BACKGROUND Emphysematous pyelonephritis(EPN)is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection,predominantly affecting diabetic and immunocomp...BACKGROUND Emphysematous pyelonephritis(EPN)is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection,predominantly affecting diabetic and immunocompromised patients.It carries high morbidity and mortality,requiring early diagnosis and timely intervention.Various prognostic scoring systems help in triaging critically ill patients.The National Early Warning Score 2(NEWS 2)scoring system is a widely used physiological assessment tool that evaluates clinical deterioration based on vital parameters,but its standard form lacks specificity for risk stratification in EPN,necessitating modifications to improve treatment decisionmaking and prognostic accuracy in this critical condition.AIM To highlight the need to modify the NEWS 2 score to enable more intense monitoring and better treatment outcomes.METHODS This prospective study was done on all EPN patients admitted to our hospital over the past 12 years.A weighted average risk-stratification index was calculated for each of the three groups,mortality risk was calculated for each of the NEWS 2 scores,and the need for intervention for each of the three groups was calculated.The NEWS 2 score was subsequently modified with 0-6,7-14 and 15-20 scores included in groups 1,2 and 3,respectively.RESULTS A total of 171 patients with EPN were included in the study,with a predominant association with diabetes(90.6%)and a female-to-male ratio of 1.5:1.The combined prognostic scoring of the three groups was 10.7,13.0,and 21.9,respectively(P<0.01).All patients managed conservatively belonged to group 1(P<0.01).Eight patients underwent early nephrectomy,with six from group 3(P<0.01).Overall mortality was 8(4.7%),with seven from group 3(87.5%).The cutoff NEWS 2 score for mortality was identified to be 15,with a sensitivity of 87.5%,specificity of 96.9%,and an overall accuracy rate of 96.5%.The area under the curve to predict mortality based on the NEWS 2 score was 0.98,with a confidence interval of(0.97,1.0)and P<0.001.CONCLUSION Modified NEWS 2(mNEWS 2)score dramatically aids in the appropriate assessment of treatment-related outcomes.MNEWS 2 scores should become the practice standard to reduce the morbidity and mortality associated with this dreaded illness.展开更多
Emphysematous pyelonephritis(EPN)is a severe,a lethal necrotizing upper urinary tract infection,characterized by gas production within the renal pa-renchyma,collecting system,or perinephric tissue.EPN is emerging as a...Emphysematous pyelonephritis(EPN)is a severe,a lethal necrotizing upper urinary tract infection,characterized by gas production within the renal pa-renchyma,collecting system,or perinephric tissue.EPN is emerging as a sig-nificant concern,necessitating early diagnosis,severity assessment,and timely intervention to improve outcomes.This study proposes a modified National Early Warning Score 2(mNEWS 2)to enhance risk stratification and predictive accuracy in EPN management.The mNEWS 2 refines the original NEWS 2 system,which aggregates 6 physiological indicators(body temperature,systolic blood pressure,pulse rate,oxygen saturation,breathing rate,and degree of consciousness),by incorporating weighted risk stratification indices and specific cutoff values derived from clinical observations,statistical modeling,and predictive per-formance analysis.A pilot study identified optimal thresholds,with a score of 15 maximizing predictive performance for mortality risk and intervention needs,validated through receiver operating characteristic curve analysis.So,the mNEWS 2 score represents a significant advancement in EPN management,offering improved risk stratification and treatment outcomes.展开更多
BACKGROUND The relationship between low physical activity and cognitive impairment in type 2 diabetes mellitus(T2DM)patients remains unclear.AIM To explore this association and identify risk factors for cognitive impa...BACKGROUND The relationship between low physical activity and cognitive impairment in type 2 diabetes mellitus(T2DM)patients remains unclear.AIM To explore this association and identify risk factors for cognitive impairment in elderly T2DM patients.METHODS A retrospective analysis was conducted on 245 elderly T2DM patients treated at Xuanwu Hospital,Beijing,in 2023.Patients were categorized into low physical activity(n=126)and non-low physical activity(n=119)groups.After propensity score matching(PSM)of 100 pairs,univariate and binary logistic regression analyses identified risk factors for cognitive impairment.A predictive model was constructed and evaluated using receiver operating characteristic curve analysis.RESULTS Before PSM,the percentage of cognitive impairment was higher in the low physical activity group(P<0.05),but after PSM,this difference was not signi-ficant(P>0.05).Additionally,on regression analyses after PSM,age,occupation type,history of stroke,malnutrition,and frailty remained independent factors associated with cognitive impairment,while low physical activity did not.The constructed risk prediction model for cognitive impairment in elderly T2DM patients exhibited an area under the curve of 0.77.CONCLUSION Low physical activity was not associated with cognitive impairment in our study population.Some results differed before and after PSM analysis,indicating that PSM supports objective assessment of risk factors by controlling for selection bias and confounding factors related to population characteristics.The constructed cognitive risk model insight for the development of a clinical tool for early prevention of cognitive impairment in elderly patients.展开更多
BACKGROUND Cardiovascular disease represents a major complication in patients with type 2 diabetes mellitus(T2DM),with insulin resistance(IR)recognized as a key underlying pathophysiological mechanism.The metabolic sc...BACKGROUND Cardiovascular disease represents a major complication in patients with type 2 diabetes mellitus(T2DM),with insulin resistance(IR)recognized as a key underlying pathophysiological mechanism.The metabolic score for IR(METS-IR),a simple,non-invasive,and insulin-independent surrogate marker of IR,has been validated for risk stratification and prognostic assessment in conditions such as hypertension,ischemic cardiomyopathy,and T2DM.Monitoring fluctuations in METS-IR levels among individuals with T2DM may facilitate early identification of elevated cardiovascular risk and inform timely therapeutic adjustments.AIM To investigate the association between METS-IR and cardiovascular risk in patients with T2DM and to evaluate its potential utility as a predictive biomarker.METHODS This study represents a secondary analysis of a multicenter randomized controlled trial,ultimately including 10191 patients with T2DM aged 40 years to 79 years,with a follow-up duration of approximately 10 years.Baseline METS-IR was calculated using triglycerides,body mass index,high-density lipoprotein cholesterol and fasting plasma glucose.The predictive value of METS-IR for major adverse cardiovascular events(MACEs),all-cause mortality,congestive heart failure,and major coronary heart disease events,was assessed using Cox proportional hazards models,restricted cubic spline analysis,and stratified subgroup analyses.Multivariable adjustments were performed to account for potential confounding factors.RESULTS The incidence of MACEs increased steadily across higher METS-IR quartiles.After adjusting for multiple confounding factors,hazard ratios comparing the highest to the lowest METS-IR quartile were 1.25[95%confidence interval(CI):1.08-1.45]for MACEs,1.55(95%CI:1.23-1.96)for cardiovascular death,1.39(95%CI:1.21-1.59)for allcause mortality,2.22(95%CI:1.74-2.82)for congestive heart failure,and 1.35(95%CI:1.17-1.56)for major coronary heart disease.Restricted cubic spline analysis supported a positive,dose-dependent relationship between rising METS-IR levels and cardiovascular risk.Moreover,adding METS-IR to conventional risk prediction models enhanced their performance,as evidenced by improvements in the C-statistic,net reclassification improvement,and integrated discrimination improvement.Subgroup analyses indicated possible interactions between METS-IR,hemoglobin A1c levels,and aspirin therapy.CONCLUSION METS-IR shows a strong correlation with cardiovascular risk in individuals with T2DM.Tracking METS-IR levels could enhance risk assessment and the prediction of cardiovascular events.展开更多
BACKGROUND Diabetic retinopathy(DR)is the leading cause of blindness among working-age adults,with an increasing prevalence due to the global burden of diabetes.AIM To develop a polygenic risk score(PRS)to identify hi...BACKGROUND Diabetic retinopathy(DR)is the leading cause of blindness among working-age adults,with an increasing prevalence due to the global burden of diabetes.AIM To develop a polygenic risk score(PRS)to identify high-risk groups for DR and evaluate its severity in patients with type 2 diabetes(T2D).METHODS This population-based study included 13335 patients with T2D,comprising 7295 patients with DR and 6040 without DR.Genetic data,duration of DR diagnosis,body mass index,systolic blood pressure,diastolic blood pressure,and glycated hemoglobin A1c levels were obtained from the study population.The PRS was constructed from a genome-wide association study conducted in a Taiwan region of China Han population.Electronic medical records were used to track patients with T2D and analyze the associations between PRS,timing of DR diagnosis,and therapeutic interventions.The hazard ratio(HR)of PRS for DR development and severity was estimated using multivariate Cox proportional hazards regression.RESULTS The results demonstrated that patients with T2D in the top PRS decile had a 1.21-fold greater risk of developing DR[HR=1.21;95%confidence interval(CI):1.01-1.45;P=0.041]over a 20-year follow-up period.Among patients with DR,those in the highest PRS decile exhibited a 4.81-fold increased risk of requiring more than four laser treatments(HR=4.81;95%CI:1.40-16.5;P=0.012)and a 1.38-fold increased risk of undergoing vitreoretinal surgery(HR=1.38;95%CI:1.01-1.90;P=0.044).CONCLUSION Patients with T2D with a higher PRS are at increased risk of developing DR and may experience more severe forms of the disease.展开更多
BACKGROUND There are limited studies on diabetes empowerment among type 2 diabetes patients,particularly in the primary care setting.AIM To assess the diabetes empowerment scores and its correlated factors among type ...BACKGROUND There are limited studies on diabetes empowerment among type 2 diabetes patients,particularly in the primary care setting.AIM To assess the diabetes empowerment scores and its correlated factors among type 2 diabetes patients in a primary care clinic in Malaysia.METHODS This is a cross sectional study involving 322 patients with type 2 diabetes mellitus(DM)followed up in a primary care clinic.Systematic sampling method was used for patient recruitment.The Diabetes Empowerment Scale(DES)questionnaire was used to measure patient empowerment.It consists of three domains:(1)Managing the psychosocial aspect of diabetes(9 items);(2)Assessing dissatisfaction and readiness to change(9 items);and(3)Setting and achieving diabetes goal(10 items).A score was considered high if it ranged from 100 to 140.Data analysis was performed using SPSS version 25 and multiple linear regressions was used to identify the predictors of total diabetes empowerment scores.RESULTS The median age of the study population was 55 years old.56%were male and the mean duration of diabetes was 4 years.The total median score of the DES was 110[interquartile range(IQR)=10].The median scores of the three subscales were 40 with(IQR=4)for"Managing the psychosocial aspect of diabetes";36 with(IQR=3)for"Assessing dissatisfaction and readiness to change";and 34 with(IQR=5)for"Setting and achieving diabetes goal".According to multiple linear regressions,factors that had significant correlation with higher empowerment scores among type 2 diabetes patients included an above secondary education level(P<0.001),diabetes education exposure(P=0.003),lack of ischemic heart disease(P=0.017),and lower glycated hemoglobin(HbA1c)levels(P<0.001).CONCLUSION Diabetes empowerment scores were high among type 2 diabetes patients in this study population.Predictors for high empowerment scores included above secondary education level,diabetes education exposure,lack of ischemic heart disease status and lower HbA1c.展开更多
AIM: To assess the performance of the Finnish Diabetes Risk Score(FINDRISC) questionnaire for detecting and predicting type 2 diabetes mellitus(DM2) in a Colombian population.METHODS: This is a longitudinal observatio...AIM: To assess the performance of the Finnish Diabetes Risk Score(FINDRISC) questionnaire for detecting and predicting type 2 diabetes mellitus(DM2) in a Colombian population.METHODS: This is a longitudinal observational study conducted in Floridablanca, Colombia. Adult subjects(age ≥ 35 years) without known diabetes, were included. A modified version of FINDRISC was completed, and the glycemia values from all the subjects were collected from the hospital's database. Firstly, a cross-sectional analysis was performed and then, the subsample of prediabetic participants was followed for diabetes incidence. RESULTS: A total of 772 subjects were suitable for the study. The overall prevalence of undiagnosed DM2 was 2.59%, and the incidence of DM2 among the prediabetic participants was 7.5 per 100 person-years after a total of 265257 person-years follow-up. The FINDRISC at baseline was significantly associated with undiagnosed and incident DM2. The area under receiver operating characteristics curve of the FINDRISC score for detecting undiagnosed DM2 in both men and women was 0.7477 and 0.7175, respectively; and for predicting the incidence of DM2 among prediabetics was 71.99% in men and 67.74% in women. CONCLUSION: The FINDRISC questionnaire is a useful screening tool to identify cross-sectionally unknown DM2 and to predict the incidence of DM2 among prediabetics in the Colombian population.展开更多
Background Previous studies have demonstrated that micro RNA-204(mi R-204) is involved in atherosclerosis and vascular calcification. However, the value of mi R-204 as the predictive biomarker for cardiovascular disea...Background Previous studies have demonstrated that micro RNA-204(mi R-204) is involved in atherosclerosis and vascular calcification. However, the value of mi R-204 as the predictive biomarker for cardiovascular disease(CVD) remains unclear. We aimed to evaluate the association between the circulating mi R-204 level and ten-year CVD risk based on the Framingham risk score(FRS). Methods In this retrospective study, we enrolled 194 consecutive patients with type 2 diabetes mellitus(T2DM) without CVD in Beijing Anzhen Hospital between January 2015 and September 2016. We used the FRS to evaluate the risk of CVD for each patient. Circulating mi R-204 levels were measured by quantitative real-time polymerase chain reaction. Results Circulating mi R-204 levels were significantly lower in the group of patients(0.49 ± 0.13) at high risk of CVD(FRS > 20%) than in the low(FRS < 10%) and intermediate(FRS: 10%–20%) risk groups(0.87 ± 0.19 and 0.75 ± 0.25, respectively;P < 0.001). FRS was negatively correlated with mi R-204 levels(r =-0.421, P < 0.001). According to multivariate logistic analyses, reduced mi R-204 level was independently associated with an increased risk of CVD after adjusting for conventional risk factors(OR = 0.876, 95% CI: 0.807–0.950, P = 0.001). Receiver-operating characteristic curve analysis showed that the circulating mi R-204 level can predict the high risk of CVD with higher specificity than the traditional risk factor of high systolic blood pressure or the protective factor of high-density lipoprotein cholesterol. Conclusions Our study demonstrated that patients with lower circulating mi R-204 levels were at high risk for CVD. After adjustment for potential confounders, mi R-204 was independently associated with CVD in patients with T2DM.展开更多
AIM: To study clinical and histopathological features of nonalcoholic fatty liver disease(NAFLD) in patients with and without type 2 diabetes mellitus(T2DM) using updated nonalcoholic steatohepatitis clinical research...AIM: To study clinical and histopathological features of nonalcoholic fatty liver disease(NAFLD) in patients with and without type 2 diabetes mellitus(T2DM) using updated nonalcoholic steatohepatitis clinical research network(NASH-CRN) grading system.METHODS: We retrospectively analyzed data of 235 patients with biopsy proven NAFLD with and without T2 DM.This database was utilized in the previously published study comparing ethnicity outcomes in NAFLD by the same corresponding author.The pathology database from University of Chicago was utilized for enrolling consecutive patients who met the criteria for NAFLD and their detailed clinical and histopathology findings were obtained for comparison.The relevant clinical profile of patients was collected from the Electronic Medical Records around the time of liver biopsy and the histology was read by a single well-trained histopathologist.The updated criteria for type 2 diabetes have been utilized for analysis.Background data of patients with NASH and NAFLD has been included.The mean differences were compared using χ2 and t-test along with regression analysis to evaluate the predictors of NASH and advanced fibrosis.RESULTS: Patients with NAFLD and T2 DM were significantly older(49.9 vs 43.0,P < 0.01),predominantly female(71.4 vs 56.3,P < 0.02),had higher rate of metabolic syndrome(88.7 vs 36.4,P < 0.01),had significantly higher aspartate transaminase(AST)/alanine transaminase(ALT) ratio(0.94 vs 0.78,P < 0.01) and Fib-4 index(1.65 vs 1.06,P < 0.01) as markers of NASH,showed higher mean NAFLD activity score(3.5 vs 3.0,P = 0.03) and higher mean fibrosis score(1.2 vs 0.52,P < 0.01) compared to patients with NAFLD without T2 DM.Furthermore,advanced fibrosis(32.5 vs 12.0,P < 0.01) and ballooning(27.3 vs 13.3,P < 0.01) was significantly higher among patients with NAFLD and T2 DM compared to patients with NAFLD without T2 DM.On multivariate analysis,T2 DM was independently associated with NASH(OR = 3.27,95%CI: 1.43-7.50,P < 0.01) and advanced fibrosis(OR = 3.45,95%CI: 1.53-7.77,P < 0.01) in all patients with NAFLD.There was a higher rate of T2DM(38.1 vs 19.4,P < 0.01) and cirrhosis(8.3 vs 0.0,P = 0.01) along with significantly higher mean Bilirubin(0.71 vs 0.56,P = 0.01) and AST(54.2 vs 38.3,P < 0.01) and ALT(78.7 vs 57.0,P = 0.01) level among patients with NASH when compared to patients with steatosis alone.The mean platelet count(247 vs 283,P < 0.01) and high-density lipoprotein cholesterol level(42.7 vs 48.1,P = 0.01) was lower among patients with NASH compared to patients with steatosis.CONCLUSION: Patients with NAFLD and T2 DM tend to have more advanced stages of NAFLD,particularly advanced fibrosis and higher rate of ballooning than patients with NAFLD without T2 DM.展开更多
目的探讨乙醛脱氢酶2(aldehyde dehydrogenase 2,ALDH2)基因型多态性与急性缺血性脑卒中严重程度的关系。方法选取2022年3月至2023年9月于北京市昌平区医院神经内科住院的224例急性缺血性脑卒中患者作为研究对象,所有患者均行ALDH2基因...目的探讨乙醛脱氢酶2(aldehyde dehydrogenase 2,ALDH2)基因型多态性与急性缺血性脑卒中严重程度的关系。方法选取2022年3月至2023年9月于北京市昌平区医院神经内科住院的224例急性缺血性脑卒中患者作为研究对象,所有患者均行ALDH2基因型检测,根据检测结果分为GG组(n=136)与GA/AA组(n=88),GG组基因型为野生型(ALDH2*1/*1),GA/AA组基因型为基因突变杂合子型(ALDH2*1/*2)与纯合子型(ALDH2*2/*2)。比较两组临床资料Alberta卒中操作早期急性卒中分级CT(Alberta stroke program early CT score,ASPECT)评分、美国国立研究院卒中量表(National Institutes of Health Stroke scale,NIHSS)评分及Barthel指数(Barthel index,BI)。结果两组性别、年龄、体重指数、同型半胱氨酸、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇及高血压病史、吸烟史、饮酒史占比比较差异均无统计学意义。GG组ASPECT评分、BI均高于GA/AA组,NIHSS评分低于GA/AA组,差异有统计学意义(P<0.05)。结论ALDH2基因型与急性缺血性脑卒中严重程度有关,ALDH2基因突变型患者急性缺血性脑卒中严重程度更严重。展开更多
Objective:To determine the predictive value of P2/MS in patients with chronic HBV-related cirrhosis, and to predict high-risk esophageal varices, and obtain a cut-off value.Methods:A total of 412 patients with HBV-rel...Objective:To determine the predictive value of P2/MS in patients with chronic HBV-related cirrhosis, and to predict high-risk esophageal varices, and obtain a cut-off value.Methods:A total of 412 patients with HBV-related cirrhosis who were admitted to our hospital between August 2014 and August 2017 were retrospectively evaluated. A diagnosis of cirrhosis was made with standard laboratory, radiological and physical examination findings. According to these evaluations, esophageal varices were classified as small, medium and large. For all obtained data, P2/MS was calculated. Two threshold values (P2/MS<11 and P2/MS>25) were considered in predicting the presence of high-risk EVs during recording. And the optimal cut-off value of the P2/MS index was determined for high-risk esophageal varices in patients with chronic viral hepatitis B.Results:A total of 375 patients who met the inclusion criteria were included in the study. When the P2/MS index was compared with other noninvasive tests, the mean and median P2/MS scores were respectively 54.17 and 33.25. The P2/MS value of the patients without esophageal varices was higher than that of the patients with esophageal varices. When these results were evaluated, the higher the score, the lower the risk of varices. We obtained a positive predictive value of 93.80% [95%CI(80.20-98.70)] when the cut-off value of P2/MS was taken as <11, and obtained a negative predictive value of 94.30% [95%CI(86.20-98.20%)] when the cut-off value of P2/MS was taken as >25.Conclusions:We could predict the patients with high-risk esophageal varices within this group at a extremely good rate. We also compared the results of this test with other non-invasive tests and achieved successful results. We have shown that P2/MS can be used in order to optimally select patients for endoscopic screening and prevent all of the expensive and unnecessary procedures safely.展开更多
Objective: To develop and validate a prognostic scoring scheme for the prediction of microalbuminuria in type 2 diabetic patients of Thai descent. Methods: The clinical information from type 2 diabetic patients who we...Objective: To develop and validate a prognostic scoring scheme for the prediction of microalbuminuria in type 2 diabetic patients of Thai descent. Methods: The clinical information from type 2 diabetic patients who were treated at community hospitals was used to develop a prediction model (derivation set). The model evaluated at a tertiary hospital (validation set). A stepwise logistic regression model was used to identify the independent risk variables from the derivation set and a simple point scoring system was derived from the beta-coefficients. The risk scoring scheme was validated by the validation set. Results: The risk scoring scheme is based on six risk predictors: the duration of diabetes, age at the onset of diabetes, systolic blood pressure, low density lipoprotein levels, creatinine levels, and alcohol consumption. The total score ranged from 0 to 11.5. The likelihood of microalbuminuria in patients with low risk (scores ≤ 2) was 0.28, with moderate risk (scores 2.5 to 5.5) was 0.86, and high risk (scores ≥ 6) was 7.36. The area under the ROC curve of the derivation set and validation set were 0.768 (95% CI 0.73 - 0.81) and 0.758 (95% CI 0.70 - 0.80), respectively. Conclusion: Our scoring system is a simple and reasonably accurate method for predicting the future presence of microalbuminuria in type 2 diabetic patients.展开更多
Initially developed to predict stroke probability in patientswith atrial fibrillation （AF）,t1~1 CHADS2 and CHA2DS2VASCscores are used to predict different outcomes in cardiac pa-tients in both acute and chronic cond...Initially developed to predict stroke probability in patientswith atrial fibrillation （AF）,t1~1 CHADS2 and CHA2DS2VASCscores are used to predict different outcomes in cardiac pa-tients in both acute and chronic conditions. Thescores were also demonstrated to correlate with mortal-ity. AF also has been associated with mortality indifferent groups of patients, including elderly.展开更多
文摘BACKGROUND Emphysematous pyelonephritis(EPN)is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection,predominantly affecting diabetic and immunocompromised patients.It carries high morbidity and mortality,requiring early diagnosis and timely intervention.Various prognostic scoring systems help in triaging critically ill patients.The National Early Warning Score 2(NEWS 2)scoring system is a widely used physiological assessment tool that evaluates clinical deterioration based on vital parameters,but its standard form lacks specificity for risk stratification in EPN,necessitating modifications to improve treatment decisionmaking and prognostic accuracy in this critical condition.AIM To highlight the need to modify the NEWS 2 score to enable more intense monitoring and better treatment outcomes.METHODS This prospective study was done on all EPN patients admitted to our hospital over the past 12 years.A weighted average risk-stratification index was calculated for each of the three groups,mortality risk was calculated for each of the NEWS 2 scores,and the need for intervention for each of the three groups was calculated.The NEWS 2 score was subsequently modified with 0-6,7-14 and 15-20 scores included in groups 1,2 and 3,respectively.RESULTS A total of 171 patients with EPN were included in the study,with a predominant association with diabetes(90.6%)and a female-to-male ratio of 1.5:1.The combined prognostic scoring of the three groups was 10.7,13.0,and 21.9,respectively(P<0.01).All patients managed conservatively belonged to group 1(P<0.01).Eight patients underwent early nephrectomy,with six from group 3(P<0.01).Overall mortality was 8(4.7%),with seven from group 3(87.5%).The cutoff NEWS 2 score for mortality was identified to be 15,with a sensitivity of 87.5%,specificity of 96.9%,and an overall accuracy rate of 96.5%.The area under the curve to predict mortality based on the NEWS 2 score was 0.98,with a confidence interval of(0.97,1.0)and P<0.001.CONCLUSION Modified NEWS 2(mNEWS 2)score dramatically aids in the appropriate assessment of treatment-related outcomes.MNEWS 2 scores should become the practice standard to reduce the morbidity and mortality associated with this dreaded illness.
文摘Emphysematous pyelonephritis(EPN)is a severe,a lethal necrotizing upper urinary tract infection,characterized by gas production within the renal pa-renchyma,collecting system,or perinephric tissue.EPN is emerging as a sig-nificant concern,necessitating early diagnosis,severity assessment,and timely intervention to improve outcomes.This study proposes a modified National Early Warning Score 2(mNEWS 2)to enhance risk stratification and predictive accuracy in EPN management.The mNEWS 2 refines the original NEWS 2 system,which aggregates 6 physiological indicators(body temperature,systolic blood pressure,pulse rate,oxygen saturation,breathing rate,and degree of consciousness),by incorporating weighted risk stratification indices and specific cutoff values derived from clinical observations,statistical modeling,and predictive per-formance analysis.A pilot study identified optimal thresholds,with a score of 15 maximizing predictive performance for mortality risk and intervention needs,validated through receiver operating characteristic curve analysis.So,the mNEWS 2 score represents a significant advancement in EPN management,offering improved risk stratification and treatment outcomes.
基金Supported by The Capital Funds for Health Improvement and Research,No.2024-2-1033The Beijing Municipal Administration of Hospitals Incubating Program,No.PX2022032+1 种基金Post-subsidy Fund from the National Clinical Research Center,the Ministry of Science and Technology of China,No.303-01-001-0272-08The Beijing Municipal Public Welfare Development and Reform Pilot Project for Medical Research Institutes,No.JYY2023-13.
文摘BACKGROUND The relationship between low physical activity and cognitive impairment in type 2 diabetes mellitus(T2DM)patients remains unclear.AIM To explore this association and identify risk factors for cognitive impairment in elderly T2DM patients.METHODS A retrospective analysis was conducted on 245 elderly T2DM patients treated at Xuanwu Hospital,Beijing,in 2023.Patients were categorized into low physical activity(n=126)and non-low physical activity(n=119)groups.After propensity score matching(PSM)of 100 pairs,univariate and binary logistic regression analyses identified risk factors for cognitive impairment.A predictive model was constructed and evaluated using receiver operating characteristic curve analysis.RESULTS Before PSM,the percentage of cognitive impairment was higher in the low physical activity group(P<0.05),but after PSM,this difference was not signi-ficant(P>0.05).Additionally,on regression analyses after PSM,age,occupation type,history of stroke,malnutrition,and frailty remained independent factors associated with cognitive impairment,while low physical activity did not.The constructed risk prediction model for cognitive impairment in elderly T2DM patients exhibited an area under the curve of 0.77.CONCLUSION Low physical activity was not associated with cognitive impairment in our study population.Some results differed before and after PSM analysis,indicating that PSM supports objective assessment of risk factors by controlling for selection bias and confounding factors related to population characteristics.The constructed cognitive risk model insight for the development of a clinical tool for early prevention of cognitive impairment in elderly patients.
基金Supported by the Key Research and Development Plan of Hunan Province,No.2022SK2013Central South University,No.2024ZZTS0931.
文摘BACKGROUND Cardiovascular disease represents a major complication in patients with type 2 diabetes mellitus(T2DM),with insulin resistance(IR)recognized as a key underlying pathophysiological mechanism.The metabolic score for IR(METS-IR),a simple,non-invasive,and insulin-independent surrogate marker of IR,has been validated for risk stratification and prognostic assessment in conditions such as hypertension,ischemic cardiomyopathy,and T2DM.Monitoring fluctuations in METS-IR levels among individuals with T2DM may facilitate early identification of elevated cardiovascular risk and inform timely therapeutic adjustments.AIM To investigate the association between METS-IR and cardiovascular risk in patients with T2DM and to evaluate its potential utility as a predictive biomarker.METHODS This study represents a secondary analysis of a multicenter randomized controlled trial,ultimately including 10191 patients with T2DM aged 40 years to 79 years,with a follow-up duration of approximately 10 years.Baseline METS-IR was calculated using triglycerides,body mass index,high-density lipoprotein cholesterol and fasting plasma glucose.The predictive value of METS-IR for major adverse cardiovascular events(MACEs),all-cause mortality,congestive heart failure,and major coronary heart disease events,was assessed using Cox proportional hazards models,restricted cubic spline analysis,and stratified subgroup analyses.Multivariable adjustments were performed to account for potential confounding factors.RESULTS The incidence of MACEs increased steadily across higher METS-IR quartiles.After adjusting for multiple confounding factors,hazard ratios comparing the highest to the lowest METS-IR quartile were 1.25[95%confidence interval(CI):1.08-1.45]for MACEs,1.55(95%CI:1.23-1.96)for cardiovascular death,1.39(95%CI:1.21-1.59)for allcause mortality,2.22(95%CI:1.74-2.82)for congestive heart failure,and 1.35(95%CI:1.17-1.56)for major coronary heart disease.Restricted cubic spline analysis supported a positive,dose-dependent relationship between rising METS-IR levels and cardiovascular risk.Moreover,adding METS-IR to conventional risk prediction models enhanced their performance,as evidenced by improvements in the C-statistic,net reclassification improvement,and integrated discrimination improvement.Subgroup analyses indicated possible interactions between METS-IR,hemoglobin A1c levels,and aspirin therapy.CONCLUSION METS-IR shows a strong correlation with cardiovascular risk in individuals with T2DM.Tracking METS-IR levels could enhance risk assessment and the prediction of cardiovascular events.
基金Supported by China Medical University Hospital,No.DMR-113-105.
文摘BACKGROUND Diabetic retinopathy(DR)is the leading cause of blindness among working-age adults,with an increasing prevalence due to the global burden of diabetes.AIM To develop a polygenic risk score(PRS)to identify high-risk groups for DR and evaluate its severity in patients with type 2 diabetes(T2D).METHODS This population-based study included 13335 patients with T2D,comprising 7295 patients with DR and 6040 without DR.Genetic data,duration of DR diagnosis,body mass index,systolic blood pressure,diastolic blood pressure,and glycated hemoglobin A1c levels were obtained from the study population.The PRS was constructed from a genome-wide association study conducted in a Taiwan region of China Han population.Electronic medical records were used to track patients with T2D and analyze the associations between PRS,timing of DR diagnosis,and therapeutic interventions.The hazard ratio(HR)of PRS for DR development and severity was estimated using multivariate Cox proportional hazards regression.RESULTS The results demonstrated that patients with T2D in the top PRS decile had a 1.21-fold greater risk of developing DR[HR=1.21;95%confidence interval(CI):1.01-1.45;P=0.041]over a 20-year follow-up period.Among patients with DR,those in the highest PRS decile exhibited a 4.81-fold increased risk of requiring more than four laser treatments(HR=4.81;95%CI:1.40-16.5;P=0.012)and a 1.38-fold increased risk of undergoing vitreoretinal surgery(HR=1.38;95%CI:1.01-1.90;P=0.044).CONCLUSION Patients with T2D with a higher PRS are at increased risk of developing DR and may experience more severe forms of the disease.
基金Supported by research grant from University Putra Malaysia,No.GPIPS/2018/9612600
文摘BACKGROUND There are limited studies on diabetes empowerment among type 2 diabetes patients,particularly in the primary care setting.AIM To assess the diabetes empowerment scores and its correlated factors among type 2 diabetes patients in a primary care clinic in Malaysia.METHODS This is a cross sectional study involving 322 patients with type 2 diabetes mellitus(DM)followed up in a primary care clinic.Systematic sampling method was used for patient recruitment.The Diabetes Empowerment Scale(DES)questionnaire was used to measure patient empowerment.It consists of three domains:(1)Managing the psychosocial aspect of diabetes(9 items);(2)Assessing dissatisfaction and readiness to change(9 items);and(3)Setting and achieving diabetes goal(10 items).A score was considered high if it ranged from 100 to 140.Data analysis was performed using SPSS version 25 and multiple linear regressions was used to identify the predictors of total diabetes empowerment scores.RESULTS The median age of the study population was 55 years old.56%were male and the mean duration of diabetes was 4 years.The total median score of the DES was 110[interquartile range(IQR)=10].The median scores of the three subscales were 40 with(IQR=4)for"Managing the psychosocial aspect of diabetes";36 with(IQR=3)for"Assessing dissatisfaction and readiness to change";and 34 with(IQR=5)for"Setting and achieving diabetes goal".According to multiple linear regressions,factors that had significant correlation with higher empowerment scores among type 2 diabetes patients included an above secondary education level(P<0.001),diabetes education exposure(P=0.003),lack of ischemic heart disease(P=0.017),and lower glycated hemoglobin(HbA1c)levels(P<0.001).CONCLUSION Diabetes empowerment scores were high among type 2 diabetes patients in this study population.Predictors for high empowerment scores included above secondary education level,diabetes education exposure,lack of ischemic heart disease status and lower HbA1c.
基金Supported by The Ophthalmological Foundation of Santander-FOSCAL
文摘AIM: To assess the performance of the Finnish Diabetes Risk Score(FINDRISC) questionnaire for detecting and predicting type 2 diabetes mellitus(DM2) in a Colombian population.METHODS: This is a longitudinal observational study conducted in Floridablanca, Colombia. Adult subjects(age ≥ 35 years) without known diabetes, were included. A modified version of FINDRISC was completed, and the glycemia values from all the subjects were collected from the hospital's database. Firstly, a cross-sectional analysis was performed and then, the subsample of prediabetic participants was followed for diabetes incidence. RESULTS: A total of 772 subjects were suitable for the study. The overall prevalence of undiagnosed DM2 was 2.59%, and the incidence of DM2 among the prediabetic participants was 7.5 per 100 person-years after a total of 265257 person-years follow-up. The FINDRISC at baseline was significantly associated with undiagnosed and incident DM2. The area under receiver operating characteristics curve of the FINDRISC score for detecting undiagnosed DM2 in both men and women was 0.7477 and 0.7175, respectively; and for predicting the incidence of DM2 among prediabetics was 71.99% in men and 67.74% in women. CONCLUSION: The FINDRISC questionnaire is a useful screening tool to identify cross-sectionally unknown DM2 and to predict the incidence of DM2 among prediabetics in the Colombian population.
基金the National Natural Scientific Foundation of China (No. 81573744 & No. 81973841)。
文摘Background Previous studies have demonstrated that micro RNA-204(mi R-204) is involved in atherosclerosis and vascular calcification. However, the value of mi R-204 as the predictive biomarker for cardiovascular disease(CVD) remains unclear. We aimed to evaluate the association between the circulating mi R-204 level and ten-year CVD risk based on the Framingham risk score(FRS). Methods In this retrospective study, we enrolled 194 consecutive patients with type 2 diabetes mellitus(T2DM) without CVD in Beijing Anzhen Hospital between January 2015 and September 2016. We used the FRS to evaluate the risk of CVD for each patient. Circulating mi R-204 levels were measured by quantitative real-time polymerase chain reaction. Results Circulating mi R-204 levels were significantly lower in the group of patients(0.49 ± 0.13) at high risk of CVD(FRS > 20%) than in the low(FRS < 10%) and intermediate(FRS: 10%–20%) risk groups(0.87 ± 0.19 and 0.75 ± 0.25, respectively;P < 0.001). FRS was negatively correlated with mi R-204 levels(r =-0.421, P < 0.001). According to multivariate logistic analyses, reduced mi R-204 level was independently associated with an increased risk of CVD after adjusting for conventional risk factors(OR = 0.876, 95% CI: 0.807–0.950, P = 0.001). Receiver-operating characteristic curve analysis showed that the circulating mi R-204 level can predict the high risk of CVD with higher specificity than the traditional risk factor of high systolic blood pressure or the protective factor of high-density lipoprotein cholesterol. Conclusions Our study demonstrated that patients with lower circulating mi R-204 levels were at high risk for CVD. After adjustment for potential confounders, mi R-204 was independently associated with CVD in patients with T2DM.
文摘AIM: To study clinical and histopathological features of nonalcoholic fatty liver disease(NAFLD) in patients with and without type 2 diabetes mellitus(T2DM) using updated nonalcoholic steatohepatitis clinical research network(NASH-CRN) grading system.METHODS: We retrospectively analyzed data of 235 patients with biopsy proven NAFLD with and without T2 DM.This database was utilized in the previously published study comparing ethnicity outcomes in NAFLD by the same corresponding author.The pathology database from University of Chicago was utilized for enrolling consecutive patients who met the criteria for NAFLD and their detailed clinical and histopathology findings were obtained for comparison.The relevant clinical profile of patients was collected from the Electronic Medical Records around the time of liver biopsy and the histology was read by a single well-trained histopathologist.The updated criteria for type 2 diabetes have been utilized for analysis.Background data of patients with NASH and NAFLD has been included.The mean differences were compared using χ2 and t-test along with regression analysis to evaluate the predictors of NASH and advanced fibrosis.RESULTS: Patients with NAFLD and T2 DM were significantly older(49.9 vs 43.0,P < 0.01),predominantly female(71.4 vs 56.3,P < 0.02),had higher rate of metabolic syndrome(88.7 vs 36.4,P < 0.01),had significantly higher aspartate transaminase(AST)/alanine transaminase(ALT) ratio(0.94 vs 0.78,P < 0.01) and Fib-4 index(1.65 vs 1.06,P < 0.01) as markers of NASH,showed higher mean NAFLD activity score(3.5 vs 3.0,P = 0.03) and higher mean fibrosis score(1.2 vs 0.52,P < 0.01) compared to patients with NAFLD without T2 DM.Furthermore,advanced fibrosis(32.5 vs 12.0,P < 0.01) and ballooning(27.3 vs 13.3,P < 0.01) was significantly higher among patients with NAFLD and T2 DM compared to patients with NAFLD without T2 DM.On multivariate analysis,T2 DM was independently associated with NASH(OR = 3.27,95%CI: 1.43-7.50,P < 0.01) and advanced fibrosis(OR = 3.45,95%CI: 1.53-7.77,P < 0.01) in all patients with NAFLD.There was a higher rate of T2DM(38.1 vs 19.4,P < 0.01) and cirrhosis(8.3 vs 0.0,P = 0.01) along with significantly higher mean Bilirubin(0.71 vs 0.56,P = 0.01) and AST(54.2 vs 38.3,P < 0.01) and ALT(78.7 vs 57.0,P = 0.01) level among patients with NASH when compared to patients with steatosis alone.The mean platelet count(247 vs 283,P < 0.01) and high-density lipoprotein cholesterol level(42.7 vs 48.1,P = 0.01) was lower among patients with NASH compared to patients with steatosis.CONCLUSION: Patients with NAFLD and T2 DM tend to have more advanced stages of NAFLD,particularly advanced fibrosis and higher rate of ballooning than patients with NAFLD without T2 DM.
文摘目的探讨乙醛脱氢酶2(aldehyde dehydrogenase 2,ALDH2)基因型多态性与急性缺血性脑卒中严重程度的关系。方法选取2022年3月至2023年9月于北京市昌平区医院神经内科住院的224例急性缺血性脑卒中患者作为研究对象,所有患者均行ALDH2基因型检测,根据检测结果分为GG组(n=136)与GA/AA组(n=88),GG组基因型为野生型(ALDH2*1/*1),GA/AA组基因型为基因突变杂合子型(ALDH2*1/*2)与纯合子型(ALDH2*2/*2)。比较两组临床资料Alberta卒中操作早期急性卒中分级CT(Alberta stroke program early CT score,ASPECT)评分、美国国立研究院卒中量表(National Institutes of Health Stroke scale,NIHSS)评分及Barthel指数(Barthel index,BI)。结果两组性别、年龄、体重指数、同型半胱氨酸、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇及高血压病史、吸烟史、饮酒史占比比较差异均无统计学意义。GG组ASPECT评分、BI均高于GA/AA组,NIHSS评分低于GA/AA组,差异有统计学意义(P<0.05)。结论ALDH2基因型与急性缺血性脑卒中严重程度有关,ALDH2基因突变型患者急性缺血性脑卒中严重程度更严重。
文摘Objective:To determine the predictive value of P2/MS in patients with chronic HBV-related cirrhosis, and to predict high-risk esophageal varices, and obtain a cut-off value.Methods:A total of 412 patients with HBV-related cirrhosis who were admitted to our hospital between August 2014 and August 2017 were retrospectively evaluated. A diagnosis of cirrhosis was made with standard laboratory, radiological and physical examination findings. According to these evaluations, esophageal varices were classified as small, medium and large. For all obtained data, P2/MS was calculated. Two threshold values (P2/MS<11 and P2/MS>25) were considered in predicting the presence of high-risk EVs during recording. And the optimal cut-off value of the P2/MS index was determined for high-risk esophageal varices in patients with chronic viral hepatitis B.Results:A total of 375 patients who met the inclusion criteria were included in the study. When the P2/MS index was compared with other noninvasive tests, the mean and median P2/MS scores were respectively 54.17 and 33.25. The P2/MS value of the patients without esophageal varices was higher than that of the patients with esophageal varices. When these results were evaluated, the higher the score, the lower the risk of varices. We obtained a positive predictive value of 93.80% [95%CI(80.20-98.70)] when the cut-off value of P2/MS was taken as <11, and obtained a negative predictive value of 94.30% [95%CI(86.20-98.20%)] when the cut-off value of P2/MS was taken as >25.Conclusions:We could predict the patients with high-risk esophageal varices within this group at a extremely good rate. We also compared the results of this test with other non-invasive tests and achieved successful results. We have shown that P2/MS can be used in order to optimally select patients for endoscopic screening and prevent all of the expensive and unnecessary procedures safely.
文摘Objective: To develop and validate a prognostic scoring scheme for the prediction of microalbuminuria in type 2 diabetic patients of Thai descent. Methods: The clinical information from type 2 diabetic patients who were treated at community hospitals was used to develop a prediction model (derivation set). The model evaluated at a tertiary hospital (validation set). A stepwise logistic regression model was used to identify the independent risk variables from the derivation set and a simple point scoring system was derived from the beta-coefficients. The risk scoring scheme was validated by the validation set. Results: The risk scoring scheme is based on six risk predictors: the duration of diabetes, age at the onset of diabetes, systolic blood pressure, low density lipoprotein levels, creatinine levels, and alcohol consumption. The total score ranged from 0 to 11.5. The likelihood of microalbuminuria in patients with low risk (scores ≤ 2) was 0.28, with moderate risk (scores 2.5 to 5.5) was 0.86, and high risk (scores ≥ 6) was 7.36. The area under the ROC curve of the derivation set and validation set were 0.768 (95% CI 0.73 - 0.81) and 0.758 (95% CI 0.70 - 0.80), respectively. Conclusion: Our scoring system is a simple and reasonably accurate method for predicting the future presence of microalbuminuria in type 2 diabetic patients.
文摘Initially developed to predict stroke probability in patientswith atrial fibrillation （AF）,t1~1 CHADS2 and CHA2DS2VASCscores are used to predict different outcomes in cardiac pa-tients in both acute and chronic conditions. Thescores were also demonstrated to correlate with mortal-ity. AF also has been associated with mortality indifferent groups of patients, including elderly.
