OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ej...OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ejection fraction(LVEF)level.METHODS We enrolled hospitalized HF patients with AF from China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study.COX proportional hazard regression models were employed to calculate hazard ratio of betablockers.The primary outcome was all-cause death.RESULTS Among 1762 HF patients with AF(756 women[41.4%]),1041(56%)received beta-blockers at discharge and 1272(72.2%)had an LVEF>40%.During one year follow up,all-cause death occurred in 305(17.3%),cardiovascular death occurred in203 patients(11.5%),and rehospitalizations for HF occurred in 622 patients(35.2%).After adjusting for demographic characteristics,social economic status,smoking status,medical history,anthropometric characteristics,and medications used at discharge,the use of beta-blockers at discharge was not associated with all-cause death[hazard ratio(HR):0.86;95%Confidence Interval(CI):0.65-1.12;P=0.256],cardiovascular death(HR:0.76,95%CI:0.52-1.11;P=0.160),or the composite outcome of all-cause death and HF rehospitalization(HR:0.97,95%CI:0.82-1.14;P=0.687)in the entire cohort.There were no significant interactions between use of beta-blockers at discharge and LVEF with respect to all-cause death,cardiovascular death,or composite outcome.In the adjusted models,the use of beta-blockers at discharge was not associated with all-cause death,cardiovascular death,or composite outcome across the different levels of LVEF:reduced(<40%),mid-range(40%-49%),or preserved LVEF(≥50%).CONCLUSION Among HF patients with AF,the use of beta-blockers at discharge was not associated with 1-year clinical outcomes,regardless of LVEF.展开更多
Background:Acute kidney injury(AKI)is primarily defined and classified according to the magnitude of theelevation of serum creatinine(Scr).We aimed to determine whether the duration of AKI adds prognostic valuein addi...Background:Acute kidney injury(AKI)is primarily defined and classified according to the magnitude of theelevation of serum creatinine(Scr).We aimed to determine whether the duration of AKI adds prognostic valuein addition to that obtained from the magnitude of injury alone.Methods:This retrospective study enrolled very elderly inpatients(≥75 years)in the Chinese PLA General Hospitalfrom January 2007 to December 2018.AKI was stratified by magnitude according to KDIGO stage(1,2,and 3)andduration(1–2 days,3–4 days,5–7 days,and>7 days).The primary outcome was the 1-year mortality after AKI.Multivariable Cox regression analysis was performed to identify covariates associated with the 1-year mortality.The probability of survival was estimated using the Kaplan–Meier method,and curves were compared using thelog-rank test.Results:In total,688 patients were enrolled,with the median age was 88(84–91)years,and the majority(652,94.8%)were male.According to the KDIGO criteria,317 patients(46.1%)had Stage 1 AKI,169(24.6%)hadStage 2 AKI,and 202(29.3%)had Stage 3 AKI.Of the 688 study subjects,61(8.9%)with a duration of AKIlasted 1–2 days,104(15.1%)with a duration of AKI lasted 3–4 days,140(20.3%)with a duration of AKI lasted5–7 days,and 383(55.7%)with a duration of AKI lasted>7 days.Within each stage,a longer duration of AKIwas slightly associated with a higher rate of 1-year mortality.However,within each of the duration categories,the stage of AKI was significantly associated with 1-year mortality.When considered separately in multivariateanalyses,both the duration of AKI(3–4 days:HR=3.184;95%CI:1.733–5.853;P<0.001,5–7 days:HR=1.915;95%CI:1.073–3.416;P=0.028;>7 days:HR=1.766;95%CI:1.017–3.065;P=0.043)and more advanced AKIstage(Stage 2:HR=3.063;95%CI:2.207–4.252;P<0.001;Stage 3:HR=7.333;95%CI:5.274–10.197;P<0.001)were independently associated with an increased risk of 1-year mortality.Conclusions:In very elderly AKI patients,both a higher stage and duration were independently associated withan increased risk of 1-year mortality.Hence,the duration of AKI adds additional information to predict long-termmortality.展开更多
目的探讨原发性喉癌患者癌组织中微小核糖核酸-425-5p(miR-425-5p)/跨膜蛋白受体Patched1(PTCH1)轴分子与临床病理参数及预后的关系。方法前瞻性选取2018年7月至2021年6月新乡医学院第一附属医院收治的108例原发性喉癌患者作为研究对象...目的探讨原发性喉癌患者癌组织中微小核糖核酸-425-5p(miR-425-5p)/跨膜蛋白受体Patched1(PTCH1)轴分子与临床病理参数及预后的关系。方法前瞻性选取2018年7月至2021年6月新乡医学院第一附属医院收治的108例原发性喉癌患者作为研究对象。比较癌组织、癌旁组织及不同病理特征癌组织miR-425-5p、PTCH1 m RNA相对表达量,采用Spearman法分析miR-425-5p、PTCH1与临床病理特征的相关性,随访3年,统计所有患者的3年生存率,比较生存与死亡患者癌组织中的miR-425-5p、而PTCH1 m RNA相对表达量,并利用受试者工作特征(ROC)曲线获取miR-425-5p、PTCH1最佳截断值,采用KM曲线分析miR-425-5p、PTCH1与预后的关系。结果原发性喉癌患者癌组织中的miR-425-5p相对表达量为1.81±0.48,明显高于癌旁组织的1.08±0.23,PTCH1 m RNA相对表达量为1.21±0.36,明显低于癌旁组织的1.63±0.41,差异均有统计学意义(P<0.05);Ⅲ~Ⅳ期、淋巴结转移、低分化癌组织中的miR-425-5p相对表达量分别为1.97±0.46、2.09±0.42、2.14±0.46,明显高于Ⅰ~Ⅱ期、无淋巴结转移、中高分化癌组织的1.54±0.41、1.66±0.39、1.60±0.40,PTCH1 m RNA相对表达量分别为1.09±0.21、1.04±0.24、1.01±0.20,明显低于Ⅰ~Ⅱ期、无淋巴结转移、中高分化癌组织的1.42±0.25、1.30±0.27、1.34±0.23,差异均有统计学意义(P<0.05);Spearman法分析结果显示,miR-425-5p与临床分期、淋巴结转移呈正相关(r=0.663、0.702,P<0.05),与分化程度呈负相关(r=-0.681,P<0.05),PTCH1与临床分期、淋巴结转移呈负相关(r=-0.652、-0.711,P<0.05),与分化程度呈正相关(r=0.694,P<0.05);死亡患者癌组织中的miR-425-5p相对表达量为2.23±0.46,明显高于生存患者癌组织的1.67±0.38,而PTCH1 m RNA相对表达量为0.96±0.21,明显低于生存患者癌组织的1.30±0.34,差异均有统计学意义(P<0.05);ROC分析结果显示,miR-425-5p、PTCH1预测死亡的曲线下面积(AUC)分别为0.815(95%CI:0.727~0.884)、0.792(95%CI:0.702~0.865),最佳截断值分别为2.01、1.09;KM分析结果显示,miR-425-5p高表达、PTCH1低表达患者3年生存率均低于miR-425-5p低表达、PTCH1高表达患者,差异均有统计学意义(P<0.05)。结论miR-425-5p在原发性喉癌癌组织中表达上调,PTCH1表达下调,联合检测对预后具有一定预测价值,可作为临床评估病情、预测预后的辅助指标,以指导临床工作。展开更多
基金supported by the National Key Research and Development Program from the Ministry of Science and Technology of China(grant number:2018YFC1312400)the CAMS Innovation Fund for Medical Science(grant number:2016-I2M-2-004,2017-I2M-2-002)+1 种基金the National Key Technology R&D Program from the Ministry of Science and Technology of China(grant number:2015BAI12B02)the 111 Project from the Ministry of Education of China(grant number:B16005)。
文摘OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ejection fraction(LVEF)level.METHODS We enrolled hospitalized HF patients with AF from China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study.COX proportional hazard regression models were employed to calculate hazard ratio of betablockers.The primary outcome was all-cause death.RESULTS Among 1762 HF patients with AF(756 women[41.4%]),1041(56%)received beta-blockers at discharge and 1272(72.2%)had an LVEF>40%.During one year follow up,all-cause death occurred in 305(17.3%),cardiovascular death occurred in203 patients(11.5%),and rehospitalizations for HF occurred in 622 patients(35.2%).After adjusting for demographic characteristics,social economic status,smoking status,medical history,anthropometric characteristics,and medications used at discharge,the use of beta-blockers at discharge was not associated with all-cause death[hazard ratio(HR):0.86;95%Confidence Interval(CI):0.65-1.12;P=0.256],cardiovascular death(HR:0.76,95%CI:0.52-1.11;P=0.160),or the composite outcome of all-cause death and HF rehospitalization(HR:0.97,95%CI:0.82-1.14;P=0.687)in the entire cohort.There were no significant interactions between use of beta-blockers at discharge and LVEF with respect to all-cause death,cardiovascular death,or composite outcome.In the adjusted models,the use of beta-blockers at discharge was not associated with all-cause death,cardiovascular death,or composite outcome across the different levels of LVEF:reduced(<40%),mid-range(40%-49%),or preserved LVEF(≥50%).CONCLUSION Among HF patients with AF,the use of beta-blockers at discharge was not associated with 1-year clinical outcomes,regardless of LVEF.
基金This study was funded by grants from the Special Scientific Research Project of Military Health Care(grant number:20BJZ27 to Dr FHZ)Special Scientific Research Project ofMilitary Key Laboratory of Military Medical Engineering(grantnumber:2022SYSZZKY12 to Dr FHZ).
文摘Background:Acute kidney injury(AKI)is primarily defined and classified according to the magnitude of theelevation of serum creatinine(Scr).We aimed to determine whether the duration of AKI adds prognostic valuein addition to that obtained from the magnitude of injury alone.Methods:This retrospective study enrolled very elderly inpatients(≥75 years)in the Chinese PLA General Hospitalfrom January 2007 to December 2018.AKI was stratified by magnitude according to KDIGO stage(1,2,and 3)andduration(1–2 days,3–4 days,5–7 days,and>7 days).The primary outcome was the 1-year mortality after AKI.Multivariable Cox regression analysis was performed to identify covariates associated with the 1-year mortality.The probability of survival was estimated using the Kaplan–Meier method,and curves were compared using thelog-rank test.Results:In total,688 patients were enrolled,with the median age was 88(84–91)years,and the majority(652,94.8%)were male.According to the KDIGO criteria,317 patients(46.1%)had Stage 1 AKI,169(24.6%)hadStage 2 AKI,and 202(29.3%)had Stage 3 AKI.Of the 688 study subjects,61(8.9%)with a duration of AKIlasted 1–2 days,104(15.1%)with a duration of AKI lasted 3–4 days,140(20.3%)with a duration of AKI lasted5–7 days,and 383(55.7%)with a duration of AKI lasted>7 days.Within each stage,a longer duration of AKIwas slightly associated with a higher rate of 1-year mortality.However,within each of the duration categories,the stage of AKI was significantly associated with 1-year mortality.When considered separately in multivariateanalyses,both the duration of AKI(3–4 days:HR=3.184;95%CI:1.733–5.853;P<0.001,5–7 days:HR=1.915;95%CI:1.073–3.416;P=0.028;>7 days:HR=1.766;95%CI:1.017–3.065;P=0.043)and more advanced AKIstage(Stage 2:HR=3.063;95%CI:2.207–4.252;P<0.001;Stage 3:HR=7.333;95%CI:5.274–10.197;P<0.001)were independently associated with an increased risk of 1-year mortality.Conclusions:In very elderly AKI patients,both a higher stage and duration were independently associated withan increased risk of 1-year mortality.Hence,the duration of AKI adds additional information to predict long-termmortality.
文摘目的探讨原发性喉癌患者癌组织中微小核糖核酸-425-5p(miR-425-5p)/跨膜蛋白受体Patched1(PTCH1)轴分子与临床病理参数及预后的关系。方法前瞻性选取2018年7月至2021年6月新乡医学院第一附属医院收治的108例原发性喉癌患者作为研究对象。比较癌组织、癌旁组织及不同病理特征癌组织miR-425-5p、PTCH1 m RNA相对表达量,采用Spearman法分析miR-425-5p、PTCH1与临床病理特征的相关性,随访3年,统计所有患者的3年生存率,比较生存与死亡患者癌组织中的miR-425-5p、而PTCH1 m RNA相对表达量,并利用受试者工作特征(ROC)曲线获取miR-425-5p、PTCH1最佳截断值,采用KM曲线分析miR-425-5p、PTCH1与预后的关系。结果原发性喉癌患者癌组织中的miR-425-5p相对表达量为1.81±0.48,明显高于癌旁组织的1.08±0.23,PTCH1 m RNA相对表达量为1.21±0.36,明显低于癌旁组织的1.63±0.41,差异均有统计学意义(P<0.05);Ⅲ~Ⅳ期、淋巴结转移、低分化癌组织中的miR-425-5p相对表达量分别为1.97±0.46、2.09±0.42、2.14±0.46,明显高于Ⅰ~Ⅱ期、无淋巴结转移、中高分化癌组织的1.54±0.41、1.66±0.39、1.60±0.40,PTCH1 m RNA相对表达量分别为1.09±0.21、1.04±0.24、1.01±0.20,明显低于Ⅰ~Ⅱ期、无淋巴结转移、中高分化癌组织的1.42±0.25、1.30±0.27、1.34±0.23,差异均有统计学意义(P<0.05);Spearman法分析结果显示,miR-425-5p与临床分期、淋巴结转移呈正相关(r=0.663、0.702,P<0.05),与分化程度呈负相关(r=-0.681,P<0.05),PTCH1与临床分期、淋巴结转移呈负相关(r=-0.652、-0.711,P<0.05),与分化程度呈正相关(r=0.694,P<0.05);死亡患者癌组织中的miR-425-5p相对表达量为2.23±0.46,明显高于生存患者癌组织的1.67±0.38,而PTCH1 m RNA相对表达量为0.96±0.21,明显低于生存患者癌组织的1.30±0.34,差异均有统计学意义(P<0.05);ROC分析结果显示,miR-425-5p、PTCH1预测死亡的曲线下面积(AUC)分别为0.815(95%CI:0.727~0.884)、0.792(95%CI:0.702~0.865),最佳截断值分别为2.01、1.09;KM分析结果显示,miR-425-5p高表达、PTCH1低表达患者3年生存率均低于miR-425-5p低表达、PTCH1高表达患者,差异均有统计学意义(P<0.05)。结论miR-425-5p在原发性喉癌癌组织中表达上调,PTCH1表达下调,联合检测对预后具有一定预测价值,可作为临床评估病情、预测预后的辅助指标,以指导临床工作。
