In recent years, numerous studies have indicated that hyperuricemia (HUA) is a contributing factor to certain diseases. However, whether HUA is a contributing factor to chronic pulmonary heart disease (CPHD) still requires further investigation.
To explore the association between HUA and CPHD, aiming to provide a theoretical basis for the management of serum uric acid (SUA) levels in patients with CPHD.
A total of1 171 patients with chronic obstructive pulmonary disease (COPD) admitted to the First Affiliated Hospital of Xinjiang Medical University from 2019 to 2023 were included in the study. They were divided into a CPHD group (470 cases) and a COPD group (701 cases) based on whether they had CPHD. General information, laboratory test results, and echocardiographic findings of the patients were collected. LASSO regression was used to select variables, and propensity score matching (PSM) was employed to eliminate the influence of confounding factors. Multivariate Logistic regression analysis was conducted to explore the influencing factors of CPHD in COPD patients.
The CPHD group had lower proportions of females, Han ethnicity, smokers, drinkers, idiopathic pulmonary fibrosis, chronic bronchitis, bronchial asthma, lymphocyte percentage, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, cardiac output, left ventricular ejection fraction compared to the COPD group. Higher proportions of heart function class 3-4, HUA, pulmonary embolism, congenital heart disease, red blood cell count, neutrophil percentage, SUA, blood urea nitrogen, D-dimer, N-terminal pro-B-type natriuretic peptide, right atrial diameter, right ventricular diameter, left atrial diameter, right ventricular outflow tract diameter, and pulmonary artery diameter were observed in the CPHD group, with statistically significant differences (P<0.05). After variable selection by LASSO regression and PSM, 469 cases were included in both the COPD and CPHD groups. After matching, the CPHD group had higher proportions of heart function class 3-4, HUA, right atrial diameter, right ventricular diameter, right ventricular outflow tract diameter, and pulmonary artery diameter, while lower proportions of bronchial asthma and lymphocyte percentage compared to the COPD group, with statistically significant differences (P<0.05). Multivariate Logistic regression analysis showed that increased HUA, heart function class 3-4, right atrial diameter, right ventricular diameter, and pulmonary artery diameter were risk factors for CPHD in COPD patients (P<0.05), while having bronchial asthma and increased left ventricular end-diastolic diameter were protective factors for CPHD in COPD patients (P<0.05). SUA levels were stratified by quartiles, and multivariate Logistic regression analysis showed that compared to Q1 (SUA<237.31 μmol/L), patients in Q4 (SUA>381.29 μmol/L) had a 1.421-fold inScrsed risk of having CPHD.
HUA is a contributing factor to the occurrence and development of CPHD. Actively controlling SUA levels may help prevent the occurrence and development of CPHD.
Sleep disturbances are the most common health issues in high-altitude environments. Current research on the sleep architecture of healthy populations is limited to the same altitude and involves a small number of subjects, lacking sufficient reliability.
This study aims to analyze the differences in sleep monitoring indicators among healthy adults of different ages and genders across various altitudes, exploring the impact of altitude, age, and gender interactions on these indicators.
Healthy volunteers recruited from the plains of Chengdu, Sichuan Province, and the plateau area of Kunming, Yunnan Province, from January 2020 to September 2022 were selected as study subjects. Volunteers' gender, height, body mass, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) were collected. Total sleep time (TST), sleep efficiency, and sleep parameters [percentage of stage N1 (N1%), stage N2 (N2%), stage N3 (N3%) of non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep in total sleep time] were recorded. Age was categorized into two groups (20-39 and 40-60 years) for a two-way ANOVA to explore the effects of age, gender, and altitude on sleep parameters.
A total of 91 people were recruited in low-altitude areas, including 48 men and 43 women. A total of 90 people were recruited for the high-altitude area, including 46 men and 44 women. In females, TST was higher in high-altitude areas compared to low-altitude areas (P<0.05). In both males and females, N1% was higher and N2% was lower in high-altitude areas (P<0.05). N3% was higher in females than in males in high-altitude areas (P<0.05). In males, REM% was higher in high-altitude areas (P<0.05). TST was higher in the 20-39 age group than in the 40-60 age group in high-altitude areas (P<0.05). Sleep efficiency was higher in the 40-60 age group in low-altitude areas compared to high-altitude areas, with the 20-39 age group showing higher sleep efficiency in high-altitude areas (P<0.05). In both age groups, N1% was higher in high-altitude areas (P<0.05). In low-altitude areas, N1% was higher in the 20-39 age group than in the 40-60 age group, whereas in high-altitude areas, it was lower in the 20-39 age group (P<0.05). N2% was higher in low-altitude areas in both age groups (P<0.05), with the 40-60 age group having a higher N2% in high-altitude areas (P<0.05). N3% was higher in the 20-39 age group in high-altitude areas (P<0.05). In low-altitude areas, N3% was lower in the 20-39 age group compared to the 40-60 age group, while in high-altitude areas, it was higher in the 20-39 age group (P<0.05). REM% was higher in high-altitude areas in both age groups (P<0.05) .
The factors of age and altitude have varying degrees of influence on total sleep time, sleep efficiency, N1%, N2%, and REM%. Age factors have a greater impact on sleep structure, the older the age, the shorter TST, the lower the sleep efficiency, the higher the proportion of N1. The higher the altitude, the greater the influence of age on sleep structure. In the high altitude area, the TST, sleep efficiency and N3% of the elderly population are lower, and the proportion of N1% is higher.
Knee osteoarthritis (KOA) is a common clinical condition with a decades-long course. Long-term and personalised health management in community hospitals is the best way to prevent and treat KOA, and non-surgical treatment is an effective way to slow joint degeneration and postpone joint replacement surgery.
To understand the population characteristics, clinical staging and treatment modality characteristics of the population attending community hospitals for knee osteoarthritis, in order to provide a basis for optimising the treatment protocol for knee osteoarthritis at the grassroots level.
All streets in the urban area of Beijing were randomly selected for the study using the whole cluster sampling method, and Hepingli Street in Dongcheng District, Beijing was censored for all patients who attended all community hospitals (7) belonging to the street from January to June 2022, and general information, medical history, personal history, clinical staging, K-L grading and treatment modalities were collected.
A total of 3 615 KOA patients were included in this study, including 1 327 males (36.71%) and 2 288 females (63.29%), aged (71.8±13.3) years. There were 867 cases (23.98%) in the onset period, 2009 cases (55.57%) in the remission period and 739 cases (20.45%) in the rehabilitation period. Gender and age of patients with different clinical stages were not correlated with clinical stages (P>0.05), while BMI (K=0.235) and KL grading (K=0.406) were correlated with clinical stages (P<0.001). During the attack period, 4-5 kinds of treatment methods (48.67%) were combined, and the treatment methods were mainly traditional Chinese patent medicines and simple preparations for external use 598 cases (68.97%), 475 cases (54.79%) of traditional Chinese patent medicines and simple preparations for oral use, and 396 cases (45. 67%) of health education; in the remission stage, 2-3 treatment methods were used in combination (48.58%), mainly including 1 084 cases (53.96%) of traditional Chinese patent medicines and simple preparations for external use, 1 047 cases (52.12%) of health education and 790 cases (39.32%) of cupping; in the rehabilitation stage, 2-3 kinds of treatment methods were used in combination (47.23%). The main treatment methods were health education in 488 cases (66.04%), traditional exercises in 286 cases (38.70%), and external use of traditional Chinese patent medicines and simple preparations in 279 cases (37.75%). There was a correlation between clinical stage and type of combination therapy (K=0.356, P<0.05) .
KOA patients in community hospitals are mainly in remission, and treatment is often combined with various methods of traditional Chinese patent medicine and simple preparations, and traditional exercises are also widely used.
The pan-immune inflammatory value (PIV) and systemic immune-inflammatory index (SII) are considered novel inflammatory markers for assessing the risk of atherosclerotic cardiovascular diseases. However, few studies have confirmed the impact of PIV and SII on atherosclerotic plaques.
To explore the relationship between PIV, SII, and vulnerable atherosclerotic plaques in patients with acute coronary syndrome (ACS) using optical coherence tomography (OCT) .
This retrospective study included 525 ACS patients treated at the Second Affiliated Hospital of Zhengzhou University from December 2020 to June 2023. All patients underwent coronary angiography and OCT imaging. Patients were further categorized into low PIV (<337.86, 79 cases) and high PIV (≥337.86, 139 cases) groups based on the optimal PIV cutoff value, as well as into low SII (<775.63, 74 cases) and high SII (≥775.63, 144 cases) groups based on the optimal SII cutoff value. Data were collected and analyzed. Multifactorial ordinal Logistic regression analysis was used to explore the influencing factors of TCFA. Receiver operating characteristic (ROC) curves were plotted for PIV and SII in diagnosing TCFA, and the area under the curve (AUC) was calculated. Based on the diagnostic criteria for thin-cap fibroatheroma (TCFA), patients were divided into a non-TCFA group (112 cases) and a TCFA group (106 cases) .
The TCFA group had higher proportions of hypertension, diabetes, pan-PIV, SII, C-reactive protein (CRP), smoking history, and preoperative systolic pressure compared to the non-TCFA group (P<0.05). Multifactorial Logistic regression analysis showed that PIV (OR=1.015, 95%CI=1.010-1.020, P<0.001) and SII (OR=1.005, 95%CI=1.003-1.007, P<0.001) were risk factors for TCFA. ROC curve results indicated that the AUCs for PIV and SII in diagnosing TCFA were 0.785 (95%CI=0.725-0.845, P<0.001) and 0.707 (95%CI=0.639-0.776, P<0.001), respectively. The high PIV group showed higher rates of macrophage infiltration, punctate calcification, and vulnerable plaques than the low PIV group (P<0.05). The high SII group showed higher rates of macrophage infiltration, microchannels, and vulnerable plaques than the low SII group (P<0.05). The high PIV group had thinner fibrous caps, larger maximum lipid core angle, average lipid core angle, lipid core length, and lipid index compared to the low PIV group (P<0.05), and the high SII group had thinner fibrous caps, larger maximum lipid core angle, average lipid core angle, lipid core length, and lipid index compared to the low SII group (P<0.05) .
High levels of PIV and SII may be associated with the incidence of vulnerable plaques in patients with ACS. PIV and SII levels have potential value in assessing the characteristics and vulnerability of coronary atherosclerotic plaques in ACS patients.
Geriatric depression is a severe mental illness distinct from depression in other age groups, characterized by significant heterogeneity. Subclinical hypothyroidism (SCH) is a state of hypothyroidism with subtle clinical signs. The impact of SCH on elderly depression is easily overlooked, and the association between SCH and elderly depression is not well understood.
To explore the clinical characteristics of hospitalized elderly depression patients with SCH.
Depressed patients hospitalized in the Fourth People's Hospital of Hefei from April 2019 to March 2023 were included in the study and divided into the subclinical hypothyroidism depression (SCHD) group (n=108) and control depression (CD) group (n=110). General data of the subjects was collected, fasting venous blood samples were collected for testing biochemical markers, and the Hamilton Depression Rating Scale (HAMD-24) was used to assess depressive symptoms.
The SCHD group showed a higher number of antipsychotic drug use, comorbid somatic diseases, days of hospitalization, and duration of the disease than the CD group (P<0.05). There was a statistically significant difference between the two groups in terms of the types of antidepressants used and the number of hospitalizations (P<0.05). The sleep disorder scores of patients in the SCHD group were higher than those in the CD group (P<0.05), and there was a significant difference in body mass and diurnal variation scores between the two groups (P<0.05). The SCHD group had higher levels of thyrotropin and lower levels of serum free triiodothyronine and free thyroxine than the CD group (P<0.05) .
Elderly depression patients with SCH exhibit unique clinical characteristics, including longer hospitalization, more frequent episodes, greater difficulty to cure, and poorer prognosis, making interventions for SCH essential.
Hypertrophic cardiomyopathy (HCM) is a common primary cardiomyopathy that is closely associated with sudden death in adolescents and athletes. The disease progression of HCM is prone to structural and functional alterations in the left atrium, leading to increased incidence of acute cerebrovascular accidents, embolism and atrial fibrillation, and a severe influence on the quality of life.
To evaluate the structural and functional changes in the left atrium of family members of familial hypertrophic cardiomyopathy (FHCM) with a positive genotype but negative phenotype by real-time three-dimensional echocardiography (RT-3DE), providing valuable references for early identification, assessment and management of family members of FHCM.
A total of 141 HCM patients and family members admitted in the General Hospital of Ningxia Medical University from October 2021 to August 2022 were recruited. Blood samples were collected for genetic testing. Subjects were divided into G+P+ group with positive genotype and positive phenotype of ventricular wall thickening (n=54), G+P- group with positive genotype and negative phenotype (n=35) and G-P- group with negative genotype and negative phenotype (n=31). Baseline characteristics of subjects were collected. Two-dimensional transthoracic echocardiography (2DE-TTE) scans of the left atrium and ventricle and RT-3DE scans of the left atrium, and their relevant parameters were collected as well. Pearson correlation analysis was performed to identify the correlation between RT-3DE parameters of the left atrium and 2DE-TTE parameters of the left ventricle in subjects of G+P- group.
Genetic testing identified 24 subjects carrying the titin (TTN) gene, 2 carrying both the TTN and tropomyosin 1 (TPM1) gene, 6 carrying the myosin binding protein C3 (MYBPC3) gene, 2 carrying the troponin I3 (TNNI3) gene, 9 carrying the myosin heavy chain 7 (MYH7) gene, 8 carrying both the MYBPC3 and TNNI3 genes, and 3 carrying both the TTN and MYH7 genes in G+P+ group. In G+P- group, 11 subjects carrying the TTN gene, 8 carrying the MYBPC3 gene, 3 carrying the TNNI3 gene, 8 carrying the MYH7 gene and 5 carrying both the MYBPC3 and TNNI3 genes. 2DE-TTE parameters were analyzed. Subjects in G+P+ group showed significantly higher left atrial diameter index (LADI), left atrial volume index (LAVI), end-diastolic interventricular septal thickness (IVST), end-diastolic left ventricular posterior wall thickness (LVPWT), left ventricular mass (LVM), left ventricular mass index (LVMI) and ratio of early diastolic flow velocity peak to annular velocities (E/e') compared with those of G-P- group and G+P- group, but significantly lower end-diastolic volume index (EDVI) and end-systolic volume index (ESVI) (P<0.05). The peak velocity blood flow from left ventricular relaxation in early diastole (the E wave) and late diastole caused by atrial contraction (the A wave) were significantly higher in subjects of G+P+ group than those of G-P- group (P<0.05). The A wave and E/e' were significantly higher in subjects of G+P- group than those of G-P- group (P<0.05). RT-3DE parameters of the left atrium were analyzed. Subjects in G+P+ group had significantly higher maximum (LAVImax) and minimum left atrial volume indices (LAVImin), and pre-contraction volume index (LAVIpre), but significantly lower left atrial total (LATEF), passive (LAPEF) and active ejection fractions (LAAEF) compared to those of G-P- group and G+P- group (P<0.05). LATEF and LAAEF were significantly lower in G+P- group than in G-P- group (P<0.05). Pearson correlation analysis showed positive correlations of LAVImax and LAVIpre with IVST (r=0.385 and 0.399, respectively; both P<0.05), positive correlations of LAVImax and LAVImin with LVM (r=0.371 and 0.432, respectively; both P<0.05), and negative correlations of LATEF and LAAEF with LVM (r=-0.375 and -0.401, respectively; both P<0.05) in G+P- group.
RT-3DE can reflect changes in left atrial function in family members of FHCM with positive genotype and negative phenotype by measuring atrial volumes, and they may already suffer from the left atrial dysfunction even when the atrial size is normal. Changes in their left atrial volume are positively correlated with changes in left ventricular wall thickness and mass, while functional changes are negatively correlated with the LVM.
Dapagliflozin is an effective drug for the treatment of type 2 diabetes mellitus (T2DM), which can also reduce the risk of nephropathy progression, decrease urinary protein and protect the heart. However, whether dapagliflozin can reduce the incidence of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in T2DM patients remain unclear.
To investigate the impact of dapagliflozin on the incidence of CIN in patients with T2DM underwent PCI.
According to the principle of 1∶1 propensity matching based on the use of dapagliflozin, a total of 484 T2DM patients who underwent PCI in the Department of Cardiology, Tianjin Chest Hospital from 2021 to 2023 were retrospectively consecutively enrolled in the study, of which 242 cases were in the dapagliflozin group and 242 cases were in the control group. The pre-PCI clinical data of the two groups were collected and compared, and the renal functions of the two groups were recorded before PCI, 48 hours after PCI and 1 week after PCI, including blood urea nitrogen (BUN), serum creatinine (Scr), creatinine clearance rate (Ccr), cystatin C (Cys-C), β2- microglobulin (β2-MG), and neutrophil gelatinase associated apolipoprotein (NGAL). The primary study endpoint was the incidence of CIN, and the secondary study endpoint was the change in renal function during the perioperative period of PCI. Multivariate Logistic regression was used to analyze the effect of dapagliflozin on the incidence of CIN after PCI in patients with T2DM.
The incidence of CIN in patients in the dapagliflozin group was 6.2% lower than that in patients in the control group (12.0%). The difference was statistically significant (χ2=4.900, P=0.039). The CIN risk score and B-type natriuretic peptide of patients in the dapagliflozin group were higher than those in the control group (P<0.05). There was no statistically significant difference in BUN, Scr, Ccr, Cys-C, β2-MG, and NGAL levels between 2 groups before and 1 week after PCI (P>0.05). At 48 hours after PCI, the levels of Cys-C, β2-MG, and NGAL in the dapagliflozin group were lower than those in the control group (P<0.05). Multivariate Logistic regression analysis showed that high CIN risk score (OR=1.213, 95%CI=1.085-1.358, P=0.001) and B-type natriuretic peptide levels (OR=3.940, 95%CI=1.479-10.494, P=0.006) were independent risk factors for CIN after PCI in patients with T2DM, and the use of dapagliflozin (OR=0.338, 95%CI=0.159-0.717, P=0.005) was an independent protective factor for the development of CIN after PCI in patients with T2DM.
The use of dapagliflozin is an independent protective factor against the development of CIN after PCI in patients with T2DM, and dapagliflozin does not increase the risk of developing acute kidney injury after PCI in patients with T2DM and may reduce the incidence of CIN.
The occurrence and development of acute coronary syndrome (ACS) are closely associated with inflammatory responses, but the relationship between dietary inflammatory potential and severity of coronary artery disease of ACS patients is currently unknown.
To investigate the relationship between dietary inflammatory potential evaluated by dietary inflammation index (DII) and severity of coronary artery disease in ACS patients.
Convenient sampling method was used to select 309 patients diagnosed as ACS for the first time by coronary arteriography in the Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University from April 2022 to March 2023, and they were divided into DII-1 group (from -8.35 to -4.56), DII-2 group (from -4.55 to -0.77), DII-3 group (from -0.76 to 3.02) and DII-4 group (from 3.03 to 6.81) according to the quartile of DII, into Q1 group (4-32 scores), Q2 group (34-52 scores), Q3 group (54-84 scores) and Q4 group (86-192 scores) according to the quartile of Gensini score. Demographic and clinical features, overall DII, and DII of nutrient were compared in ACS patients with different severity of coronary artery stenosis, multivariate Logistic regression analysis was used to analyze the relation of DII with the severity of coronary artery stenosis.
There was significant difference in educational level, LDL-C, LP-a, overall DII, DII of total fat, saturated fatty acids, vitamin E, carotene in ACS patients with different severity of coronary artery stenosis, respectively (P≤0.05). After the correction of confounders of educational level, LDL-C and LP-a, the multivariate Logistic regression analysis showed that, DII-4 group was the influencing factor of Q2 group (OR=15.389, 95%CI=1.595-148.432), Q3 group (OR=15.102, 95%CI=1.620-140.788) and Q4 group (OR=17.319, 95%CI=1.901-157.807), respectively (P<0.05) ; DII of total fat (OR=3.831, 95%CI=1.195-9.094), saturated fatty acids (OR=8.562, 95%CI=1.519-48.258) and vitamin E (OR=0.640, 95%CI=0.460-0.890) was the influencing factor of Q4 group, respectively (P<0.05) .
Dietary inflammatory potential as well as inflammatory potential of nutrient total fat, saturated fatty acids and vitamin E are influencing factors of severity of coronary artery disease in ACS patients, thus clinicians should further strengthen the reasonable anti-inflammatory dietary guidance of ACS patients.
Low back pain (LBP) in middle-aged and elderly adults has become a significant public health issue worldwide. Physical activity and sleep are two core components of the 24-hour lifecycle, and maintaining adequate physical activity and good sleep are crucial for health, both of which are associated with LBP.
To investigate the prevalence of LBP in middle-aged and elderly adults in China, analyze the independent and combined effects of physical activity and sleep on its occurrence, and provide scientific evidence for behavioral health.
Based on the 2018 China Health and Retirement Longitudinal Study, participants without demographic, physical activity, sleep, and LBP data were excluded. A total of 13 496 eligible individuals aged 45 to 69 were included, and their demographic and behavioral information was collected. Binary logistic regression and multiple linear regression were used to examine the relationship between physical activity, sleep duration, and LBP, and a mediation model was constructed to analyze the mediating effect of sleep duration on the association between physical activity and LBP.
The prevalence of LBP among the 13 496 participants was 39.0% (n=5 269). Inadequate sleep (<7 hours) was reported by 57.1% (n=7 704) of middle-aged and elderly adults in China, with 11.6% (n=1 561) engaging in mild physical activity and 88.4% (n=11 935) engaging in moderate to high-intensity physical activity. The multicollinearity diagnosis results for confounding variables (gender, age, alcohol consumption, and smoking) showed that all variance inflation factors were less than 5, indicating no collinearity. Regression analysis revealed a positive correlation between physical activity and LBP (β=0.120, P<0.05), a negative correlation between sleep duration and LBP (β=-0.220, P<0.01), and a negative correlation between physical activity and sleep duration (β=-0.081, P<0.05). The mediation analysis of categorical variables indicated Z=2.223>1.96, and the path from physical activity to LBP was not significant (β=0.105, P>0.05), suggesting a complete mediating effect of sleep duration on the association between physical activity and LBP.
Over one-third of middle-aged and elderly adults in China suffer from LBP. Higher levels of physical activity or shorter sleep duration are associated with increased risk of LBP. Sleep duration plays a complete mediating role in the association between physical activity and LBP, where the increased risk of LBP associated with high-intensity physical activity is completely transmitted through reduced sleep duration. Adequate sleep duration plays an important role in reducing the risk of LBP associated with high-intensity physical activity. This study suggests that older adults should adjust their exercise intensity according to their own conditions and maintain adequate sleep duration to reduce the risk of LBP.
The prevalence of pelvic floor dysfunction in postmenopausal women is progressively increasing, leading to a significant impact on both physical and mental well-being due to stress urinary incontinence (SUI) .
To investigate the impact of menopausal hormone therapy (MHT) in conjunction with Kegel exercises on pelvic floor structure and clinical symptoms in individuals experiencing mild to moderate SUI.
A total of 75 patients with menopausal syndrome accompanied by mild to moderate SUI who visited the Menopause Clinic at Beijing Shijitan Hospital, Capital Medical University in 2022 were selected. They were allocated into the MHT group and the control group in a 2∶1 ratio using a random number table method, and the MHT group was further randomly divided into subgroups receiving Tibolone and estrogen combined with progestogen therapy (EPT) in a 1∶1 ratio. Both the control group and the MHT group underwent pelvic floor muscle training (PFMT), commonly referred to as Kegel exercises, for 15-30 minutes per session, 2-3 times daily, and 2-3 d per weekly, over a continuous period of 12 months. The control group received Kuntai capsules orally in combination with PFMT, with 4 capsules taken per dose, 3 times a day, for 12 months. The MHT group received menopausal hormone therapy in conjunction with PFMT. The EPT subgroups include continuous combined estrogen-progestin therapy (1 mg estradiol valerate + 10 mg dydrogesterone, once daily), continuous sequential estrogen-progestin therapy (femoston 12 courses), and the Tibolone subgroup takes tibolone orally, all of which were administered continuously for 12 months. The study examined serum estradiol (E2) and follicle-stimulating hormone (FSH) levels within and between groups and subgroups before and after treatment. In addition, measurements were obtained for urethral rotation angle (URA), bladder detrusor thickness (BDT), posterior vesicourethral angle (PVUA), levator hiatus area (LHA), urinary incontinence quantification, ICI-Q-SF score, clinical efficacy, as well as changes in the modified Kupperman Menopausal Index (KMI) score, and the modified oxford staging (MOS) .
Upon completion of the study, 7 participants from the MHT group were lost to follow-up (5 in the Tibolone subgroup and 2 in the EPT subgroup), with 3 participants from the control group also lost to follow-up. In the end, a total of 65 participants were included. After 1 year of treatment, there were no statistically significant differences in FSH, E2, and MOS between the MHT group and the control group (P>0.05). After 1 year of treatment, there were no statistically significant differences in PUVA, BDT, and URA between the MHT group and the control group (P>0.05). However, the LHA of the MHT group was significantly lower than that of the control group (P=0.028). After 1 year of treatment, there were no statistically significant differences in PUVA, BDT, URA, and LHA between the EPT and Tibolone subgroups (P>0.05). Statistically significant differences were found in the comparison of clinical efficacy between the control group and the MHT group (P=0.005). Conversely, no statistically significant differences were observed in the comparison of clinical efficacy between the EPT and Tibolone subgroups (P=0.727). After 1 year of treatment, the MHT group showed lower urinary incontinence quantity, ICI-Q-SF score, and KMI score compared to the control group (P<0.05). Before and after the treatment, there were no statistically significant differences in urinary incontinence quantity, ICI-Q-SF score, and KMI score between the EPT and Tibolone subgroups (P>0.05) .
The combination of MHT with PFMT yields a positive effect on the pelvic floor structure and markedly alleviates symptoms of urinary incontinence. Nevertheless, there is no significant differences between EPT and Tibolone in the improvement of pelvic floor structure and alleviation of clinical symptoms in patients.
Chromosomal abnormalities are one of the common causes of birth defects, and karyotype analysis is still an important method for prenatal diagnosis of chromosomal abnormalities as well as an effective way to prevent and control birth defects. However, karyotype analysis, especially chromosomal image segmentation and classification mainly depends on manual work at present, which is laborious and time-consuming. As an emerging approach to karyotype analysis, it is of great significance to investigate the application value of artificial intelligence (AI) in prenatal chromosomal karyotype diagnosis.
To investigate the application effect and clinical value of AI in prenatal karyotype diagnosis.
A total of 1 000 pregnant women who received interventional prenatal diagnosis and karyotype analysis of amniotic fluid cells in the department of medical genetics and prenatal diagnosis of Wuxi Maternity and Child Health Care Hospital between 2020 and 2022 were selected as the study subjects. The karyotype analysis of all cases was performed using two-line mode, the results of the AI reading were reviewed by one geneticist in the first line, and another geneticist analyzed the karyotypes by Ikaros karyotype analysis workstation in the second line, the diagnostic results and time were recorded respectively. The final diagnosis of the samples were based on the manual review of the first line and the manual reading of the second line.
Among the 1 000 amniotic fluid samples, 735 cases were diagnosed as normal karyotype, 233 cases as aneuploidy, 0 case as structural abnormality and 32 cases as mosaicism by AI. The numbers of normal karyotype, aneuploidy, structural abnormality and mosaicism assessed by AI-assisted geneticist were 689, 233, 45 and 33, which were completely consistent with those evaluated by geneticist using Ikaros system. Compared with AI-assisted geneticist, AI-based diagnosis had strong consistency (Kappa=0.895, 95%CI=0.866-0.924, P<0.01). The diagnostic accuracy, sensitivity and positive predictive value of AI-based diagnosis was 95.4%, 95.4% and 100.0%, respectively, among which the normal karyotype, aneuploidy, structural abnormality and mosaicism were detected with a sensitivity of 100.0%, 100.0%, 0 and 97.0%, and the positive predictive value of 100.0%, 100.0%, 0 and 100.0%. The average diagnostic time of AI was shorter than that of AI-assisted geneticist and Ikaros-assisted geneticist (P<0.001), and AI-assisted geneticist took less time on average to diagnose than the Ikaros-assisted geneticist (P<0.001) .
AI-assisted karyotype analysis of amniotic fluid cells has a high degree of automation, but its ability to recognize chromosomal structural abnormalities needs to be improved. It is suggested that AI be combined with the geneticist for karyotype analysis in clinical application to ensure the quality of prenatal diagnosis and improve efficiency.
Acute myocardial infarction (AMI) is one of the common cardiovascular diseases, and despite the widespread use of biomarkers for myocardial necrosis, morbidity and mortality of AMI remain high.
To investigate the expression levels and clinical significance of miR-126, mitochondrial components and adhesion molecules in endothelial microparticles (EMPs) .
A total of 50 patients with AMI (AMI group), 50 patients with stable coronary artery disease (SCAD) (SCAD group) and 50 healthy subjects (control group) were enrolled in the People's Hospital of Xinjiang Uygur Autonomous Region from September 2021 to September 2022. AMI patients and SCAD patients were hospitalized in our hospital and received percutaneous coronary intervention (PCI), and all healthy subjects were evaluated by the physical examination center of our hospital. Peripheral blood samples and general data of three groups were collected. The morphology of the microparticles (MPs) was observed by transmission electron microscopy (TEM), the level of EMPs was identified by flow cytometry, and the expression of miR-126 in EMPs was detected by fluorescence quantitative PCR. ELISA was used to detect the levels of mitochondrial reactive oxygen species (ROS) and intracellular adhesion molecules [vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), E-selectin, and P-selectin] in EMPs.
As observed by TEM, the membrane structure of the isolated MPs was intact and its diameter ranged from 100 to 400 nm. Compared with the control group, the expression of miR-126 in plasma EMPs in the AMI group was significantly decreased (P<0.001), the expression of ROS was significantly increased (P<0.001), the expression of VCAM-1 was increased (P=0.019), and the expression of ICAM-1 (P<0.001), E-selectin (P=0.019) and P-selectin (P<0.001) were increased. Multivariate Logistic regression analysis showed that the decreased expression of miR-126 (OR=0.026, 95%CI=0.003-0.210, P=0.001) was a protective factor for AMI, increased expression of ROS (OR=1.009, 95%CI=1.005-1.013, P<0.001) and P-selectin (OR=1.063, 95%CI=1.022-1.105, P=0.002) were risk factors for AMI. The receiver operator characteristic curve (ROC) showed that the area under the curve of miR-126 for the diagnosis of AMI was 0.816, the area under the curve of ROS for the diagnosis of AMI was 0.892, the area under the curve of P-selectin for the diagnosis of AMI was 0.728, and the area under the curve of miR-126, ROS and P-selectin combined diagnosis was 0.950.
In EMPs, miR-126, ROS, P-selectin and their combined indicators all have diagnostic value for AMI, and the combined indicators of the three have the highest diagnostic value, indicating that they may be potential diagnostic indicators for AMI patients.
Cervical cancer (CC) is one of the common malignant tumors that poses a threat to female health. The screening and prevention strategies of CC vary in different regions. The economic and cultural levels in the Xinjiang region differ significantly from those in other areas. It is of practical significance to identify CC screening efficacy in this region, thus favoring the modification of CC screening program.
To compare and analyze the CC screening results in Shihezi city, Xinjiang Uyghur Autonomous Region from 2019 to 2021, and to understand the distribution of high-risk human papillomavirus (hrHPV) infection and the changes in cervical lesion detection in this region.
CC screening in Shihezi city was conducted in a three-year interval. We retrospectively collected the screening data of 68 300 women from 2019 to 2021, who underwent hrHPV-based screening in the First Affiliated Hospital of Shihezi University, Shihezi City People's Hospital, and Shihezi Maternal and Child Health Hospital. The distribution of hrHPV infection and the changes in cervical lesion detection from 2019 to 2021 were compared and analyzed.
A total of 18 378, 28 616 and 21 306 individuals were screened for CC in 2019, 2020 and 2021, respectively. The hrHPV-positive rate in 2021 and 2022 was significantly lower than that in 2019 [9.90% (2 109/21 306) vs 9.13% (2 612/28 616) vs 15.32% (2 816/18 378), P<0.017]. The hrHPV 52 type and hrHPV 16 type had the highest positive rates for three consecutive years in Shihezi city. The rate of thin-layer cytology (TCT) examination for non-HPV 16/18 types in 2021 and 2020 was significantly higher than that in 2019 [88.61% (1 502/1 695) vs 74.70% (1 559/2 087) vs 48.90% (1 090/2 229), P<0.017]. Among women who underwent vaginal colposcopy, the positive pathology rate of LSIL (low-grade squamous intraepithelial lesion) and above was the highest in 2021 [52.80% (217/411) ], followed by that in 2020 [41.42% (239/577) ] and the lowest in 2019 [28.53% (107/375) ] (P<0.017) .
The hrHPV-positive rate in Shihezi city, Xinjiang Uyghur Autonomous Region showed certain decline from 2019 to 2021, but hrHPV 52 type and hrHPV 16 type remained the main infection types. Since the initiation of CC screening in 2019, the hrHPV-positive rate has decreased from 15.32% to 9.90%, the TCT examination rate has increased from 48.90% to 88.61%, and the positive rate of cervical lesion detection of LSIL and above has increased from 28.53% to 52.80% from 2019 to 2021. There have been significant improvements in the completion rate of CC screening and the detection rate of cervical lesions.
Cerebral infarction is a disorder of blood supply to the local brain tissue area caused by various causes. Tongnao Decoction is approved and used in Jiangsu Province Hospital of Chinese Medicine for the treatment of cerebral infarction. However, the specific mechanisms underlying its action remain unclear.
To explain the mechanism of Tongnao Decoction in the treatment of cerebral infarction through network pharmacology and clinical trails.
From January 2019 to June 2020, a total of 199 patients with cerebral infarction admitted to Jiangsu Province Hospital of Chinese Medicine were included in the clinical study. and divided into the control group (97 cases) and experimental group (102 cases) according to the method of random number table. Both groups received standardized treatment for stable cerebral infarction, and the experimental group was treated with Tongnao Decoction. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the degree of functional impairment caused by stroke, and the modified Rankin Scale (mRS) was used to assess the recovery of neurological function for both groups before treatment and at 2 weeks of treatment. The chemical compounds of Tongnao Decoction were screened from TCMSP and literature, and those with bioavailability (OB) ≥30% and drug-like properties (DL) ≥0.18 requirements were selected to find the active ingredient of the prescription. OMIM and GeneCards databases were used to analyze the molecular targets of Tongnao Decoction for the treatment of cerebral infarction. After screening the common targets, Cytoscape software, String database were used to plot the network of compounds and target proteins, construct protein-protein interaction (PPI) network, gene ontology (GO) function, and Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway enrichment analysis, respectively. Molecular docking experiments were finally performed to identify the main active ingredients of Tongnao Decoction for the treatment of cerebral infarction.
After treatment, the scores of NIHSS and mRS in the experimental group were lower than those in the control group (P<0.05). Finally, 60 active ingredients of Tongnao Decoction were obtained, including 147 potential targets, 5 167 disease-related targets, and 121 intersection targets of drugs and diseases. The enrichment analysis of KEGG signaling pathway obtained prostate cancer, neuroactive ligand-receptor interaction, IL-17 signaling pathway, prolactin signaling pathway, PI3K-Akt signaling pathway, calcium signaling pathway, etc. Molecular docking showed that β-sitosterol, kastricol and carotene, the main active ingredients of Tongnao Decoction in the treatment of stroke, had good binding properties to the core protein androgen receptor (AR) .
Tongnao Decoction may play a role in treating cerebral infarction by activating AR. IL-17 signaling pathway, PI3K-Akt signaling pathway and prolactin signaling pathway are potential mechanisms as well.
Carotid atherosclerosis (CAS) is a significant indicator of early systemic atherosclerosis. Previous studies have demonstrated a close relationship between elevated remnant cholesterol (RC) levels and the pathogenesis of CAS. However, limited information is available regarding the association between RC and the development of CAS in menopausal women.
To investigate the correlation between RC and the pathogenesis of CAS in menopausal women.
A total of 307 menopausal women from Fengxiang Town, Anding District, Dingxi City were selected as the research subjects. These women had participated in the national high-risk stroke screening project and completed carotid artery ultrasound examination between January 2020 and October 2023. General information on the ordinary people was collected and participants' characteristics of the carotid artery intima were analyzed by means of using color doppler ultrasound. Based on the cervical ultrasound results, the subjects were divided into CAS group and non-CAS group. Spearman rank correlation analysis was used to explore the correlation between RC and other risk factors for CAS. Furthermore, multifactor Logistic regression was employed to analyze and explore the correlation between RC and CAS in menopausal women.
The findings revealed that participants in the CAS group (n=130) has higher levels than those in the non-CAS group (n=177) in terms of menopausal female age, history of stroke and transient ischemic attack (TIA), fasting plasma glucose (FPG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), RC and pulse pressure (P<0.05). Spearman rank correlation analysis indicated a positive correlation between RC and FPG as well as TC (rs=0.113, 0.280, P<0.05), while a negative correlation was observed with LDL-C (rs=-0.112, P<0.05). Furthermore, multivariate logistic regression analysis identified high RC levels (OR=1.539, 95%CI=1.185-1.999, P=0.001), age (OR=1.059, 95%CI=1.003-1.117, P=0.038), and history of stroke and TIA (OR=1.910, 95%CI=1.047-3.485, P=0.035) as risk factors for the onset of CAS in menopausal women. The menopausal women were further divided into high RC (RC≥0.70 mmol/L, n=155) and low RC (RC<0.70 mmol/L, n=152) groups based on the median RC. The high RC group had a higher proportion of women with dyslipidemia, CAS, waist circumference, BMI, and TG compared to the low RC group (P<0.05). Additionally, the high RC group had lower levels of high density lipoprotein cholesterol (HDL-C) compared to the low RC group (P<0.05) .
High RC levels are associated with CAS in menopausal women and may be an independent risk factor for CAS in menopausal women.
Continuous glucose monitoring (CGM) is rarely applied to outpatient treatments. The impact of CGM-based diabetes education to change unhealthy living and eating habits on the blood glucose profile is still unclear.
Based on the retrospective results of CGM, outpatient education such as diet and exercise was applied to outpatients with type 2 diabetes mellitus (T2DM) who were managed by oral hypoglycemic drugs. This study aims to evaluate the effects on blood glucose profiles.
A total of 88 outpatient T2DM patients medicated with oral hypoglycemic drugs in the Department of Endocrinology, Nanjing First Hospital in 2021 were included and managed by CGM, involving 60 male and 28 female patients. The enrolled patients maintained the original hypoglycemic treatment regimen and lifestyle habits on the 1st to 3rd day. On the 4th day, we downloaded and analyzed CGM data and provided outpatient education based on individualized eating habit and exercise. On the 6th day, the CGM sensor and recorder were removed. CGM data on the 2nd day versus 5th day were compared for dynamic blood glucose profiles, including the 24 h mean blood glucose (MBG), mean amplitude of glycemic excursion (MAGE) and time in target glucose range (TIR) .
Based on the CGM results, MBG in outpatients with T2DM on the 5th day after outpatient education was significantly reduced from (8.34±1.97) mmol/L to (7.85±1.65) mmol/L (P<0.05). TIR was significantly elevated from (78.21±24.64) % to (84.28±21.87) % (P<0.05). Moreover, MAGE was significantly reduced from (4.53±2.25) mmol/L to (3.80±1.80) mmol/L (P<0.05). Stratified by the course of T2DM, MBG after outpatient education significantly decreased in both patients with T2DM course <10 years (n=62) and those with T2DM course ≥10 years (n=26) than the baseline before education (P<0.05). After outpatient education, the standard deviation (SD), MAGE and target glucose range (TAR) were significantly reduced, while TIR was significantly elevated in patients with T2DM course <10 years (P<0.05). Stratified by age, MBG and TAR after outpatient education were significantly reduced in both patients aged <65 years old (n=55) and those aged ≥65 years old (n=33) than the baseline before education, while TIR was significantly elevated (P<0.05). SD and MAGE were significantly reduced after outpatient education in patients aged <65 years old (P<0.05) .
Based on CGM results, outpatient education such as diet and exercise could effectively improve MBG, TIR levels, and blood glucose variability in outpatient T2DM patients using oral hypoglycemic drugs. Patients with less than 10 years of T2DM course and younger than 65 years of age gain more clinical benefits.
Diuretic resistance is associated with increased mortality in patients with heart failure (HF). Qi Li Qiang Xin Jiao Nang, a Traditional Chinese Medicine, are used in the treatment of HF. However, clinical evidence of their effectiveness in improving diuretic resistance is lacking.
To investigate whether Qi Li Qiang Xin Jiao Nang can reduce the risk of diuretic resistance and improve prognosis in patients with acute decompensated chronic heart failure (ADCHF) .
This study included 374 HF patients treated in the CICU ward of Tianjin University Chest Hospital from January 2018 to June 2022. Patients were divided into diuretic resistance (118 patients) and non-diuretic resistance groups (256 patients) based on the occurrence of diuretic resistance. Patient data and laboratory results were collected. A 12-month follow-up was conducted to observe rehospitalization due to cardiovascular events or all-cause mortality. Kaplan-Meyer survival curves were plotted for each group, and the Log-rank test was used for comparison. Multivariate Logistic regression analysis was performed to explore factors influencing diuretic resistance. Multivariable Cox regression analysis was used to explore factors affecting the occurrence of endpoint events in ADCHF patients.
The diuretic resistance group showed higher age, body mass, NT-proBNP, blood urea nitrogen, creatinine, uric acid, and international normalized ratio (INR) but lower 24-hour fluid intake, estimated glomerular filtration rate (eGFR), lymphocyte count, and usage of Qi Li Qiang Xin Jiao Nang. Multivariate Logistic regression analysis indicated that the use of Qi Li Qiang Xin Jiao Nang (OR=0.363, 95%CI=0.186-0.708, P=0.003) and increased 24-hour fluid intake (OR=0.286, 95%CI=0.177-0.461, P<0.001) were protective factors against diuretic resistance in ADCHF patients. Increased body mass (OR=1.064, 95%CI=1.040-1.088, P<0.001) and elevated uric acid (OR=1.002, 95%CI=1.000-1.004, P=0.027) were risk factors. Log-rank test results showed that the average survival time without endpoint events was shorter in the diuretic resistance group (χ2=11.866, P=0.001) and in patients not using Qi Li Qiang Xin Jiao Nang (χ2=6.502, P=0.011). Multivariable Cox regression analysis revealed that the use of Qi Li Qiang Xin Jiao Nang (HR=0.536, 95%CI=0.308-0.933, P=0.027) and angiotensin receptor enkephalase inhibitors/angiotensin converting enzyme inhibitors/angiotensin receptor blockers (HR=0.435, 95%CI=0.229-0.826, P=0.011) were protective factors against endpoint events, while increased total bilirubin (HR=1.019, 95%CI=1.008-1.030, P=0.001) and total bile acids (HR=1.029, 95%CI=1.002-1.058, P=0.036) were risk factors.
The use of Qi Li Qiang Xin Jiao Nang in addition to standard HF treatment can reduce the risk of diuretic resistance in patients with ADCHF and decrease the risk of rehospitalization due to cardiovascular events or all-cause mortality within one year.
Maintenance hemodialysis (MHD) and peritoneal dialysis (PD) are main treatment methods for uremic patients. It remains an important content of clinical research on better developing treatment protocols to address overhydration (OH) in dialysis patients, and the effect of applying body composition monitor (BCM) on the prognosis of dialysis patients treated with different dialysis models is still controversial.
To explore the relationship between OH parameters of BCM and prognosis in patients treated with MHD and PD.
From October 2017 to March 2022, 334 patients on maintenance dialysis in Beijing Jishuitan Hospital affiliated to Capital Medical Medical University, Beijing Boai Hospital, Aviation General Hospital, Beijing Changping District Hospital and Beijing Changping Hospital of Integrated Traditional Chinese and Western Medicine were included as the study objects and divided into MHD group (n=188) and PD group (n=146) according to their renal replacement therapy mode. The general data of and BCM related parameters were collected through the electronic medical record system. Patients included in the study were followed up, dialysis treatment parameters, body weight, systolic blood pressure and diastolic blood pressure were recorded, and the average of multiple follow-up results were calculated. Endpoint events were recorded during follow-up period, with the primary endpoint event as all-cause death (ACM), secondary endpoint events as cardiovascular events (CVE), combined adverse events (CAE), surgery or fracture (SOF). Spearman rank correlation analysis was used to explore the correlation between endpoint events and BCM parameters, and stepwise multiple Logistic regression analysis was used to explore the influencing factors of secondary endpoint events in patients. The ACM survival curve was plotted by Kaplan-Meier method, and the difference of survival curve between the two groups was compared by Log-rank test. Multivariate Cox regression analysis was used to explore the influencing factors of ACM.
A total of 311 patients completed follow-up, with a median follow-up time of 29.9 (18.0, 36.0) months, including 176 patients in MHD group and 135 patients in PD group. Dialysis age, body weight, target body weight, adipose tissue content and adipose tissue index in MHD group were higher than those in PD group, and OH was lower than that in PD group (P<0.05). The mean values of body weight, target body weight, systolic blood pressure, adipose tissue content and adipose tissue index in MHD group were higher than those in PD group, while the mean value of OH, standard deviation of OH (OHsd), maximum change value of OH (OHd) and maximum change value of OH in MHD group were lower than those in the PD group (P<0.05). The incidence of CVE, CAE and SOF was 16.5% (29/176), 39.2% (69/176) and 4.0% (7/176) in the MHD group, and 45.9% (62/135), 83.0% (112/135) and 8.2% (11/135) in PD group, respectively. The incidence of CVE and CAE in MHD group was significantly lower than PD group (χ2=32.009, P<0.001; χ2=60.132, P<0.001). Multivariate Logistic regression analysis showed that the ratio of mean value of extracellular water to mean value of intracellular water in MHD group (OR=57.974, 95%CI=1.393-2 413.247) was the influencing factor of CVE, OHd (OR=1.255, 95%CI=1.076-1.462) was the influencing factor of CAE (P<0.05). The age of patients in PD group (OR=1.029, 95%CI=1.008-1.052) was the influencing factor of CVE (P<0.05), and OHd (OR=1.962, 95%CI=1.355-2.842) was the influencing factor of CAE (P<0.05). Kaplan-Meier survival curve of ACM between the two groups showed that the incidence of ACM in PD group was higher than that in MHD group (χ2=7.145, P=0.008). Multivariate Cox regression analysis showed that age (HR=1.070, 95%CI=1.019-1.123) was the influencing factor of ACM in MHD group (P<0.05), DBPm (HR=0.942, 95%CI=0.854-0.992) and OHsd (HR=3.612, 95%CI=2.072-6.296) were the influencing factors of ACM in PD group (P<0.05) .
The incidence of primary endpoint event and secondary endpoint events in PD group was higher than that in MHD patients, and OH was more obvious in PD patients than MHD patients. The fluctuation of OH value obtained by BCM could predict ACM in PD patients.
Primary hyperaldosteronism (PA) has been recommended by numerous hypertension guidelines to expand screening, early diagnosis and treatment, as a secondary hypertension disease with the highest incidence, great cardiovascular and cerebrovascular dangers but high cure rate after surgery. However, the diagnosis, classification and clinical outcomes evaluation of these patients are varied and controversial. Captopril challenge test (CCT) is expected to provide whole-course management for PA patients because it is convenient, safe and can be used directly in the community or outpatient clinic.
To explore the diagnostic efficacy, classification and biochemical remission assessment of CCT in patients with PA.
The study population consisted of 824 patients who completed the cause screening for hypertension and were enrolled in the Department of Endocrinology and Metabolism, West China Hospital, Sichuan University from October 1 th 2020 to December 30 th 2022. After screening, 247 patients with PA and 123 patients with essential hypertension (EH) were enrolled, and PA was classified into aldosterone-producing adenoma (APA, 81 patients), idiopathic hyperaldosteronism (IHA, 55 patients), and uncategorized PA (u-PA, 111 patients). The differences among the four groups were compared and the receiver operating characteristic (ROC) curve analysis showed the diagnostic performance for the prediction of PA. Secondly, the ROC curves of each post-CCT index for APA and IHA respectively were plotted. Finally, according to the postoperative clinical outcomes, the patients with unilateral adrenal resection were divided into three groups: clinical remission, clinical improvement, and no remission group. The difference between the three groups was compared, and the cut-off point of biochemical remission of CCT in APA patients was analyzed.
The post-CCT plasma aldosterone concentration (PAC) level had the highest diagnostic efficiency for PA (AUC=0.921, 95%CI=0.893-0.950), and the cut-off was 11.7 ng/dL. The sensitivity and specificity respectively was 84.6% and 86.0%. The post-CCT aldosterone to renin ratio (ARR) also had a good diagnostic efficacy for PA (AUC=0.868, 95%CI=0.823-0.923). The cut-off was 2.8 (ng/dL) / (mU/L), and the sensitivity and specificity respectively were 82.2% and 81.0%. The post-CCT PAC>17 ng/dL can assist in the diagnosis of APA subtypes. When post-CCT PAC<11.7 ng/dL combined with post-CCT ARR< 2.8 (ng/dL) / (mU/L), APA was almost excluded. The inhibition rate of PAC after CCT and the PAC remission rate after surgery were less effective in judging the biochemical remission assessment of APA, and post-CCT PAC<11.7 ng/dL or post-CCT ARR<2.8 (ng/dL) / (mU/L) could better. Among the patients receiving surgical treatment, 87.2% had post-CCT PAC<11.7 ng/dL, and 89.7% had post-CCT ARR<2.8 (ng/dL) / (mU/L), which was close to the postoperative clinical remission level (88.0%) .
CCT can be used throughout the diagnosis, classification and clinical outcomes evaluation of PA patients. post-CCT PAC 11.7 ng/dL and post-CCT ARR 2.8 (ng/dL) / (mU/L) are good cut-off for the diagnosis, and can also be used for the classification of APA and the judgment of postoperative biochemical remission. Secondly, detection before CCT has little clinical significance and can simplify the process.
The elderly colorectal cancer population has a high prevalence and complex condition, and postoperative rehabilitation faces various challenges. It is of great significance to construct a scientific, practical and comprehensive postoperative health management program for colorectal cancer in the elderly to improve patients' health.
To construct a comprehensive health management program for elderly postoperative colorectal cancer patients, and provide reference for postoperative rehabilitation of elderly colorectal cancer patients.
Based on literature review and qualitative interviews, the management program for elderly postoperative colorectal cancer patients was initially formulated. The Delphi method was used to conduct 2 rounds of correspondence with 16 experts from tertiary hospitals in Nanjing and Shanghai. The motivation degree of the experts was evaluated based on questionnaire recovery rate and text revision rate. Furthermore, the authority coefficient was used to evaluate the degree of expert authority, while the coefficient of variation and Kendall's W coefficient were used to evaluate the coordination of expert opinions. Based on opinions and discussion of experts, the ultimate formation of the health management program for elderly postoperative colorectal cancer patients was constructed after adjusting the content of entries.
The recovery rates of the two rounds of expert correspondence were 94.12% and 100.00%, respectively. The text revision rates were 56.25%, and the authority coefficient was 0.91. The mean importance scores of items in the two rounds of the consultation ranged from 3.81 to 5.00 and 4.13 to 5.00, with the coefficients of variation from 0 to 0.24 and 0 to 0.20. The Kendall's W coefficients of expert opinions were 0.211 and 0.222, respectively (P<0.001), with an improvement observed in the second round compared to the first round. After two rounds of expert correspondence and the expert group discussion, the final management program for elderly postoperative colorectal cancer patients was determined, including 9 primary items (team building, psychological support, physical activity, stoma care, nutritional intervention, TCM rehabilitation techniques, peer education, treatment and follow-up, self-management) and 39 secondary items.
The health management program constructed in this study for elderly postoperative colorectal cancer patients is scientific, reliable, applicable and practical, and can provide guidance for rehabilitation of elderly patients after colorectal cancer surgery.
Lawyer is one of the most stressful jobs, but lawyers' occupational stress is rather under-researched in China. Previous studies have shown that occupational stress and mental health are related to self-regulatory fatigue and health literacy in lawyers, but there is a lack of research on their interaction mechanism.
To explore the association of occupational stress and mental health in lawyers and the internal mechanism of action of self-regulatory fatigue and health literacy between them.
A convenience sample of 660 lawyers from 7 leading Chinese law firms were surveyed from May to June 2022 using questionnaires including a self-compiled Demographic Questionnaire, the Lawyers' Occupational Stress Scale, Symptom Checklist-90 (SCL-90), Self-regulatory Fatigue Scale (SRF-S) and National Residents' Health Literacy Surveillance Rapid Assessment Questionnaire (HLSRAQ). Stepwise regression was used to explore the mediating effect of self-regulatory fatigue between occupational stress and mental health, and bootstrap method was used to test the mediating effect of self-regulatory fatigue. Model 5 in PROCESS 3.4 was used to explore the moderated mediating effect of health literacy between occupational stress and mental health. Bootstrap method was used to test the moderating mediating effect of health literacy, and further simple slope test was used to test the moderating effect, and the effects of occupational stress on the mental health of lawyers with different health literacy levels were analyzed.
Six hundred and fifty-six cases (99.39%) who effectively responded to the survey were included for final analysis. The average scores of occupational stress, SCL-90, SRF-S and HLSRAQ were (106.9±34.8), 39.0 (15.0, 84.0), (39.4±10.0) and (13.9±3.7), respectively. Stepwise regression analysis showed that occupational stress could positively predict mental health (β=0.36, t=13.40, P<0.01). Self-regulatory fatigue also had a significant positive predictive effect on mental health (β=0.55, t=20.32, P<0.01). Bootstrap analysis showed that 95%CI of the total effect, indirect effect and direct effect of occupational stress on mental health did not include 0 (P<0.01). The moderated mediating effect analysis showed that the product of occupational stress and health literacy had a significant predictive effect on mental health (β=-0.02, t=-2.00, P<0.05). The Bootstrap method showed that the 95%CI of the indirect effect of lawyer occupational stress on mental health did not include 0 (P<0.01). Simple slope test showed that the association between them was found to be statistically significant regardless of being moderated by different levels of health literacy (P<0.01), and the predictive effect of occupational stress showed a downward trend with the improvement of health literacy level (P<0.01) .
Occupational stress influenced mental health in lawyers medicated by self-regulatory fatigue with health literacy as a moderator.
Salidroside has been shown to protect diabetic kidney disease (DKD) rats, however, whether it is equally effective in a hypoxic environment and the specific mechanism of action remain unclear.
To observe the effects of salidroside on biochemical parameters, renal tissue pathological lesion, and the expression of cell pyroptosis-related proteins in a rat model of DKD under hypoxia, and explore its mechanisms of action.
From March 2022 to March 2023, forty 6-week-old SPF-grade SD male rats were used, with eight randomly selected as the control group, the remaining were modeled. Twenty-four DKD model rats were randomly divided into three groups of the model group, salidroside group, and salidroside+nod-like receptor protein 3 (NLRP3) activator group for intervention, with 8 in each group. After the intervention, blood was collected from the abdominal aorta for biochemical parameter testing, hematoxylin-eosin (HE) staining, and transmission electron microscopy were used to observe renal pathological changes. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of interleukin (IL) 1β and IL-18. Western blotting was used to measure the expression levels of Caspase-1, Gasdermin D (GSDMD), NLRP3, and transforming growth factor β1 (TGF-β1) in renal tissue.
The body weight of the rats after modeling was significantly lower than that of the control group (P<0.05). Compared to the control group, the levels of triglyceride (TG), total cholesterol (TC), fasting blood glucose (FBG), urinary microalbumin (UMA), blood urea nitrogen (BUN), and serum creatinine (Scr) were significantly higher in the model group (P<0.05). Compared to the model group, the BUN, UMA, and Scr levels were significantly lower in the salidroside group (P<0.05). Compared to the salidroside group, the UMA, BUN, and Scr levels were significantly higher in the salidroside+NLRP3 activator group (P<0.05). HE staining and transmission electron microscopy revealed that renal tissue pathological changes in the salidroside group were significantly reduced than the model group, and aggravated in the salidroside+NLRP3 activator group. Compared to the control group, serum IL-1β and IL-18 levels were significantly higher in the model group (P<0.05) ; these levels were significantly lower in the salidroside group compared to the model group (P<0.05), and higher in the salidroside+NLRP3 activator group compared to the salidroside group (P<0.05). Compared to the control group, the expression of Caspase-1, GSDMD, NLRP3, and TGF-β1 proteins was significantly higher in the model group (P<0.05) ; it was significantly lower in the salidroside group compared to the model group (P<0.05), and higher in the salidroside+NLRP3 activator group compared to the salidroside group (P<0.05) .
Salidroside exerted therapeutic effects on DKD rats in a hypoxic environment without reducing blood glucose and lipid levels, this effect may be related to the inhibition of NLRP3, affecting the NLRP3/IL-1β/TGF-β1 signaling pathway, ultimately improving podocyte pyroptosis injury.
Respiratory problems in chronic obstructive pulmonary disease (COPD) patients are prone to poor sleep quality, anxiety and depression, but they are often ignored by medical staff and patients themselves. Understanding the sleep quality, anxiety and depression symptoms of patients with COPD and their influencing factors can help to improve the quality of life of patients, however, there are few relevant studies.
To investigate the sleep quality, anxiety and depression of patients with COPD and explore the influencing factors.
Convenience sampling was used to recruit COPD patients who visited the Department Respiratory Diseases and Critical Care Medicine of seven hospitals in Anhui Province from August to November 2022. Demographic characteristics, dyspnea grade, airflow restriction severity, risk of malnutrition, physical activity level, vaccination, and acute exacerbations in the last 1 year were collected. The Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS) were used to evaluate the sleep quality and anxiety and depression symptoms of COPD patients, and the influencing factors were analyzed by multivariate Logistic regression.
A total of 248 patients with COPD were investigated, among which the incidence of poor sleep quality was 60.9% (151/248), only 8.9% (22/248) of the patients thought they had good sleep quality, and more than half of the patients actually had insufficient sleep time (54.4%) or low sleep efficiency (60.1%). 29.4% (73/248) of COPD patients had at least one of the symptoms of anxiety or depression, of which 35 had anxiety symptoms, 61 had depression symptoms, and 23 had both anxiety and depression symptoms. Multivariate Logistic regression analysis showed that older ages (OR=1.052, 95%CI=1.018-1.086) and risk of malnutrition (OR=3.393, 95%CI=1.855-6.206) were risk factors for poor sleep quality in COPD patients. Regular physical activity was a protective factor for poor sleep quality in COPD patients (OR=0.450, 95%CI=0.242-0.834) (P<0.05). Acute exacerbations ≥2 times (OR=2.220, 95%CI=1.093-4.510) and malnutrition risk (OR=1.961, 95%CI=1.044-3.683) were risk factors for anxiety and depression symptoms in COPD patients (P<0.04). In COPD patients, PSQI score was positively correlated with HADS-A (rs=0.413) and HADS-D score (rs=0.430), and there was a positive correlation between HADS-A score and HADS-D score (rs=0.719, P<0.05) .
The incidence of poor sleep quality, anxiety and depression symptoms was high in COPD patients, and age, malnutrition risk, regular physical activity and number of acute exacerbations in the past year are important influencing factors. Medical staff, family members and patients themselves should improve the awareness of sleep quality, anxiety and depression, and actively carry out screening and intervention work for key patients to improve the sleep quality and mental health of patients.
In the current rehabilitation environment, emotional issues and cognitive dysfunctions in stroke patients are often overshadowed by physical, speech, and swallowing difficulties, leading to their underestimation in clinical rehabilitation. This oversight can result in adverse outcomes, impacting the overall success of rehabilitation. Currently, clinical treatments primarily rely on pharmacotherapy to alleviate symptoms, which has limited effectiveness and can cause a range of adverse reactions.
To observe the efficacy of precision exercise prescriptions on anxiety, depression, and cognitive functions in stroke patients and to preliminarily analyze the underlying mechanisms of action.
A total of 84 stroke patients hospitalized in the Rehabilitation Department of Changzhou Dean Hospital from January 2022 to March 2023 were selected. They were randomly divided into a control group (42 patients) and an experimental group (42 patients). The control group received standard rehabilitation treatment, while the experimental group received precision exercise prescriptions based on cardiopulmonary exercise testing (CPET) results in addition to standard rehabilitation, over 12 weeks. The Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Mini-mental State Examination (MMSE) scores, and Homocysteine (Hcy) levels were compared before and after rehabilitation training in both groups. A Pearson correlation analysis was conducted between pre-rehabilitation Hcy levels and SAS, SDS, MMSE scores.
All 42 patients in the experimental group completed the CPET and the 12-week precision exercise prescription rehabilitation without any adverse events. Before rehabilitation training, there were no statistically significant differences in SAS, SDS, MMSE scores, and Hcy levels between the two groups (P>0.05). After rehabilitation training, the scores of SAS, SDS, and Hcy levels in the experimental group were significantly lower compared to pre-treatment values (P<0.05), and which were significantly lower than those of the control group (P<0.05). The MMSE score in experimental groups increased significantly after interventions compared to pre-treatment value (P<0.05), and it was significantly higher than that of the control group (P<0.05). There were no significant differences in SAS, SDS, MMSE scores, and Hcy levels before and after rehabilitation training in the control group (P>0.05). Pearson correlation analysis revealed a positive correlation between Hcy levels and SAS, SDS scores (r-values of 0.420 and 0.507, respectively, P<0.05) and no correlation with MMSE scores (r=0.079, P=0.473) .
Our findings suggest that precision exercise prescriptions significantly improve anxiety, depression, and cognitive functions in stroke patients, suggesting their potential as a novel therapeutic approach in clinical applications. Hcy may be one of the mechanisms through which precision exercise prescriptions improve anxiety and depression in stroke patients. Further research is needed to determine whether Hcy is related to the improvement of cognitive functions through this prescription.
Chronic non-specific low back pain (CNLBP) has become one of the common causes of limited activity, which seriously threatens the physical and mental health and quality of life of patients. According to certain studies, sensitivity and tension in the myofascial tissue play an important role in chronic pain disorders. By releasing fascial tension, myofascial release theropy (MFR) is primarily used to relieve pain; however, there is a lack of high-quality clinical evidence to support this application.
To investigates the effectiveness of MFR in CNLBP cases treated non-surgically.
From January to December 2022, 56 patients with CNLBP were recruited as study subjects by Chengdu Sports Institute Sports Hospital. The patients were then divided into two groups using a randomised number table. The MFR group received MFR intervention (lumbar-abdominal MFR intervention) and the patients in the control group (CG group) received pseudo-MFR intervention (pseudo-MFR intervention in the same area) for the duration of 4 weeks, once a week for 20 minutes each time. The following variables were measured: Visual Analogue Scale (VAS) scores, Activities of Daily Living (ADL) scores, Oswestry Dysfunction Index (ODI), lumbar joint mobility[including anterior lumbar flexion (ALF), posterior lumbar extension (LR) and lumbar spine rotation (LSR) on both sides], scores on the SAS, and changes in tumour necrosis factor α (TNF-α) .
A total of 56 subjects were enrolled in this study. Of these, 8 cases were lost, 8 cases were automatically withdrawn and 40 cases -20 in the MFR group and 20 in the CG group eventually completed follow-up. There were no significant difference in VAS scores, ADL scores, ODI scores, ALF scores, SAS scores, SDS scores and TNF-α level between two groups before intervention (P>0.05). LR and LSR in MFR group were lower than those in CG group before intervention (P<0.05). After 4 weeks of intervention, VAS, ODI, SAS, SDS scores and TNF-α levels in MFR group were lower than those in CG group, ADL scores were higher than those in CG group, ALF, LR, LSR were higher than those in CG group (P<0.05). After 4 weeks of intervention, VAS, ODI, SAS, SDS scores and TNF-α levels in MFR group were lower than before intervention, ADL scores were higher than before intervention, ALF, LR, LSR were higher than before intervention (P<0.05) .
These results highlight the importance of MFR has been shown to have a better safety profile in patients with CNLBP, lowering the pain threshold, increasing lumbar joint mobility and improving negative psychological states such as anxiety and depression.
Stroke is a chronic condition that seriously impairs human health. The correlation between rainfall and onset of stroke remains unclear.
To analyze the correlation between rainfall and stroke admissions in Nanchang City, and to provide scientific references for developing a comprehensive prevention and treatment strategy for stroke.
Stroke admission data from Nanchang City (2015-2019) from the digital-related group (DRG) system of the Jiangxi Provincial Health Commission Information Center were collected. In addition, atmospheric pollutant data from the national urban air quality real-time release platform and meteorological data from the Nanchang meteorological base station were collected. Basic characteristics of stroke admission patients, air pollutants, and meteorological factors were analyzed. Spearman rank correlation analysis was performed to identify the correlation of case number of stroke admissions with air pollutants and atmospheric factors. Distributional lag nonlinear model was used to explore the linkage between rainfall and stroke admissions. Stratified analysis was conducted based on gender and age (<65 years old and ≥65 years old), and lag represented the lagging days.
From 2015 to 2019, there were 79 523 hospitalized patients with stroke in Nanchang City, of which 49 072 (61.71%) were males and 48 092 (60.48%) were ≥65 years old, accounting for a large proportion. The number of stroke admissions in winter (December to February) and spring (March to May) were 20 065 (25.23%) and 20 358 (25.60%), respectively. There was a nonlinear relationship between rainfall and stroke admission, and there was a certain lag effect. The RR values of lag1 and lag2 for the effect of rainfall on stroke admission was both 1.009, and 95%CI were 1.000-1.019 and 1.001-1.016, respectively. Stratified analysis showed that the main effect of higher rainfall on the number of male stroke admissions was lag6, RR value was 1.003; the main effect on the number of hospital admissions for female stroke was lag1 and lag2, with RR values of 1.018 (95%CI=1.004-1.031) and 1.020 (95%CI=1.009-1.031), respectively. The main effects on the number of hospitalizations for ischemic stroke under 65 years of age were lag1 (RR=1.016, 95%CI=1.003-1.030), and lag2 (RR=1.018, 95%CI=1.007-1.029) .
Short-term exposure to higher rainfall can increase the risk of stroke hospitalization, and women and people under 65 years of age are more sensitive to rainfall exposure, and protection should be strengthened for this group of people.
Chronic atrophic gastritis (CAG) with intestinal metaplasia (IM) is an independent risk factor for gastric cancer. Long-term inflammation and oxidative stress response stimulate the physical and mental state of patients. Under the modern medical model, proton pump inhibitors and gastric mucosal protective agents are increasingly unable to meet the high drug resistance of patients. It is urgent to seek effective new Chinese medicine treatments and multiple methods to treat CAG and IM.
To evaluate the clinical efficacy and safety of modified Piwei Peiyuan Decoction combined with acupuncture in the treatment of CAG with IM.
From January 2022 to September 2023, 202 patients with CAG and IM diagnosed by gastroscopy and pathological examination in the Department of Spleen and Stomach, the Center for Preventive Treatment of Disease, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine and the Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine were selected. The patients were divided into control group (n=67), treatment group A (n=68) and treatment group B (n=67) by random number table method. All patients participated in 6 weeks of treatment: (1) Control group: aluminum magnesium suspension combined with folic acid tablets (3 times/d) ; (2) Treatment group A: to add and subtract syndrome types of Piwei Peiyuan Decoction (2 times/d) ; (3) Treatment group B: Piwei Peiyuan Decoction (the same as group A) combined with acupuncture (1 time/d), with Zusanli, Liangqiu, Gongsun, Neiguan, Zhongwan as the main points, according to the syndrome type selection of acupoints. Before and 6 weeks after treatment, OLGA, OLGIM staging, gastric mucosal pathological efficacy, gastric mucosal pathological score, clinical symptom score, PRO scale score, drug-related adverse events (AE) and adverse drug reactions (ADR) were recorded.
A total of 192 patients completed the 6-week course of treatment (62 in the control group, 66 in the treatment group A, and 64 in the treatment group B). The effective rate of the control group was 48.39% (30/62), the effective rate of the treatment group A was 69.70% (46/66), and the effective rate of the treatment group B was 71.88% (46/64). There was a statistically significant difference in the effective rate among the three groups (χ2=9.144, P=0.01). After treatment, the gastric mucosal pathological score, clinical symptom score and PRO scale score in the three groups were lower than those in the same group before treatment (P<0.05). Pathological score of gastric mucosa: the scores of chronic inflammation, atrophy and IM in treatment group A and treatment group B were lower than those in control group, and the scores of active inflammation and dysplasia were higher than those in control group (P<0.05). Clinical symptom score: the scores of epigastric fullness and epigastric pain in treatment group A and treatment group B were lower than those in control group (P<0.05). The PRO scale score: the treatment group A and the treatment group B were lower than the control group in acid reflux, dyspepsia, defecation, psychological state, systemic symptoms and total score (P<0.05). There was no significant difference in the incidence of AE and ADR among the three groups (P>0.05) .
The overall clinical efficacy of Piwei Peiyuan Decoction combined with acupuncture is better than that of aluminum magnesium suspension combined with folic acid tablets, which is better than that of traditional antacids and gastric mucosal protective agents.
Metabolic associated fatty liver disease (MAFLD) is more prevalent than non-alcoholic fatty liver disease (NAFLD), leading to the identification of a variety of metabolically complex fatty liver diseases. The serum uric acid/creatinine ratio (SUA/Cr) is a new biomarker discovered after renal function-normalized SUA. At present, there have been few studies on the relationship between SUA/Cr and MAFLD.
To explore the correlation of SUA/Cr with MAFLD, and its predictive value for MAFLD.
We enrolled 2 288 individuals who visited the Physical examination Center of the Affiliated Hospital of Inner Mongolia Medical University in February to June 2023. Venous blood samples were collected for laboratory tests, and abdominal ultrasonography was used to examine the liver condition. Based on the results of abdominal ultrasonography and the diagnostic criteria for MAFLD, the subjects were divided into the MAFLD group (n=945) and non-MAFLD group (n=1 343). According to SUA/Cr quartiles, the subjects were divided into Q1 group (SUA/Cr≤4.13, n=574), Q2 group (4.13<SUA/Cr≤4.84, n=573), Q3 group (4.84<SUA/Cr≤5.72, n=570), Q4 group (SUA/Cr>5.72, n=571). Spearman rank correlation analysis was used to explore the correlation between SUA/Cr and clinical data. Binary Logistic regression analysis was used to gradually explore the influencing factors of MAFLD. Receiver operating characteristic (ROC) curve was drawn, and the area under the ROC curve (AUC) was calculated to evaluate the predictive value of SUA/Cr for MAFLD.
Compared to the non-MAFLD group, the MAFLD group had higher levels of male proportion, age, waist circumference (WC), BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total cholesterol (TC), triacylglycerol (TG), low density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), homocysteine (Hcy), serum uric acid (SUA), serum creatinine (Scr), and SUA/Cr ratio (P<0.001). High-density lipoprotein cholesterol (HDL-C) in the MAFLD group was lower in the non-MAFLD group (P<0.001). In the Q4 group, the WC, BMI, ALT, GGT, SUA, TC and TG were higher than those in the Q1, Q2 and Q3 groups, the AST was higher than the Q1 and Q2 groups, the DBP, ALP and HbA1c were higher than the Q1 group, the Scr, HDL-C were lower than those in the Q1, Q2 and Q3 groups, and the age was lower than those in the Q1 and Q2 groups (P<0.05). In the Q3 group, the ALT, AST, GGT, SUA, TC and TG were higher than those in the Q1 and Q2 groups, the WC and BMI were higher than those in the Q1 group, the Scr was lower than those in the Q1 and Q2 groups, and the age and HDL-C were lower than those in the Q1 group (P<0.05). In the Q2 group, the WC, BMI, ALT, GGT, SUA, and TG were higher than those in the Q1 group, and the age and HDL-C were lower than those in the Q1 group (P<0.05). Multivariate Logistic regression analysis showed that elevated WC (OR=1.034, 95%CI=1.016-1.053), BMI (OR=1.340, 95%CI=1.266-1.418), GGT (OR=1.006, 95%CI=1.003-1.010), SUA (OR=1.002, 95%CI=1.000-1.003), TG (OR=1.319, 95%CI=1.181-1.474), and HbA1c (OR=1.348, 95%CI=1.184-1.536) were risk factors for MAFLD, while elevated HDL-C (OR=0.334, 95%CI=0.205-0.543) was a protective factor for MAFLD (P<0.05). After adjusting for confounding factors, the risk of MAFLD in Q4 group was 1.734 (95%CI=1.220-2.465, P=0.002) compared with Q1 group. SUA/Cr predicted that the area under the curve (AUC) of MAFLD was 0.607 (95%CI=0.584-0.630), with an optimal threshold value of 4.538.
The level of SUA/Cr in MAFLD group is higher compared to the non-MAFLD group. As the SUA/Cr level increased, the detection rate of MAFLD also increased. The SUA/Cr is a risk factor for MAFLD. The SUA/Cr can be used as a predictor to evaluate the risk of developing MAFLD.
As a common malignant tumor, prostate cancer (PCa) poses a significant threat to the well-being of men worldwide. The prognosis of PCa is intricately linked to the grade and stage of the tumor at the time of initial detection. Prostate specific antigen (PSA) is a key biomarker for evaluating prostate health, yet lacks specificity for prostate cancer tumors. Elevated PSA levels can also be caused by benign prostate diseases. And the indiscriminate use of biopsy resulting in overdiagnosis. Hence, the development of a prostate cancer risk prediction model based on pre-biopsy clinical indicators in patients can serve as a valuable tool for early screening of individuals with suspicious findings warranting biopsy.
To examine the individual risk factors associated with positive prostate biopsy outcomes and develop a risk assessment model for predicting positive biopsy results in PCa screening.
A total of 1 138 patients who underwent prostate biopsy in the Department of Urology, the First Affiliated Hospital of Air Force Medical University from January 2011 to June 2023 were gathered and organized. Following the exclusion of 351 cases with inadequate clinical data, the remaining 787 cases were randomly allocated into a training set and validation set in a 7∶3 ratio by R software. Patient demographics and routine biochemical test results prior to biopsy were compiled, with PCa diagnosis determined based on the outcomes of the biopsy. LASSO regression analysis in the R software was utilized to identify independent risk factors associated with the development of PCa based on biochemical indicators. Subsequently, multivariate logistic regression analysis in SPSS software was employed to construct an early screening and predictive model for PCa, with a Nomogram being generated. The model was validated according to the data of training set and validation set.
The study utilized LASSO regression analysis to identify 6 independent risk factors associated with positive prostate biopsy results, including age, total PSA (tPSA), alkaline phosphatase, serum protein level, Ca2+, and urea. Multivariate Logistic regression analysis revealed that individuals aged 60 years or older (OR=3.769, 95%CI=2.393-5.937), with tPSA levels of 10 μg/L or higher (OR=2.259, 95%CI=1.419-3.596), and alkaline phosphatase levels exceeding 45 U/L (45-<125 U/L, OR=20.136, 95%CI=4.419-91.752; ≥125 U/L, OR=45.691, 95%CI=9.199-226.951) were at increased risk for positive prostate biopsy outcomes (P<0.05). Conversely, higher levels of serum total protein (≥65 g/L, OR=0.086, 95%CI=0.031-0.236), Ca2+ (≥2.11 mmol/L, OR=0.148, 95%CI=0.054-0.403), and urea (≥9.5 mmol/L, OR=0.069, 95%CI=0.019-0.252) were found to be protective factors against positive prostate biopsy results (P<0.05). Based on the identification of 6 independent risk factors exhibiting statistically significant differences, a nomogram was constructed and a predictive model was developed. The predictive model yielded an Area under the receiver operating characteristic (ROC) curve (AUC) of 0.778 (95%CI=0.740-0.816) for PCa in the training set, with a sensitivity of 53.2% and a specificity of 85.5%. In the validation cohort, the AUC for PCa was 0.770 (95%CI=0.708-0.832), with a sensitivity of 61.2% and a specificity of 80.0%. The goodness of fit test indicated P=0.543 in the training set and P=0.372 in the validation set, demonstrating a satisfactory level of fit. The discriminant analysis (DCA) demonstrated that the high-risk threshold in the training set was below 10%, while in the validation set it was approximately 15%, indicating valuable implications for clinical practice.
This study developed a PCa nomogram risk prediction model incorporating 6 biochemical indicators, namely age, tPSA, alkaline phosphatase, serum total protein, Ca2+, and urea, prior to prostate biopsy, to effectively forecast PCa risk in patients with favorable early screening outcomes.
Fibrinogen (FIB) is often elevated in children with Henoch Schonlein purpuric nephritis (HSPN), but the correlation between FIB and renal lesions has been less studied.
To explore the correlation between FIB in children with HSPN and the International Study Group on Pediatric Kidney Disease (ISKDC) pathology grading and micropathological changes in parts of renal units, and to clarify whether FIB can assess the severity of renal injury in children with HSPN.
In total, 922 children with HSPN who were hospitalized in the First Affiliated Hospital of Henan University of Chinese Medicine in the pediatric nephrology ward and underwent kidney biopsy at the same time from December 2017 to December 2022 were collected, and the clinical information, FIB and renal pathological information during renal biopsy were summarized, and based on the FIB level, the children were categorized into group A (low) <2.38 g/L, group B (standard) 2.38-4.98 g/L, and group C (high) >4.98 g/L. The correlation between FIB and ISKDC pathological grades, glomerular mesangial hyperplasia ratio, the crescentic bodies ratio and the nature of the glomerular lesions from acute to chronic was investigated by Spearman rank correlation analysis, and the prediction of FIB on the micropathological changes of renal units was analyzed by the subject's work characteristic (ROC) curve.
Among 922 children with HSPN who had undergone renal biopsy, the FIB was (3.48±1.01) g/L. 113 cases in group A had a low FIB rate of 12.26%; 734 cases in group B had a standardized FIB rate of 79.61%; and 75 cases in group C had a high FIB rate of 8.13%. The ISKDC pathology classification was type Ⅱa in 173 cases (18.76%), type Ⅱb in 29 cases (3.15%), 466 cases (50.54%) of type Ⅲa, 232 cases (25.16%) of type Ⅲb, and 22 cases (2.39%) of type Ⅳ and above (including 2 cases of type Ⅳa, 18 cases of type Ⅳb, and 2 cases of type Ⅴ). The results of the Spearman's rank correlation analysis showed that the FIB and the grouping of the FIB of the children with HSPN were positively related to the renal pathology ISKDC grading (rs=0.146, P<0.001; rs=0.129, P<0.001). 911 (98.80%) of 922 children with HSPN were mesangial proliferative, and 655 (71.04%) had crescentic hyperplasia. Spearman rank correlation analysis showed a weak positive correlation between FIB and FIB subgroups and the rate of mesangial hyperplasia (rs=0.092, P=0.005; rs=0.096, P=0.003), and a positive correlation with the rate of crescentic bodies (rs=0.132, P<0.001; rs=0.830, P=0.012). 922 children with HSPN had glomerular acute lesions in 763 cases (82.75%), acute chronic lesions in 97 cases (10.52%), and chronic lesions in 62 cases (6.73%). In addition, FIB gradually increased with the nature of the glomerular lesions from acute to chronic (rs=0.145, P<0.001). At the same time, comparison of some renal biopsy indexes FIB in HSPN children showed statistically significant difference (P<0.05). The ROC curves showed that the FIB had the highest sensitivity for glomerulosclerosis (sensitivity=0.900, specificity=0.303), and the optimal cutoff value for FIB was 2.835 mg/L; the area under the ROC curve (AUC) of FIB for the positive prediction of tubulointerstitial fibrosis=0.623, and that of FIB for the reverse prediction of tubulointerstitial cellular granulomatous degeneration=0.641.
FIB can be used as a laboratory index reflecting the severity of renal pathological changes in patients with HSPN, can reflect the severity of renal pathological grading, is closely related to irreversible lesions according to renal microscopic indicators such as glomerular sclerosis and balloon adhesion, and can assist clinical diagnosis and treatment.
Whether considering the cumulative effect of sustained C-reactive protein (CRP) and distinguishing different aspects of depressive symptoms may be the reasons for the inconsistent conclusions of previous studies on the association between CRP and depressive symptoms among middle-aged and older adults. The relationship between cumulative effects of CRP elevations and different aspects of depressive symptoms in middle-aged and older adults in China is not well understood.
This study aims to examine the relationship between cumulative episodes of CRP elevations over two successive determinations and depressive symptoms, as well as somatic and non-somatic retardation, among Chinese middle-aged and older adults.
This study used public data from the 2011-2018 Chinese Health and Retirement Longitudinal Study (CHARLS) and included 3 868 subjects. They were categorized based on the frequency of CRP elevations over two consecutive measurements: "elevated on zero occasion" (n=2 918), "elevated on one occasion" (n=763), and "elevated on two occasions" (n=187). Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CESD-10) in 2011, 2015, and 2018, capturing both somatic and non-somatic dimensions. Multiple linear was used to explore the associations between cumulative episodes of CRP elevations over two successive determinations with depressive symptom scores in 2018, as well as the scores of somatic and non-somatic components separately. Multivariate Logistic regression was used to investigate the effects of cumulative episodes of CRP elevations on the risk of depressive symptoms in 2018.
The results of multiple linear regression analysis showed that after adjusting for all covariates, elevated on two occasions compared with elevated on zero occasion, which was an influential factor for the total score of depressive symptoms (β=1.22, P<0.05), the score of somatic depressive symptoms (β=0.51, P<0.05) and the score of non-somatic symptoms (β=0.71, P<0.05). Logistic regression analysis showed that after adjusting for all covariates, elevated on two occasions were associated with a higher risk of depressive symptoms than elevated on zero occasion (OR=1.64, 95%CI=1.18-2.29) .
Among Chinese middle-aged and older adults, there is a positive association between cumulative effects of CRP elevations and depressive symptoms, encompassing both somatic and non-somatic retardation. Addressing chronic inflammation and treating chronic inflammatory diseases promptly may help mitigate depression risk.
There is a close association between obstructive sleep apnea-hypopnea syndrome (OSAHS) and stroke. The coexistence of the two diseases not only affects the rehabilitation process of patients, prolongs their hospitalization time, but also may increase the risk of death. At present, there is still a lack of clinical research on continuous positive airway pressure (CPAP) combined with respiratory training for stroke patients with OSAHS.
To examine the impact of threshold inspiratory muscle training (TIMT) in conjunction with CPAP on sleep status, pulmonary function, and respiratory muscle strength in stroke patients with OSAHS.
Sixty-nine patients with stroke and OSAHS who met the enrollment criteria were selected from the Second Affiliated Hospital of Zhengzhou University from April 2022 to August 2023. The patients were divided into experimental group (n=35) and control group (n=34) by random number table method. The control group received CPAP and conventional treatment, and the experimental group received TIMT on this basis for 6 weeks. The sleep status, lung function and respiratory muscle function of the two groups were compared before and after intervention.
Six weeks after the intervention, the mean blood oxygen saturation (SpO2), proportion of deep sleep (proportion of N3 sleep in total sleep time), minimum arterial oxygen saturation (LSaO2), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), one-second rate (FEV1/FVC), maximum expiratory pressure (MEP) and maximum inspiratory pressure (MIP) were all higher than those before intervention in the 2 groups (P<0.05) ; After 6 weeks of intervention, SpO2, proportion of deep sleep (proportion of N3 sleep in total sleep time), LSaO2, FEV1, FVC, FEV1/FVC, MEP and MIP in experimental group were higher than those in control group (P<0.05). Sleep apnea hypopnea index (AHI), oxygen loss index (ODI), arousal index and Epworth lethargy scale (ESS) scores in the 2 groups were lower than those before intervention (P<0.05). After 6 weeks of intervention, the ODI, arousal index and ESS scores of experimental group were lower than those of the control group (P<0.05) .
TIMT combined with CPAP can significantly improve the sleep disorder of stroke patients with OSAHS, and improve arterial oxygen partial pressure, respiratory muscle strength and pulmonary function.
Dysphagia, a prevalent geriatric syndrome, has been witnessing an upward trend in incidence rates, potentially leading to severe complications like aspiration pneumonia and asphyxia. Despite its significance, research on the prevalence and determinants of dysphagia among community-dwelling elderly remains scarce.
This study aims to ascertain the prevalence of dysphagia among Shanghai's elderly community by identifying influencing factors and analyzing occurrence rates and determinants across different age brackets.
Employing a cross-sectional survey approach, the study was conducted from July 2022 to May 2023. Using convenience sampling, the study involved 358 individuals aged 60 and above, selected from the outpatient and home care services of five community health service centers in Huangpu, Baoshan and Fengxian Districts of Shanghai. Demographic data were collected, and measurements of the Appendicular Skeletal Muscle Index (ASMI), grip strength, and walking speed were taken. The Eating Assessment Tool-10 (EAT-10) was utilized to assess the risk of dysphagia among the elderly.
Out of the 358 community-dwelling elderly individuals surveyed, 80 (22.3%) exhibited symptoms of dysphagia (EAT-10≥3) (dysphagia group). Multivariate Logistic regression analysis identified advanced age (≥80 years) (OR=18.484, 95%CI=3.571-95.679), depressive state (OR=4.135, 95%CI=1.280-13.364), and a history of choking (OR=13.650, 95%CI=4.345-42.877) as significant risk factors for dysphagia (P<0.05). Conversely, a high Barthel Index (OR=0.891, 95%CI=0.832-0.953) and a robust ASMI (OR=0.330, 95%CI=0.199-0.547) emerged as protective factors (P<0.05). When stratified by age, the prevalence rates of dysphagia were 5.0% (6/119), 11.1% (16/144), and 61.1% (58/95) for the age groups 60-69, 70-79, and ≥80 respectively, with statistically significant differences (P<0.05). Significant disparities were noted between dysphagia and non-dysphagia groups in terms of BMI, ASMI, and depression status for ages 60-69 (P<0.05), grip strength, calf circumference, depression, Barthel Index, and choking history for ages 70-79 (P<0.05), and ASMI, grip strength, walking speed, Barthel Index, MMSE scores, and choking history for ages ≥80 (P<0.05). Within the dysphagia cohort, ASMI and grip strength in the 70-79 and ≥80 age groups were lower compared to the 60-69 age group (P<0.05). The walking speed of individuals aged ≥70 was reduced relative to those aged 60-69 (P<0.05). Additionally, individuals aged ≥80 showed a higher choking incidence and scored lower on the Barthel Index and MMSE than those aged 60-79 (P<0.05) .
The prevalence of dysphagia among community-dwelling elderly in Shanghai is notably high and progressively increases with age, with a corresponding rise in influencing factors. It is imperative to intensify dysphagia screening, particularly among the elderly with depressive symptoms or a history of choking. Enhancing muscle mass and self-care capabilities, coupled with age-specific preventive measures, can substantially alleviate the disease burden and improve prognoses.
Locally advanced gastric cancer mainly includes stage Ⅲ gastric cancer, which is mainly treated with comprehensive therapy. Postoperative recurrence is a key factor affecting the prognosis of patients.
To explore the influencing factors of long-term prognosis in patients with stage Ⅲ gastric cancer undergoing D2 radical surgery and adjuvant chemotherapy.
Gastric cancer patients who underwent D2 radical surgery and adjuvant chemoradiotherapy were collected from the Department of Radiotherapy at Zhongshan Hospital affiliated to Fudan University from 2009 to 2014. They were pathologically diagnosed with stage Ⅲ gastric cancer according to the International Union of Cancer (UICC) and American Cancer Federation (AJCC) 8th edition TNM staging system for gastric cancer. All postoperative patients were followed up every 3 months in the first year, every 6 months for the following 2 years, and once a year thereafter. The deadline for follow-up is December 15, 2021. Survival rates of subgroups were compared using Log-rank tests.The influencing factors of overall survival (OS) and disease-free survival (DFS) were compared using Cox proportional hazards regression analysis, and the prediction of clinicopathological features were analyzed by Nomogram. Comparison of survival differences among patients with different pTNM stagings, age, metastatic lymph node radios (LNR), and gastrectomy methods using Kaplan-Meier method.
A total of 135 qualified patients were included, with a median follow-up time of 10.48 years. Within 5 years, there were 70 cases of recurrence and 62 deaths. The 5-year DFS rate and OS rate were 48.1% (65/135) and 54.1% (73/135), respectively; Within 10 years, there were 74 cases of recurrence and 74 deaths. The 10-year DFS rate nd OS rate were both 45.2% (61/135). The Log-rank test results showed that there was a statistically significant difference in 5-year survival rates among patients with different pTNM stagings, pT stagings, LNRs, cancer nodules, tumor locations, and gastrectomy methods (P<0.05). The 10-year survival rates of patients with different pTNM stagings, pT stagings, LNRs, nerve infiltrations, and gastrectomy methods were compared, and the differences were statistically significant (P<0.05). The results of multivariate Cox proportional hazards regression analysis showed that pTNM staging (Stage ⅢA, OS: HR=0.40, 95%CI=0.19-0.83; DFS: HR=0.40, 95%CI=0.19-0.92), LNR (>50%, OS: HR=1.74, 95%CI=1.03-2.94; DFS: HR=1.73, 95%CI=1.02-2.94), and gastrectomy method (total gastrectomy, OS: HR=2.07, 95%CI=1.22-3.50; DFS: HR=2.02, 95%CI=1.20-3.41) were independent influencing factors for OS and DFS in patients with stageⅢ gastric cancer undergoing D2 radical surgery with adjuvant chemotherapy (P<0.05), while age (≤ 40 years, HR=2.19, 95%CI=1.06-4.53) was an independent influencing factor for OS. Moreover, nomogram indicated that age, pTNM staging, LNR, and gastrectomy method have good predictive effects on the prognosis. For recurrence, 10 cases (7.4%) experienced local recurrence (recurrence of anastomotic sites and lymph nodes within the radiation field), 35 cases (25.9%) experienced abdominal and pelvic dissemination of implants, and 37 cases (27.4%) experienced distant metastasis (including lung, liver, bone, brain and other organs) ; Some patients had two or more types of recurrence. The postoperative survival curves of stageⅢ gastric cancer patients with different pTNM stagings, age, LNRs, and gastrectomy methods were compared, and the differences were statistically significant (P<0.05) .
Most patients with stageⅢ gastric cancer who undergo adjuvant chemoradiotherapy after D2 radical surgery experience recurrence or death within 5 years. pTNM staging, LNR, and gastrectomy method are factors that affect the prognosis of these patients.
Depression is a common psychiatric disorder with limited treatment options. Deep transcranial magnetic stimulation (dTMS), as a new non-invasive neuromodulation technique, has been utilized in the treatment of major depressive disorder (MDD), but there is less evidence from clinical studies.
To explore the clinical efficacy of dTMS combined with escitalopram oxalate (Esc) in the treatment of depression, and provide further reliable data reference for dTMS in the treatment of depression patients.
A total of 73 patients with depression who attended Department of Psychiatry, Affiliated Hospital of Guizhou Medical University from December 2021 to January 2023 were selected as the study subjects and divided into the control group (n=35) and combined treatment group (n=38) according to the random number table. Patients in the control group were given Esc ( 10 mg per day in the first week and 20 mg per day from the second week for 2 consecutive weeks). The combined treatment group received the treatment of dTMS (left DLPFC as the stimulation target, 18 Hz, 120%MT, 1 980 times per day for 2 weeks, 10 times in total) based on the same treatment for the control group. The depressive symptoms and cognitive improvement of patients in the two groups were evaluated before and after the two weeks of treatments by Hamilton depression scale (HAMD), Beck Scale for Suicide Ideation (BSS), Montreal Cognitive Assessment Scale (MoCA) and the mean oxygenated hemoglobin (oxy-Hb) concentration in the prefrontal cortex measured by functional near-infrared spectroscopy (fNIRS) based on the verbal fluency text (VFT) task.
The actual completion of the trial was 30 cases in the control group and 31 cases in the combined treatment group. After treatment, the HAMD and BSS scores of the combined treatment group were lower than those of the control group, and the MoCA score was higher than that of the control group (P<0.05). After treatment, the HAMD and BSS scores of patients in the two groups were lower than those before treatment, and the MoCA score was higher than that before treatment (P<0.05). There was no significant activation of the prefrontal cortex after treatment in both groups. The improvement of depression symptoms and cognitive function in the combined treatment group was better than that in the control group.
The combination of dTMS and Esc can improve the depressive symptoms and cognitive function better than Esc treatment alone in depression patients.
Acute pancreatitis (AP) is one of the common gastrointestinal emergencies, and the disease progression of moderately severe and severe AP is rapid. Early and accurate identification is crucial for effective intervention and prognosis assessment. there is still a lack of effective and simple predictive indicators.
To investigate the early dynamic changes and predictive value of the systemic inflammation response index (SIRI) in patients with AP.
A total of 221 AP patients who met the inclusion and exclusion criteria at the Department of Gastroenterology, Beijing Tiantan Hospital, Capital Medical University, were included as study subjects from August 2020 to March 2023. According to the revised 2012 Atlanta criteria, patients were categorized into mild group (MAP group, mild acute pancreatitis) and non-mild group (non-MAP group, including moderate severe and severe acute pancreatitis). The SIRI values (SIRI 0 h, SIRI 48 h) and C-reactive protein (CRP) levels (CRP 0 h, CRP 48 h) during admission and within 48 hours of admission for the patients were collected by reviewing cases. The receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was calculated to analyze the predictive value of SIRI for non-MAP and compare it with CRP as a common clinical indicator of inflammation.
A total of 221 AP patients were finally included, 102 with MAP and 119 with non-MAP. SIRI 0 h and SIRI 48 h were higher in patients in the non-MAP group than in the MAP group (P<0.001). The ROC curve showed that the AUC for SIRI 0 h and SIRI 48 h in predicting non-MAP were 0.685 (95%CI=0.615-0.756) and 0.753 (95%CI=0.689-0.816), respectively, with no significant difference with CRP [0.607 (95%CI=0.533-0.681) and 0.752 (95%CI=0.687-0.817) ] during the corresponding time intervals (Z=1.67, P=0.095; Z=0.02, P=0.981). The optimal cut-off value for SIRI 48h to predict non-MAP was 2.49, with sensitivity, specificity, positive predictive value, and negative predictive value of 81.51%, 58.82%, 69.78%, and 73.17%, respectively.
SIRI is an affordable and readily available test that can be used as an indicator for assessing the severity of early-stage AP.
The treatment of coronary microvascular disease (CMVD) has always been the focus of non-coronary obstructive ischemic heart disease. Adenosine injection and adenosine disodium triphosphate (ATP) injection, which are common clinical loading drugs to determine coronary flow reserve (CFR) and evaluate CMVD, are related but significantly different. ATP is the precursor of adenosine, with low price and similar vasodilatory mechanism to adenosine, and is often substituted for adenosine in clinical practice, but its potential adverse effects are ignored.
To compare the incidence of adverse reactions in the assessment of coronary microvascular disease by adenosine load and adenosine disodium triphosphate load.
A total of 170 patients who visited the Department of Cardiology of Shaanxi Provincial People's Hospital for typical angina pectoris and underwent coronarography/Coronary CT angiography (CTA) to determine the residual stenosis diameter of each branch coronary artery <50% during June 2019 to July 2020 were selected and divided into the adenosine group (n=88) and ATP group (n=82) based on random number table method. CFR was determined by adenosine injection loading in the adenosine group and by ATP loading in the ATP group. Blood pressure, heart rate, scanning time and adverse reactions of patients were recorded during the detection process.
The incidence of adverse reactions of chest tightness [61.0% (50/82) vs 20.4% (18/88) ], dizziness [72.0% (59/82) vs 31.8% (28/88) ], headache [68.3% (56/82) vs 11.4% (10/88) ], gastrointestinal discomfort [13.4% (11/82) vs 4.5% (4/88) ], palpitation [69.5% (57/82) vs 5.7% (5/88) ], shortness of breath [40.2% (33/82) vs 2.3% (2/88) ], profuse sweating [28.0% (23/82) vs 3.4% (3/88) ], hot flush [19.5% (16/82) vs 2.3% (2/88) ] and facial flushing [13.4% (11/82) vs 4.5% (4/88) ] in patients in the ATP group were higher than those in the adenosine group (P<0.05). There was no significant difference in the incidence of neuroticism, tinnitus, dry throat and neck discomfort between the two groups (P>0.05) .
Compared with ATP loading, adenosine loading has a lower incidence of adverse reactions determine CFR.
The heterogeneity of myelodysplastic syndromes (MDS) is strong, with poor efficacy of existing therapeutic regimens and large individual differences in patient prognosis. B-cell lymphomato-2 (Bcl-2) protein is highly expressed in patients with myeloid tumors, which has been proved by previous to be associated with disease progression, chemotherapy resistance, and shortened overall survival. The Bcl-2 inhibitor Veneckla (VEN) is approved for elderly patients with newly diagnosed acute myeloid leukemia (AML) who are not eligible for intensive therapy, and there is less data on its use in MDS patients. The difference in Bcl-2 expression in MDS patients and its correlation with the efficacy and prognosis of VEN therapy haven't been reported.
To analyse the expression of Bcl-2 protein in MDS patients and assess its correlation with the efficacy and prognosis of VEN treatment.
The clinical data of 71 patients with MDS admitted to Sichuan Academy of Medical Sciences·Sichuan Provincial People's Hospital from July 2018 to December 2022 were retrospectively analyzed. Baseline data of patients including gender, age, blood routine, blood biochemistry, bone marrow hemocytology, flow cytometry, chromosome karyotype, myeloid gene mutation, fusion gene mutation and MDS-EB typing were collected. The expression of Bcl-2 protein was detected by immunohistochemical staining. According to the modified International Prognostic Score System (IPSS-R), the patients were divided into 5 risk levels of very low risk (0 case), low risk (1 case), medium risk (7 cases), high risk (40 cases) and very high risk (23 cases). Patients with bone marrow Bcl-2 positivity≥10% were defined as Bcl-2 positive and<10% as Bcl-2 negative. Patients were divided into the positive group (n=38) and negative group (n=33). Of 63 patients with high-risk and very high-risk MDS, 38 were treated and evaluated for efficacy, including 28 patients who received VEN combined with azacitidine (VA combination regimen) and 10 patients who received hypomethylated drugs (HMA, including azacitidine or decitabine) as monotherapy. The patients were followed up until 2022-12-30. Kaplan-Meier curve was plotted to analyze the overall survival time (OS) of different patients, and Log-rank test was used for comparison. Univariate Cox regression model was used to analyze the influencing factors of patients' OS.
The proportions of fusion gene mutation and nuclear myeloid phosphoprotein 1 (NPM1) gene mutation in the positive group were higher than those in the negative group, and the difference was statistically significant (P<0.05). Of the 10 patients who received HMA monotherapy, 1 was Bcl-2 negative and 9 were Bcl-2 positive, after 14 days of treatment, 4 of them (40.0%) achieved composite complete response (CR/mCR). Of the 28 patients receiving the VA combination regimen, 12 were Bcl-2 negative and 16 were Bcl-2 positive, and after 14 days of treatment, 20 (71.4%) patients receiving the VA combination regimen achieved CR/mCR. There was no significant difference in CR/mCR ratio between the two treatment regimens (P=0.087). The median overall survival time (mOS) for patients with VA combination therapy was 6.9 months, with a mOS of 2.9 months for Bcl-2 negative patients and 7.4 months for Bcl-2 positive patients. There was no significant difference in survival rate between Bcl-2 positive patients and Bcl-2 negative patients (χ2=2.075, P=0.150). The mOS of Bcl-2 positive patients receiving HMA monotherapy was 4.3 months, and there was no significant difference in the survival rate comparing with Bcl-2 positive patients receiving VA combination regimen (χ2=0.824, P=0.364). Univariate Cox regression model analysis showed that age, Bcl-2 protein expression, mutant gene number, chromosome karyotype, MDS-EB typing, IPSS-R risk, and efficacy were not the influencing factors for OS in patients treated with VA combination regimen (P>0.05) .
Bcl-2 protein contributes to MDS fusion gene mutation and myeloid gene mutation; Bcl-2 positive expression was not associated with the survival of MDS patients. There was no difference in survival rate between Bcl-2 positive and Bcl-2 negative patients who received the VA combination regimen.
Patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) face a significant risk of long-term major adverse cardiovascular events (MACEs). Accurate early risk stratification is crucial for managing post-PCI MACEs in STEMI patients, as highlighted in clinical guidelines. Existing risk scoring systems, including the Age, Creatinine, and Ejection Fraction (ACEF) score, Thrombolysis in Myocardial Infarction (TIMI) score, Zwolle score, Primary Angioplasty in Myocardial Infarction (PAMI) score, and Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) score, vary in their predictive utility for the long-term prognosis post-PCI in STEMI patients.
This study aims to analyze the risk factors for long-term MACEs post-PCI in STEMI patients in China and compare the predictive value of the commonly used ACEF, TIMI, Zwolle, PAMI, and CADILLAC risk scoring systems.
A retrospective cohort of 687 STEMI patients who underwent their first PCI between June 2016 and June 2020 at Gansu Provincial Hospital was selected. Patient demographics, laboratory, and imaging results were collected, and risk scores were assigned using the ACEF, TIMI, Zwolle, PAMI, and CADILLAC systems. Patients were followed up annually via phone or clinic visits until August 2023, with a focus on the occurrence of MACEs. Multivariable Logistic regression analysis was used to explore the factors influencing the occurrence of MACEs post-PCI. Receiver operating characteristic (ROC) curves for the different risk scoring systems were plotted, and their areas under the curve (AUC) were compared using the DeLong test.
Out of the 687 patients who underwent PCI, 44 were excluded due to incomplete data, leaving 643 for analysis. The median follow-up period was 37 (range 25-49) months. By the end of the follow-up, 134 patients had experienced MACEs, representing a 20.8% incidence rate. The MACEs group differed significantly from the non-MACEs group in terms of age, hospital stay duration, Killip class, N-terminal pro b-type natriuretic peptide, fibrinogen, anemia, left ventricular ejection fraction, estimated glomerular filtration rate, and creatinine levels (P<0.05). Multivariable Logistic regression revealed prolonged hospital stay (OR=1.071, 95%CI=1.012-1.134, P=0.018), elevated creatinine (OR=1.018, 95%CI=1.006-1.030, P=0.003), and increased fibrinogen (OR=1.226, 95%CI=1.066-1.409, P=0.004) as risk factors for MACEs, while higher left ventricular ejection fraction (OR=0.980, 95%CI=0.960-1.000, P=0.045), mild (OR=0.377, 95%CI=0.151-0.938, P=0.036), and moderate regurgitation (OR=0.164, 95%CI=0.051-0.522, P=0.002) were protective. The ACEF, TIMI, Zwolle, PAMI, and CADILLAC scores were significantly higher in the MACEs group (P<0.05). The ROC curves for predicting MACEs post-PCI in STEMI patients showed no significant differences among the five risk scoring systems (P>0.05) .
Hospital stay duration, creatinine levels, fibrinogen, left ventricular ejection fraction, and valvular regurgitation status are significant factors affecting the occurrence of long-term MACEs post-PCI in STEMI patients. While all five risk scoring systems—ACEF, TIMI, Zwolle, PAMI, and CADILLAC—can predict the occurrence of long-term MACEs in these patients, the CADILLAC score is recommended for its distinctiveness and sensitivity.
Diabetic foot (DF) is one of the most serious chronic complications in patients with diabetes. There is an incidence of DF of 15% in China, with a poor prognosis, an amputation rate of 22%, and a mortality rate of 11%, which greatly reduces the quality of life and life expectancy of patients with DF. DF wound healing may benefit from vitamin D, however, sufficient clinical studies are lacking to confirm this claim.
To explore the correlation between serum 25 (OH) D3 and DF wound healing.
A nested case-control study method was used to select DF patients with Wagner grading 2-4 who were hospitalized in the Affiliated Hospital of Zunyi Medical University from 2020 to 2021. The patients were discharged from the hospital and followed up for 3 months, and 55 patients whose DF wounds still had not healed were selected as the case group. As the control group, 110 patients whose DF wounds healed within 3 months of discharge were matched 1∶2 according to their age, gender, and Wagner grade with the patients in the case group. In the early stages of treatment, 2 mL of venous blood was obtained and serum 25 (OH) D3 levels were determined before vitamin D supplementation. Detailed basic data, biochemical and imaging indices of the patients were collected, including general demographics (age, gender, place of residence, education), BMI, diabetes duration and family history, hospitalization duration, lifestyle habits (alcohol consumption, smoking status), history of hypertension and Wagner classification. The biochemical parameters included 25 (OH) D3, glycosylated hemoglobin (HbA1c), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). An MRI was performed to determine if the patient had osteomyelitis. Logistic regression was used to analyze the relationship between different 25 (OH) D3 levels and DF wound healing.
The duration of diabetes in the case group was longer than that in the control group (P<0.001), the proportion of patients with a family history of diabetes was less than that in the control group (P=0.046), and the serum 25 (OH) D3 levels was lower than that in the control group (P<0.001) ; There was a statistically significant difference in the comparison of smoking status between the patients in the case group and the control group (P<0.001). Comparison of age, gender, residence, BMI, length of hospital stay, education level, alcohol consumption, proportion of patients with a history of hypertension, Wagner grade, incidence of osteomyelitis, HbA1c, ESR, and CRP between the two groups showed no statistically significant difference (P>0.05). Once age, gender, place of residence, education, BMI, alcohol consumption, smoking, history of hypertension, family history of diabetes mellitus, diabetes duration, length of hospitalization, Wagner grade, osteomyelitis, HbA1c, ESR, and CRP have corrected for, patients with serum 25 (OH) D3 levels of 20 to <30 ng/mL, 10 to <20 ng/mL, and <10 ng/ mL, the risk of diabetic foot wound non-healing was 1.30 times (95%CI=1.12 to 1.63), 2.01 times (95%CI=1.55 to 2.80) and 2.29 times (95%CI=1.66 to 3.92) higher than that of patients with serum 25 (OH) D3 levels≥30 ng/mL, respectively.
Serum 25 (OH) D3 levels <30 ng/mL is an independent risk factor for DF wound nonhealing.
