10 years, and to provide reference and direction for symptoms management, functional improvement in pre-elderly and elderly inpatients.
We conducted a retrospective study. Pre-elderly and elderly inpatients of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from 2014 to 2023 were included. The medical data retrieval and application platform of the hospital "IDu Cloud" was used for retrieval, and statistical data of the departments receiving treatment, the top 5 patients diagnosed with diseases and the symptoms of patients were extracted through the platform result analysis interface. The frequency of symptoms was defined as ≥5%. The high frequency symptoms of elderly hospitalized patients were divided into 6 categories: common, respiratory system, digestive system, nervous system, circulatory system, urinary system symptoms. Cases (%) were used to describe the distribution of hospitalization departments, disease diagnoses, and symptoms of elderly inpatients. To analyze the differences in high frequency symptoms among inpatients aged 50-<60 years (pre-elderly), 60-<70 years (younger elderly), 70-<80 years (middle-senior elderly), and≥80 years (senior elderly). Origin was used to plot scatter plots and graphs to describe the pattern of change in the incidence of inpatient symptoms with age.
A total of 1 214 387 pre-elderly and elderly inpatients were included in the study, including 465 488 (38.33%) pre-elderly inpatients, 422 935 (34.83%) younger elderly inpatients, 235 364 (19.38%) middle-senior elderly inpatients, and 90 600 (7.46%) senior elderly inpatients. The first inpatient department was cardiovascular medicine, the first disease diagnosis was malignant tumor chemotherapy in presenium, hypertension in the young and middle aged elderly, and coronary heart disease in advanced age. There were 12, 14, 19 and 23 kinds of high frequency symptoms in 50-<60 years old, 60-<70 years old, 70-<80 years old, and≥80 years old inpatients, respectively. The most prominent symptoms were physical decline, weight loss, cough, chest tightness, and poor appetite. Respiratory symptoms showed a "high increase" trend with aging, the age-related changes of digestive symptoms showed heterogeneity, and neurological, circulatory and urinary symptoms showed a relatively "low increase" trend with aging.
The incidence of symptoms in pre-elderly and elderly inpatients shows an overall increasing trend with age, and the rate of age-related changes varies for different symptoms. The diagnosis, the number and incidence of high-frequency symptoms in elderly inpatients after 70 years old changed significantly compared with those of the younger elderly, and the role of age-related changes became prominent. The age of 70 years may become an important turning point in the decline of the overall condition of elderly inpatients.
Rheumatoid factor (RF) is a common autoantibody found in patients with primary Sjögren's syndrome (pSS), but its specific role in the disease is not fully understood.
To explore the immune-inflammatory characteristics of pSS patients with different levels of RF.
This study included 262 pSS patients who visited the Department of Rheumatology of Traditional Chinese Medicine at China-Japan Friendship Hospital from December 2018 to September 2022. Patients were divided into three groups based on RF levels: negative group (RF<20 U/mL, n=137), low-titer positive group (RF: 20-60 U/mL, n=47), and high-titer positive group (RF>60 U/mL, n=78). Clinical data, including general information, clinical manifestations, symptom scores, and haematological indexes, were collected and compared among groups.
The RF positivity rate in 262 pSS patients was 47.7% (125/262), including 14 males (5.3%) and 248 females (94.7%), with a median age of 57.0 (49.0, 63.0) years, an average age of onset of (48.7±11.6) years, and a median disease duration of 60.0 (24.0, 120.0) months. There were no significant differences in gender, age, age of onset, or disease duration among the three groups (P>0.05). The top three common clinical manifestations in pSS patients were dry mouth (257 cases), dry eyes (247 cases), and fatigue (235 cases). The incidence of haematological involvement and arthritis was higher in the high-titer positive group than in the negative group (P<0.05). With the increase in RF titer, the incidence of haematological involvement (χ2trend=6.992, Ptrend=0.008) and arthritis (χ2trend=10.918, Ptrend=0.001) showed an upward trend. As RF titer increased, the proportions of pSS patients with antinuclear antibody≥1∶160 (χ2trend=40.691, Ptrend<0.001), anti-SSA antibody positivity (χ2trend=26.138, Ptrend<0.001), anti-Ro52 antibody positivity (χ2trend=31.426, Ptrend<0.001), anti-SSB antibody positivity (χ2trend=23.682, Ptrend<0.001), elevated erythrocyte sedimentation rate (χ2trend=40.132, Ptrend<0.001), elevated immunoglobulin (Ig) A (χ2trend=7.508, Ptrend=0.006), elevated IgG (χ2trend=71.570, Ptrend<0.001), decreased complement 3 (χ2trend=7.452, Ptrend=0.006), decreased neutrophil count (χ2trend=8.364, Ptrend=0.004), and decreased hemoglobin (χ2trend=6.390, Ptrend=0.011) all showed an upward trend.
With the increase in RF titer, the proportion of pSS patients with serum immunological abnormalities and extra-glandular involvement increases. High RF titers have predictive value for arthritis and hematologic involvement.
