BACKGROUND Mild cognitive impairment(MCI)is common in atrial fibrillation(AF)patients and may develop earlier in those with multiple cardiovascular comorbidities,potentially impairing self-management and treatment adh...BACKGROUND Mild cognitive impairment(MCI)is common in atrial fibrillation(AF)patients and may develop earlier in those with multiple cardiovascular comorbidities,potentially impairing self-management and treatment adherence.This study aimed to characterize the prevalence and profile of MCI in AF patients,examine its associations with cardiovascular comorbidities,and assess how these comorbidities influence specific cognitive domains.METHODS This cross-sectional study analyzed data from AF patients who underwent cognitive assessment between 2017 and 2021.Cognitive status was categorized as MCI or non-MCI based on the Montreal Cognitive Assessment.Associations between comorbidities and MCI were assessed by logistic regression,and cognitive domains were compared using the Mann-Whitney U test.RESULTS Of 4136 AF patients(mean age:64.7±9.4 years,64.7%male),33.5%of patients had MCI.Among the AF patients,31.2%of patients had coronary artery disease,20.1%of patients had heart failure,and 18.1%of patients had hypertension.88.7%of patients had left atrial enlargement,and 11.0%of patients had reduced left ventricular ejection fraction.Independent factors associated with higher MCI prevalence included older age(OR=1.04,95%CI:1.03-1.05,P<0.001),lower education level(OR=1.51,95%CI:1.31-1.73,P<0.001),hypertension(OR=1.28,95%CI:1.07-1.52,P=0.001),heart failure(OR=1.24,95%CI:1.04-1.48,P=0.020),and lower left ventricular ejection fraction(OR=1.43,95%CI:1.04-1.98,P=0.028).A higher CHA_(2)DS_(2)-VASc score(OR=1.27,95%CI:1.22-1.33,P<0.001;≥2 points vs.<2 points),and greater atherosclerotic cardiovascular disease burden(OR=1.45,95%CI:1.02-2.08,P=0.040;2 types vs.0 type)were linked to increased MCI risk.These above factors influenced various cognitive domains.CONCLUSIONS MCI is common in AF and closely associated with cardiovascular multimorbidity.Patients with multiple comorbidities are at higher risk,highlighting the importance of routine cognitive assessment to support self-management and integrated care.展开更多
There is growing evidence that interleukin(IL)-6 plays an important role in neurological and psychiatric disorders.This editorial comments on the study published in the recent issue of the World Journal of Psychiatry,...There is growing evidence that interleukin(IL)-6 plays an important role in neurological and psychiatric disorders.This editorial comments on the study published in the recent issue of the World Journal of Psychiatry,which employed Mendelian randomization to identify a causal relationship between IL-6 receptor blockade and decreased epilepsy incidence.The purpose of this editorial is to highlight the dual effects of IL-6 in epilepsy and its related neuropsychiatric comorbidities.IL-6 plays a critical role in the facilitation of epileptogenesis and maintenance of epileptic seizures and is implicated in neuroinflammatory proce-sses associated with epilepsy.Furthermore,IL-6 significantly influences mood regulation and cognitive dysfunction in patients with epilepsy,highlighting its involvement in neuropsychiatric comorbidities.In summary,IL-6 is not only a pivotal factor in the pathogenesis of epilepsy but also significantly contributes to the emergence of epilepsy-related neuropsychiatric complications.Future resear-ch should prioritize elucidating the specific mechanisms by which IL-6 operates across different subtypes,stages and neuropsychiatric comorbidities of epilepsy,with the aim of developing more precise and effective interventions.Furthermore,the potential of IL-6 as a biomarker for the early diagnosis and prognosis of epile-psy warrants further investigation.展开更多
BACKGROUND A significant association between increased age and an increased risk of metachronous gastric cancer(MGC)following curative endoscopic submucosal dissection(ESD)has previously been reported.AIM To determine...BACKGROUND A significant association between increased age and an increased risk of metachronous gastric cancer(MGC)following curative endoscopic submucosal dissection(ESD)has previously been reported.AIM To determine risk factors for the metachronous occurrence of early gastric cancer(EGC)in elderly individuals.METHODS This retrospective cohort study comprised 653 elderly patients(aged≥65 years)who underwent curative ESD for EGC between January 2014 and June 2020 at Nanjing Drum Tower Hospital.Comprehensive analyses were conducted to compare lifestyle habits,comorbidities,and Helicobacter pylori(H.pylori)infections as potential indicators.RESULTS During a median follow-up of 38 months,46 patients(7.0%,20.46/1000 person-years)developed MGC in the elderly cohort.The cumulative incidences of MGC at 2,3,and 5 years were 3.3%,5.3%,and 11.5%,respectively.In multivariate Cox regression analyses,the independent risk factors for MGC included metabolic dysfunctionassociated steatotic liver disease(MASLD)[hazard ratio(HR)=2.44,95%confidence interval(CI):1.15-5.17],persistent H.pylori infection(HR=10.38,95%CI:3.36-32.07),severe mucosal atrophy(HR=2.71,95%CI:1.45-5.08),and pathological differentiation of EGC(well/moderately differentiated vs poorly differentiated:HR=10.18,95%CI:1.30-79.65).Based on these risk factors,a risk stratification system was developed to categorize individuals into low(0-1 point),intermediate(2-3 points),and high(4-8 points)risk categories for MGC,with cumulative incidence rates of 12.3%,21.6%,and 45%,respectively.CONCLUSION Among elderly individuals,MASLD,persistent H.pylori infection,severe mucosal atrophy,and well/moderately differentiated EGC were associated with an increased risk of MGC.Elderly patients are recommended to adopt healthy lifestyle practices,and undergo regular endoscopic screening and H.pylori testing after curative ESD for EGC.展开更多
Facial paralysis comorbidities is now understood to include two distinct forms:synkinesis and micro-entrapment syndrome of nerves innervating the face(MESNIF).These disorders manifest as oromandibular synkinesis,stiff...Facial paralysis comorbidities is now understood to include two distinct forms:synkinesis and micro-entrapment syndrome of nerves innervating the face(MESNIF).These disorders manifest as oromandibular synkinesis,stiffness and atrophy of facial muscles on one side,which affect activities of daily living.Acupoint Injection is a treatment for facial paralysis,combining the meridian theory of traditional Chinese medicine,with the injection of specific drugs into acupuncture points of the face.In recent years,the use of acupoint injections has shown in remarkable clinical efficacy and few adverse effects.We report the case to introduce this integrative therapy and outline the key principles of rehabilitation therapy.展开更多
BACKGROUND Neurodevelopmental delays encompass a wide range of conditions that impair cognitive,motor,and social functioning,often increasing the risk of psychiatric comorbidities.Children with these delays frequently...BACKGROUND Neurodevelopmental delays encompass a wide range of conditions that impair cognitive,motor,and social functioning,often increasing the risk of psychiatric comorbidities.Children with these delays frequently present with disorders such as attention-deficit/hyperactivity disorder(ADHD),anxiety,and behavioral disturbances,which can significantly affect development and quality of life.While genetic predisposition has been linked to these comorbidities,growing evidence highlights the role of environmental factors,including prenatal and early-life stressors.However,the interaction between genetic susceptibility and environmental influences remains poorly understood.Identifying specific genetic variants,environmental risks,and their interactions is essential for early detection and targeted interventions.AIM To investigate the combined effects of genetic and environmental factors on psychiatric comorbidities in children with neurodevelopmental delays,elucidate underlying mechanisms,and inform clinical management strategies.METHODS This retrospective cohort study included 80 children with confirmed neurodevelopmental delays and 40 age-and sex-matched typically developing controls.Comprehensive clinical and psychiatric evaluations,genetic testing(chromosomal microarray analysis and targeted next-generation sequencing),and environmental exposure assessments were conducted.Statistical analyses explored associations between genetic variants and psychiatric comorbidities,environmental risk factors,and gene-environment interactions.RESULTS Children with neurodevelopmental delays exhibited significantly higher rates of psychiatric comorbidities(70.0%)compared to controls(15.0%),with ADHD(42.5%),anxiety disorders(28.8%),and behavioral disorders(23.8%)being the most common.Pathogenic genetic variants were identified in specific pathways associated with distinct psychiatric presentations:Glutamatergic signaling variants were linked to anxiety disorders(odds ratio=3.8),dopaminergic system variants to ADHD(odds ratio=4.2),and synaptic function variants to both behavioral and anxiety disorders.Environmental factors,particularly prenatal maternal stress,early childhood adversity,and family dysfunction were strong predictors of psychiatric outcomes(β=0.42).Significant gene-environment interactions were identified,indicating that environmental exposure can moderate the effects of genetic risks on psychiatric outcomes.CONCLUSION Psychiatric comorbidities in children with neurodevelopmental delays are significantly influenced by both genetic and environmental factors,with complex interactions between the two.These findings underscore the need for integrated assessments and targeted interventions addressing both biological and environmental contributors to improve outcomes in this vulnerable population.展开更多
BACKGROUND Patients with inflammatory bowel disease(IBD)are at an increased risk of bacterial pneumonia,contributing to significant morbidity and mortality.While previous studies have identified various risk factors,i...BACKGROUND Patients with inflammatory bowel disease(IBD)are at an increased risk of bacterial pneumonia,contributing to significant morbidity and mortality.While previous studies have identified various risk factors,including medications and comorbidities,the independent contribution of IBD to pneumonia risk remains unclear.We hypothesized that the increased pneumonia risk is primarily driven by factors other than IBD itself.AIM To investigate the relative contributions of IBD,comorbidities,and medications to pneumonia risk in patients with IBD.METHODS We conducted a retrospective cohort study using the All of Us Research Program database(2010-2022).We matched 2810 participants with IBD 1:1 with controls using four propensity score models:(1)Demographics/Lifestyle only;(2)Plus comorbidities;(3)Plus medications;and(4)All factors combined.Then we used Cox proportional hazards models to assess pneumonia risk and logistic regression to evaluate risk factors.RESULTS In the primary analysis of 5620 matched participants,IBD was not independently associated with increased pneumonia risk[hazard ratio(HR)=1.07,95%CI:0.84-1.35]when matched for all factors.However,participants with IBD had significantly higher risk(HR=2.08,95%CI:1.56-2.78)when matched only for demographics and lifestyle factors.Within the IBD cohort,a high comorbidity burden(Charlson Comorbidity Index≥10)[odds ratio(OR)=12.20,95%CI:6.69-23.00]and systemic steroid use(OR=2.26,95%CI:1.21-4.64)were independently associated with increased pneumonia risk.CONCLUSION Comorbidities and systemic steroids,rather than IBD itself,drive pneumonia risk.Management should focus on these factors and prioritize vaccination in high-risk patients.展开更多
Objective Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the ris...Objective Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear.Methods A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients’ medical records. Multivariable logistic regression models were used to estimate the odds ratio(OR) and 95% confidence interval(95% CI) of the associations between comorbidities(cardiometabolic or non-cardiometabolic diseases), clinical severity, and treatment outcomes of COVID-19.Results Overall, 158(13.6%) patients were diagnosed with severe illness and 32(2.7%) had unfavorable outcomes. Hypertension(2.87, 1.30–6.32), type 2 diabetes(T2 DM)(3.57, 2.32–5.49),cardiovascular disease(CVD)(3.78, 1.81–7.89), fatty liver disease(7.53, 1.96–28.96), hyperlipidemia(2.15, 1.26–3.67), other lung diseases(6.00, 3.01–11.96), and electrolyte imbalance(10.40, 3.00–26.10)were independently linked to increased odds of being severely ill. T2 DM(6.07, 2.89–12.75), CVD(8.47,6.03–11.89), and electrolyte imbalance(19.44, 11.47–32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission(5.46,3.25–9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes(6.58, 1.46–29.64) within two weeks.Conclusion Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.展开更多
BACKGROUND Chronic pancreatitis(CP)is a fibroinflammatory syndrome leading to reduced quality of life and shortened life expectancy.Population-based estimates of the incidence,prevalence,and comorbidities of CP in Chi...BACKGROUND Chronic pancreatitis(CP)is a fibroinflammatory syndrome leading to reduced quality of life and shortened life expectancy.Population-based estimates of the incidence,prevalence,and comorbidities of CP in China are scarce.AIM To characterize the incidence,prevalence,and comorbidities of CP in Sichuan Province,China,with population-based data.METHODS Data on CP from 2015 to 2021 were obtained from the Health Information Center of Sichuan Province.During the study period,a total of 38090 individuals were diagnosed with CP in Sichuan Province.The yearly incidence rate and point prevalence rate(December 31,2021)of CP were calculated.The prevalence of comorbid conditions in CP patients was estimated.The annual number of CPrelated hospitalizations,hospital length of stay,and hospitalization costs for CP were evaluated.Yearly incidence rates were standardized for age by the direct method using the permanent population of Sichuan Province in the 2020 census as the standard population.An analysis of variance test for the linearity of scaled variables and the Cochran-Armitage trend test for categorical data were performed to investigate the yearly trends,and a two-sided test with P<0.05 was considered statistically significant.RESULTS The 38090 CP patients comprised 23280 males and 14810 females.The mean age of patients at CP diagnosis was 57.83 years,with male patients(55.87 years)being younger than female patients(60.11 years)(P<0.001).The mean incidence rate of CP during the study period was 6.81 per 100000 person-years,and the incidence of CP increased each year,from 4.03 per 100000 person-years in 2015 to 8.27 per 100000 person-years in 2021(P<0.001).The point prevalence rate of CP in 2021 was 45.52 per 100000 individuals for the total population,with rates of 55.04 per 100000 individuals for men and 35.78 per 100000 individuals for women(P<0.001).Individuals aged 65 years or older had the highest prevalence of CP(113.38 per 100000 individuals)(P<0.001).Diabetes(26.32%)was the most common comorbidity in CP patients.The number of CP-related hospitalizations increased from 3739 in 2015 to 11009 in 2021.The total costs for CP-related hospitalizations for CP patients over the study period were 667.96 million yuan,with an average of 17538 yuan per patient.CONCLUSION The yearly incidence of CP is increasing,and the overall CP hospitalization cost has increased by 1.4 times during the last 7 years,indicating that CP remains a heavy health burden.展开更多
Virtually all drug interventions that have been successful pre-clinically in experimental stroke have failed to prove their efficacy in a dinical setting. This could be partly explained by the complexity and heterogen...Virtually all drug interventions that have been successful pre-clinically in experimental stroke have failed to prove their efficacy in a dinical setting. This could be partly explained by the complexity and heterogeneity of human diseases as well as the associated co-morbidities which may render neuroprotective drugs less efficacious in dinical practice. One aspect of crucial importance in the physiopathology of stroke which is not completely understood is neuroinflammation. At the pres- ent time, it is becoming evident that subtle, but continuous neuroinflammation can provide the ground for disorders such as cerebral small vessel disease. Moreover, advanced aging and a number of highly prevalent risk factors such as obesity, hypertension, diabetes and atherosclerosis could act as ＂silent contributors＂ promoting a chronic proinflammatory state. This could aggravate the out- come of various pathological entities and can contribute to a number of subsequent post-stroke complications such as dementia, depression and neurodegeneration creating a pathological vicious cycle. Moreover, recent data suggests that the inflammatory process might be dosely linked with multiple neurodegenerative pathways related to depression. In addition, pro-inflammatory cyto- kines could play a central role in the pathophysiology of both depression and dementia.展开更多
AIM: To analyze a large population of patients with diabetes and peripheral neuropathy(PN) to determine other meaningful comorbid etiologies for PN.METHODS: Peripheral Neuropathy is a common complication of type 1 and...AIM: To analyze a large population of patients with diabetes and peripheral neuropathy(PN) to determine other meaningful comorbid etiologies for PN.METHODS: Peripheral Neuropathy is a common complication of type 1 and 2 diabetes mellitus;however,other potential causes for PN may be co-existing in patients with diabetes.A prospective cohort study was performed to assess patients with diabetes and PN.We compared patients having PN due solely to diabetes with patients possessing co-existing comorbidities,performing clinical(Toronto Clinical Scoring System and the Utah Early Neuropathy Scale),laboratory and electrophysiological assessments in all patients.RESULTS: Patients with either type 1 or 2 diabetes mellitus and co-existing comorbidities did not have more severe clinical or electrophysiological PN phenotypes overall.However,in patients with type 1 diabetes,presence of a lipid disorder was associated with greater PN severity.In type 2 diabetes patients,both a lipid disorder and cobalamin deficiency were associated with greater PN severity.There was no additive effect upon PN severity with presence of three or more comorbid etiologies.CONCLUSION: The presence of specific,and not general,comorbidities in patients with type 1 or 2 diabetes corresponds with greater PN severity.展开更多
BACKGROUND Upper gastrointestinal(GI)bleeding is a life-threatening condition with high mortality rates.AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes:In-hosp...BACKGROUND Upper gastrointestinal(GI)bleeding is a life-threatening condition with high mortality rates.AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes:In-hospital mortality,intervention(endoscopic or surgical)and length of admission(≥7 d).METHODS We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021.We calculated and compared the area under the receiver operating characteristics curves(AUROCs)of Glasgow-Blatchford score(GBS),pre-endoscopic Rockall score(PERS),albumin,international normalized ratio,altered mental status,systolic blood pressure,age older than 65(AIMS65)and age,blood tests and comorbidities(ABC),including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts.We subsequently analyzed through a logistic binary regression model,if addition of lactate increased the score performance.RESULTS All scores had discriminative ability in predicting in-hospital mortality irrespective of study group.AIMS65 score had the best performance in the variceal bleeding group(AUROC=0.772;P<0.001),and ABC score(AUROC=0.775;P<0.001)in the non-variceal bleeding group.However,ABC score,at a cut-off value of 5.5,was the best predictor(AUROC=0.770,P=0.001)of inhospital mortality in both populations.PERS score was a good predictor for endoscopic treatment(AUC=0.604;P=0.046)in the variceal population,while GBS score,(AUROC=0.722;P=0.024),outperformed the other scores in predicting surgical intervention.Addition of lactate to AIMS65 score,increases by 5-fold the probability of in-hospital mortality(P<0.05)and by 12-fold if added to GBS score(P<0.003).No score proved to be a good predictor for length of admission.CONCLUSION ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population.PERS and GBS should be used to determine need for endoscopic and surgical intervention,respectively.Lactate can be used as an additional tool to risk scores for predicting inhospital mortality.展开更多
Several studies have demonstrated that the outcome of chronic hepatitis C (CHC) infection is profoundly influenced by a variety of comorbidities. Many of these comorbidities have a significant influence on the respons...Several studies have demonstrated that the outcome of chronic hepatitis C (CHC) infection is profoundly influenced by a variety of comorbidities. Many of these comorbidities have a significant influence on the response to antiviral therapy. These comorbidities negatively affect the course and outcome of liver disease, often reducing the chance of achieving a sustained virological response with PEGylated interferon and ribavirin treatments. Comorbidities affecting response to antiviral therapy reduce compliance and adherence to inadequate doses of therapy. The most important comorbidities affecting the course of CHC include hepatitis B virus coinfection, metabolic syndrome, and intestinal bacterial overgrowth. Comorbidities affecting the course and response to therapy include schistosomiasis, iron overload, alcohol abuse, and excessive smoking. Comorbidities affecting response to antiviral therapy include depression, anemia, cardiovascular disease, and renal failure.展开更多
BACKGROUND Large inter-individual and inter-population differences in the susceptibility to and outcome of severe acute respiratory syndrome coronavirus 2 or coronavirus disease 2019(COVID-19)have been noted.Understan...BACKGROUND Large inter-individual and inter-population differences in the susceptibility to and outcome of severe acute respiratory syndrome coronavirus 2 or coronavirus disease 2019(COVID-19)have been noted.Understanding these differences and how they influence vulnerability to infection and disease severity is critical to public health intervention.AIM To analyze and compare the profile of COVID-19 cases between China and North America as two regions that differ in many environmental,host and healthcare factors related to disease risk.METHODS We conducted a meta-analysis to examine and compare demographic information,clinical symptoms,comorbidities,disease severity and levels of disease biomarkers of COVID-19 cases from clinical studies and data from China(105 studies)and North America(19 studies).RESULTS COVID-19 patients from North America were older than their Chinese counterparts and with higher male:Female ratio.Fever,cough,fatigue and dyspnea were the most common clinical symptoms in both study regions(present in about 30%to 75%of the cases in both regions).Meta-analysis for the prevalence of comorbidities(such as obesity,hypertension,diabetes,cardiovascular diseases,chronic obstructive pulmonary disease,cancer,and chronic kidney diseases)in COVID-19 patients were all significantly more prevalent in North America compared to China.Comorbidities were positively correlated with age but at a significantly younger age range in China compared to North American.The most prevalent infection outcome was acute respiratory distress syndrome which was 2-fold more frequent in North America than in China.Levels of C-reactive protein were 4.5-fold higher in the North American cases than in cases from China.CONCLUSION The differences in the profile of COVID-19 cases from China and North America may relate to differences in environmental-,host-and healthcare-related factors between the two regions.Such inter-population differences-together with intrapopulation variability-underline the need to characterize the effect of health inequities and inequalities on public health response to COVID-19 and can assist in preparing for the re-emergence of the epidemic.展开更多
Lung cancer is the most common cancer type worldwide and has the highest and second highest mortality rate for men and women respectively in Germany.Yet,the role of comorbid illnesses in lung cancer patient prognosis ...Lung cancer is the most common cancer type worldwide and has the highest and second highest mortality rate for men and women respectively in Germany.Yet,the role of comorbid illnesses in lung cancer patient prognosis is still debated.We analyzed administrative claims data from one of the largest statutory health insurance(SHI)funds in Germany,covering close to 9 million people(11%of the national population);observation period was from 2005 to 2019.Lung cancer patients and their concomitant diseases were identified by ICD-10-GM codes.Comorbidities were classified according to the Charlson Comorbidity Index(CCI).Incidence,comorbidity prevalence and survival are estimated considering sex,age at diagnosis,and place of residence.Kaplan Meier curves with 95%confidence intervals were built in relation to common comorbidities.We identified 70,698 lung cancer incident cases in the sample.Incidence and survival figures are comparable to official statistics in Germany.Most prevalent comorbidities are chronic obstructive pulmonary disease(COPD)(36.7%),followed by peripheral vascular disease(PVD)(18.7%),diabetes without chronic complications(17.4%),congestive heart failure(CHF)(16.5%)and renal disease(14.7%).Relative to overall survival,lung cancer patients with CHF,cerebrovascular disease(CEVD)and renal disease are associated with largest drops in survival probabilities(9%or higher),while those with PVD and diabetes without chronic complications with moderate drops(7%or lower).The study showed a negative association between survival and most common comorbidities among lung cancer patients,based on a large sample for Germany.Further research needs to explore the individual effect of comorbidities disentangled from that of other patient characteristics such as cancer stage and histology.展开更多
Diffuse idiopathic skeletal hyperostosis(DISH) is a noninflammatory disease characterized by calcification and ossification of soft tissues, mainly enthesis and spinal ligaments. The clinical presentation primarily in...Diffuse idiopathic skeletal hyperostosis(DISH) is a noninflammatory disease characterized by calcification and ossification of soft tissues, mainly enthesis and spinal ligaments. The clinical presentation primarily includes spinal involvement-induced pain and range of motion. Although rare, life-threatening gastrointestinal, respiratory or neurological events or severe morbidity due to bone compression on the adjacent structures may develop. There is a limited amount of data on DISHrelated events in the literature. In recent years, comorbid metabolic disorders are of great interest in patients with DISH. The early diagnosis of these conditions as well as rare entities allows an effective multidisciplinary approach for the treatment of DISH. In this article, we review extraskeletal symptoms and associated comorbidities in patients with DISH.展开更多
Background: Using baseline data from the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC), we assessed disease characteristics and prevalence of select comorbidities among subjects with schizophrenia in di...Background: Using baseline data from the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC), we assessed disease characteristics and prevalence of select comorbidities among subjects with schizophrenia in different clinical settings across 18 countries. ZODIAC was a randomized, open-label, one-year, large simple trial (LST) that enrolled 18,239 individuals with schizophrenia. Methods: Subjects were randomized to open-label treatment with ziprasidone (n = 9120) or olanzapine (n = 9119) in naturalistic (usual care) settings and followed for one year. Study sites (n = 749) applied minimal selection criteria in an attempt to make the study population as representative as possible of those receiving treatment in “real world” circumstances across the countries. Results: Mean patient age was 41 years, 55% were male, 34% were markedly ill or presented with more severe disease, and 66% of subjects had one or more select comorbid conditions [i.e. heart attack, stroke, hypertension, CAD/angina, high cholesterol/triglycerides, diabetes, or overweight (BMI ≥ 25)] at baseline. History of suicide attempt was greatest in the US (38%), compared with Sweden (34%), Brazil/South America (26%), Asia (23%), and Eastern Europe (20%). Overweight or obesity was the most prevalent comorbid risk factor, representing 60% of enrolled subjects, 70% of US subjects compared with 30% in Asia and 52% - 64% in the other regions studied. High cholesterol/triglycerides levels were found in 23% of US subjects compared with a relatively low prevalence in other countries (3% - 11%). History of cardiovascular or diabetes-related comorbidities was found in 31% of subjects. Current smoking (46.5%) and past smoking (11.8%) were common with men dominating the proportion of current smokers: US (61%);Asia (60%);Sweden (50%);Eastern Europe (49%);and Latin America (44%). Conclusions: Our findings indicate substantial baseline variations across countries in demographics, comorbid conditions, and psychiatric disease history. These data provide an international epidemiologic picture of schizophrenia and may help guide future research and treatment initiatives.展开更多
Background:Chitinase-3-like protein-1(CHI3L1),also known as human cartilage glycoprotein-39(HC-gp39),plays a role in several biological processes,including oxidative damage,apoptosis,inflammatory vesicle activation,ma...Background:Chitinase-3-like protein-1(CHI3L1),also known as human cartilage glycoprotein-39(HC-gp39),plays a role in several biological processes,including oxidative damage,apoptosis,inflammatory vesicle activation,macrophage formation,and fibroblast proliferation.Purpose:The potential of CHI3L1 as a biomarker and therapeutic target in allergic disorders and respiratory comorbidities.It also discusses CHI3L1-specific inhibitors and highlights the need for further research on their safety,efficacy,and interactions with other medications.Recent findings:The crucial roles of CHI3L1 in antigen-induced helper T cell 2(Th2)response,antigen sensitization,and IgE production highlight its importance in allergic diseases.Elevated CHI3L1 expression has been noted in various allergic conditions,including asthma,allergic rhinitis,and allergic dermatitis.Plasma CHI3L1 levels are strongly correlated with disease incidence and progression,making it valuable for predicting disease onset and prognosis.Consequently,CHI3L1 has been studied as a potential therapeutic target and diagnostic marker.Conclusion:This review highlights the growing importance of CHI3L1 as a biomarker for allergic diseases,with particular emphasis on its potential in asthma,where it correlates with disease severity.展开更多
Aim： To evaluate whether the response to sildenafil administration in patients with arterial erectile dysfunction （ED） was related to their peak systolic velocity （PSV）, peripheral atherosclerosis, cardiovascular...Aim： To evaluate whether the response to sildenafil administration in patients with arterial erectile dysfunction （ED） was related to their peak systolic velocity （PSV）, peripheral atherosclerosis, cardiovascular risk factors （RF） and/or comorbidities at low cardiovascular risk. Methods： We enrolled 97 patients with 1-2 RF and comorbidities, combined with arterial ED alone （group A, n = 27）, ED plus atherosclerotic carotid artery （group B, n = 23）, ED plus lower limb artery abnormalities （group C, n = 25）, and ED plus carotid and lower limb artery abnormalities （group D, n = 22）. Sildenafil efficacy （100 mg twice a week for 12 weeks） was also examined in patients with ≥ 3 RF, peripheral a（herosclerosis and no cardiovascular comorbidities （group E, n = 20）. Results： Median PSV was 24.1, 21.0, 19.3, 14.5 and 17.5 cm/s in groups A, B, C, D and E, respectively. Sildenafil response was higher in group A patients （77.8%）, intermediate in groups B and C （65.2% and 56%） and lowest in groups D （45.4%） and E （50%）, and the response in latter two groups was significantly lower than in the other three groups. In addition, sildenafil response was nega- tively influenced by： 〉 3 RF, peripheral atherosclerosis and no systemic comorbidity, or presence of 1-2 RF associated with extended atherosclerosis and comorbidities. The number of comorbidifies was positively related to atherosclerosis localization or extension （25, 35, 38 and 47 in groups A, B, C and D, respectively）. Conclusion： Low sildenafil efficacy in patients with arterial ED was associated with extended atherosclerosis. These patients should undergo extensive ultrasonography and a full cardiovascular examination.展开更多
BACKGROUND Hemorrhoidal disease(HD)is considered a low-severity pathology by both general population and physicians,but the lengthy conservative therapy and postoperative complications suggest otherwise.AIM To assess ...BACKGROUND Hemorrhoidal disease(HD)is considered a low-severity pathology by both general population and physicians,but the lengthy conservative therapy and postoperative complications suggest otherwise.AIM To assess the effectiveness of different treatment options,both conservative and surgical,in contrast with some preexisting comorbidities.METHODS We conducted a retrospective,10-yearlong study between January 2011 and December 2021 in two surgical centers,a private and a state-owned hospital.We compared the efficacy and safety of several treatment options,such as open hemorrhoidectomy,stapled hemorrhoidopexy,rubber band ligation and infrared coagulation in terms of complication rates and types and their correlation with different preexisting comorbidities such as inflammatory bowel disease(IBD),use of anticoagulant medication(AM)and liver cirrhosis.We also conducted a 20-years long PubMed research(1.263 articles)for relevant comparisons.RESULTS Our study recorded 10940 patients with HD,10241 with conservative and 699 with surgical treatment.Out of these,the male-to-female ratio of 1.3,and a peak in age distribution between 59 and 68 years old(32%of patients).For the entire study,we recorded a 90%incidence of immediate pain,immediate bleeding in 1.5%(11 cases),delayed bleeding in 1.0%(7 cases),and 0.6%surgical site infections.Urinary retention was also present,with 0.2%of patients,anal stricture in 1%and fecal incontinence for 0.5%of patients(4 cases).We recorded no severe complications such as Fournier`s gangrene or rectovaginal perforations.IBD accounted for 6%of the patients,with ulcerative colitis in 12%and Chron`s disease in 10.5%.6.6%of the patients had AM,determining 4%immediate and 2%delayed bleeding,in surgically treated patients.CONCLUSION Our study determined that most common complications(pain,urinary retention,bleeding,and stricture)are correlated with each surgical technique and pre-existing comorbidities.展开更多
Though it has been reported that in Western developed countries socioeconomic status is associated with non-communicable diseases (NCD), there are sparse evidence from Japan, midst an income gap that has been pointed ...Though it has been reported that in Western developed countries socioeconomic status is associated with non-communicable diseases (NCD), there are sparse evidence from Japan, midst an income gap that has been pointed out in recent years. Therefore, we examined the presence or absence of NCD and the number of comorbidities according to household income in Japanese, using data from the National Health and Nutrition Survey of 2010. 1287 men and 1659 women aged 20 - 79 years from households at 3 income levels (<2, 2 - 5.9, ≥6 million yen) were analyzed. Participants completed questionnaires regarding whether they had been diagnosed with NCD, as well as undergoing clinical laboratory tests. Logistic regression analyses were used for statistical analysis with adjustment for age, gender, household size, and population of municipalities. The prevalences of participants with high, medium, and low income were 22.3%, 57.6%, and 20.2%, respectively. Participants with the lowest income had the highest odds of hypertension (OR [95% confidence interval (CI)] = 1.71 [1.29 - 2.26], p p = 0.041), and stroke (5.07 [2.04 - 12.60] p < 0.001). Additionally, prevalences of participants with 2 or 3 NCD (hypertension, diabetes, and hypercholesterolemia) were 15.0% and 33.0% in high and low income levels, respectively. A low income could contribute to a high prevalence of NCD and large number of comorbidities among Japanese. Establishing a health policy in Japan is needed to enable an optimal health condition and lifestyle regardless of socioeconomic disparities.展开更多
基金supported by the National Natural Science Foundation of China(No.82270316)the Beijing Municipal Commission of Science and Technology(Z24-1100007724008).
文摘BACKGROUND Mild cognitive impairment(MCI)is common in atrial fibrillation(AF)patients and may develop earlier in those with multiple cardiovascular comorbidities,potentially impairing self-management and treatment adherence.This study aimed to characterize the prevalence and profile of MCI in AF patients,examine its associations with cardiovascular comorbidities,and assess how these comorbidities influence specific cognitive domains.METHODS This cross-sectional study analyzed data from AF patients who underwent cognitive assessment between 2017 and 2021.Cognitive status was categorized as MCI or non-MCI based on the Montreal Cognitive Assessment.Associations between comorbidities and MCI were assessed by logistic regression,and cognitive domains were compared using the Mann-Whitney U test.RESULTS Of 4136 AF patients(mean age:64.7±9.4 years,64.7%male),33.5%of patients had MCI.Among the AF patients,31.2%of patients had coronary artery disease,20.1%of patients had heart failure,and 18.1%of patients had hypertension.88.7%of patients had left atrial enlargement,and 11.0%of patients had reduced left ventricular ejection fraction.Independent factors associated with higher MCI prevalence included older age(OR=1.04,95%CI:1.03-1.05,P<0.001),lower education level(OR=1.51,95%CI:1.31-1.73,P<0.001),hypertension(OR=1.28,95%CI:1.07-1.52,P=0.001),heart failure(OR=1.24,95%CI:1.04-1.48,P=0.020),and lower left ventricular ejection fraction(OR=1.43,95%CI:1.04-1.98,P=0.028).A higher CHA_(2)DS_(2)-VASc score(OR=1.27,95%CI:1.22-1.33,P<0.001;≥2 points vs.<2 points),and greater atherosclerotic cardiovascular disease burden(OR=1.45,95%CI:1.02-2.08,P=0.040;2 types vs.0 type)were linked to increased MCI risk.These above factors influenced various cognitive domains.CONCLUSIONS MCI is common in AF and closely associated with cardiovascular multimorbidity.Patients with multiple comorbidities are at higher risk,highlighting the importance of routine cognitive assessment to support self-management and integrated care.
文摘There is growing evidence that interleukin(IL)-6 plays an important role in neurological and psychiatric disorders.This editorial comments on the study published in the recent issue of the World Journal of Psychiatry,which employed Mendelian randomization to identify a causal relationship between IL-6 receptor blockade and decreased epilepsy incidence.The purpose of this editorial is to highlight the dual effects of IL-6 in epilepsy and its related neuropsychiatric comorbidities.IL-6 plays a critical role in the facilitation of epileptogenesis and maintenance of epileptic seizures and is implicated in neuroinflammatory proce-sses associated with epilepsy.Furthermore,IL-6 significantly influences mood regulation and cognitive dysfunction in patients with epilepsy,highlighting its involvement in neuropsychiatric comorbidities.In summary,IL-6 is not only a pivotal factor in the pathogenesis of epilepsy but also significantly contributes to the emergence of epilepsy-related neuropsychiatric complications.Future resear-ch should prioritize elucidating the specific mechanisms by which IL-6 operates across different subtypes,stages and neuropsychiatric comorbidities of epilepsy,with the aim of developing more precise and effective interventions.Furthermore,the potential of IL-6 as a biomarker for the early diagnosis and prognosis of epile-psy warrants further investigation.
基金Supported by the National Natural Science Foundation of China,No.81572338 and No.82170548C-class-sponsored research project of the Jiangsu Provincial Six Talent Peaks,No.WSN-078+2 种基金Jiangsu Province“333 High-level Talents Training Project”,No.2016-III-0126the Jiangsu Provincial Key Research and Development Program,No.BE2021601the Postgraduate Research and Practice Innovation Program of Jiangsu Province,No.SJCX24_1037.
文摘BACKGROUND A significant association between increased age and an increased risk of metachronous gastric cancer(MGC)following curative endoscopic submucosal dissection(ESD)has previously been reported.AIM To determine risk factors for the metachronous occurrence of early gastric cancer(EGC)in elderly individuals.METHODS This retrospective cohort study comprised 653 elderly patients(aged≥65 years)who underwent curative ESD for EGC between January 2014 and June 2020 at Nanjing Drum Tower Hospital.Comprehensive analyses were conducted to compare lifestyle habits,comorbidities,and Helicobacter pylori(H.pylori)infections as potential indicators.RESULTS During a median follow-up of 38 months,46 patients(7.0%,20.46/1000 person-years)developed MGC in the elderly cohort.The cumulative incidences of MGC at 2,3,and 5 years were 3.3%,5.3%,and 11.5%,respectively.In multivariate Cox regression analyses,the independent risk factors for MGC included metabolic dysfunctionassociated steatotic liver disease(MASLD)[hazard ratio(HR)=2.44,95%confidence interval(CI):1.15-5.17],persistent H.pylori infection(HR=10.38,95%CI:3.36-32.07),severe mucosal atrophy(HR=2.71,95%CI:1.45-5.08),and pathological differentiation of EGC(well/moderately differentiated vs poorly differentiated:HR=10.18,95%CI:1.30-79.65).Based on these risk factors,a risk stratification system was developed to categorize individuals into low(0-1 point),intermediate(2-3 points),and high(4-8 points)risk categories for MGC,with cumulative incidence rates of 12.3%,21.6%,and 45%,respectively.CONCLUSION Among elderly individuals,MASLD,persistent H.pylori infection,severe mucosal atrophy,and well/moderately differentiated EGC were associated with an increased risk of MGC.Elderly patients are recommended to adopt healthy lifestyle practices,and undergo regular endoscopic screening and H.pylori testing after curative ESD for EGC.
基金funded by Beijing Municipal Key Specialty Construction Project of Traditional Chinese Medicine[(1+X+N)2017].
文摘Facial paralysis comorbidities is now understood to include two distinct forms:synkinesis and micro-entrapment syndrome of nerves innervating the face(MESNIF).These disorders manifest as oromandibular synkinesis,stiffness and atrophy of facial muscles on one side,which affect activities of daily living.Acupoint Injection is a treatment for facial paralysis,combining the meridian theory of traditional Chinese medicine,with the injection of specific drugs into acupuncture points of the face.In recent years,the use of acupoint injections has shown in remarkable clinical efficacy and few adverse effects.We report the case to introduce this integrative therapy and outline the key principles of rehabilitation therapy.
文摘BACKGROUND Neurodevelopmental delays encompass a wide range of conditions that impair cognitive,motor,and social functioning,often increasing the risk of psychiatric comorbidities.Children with these delays frequently present with disorders such as attention-deficit/hyperactivity disorder(ADHD),anxiety,and behavioral disturbances,which can significantly affect development and quality of life.While genetic predisposition has been linked to these comorbidities,growing evidence highlights the role of environmental factors,including prenatal and early-life stressors.However,the interaction between genetic susceptibility and environmental influences remains poorly understood.Identifying specific genetic variants,environmental risks,and their interactions is essential for early detection and targeted interventions.AIM To investigate the combined effects of genetic and environmental factors on psychiatric comorbidities in children with neurodevelopmental delays,elucidate underlying mechanisms,and inform clinical management strategies.METHODS This retrospective cohort study included 80 children with confirmed neurodevelopmental delays and 40 age-and sex-matched typically developing controls.Comprehensive clinical and psychiatric evaluations,genetic testing(chromosomal microarray analysis and targeted next-generation sequencing),and environmental exposure assessments were conducted.Statistical analyses explored associations between genetic variants and psychiatric comorbidities,environmental risk factors,and gene-environment interactions.RESULTS Children with neurodevelopmental delays exhibited significantly higher rates of psychiatric comorbidities(70.0%)compared to controls(15.0%),with ADHD(42.5%),anxiety disorders(28.8%),and behavioral disorders(23.8%)being the most common.Pathogenic genetic variants were identified in specific pathways associated with distinct psychiatric presentations:Glutamatergic signaling variants were linked to anxiety disorders(odds ratio=3.8),dopaminergic system variants to ADHD(odds ratio=4.2),and synaptic function variants to both behavioral and anxiety disorders.Environmental factors,particularly prenatal maternal stress,early childhood adversity,and family dysfunction were strong predictors of psychiatric outcomes(β=0.42).Significant gene-environment interactions were identified,indicating that environmental exposure can moderate the effects of genetic risks on psychiatric outcomes.CONCLUSION Psychiatric comorbidities in children with neurodevelopmental delays are significantly influenced by both genetic and environmental factors,with complex interactions between the two.These findings underscore the need for integrated assessments and targeted interventions addressing both biological and environmental contributors to improve outcomes in this vulnerable population.
基金Supported by The Interdisciplinary Guided Network for Investigation,Translation and Equity for the All of Us Research Program,No.OT2 OD031915.
文摘BACKGROUND Patients with inflammatory bowel disease(IBD)are at an increased risk of bacterial pneumonia,contributing to significant morbidity and mortality.While previous studies have identified various risk factors,including medications and comorbidities,the independent contribution of IBD to pneumonia risk remains unclear.We hypothesized that the increased pneumonia risk is primarily driven by factors other than IBD itself.AIM To investigate the relative contributions of IBD,comorbidities,and medications to pneumonia risk in patients with IBD.METHODS We conducted a retrospective cohort study using the All of Us Research Program database(2010-2022).We matched 2810 participants with IBD 1:1 with controls using four propensity score models:(1)Demographics/Lifestyle only;(2)Plus comorbidities;(3)Plus medications;and(4)All factors combined.Then we used Cox proportional hazards models to assess pneumonia risk and logistic regression to evaluate risk factors.RESULTS In the primary analysis of 5620 matched participants,IBD was not independently associated with increased pneumonia risk[hazard ratio(HR)=1.07,95%CI:0.84-1.35]when matched for all factors.However,participants with IBD had significantly higher risk(HR=2.08,95%CI:1.56-2.78)when matched only for demographics and lifestyle factors.Within the IBD cohort,a high comorbidity burden(Charlson Comorbidity Index≥10)[odds ratio(OR)=12.20,95%CI:6.69-23.00]and systemic steroid use(OR=2.26,95%CI:1.21-4.64)were independently associated with increased pneumonia risk.CONCLUSION Comorbidities and systemic steroids,rather than IBD itself,drive pneumonia risk.Management should focus on these factors and prioritize vaccination in high-risk patients.
基金This study was supported by the‘National Major Science and Technology Projects of China'[2018ZX10101001-005-003,2018ZX10101001-005-004]
文摘Objective Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear.Methods A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients’ medical records. Multivariable logistic regression models were used to estimate the odds ratio(OR) and 95% confidence interval(95% CI) of the associations between comorbidities(cardiometabolic or non-cardiometabolic diseases), clinical severity, and treatment outcomes of COVID-19.Results Overall, 158(13.6%) patients were diagnosed with severe illness and 32(2.7%) had unfavorable outcomes. Hypertension(2.87, 1.30–6.32), type 2 diabetes(T2 DM)(3.57, 2.32–5.49),cardiovascular disease(CVD)(3.78, 1.81–7.89), fatty liver disease(7.53, 1.96–28.96), hyperlipidemia(2.15, 1.26–3.67), other lung diseases(6.00, 3.01–11.96), and electrolyte imbalance(10.40, 3.00–26.10)were independently linked to increased odds of being severely ill. T2 DM(6.07, 2.89–12.75), CVD(8.47,6.03–11.89), and electrolyte imbalance(19.44, 11.47–32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission(5.46,3.25–9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes(6.58, 1.46–29.64) within two weeks.Conclusion Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.
基金the Special Project on“Digital Development of Health”of the Health Information Center of Sichuan Province,China,No.2021ZXKY06007the National Natural Science Fund of China,No.82241054 and 82000613。
文摘BACKGROUND Chronic pancreatitis(CP)is a fibroinflammatory syndrome leading to reduced quality of life and shortened life expectancy.Population-based estimates of the incidence,prevalence,and comorbidities of CP in China are scarce.AIM To characterize the incidence,prevalence,and comorbidities of CP in Sichuan Province,China,with population-based data.METHODS Data on CP from 2015 to 2021 were obtained from the Health Information Center of Sichuan Province.During the study period,a total of 38090 individuals were diagnosed with CP in Sichuan Province.The yearly incidence rate and point prevalence rate(December 31,2021)of CP were calculated.The prevalence of comorbid conditions in CP patients was estimated.The annual number of CPrelated hospitalizations,hospital length of stay,and hospitalization costs for CP were evaluated.Yearly incidence rates were standardized for age by the direct method using the permanent population of Sichuan Province in the 2020 census as the standard population.An analysis of variance test for the linearity of scaled variables and the Cochran-Armitage trend test for categorical data were performed to investigate the yearly trends,and a two-sided test with P<0.05 was considered statistically significant.RESULTS The 38090 CP patients comprised 23280 males and 14810 females.The mean age of patients at CP diagnosis was 57.83 years,with male patients(55.87 years)being younger than female patients(60.11 years)(P<0.001).The mean incidence rate of CP during the study period was 6.81 per 100000 person-years,and the incidence of CP increased each year,from 4.03 per 100000 person-years in 2015 to 8.27 per 100000 person-years in 2021(P<0.001).The point prevalence rate of CP in 2021 was 45.52 per 100000 individuals for the total population,with rates of 55.04 per 100000 individuals for men and 35.78 per 100000 individuals for women(P<0.001).Individuals aged 65 years or older had the highest prevalence of CP(113.38 per 100000 individuals)(P<0.001).Diabetes(26.32%)was the most common comorbidity in CP patients.The number of CP-related hospitalizations increased from 3739 in 2015 to 11009 in 2021.The total costs for CP-related hospitalizations for CP patients over the study period were 667.96 million yuan,with an average of 17538 yuan per patient.CONCLUSION The yearly incidence of CP is increasing,and the overall CP hospitalization cost has increased by 1.4 times during the last 7 years,indicating that CP remains a heavy health burden.
基金supported by a POSDRU grant no.159/1.5/S/136893 grant:"Strategic partnership for the increase of the scientific research quality in medical universities through the award of doctoral and postdoctoral fellowships–Doc Med.Net_2.0"
文摘Virtually all drug interventions that have been successful pre-clinically in experimental stroke have failed to prove their efficacy in a dinical setting. This could be partly explained by the complexity and heterogeneity of human diseases as well as the associated co-morbidities which may render neuroprotective drugs less efficacious in dinical practice. One aspect of crucial importance in the physiopathology of stroke which is not completely understood is neuroinflammation. At the pres- ent time, it is becoming evident that subtle, but continuous neuroinflammation can provide the ground for disorders such as cerebral small vessel disease. Moreover, advanced aging and a number of highly prevalent risk factors such as obesity, hypertension, diabetes and atherosclerosis could act as ＂silent contributors＂ promoting a chronic proinflammatory state. This could aggravate the out- come of various pathological entities and can contribute to a number of subsequent post-stroke complications such as dementia, depression and neurodegeneration creating a pathological vicious cycle. Moreover, recent data suggests that the inflammatory process might be dosely linked with multiple neurodegenerative pathways related to depression. In addition, pro-inflammatory cyto- kines could play a central role in the pathophysiology of both depression and dementia.
文摘AIM: To analyze a large population of patients with diabetes and peripheral neuropathy(PN) to determine other meaningful comorbid etiologies for PN.METHODS: Peripheral Neuropathy is a common complication of type 1 and 2 diabetes mellitus;however,other potential causes for PN may be co-existing in patients with diabetes.A prospective cohort study was performed to assess patients with diabetes and PN.We compared patients having PN due solely to diabetes with patients possessing co-existing comorbidities,performing clinical(Toronto Clinical Scoring System and the Utah Early Neuropathy Scale),laboratory and electrophysiological assessments in all patients.RESULTS: Patients with either type 1 or 2 diabetes mellitus and co-existing comorbidities did not have more severe clinical or electrophysiological PN phenotypes overall.However,in patients with type 1 diabetes,presence of a lipid disorder was associated with greater PN severity.In type 2 diabetes patients,both a lipid disorder and cobalamin deficiency were associated with greater PN severity.There was no additive effect upon PN severity with presence of three or more comorbid etiologies.CONCLUSION: The presence of specific,and not general,comorbidities in patients with type 1 or 2 diabetes corresponds with greater PN severity.
文摘BACKGROUND Upper gastrointestinal(GI)bleeding is a life-threatening condition with high mortality rates.AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes:In-hospital mortality,intervention(endoscopic or surgical)and length of admission(≥7 d).METHODS We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021.We calculated and compared the area under the receiver operating characteristics curves(AUROCs)of Glasgow-Blatchford score(GBS),pre-endoscopic Rockall score(PERS),albumin,international normalized ratio,altered mental status,systolic blood pressure,age older than 65(AIMS65)and age,blood tests and comorbidities(ABC),including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts.We subsequently analyzed through a logistic binary regression model,if addition of lactate increased the score performance.RESULTS All scores had discriminative ability in predicting in-hospital mortality irrespective of study group.AIMS65 score had the best performance in the variceal bleeding group(AUROC=0.772;P<0.001),and ABC score(AUROC=0.775;P<0.001)in the non-variceal bleeding group.However,ABC score,at a cut-off value of 5.5,was the best predictor(AUROC=0.770,P=0.001)of inhospital mortality in both populations.PERS score was a good predictor for endoscopic treatment(AUC=0.604;P=0.046)in the variceal population,while GBS score,(AUROC=0.722;P=0.024),outperformed the other scores in predicting surgical intervention.Addition of lactate to AIMS65 score,increases by 5-fold the probability of in-hospital mortality(P<0.05)and by 12-fold if added to GBS score(P<0.003).No score proved to be a good predictor for length of admission.CONCLUSION ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population.PERS and GBS should be used to determine need for endoscopic and surgical intervention,respectively.Lactate can be used as an additional tool to risk scores for predicting inhospital mortality.
文摘Several studies have demonstrated that the outcome of chronic hepatitis C (CHC) infection is profoundly influenced by a variety of comorbidities. Many of these comorbidities have a significant influence on the response to antiviral therapy. These comorbidities negatively affect the course and outcome of liver disease, often reducing the chance of achieving a sustained virological response with PEGylated interferon and ribavirin treatments. Comorbidities affecting response to antiviral therapy reduce compliance and adherence to inadequate doses of therapy. The most important comorbidities affecting the course of CHC include hepatitis B virus coinfection, metabolic syndrome, and intestinal bacterial overgrowth. Comorbidities affecting the course and response to therapy include schistosomiasis, iron overload, alcohol abuse, and excessive smoking. Comorbidities affecting response to antiviral therapy include depression, anemia, cardiovascular disease, and renal failure.
文摘BACKGROUND Large inter-individual and inter-population differences in the susceptibility to and outcome of severe acute respiratory syndrome coronavirus 2 or coronavirus disease 2019(COVID-19)have been noted.Understanding these differences and how they influence vulnerability to infection and disease severity is critical to public health intervention.AIM To analyze and compare the profile of COVID-19 cases between China and North America as two regions that differ in many environmental,host and healthcare factors related to disease risk.METHODS We conducted a meta-analysis to examine and compare demographic information,clinical symptoms,comorbidities,disease severity and levels of disease biomarkers of COVID-19 cases from clinical studies and data from China(105 studies)and North America(19 studies).RESULTS COVID-19 patients from North America were older than their Chinese counterparts and with higher male:Female ratio.Fever,cough,fatigue and dyspnea were the most common clinical symptoms in both study regions(present in about 30%to 75%of the cases in both regions).Meta-analysis for the prevalence of comorbidities(such as obesity,hypertension,diabetes,cardiovascular diseases,chronic obstructive pulmonary disease,cancer,and chronic kidney diseases)in COVID-19 patients were all significantly more prevalent in North America compared to China.Comorbidities were positively correlated with age but at a significantly younger age range in China compared to North American.The most prevalent infection outcome was acute respiratory distress syndrome which was 2-fold more frequent in North America than in China.Levels of C-reactive protein were 4.5-fold higher in the North American cases than in cases from China.CONCLUSION The differences in the profile of COVID-19 cases from China and North America may relate to differences in environmental-,host-and healthcare-related factors between the two regions.Such inter-population differences-together with intrapopulation variability-underline the need to characterize the effect of health inequities and inequalities on public health response to COVID-19 and can assist in preparing for the re-emergence of the epidemic.
文摘Lung cancer is the most common cancer type worldwide and has the highest and second highest mortality rate for men and women respectively in Germany.Yet,the role of comorbid illnesses in lung cancer patient prognosis is still debated.We analyzed administrative claims data from one of the largest statutory health insurance(SHI)funds in Germany,covering close to 9 million people(11%of the national population);observation period was from 2005 to 2019.Lung cancer patients and their concomitant diseases were identified by ICD-10-GM codes.Comorbidities were classified according to the Charlson Comorbidity Index(CCI).Incidence,comorbidity prevalence and survival are estimated considering sex,age at diagnosis,and place of residence.Kaplan Meier curves with 95%confidence intervals were built in relation to common comorbidities.We identified 70,698 lung cancer incident cases in the sample.Incidence and survival figures are comparable to official statistics in Germany.Most prevalent comorbidities are chronic obstructive pulmonary disease(COPD)(36.7%),followed by peripheral vascular disease(PVD)(18.7%),diabetes without chronic complications(17.4%),congestive heart failure(CHF)(16.5%)and renal disease(14.7%).Relative to overall survival,lung cancer patients with CHF,cerebrovascular disease(CEVD)and renal disease are associated with largest drops in survival probabilities(9%or higher),while those with PVD and diabetes without chronic complications with moderate drops(7%or lower).The study showed a negative association between survival and most common comorbidities among lung cancer patients,based on a large sample for Germany.Further research needs to explore the individual effect of comorbidities disentangled from that of other patient characteristics such as cancer stage and histology.
文摘Diffuse idiopathic skeletal hyperostosis(DISH) is a noninflammatory disease characterized by calcification and ossification of soft tissues, mainly enthesis and spinal ligaments. The clinical presentation primarily includes spinal involvement-induced pain and range of motion. Although rare, life-threatening gastrointestinal, respiratory or neurological events or severe morbidity due to bone compression on the adjacent structures may develop. There is a limited amount of data on DISHrelated events in the literature. In recent years, comorbid metabolic disorders are of great interest in patients with DISH. The early diagnosis of these conditions as well as rare entities allows an effective multidisciplinary approach for the treatment of DISH. In this article, we review extraskeletal symptoms and associated comorbidities in patients with DISH.
文摘Background: Using baseline data from the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC), we assessed disease characteristics and prevalence of select comorbidities among subjects with schizophrenia in different clinical settings across 18 countries. ZODIAC was a randomized, open-label, one-year, large simple trial (LST) that enrolled 18,239 individuals with schizophrenia. Methods: Subjects were randomized to open-label treatment with ziprasidone (n = 9120) or olanzapine (n = 9119) in naturalistic (usual care) settings and followed for one year. Study sites (n = 749) applied minimal selection criteria in an attempt to make the study population as representative as possible of those receiving treatment in “real world” circumstances across the countries. Results: Mean patient age was 41 years, 55% were male, 34% were markedly ill or presented with more severe disease, and 66% of subjects had one or more select comorbid conditions [i.e. heart attack, stroke, hypertension, CAD/angina, high cholesterol/triglycerides, diabetes, or overweight (BMI ≥ 25)] at baseline. History of suicide attempt was greatest in the US (38%), compared with Sweden (34%), Brazil/South America (26%), Asia (23%), and Eastern Europe (20%). Overweight or obesity was the most prevalent comorbid risk factor, representing 60% of enrolled subjects, 70% of US subjects compared with 30% in Asia and 52% - 64% in the other regions studied. High cholesterol/triglycerides levels were found in 23% of US subjects compared with a relatively low prevalence in other countries (3% - 11%). History of cardiovascular or diabetes-related comorbidities was found in 31% of subjects. Current smoking (46.5%) and past smoking (11.8%) were common with men dominating the proportion of current smokers: US (61%);Asia (60%);Sweden (50%);Eastern Europe (49%);and Latin America (44%). Conclusions: Our findings indicate substantial baseline variations across countries in demographics, comorbid conditions, and psychiatric disease history. These data provide an international epidemiologic picture of schizophrenia and may help guide future research and treatment initiatives.
文摘Background:Chitinase-3-like protein-1(CHI3L1),also known as human cartilage glycoprotein-39(HC-gp39),plays a role in several biological processes,including oxidative damage,apoptosis,inflammatory vesicle activation,macrophage formation,and fibroblast proliferation.Purpose:The potential of CHI3L1 as a biomarker and therapeutic target in allergic disorders and respiratory comorbidities.It also discusses CHI3L1-specific inhibitors and highlights the need for further research on their safety,efficacy,and interactions with other medications.Recent findings:The crucial roles of CHI3L1 in antigen-induced helper T cell 2(Th2)response,antigen sensitization,and IgE production highlight its importance in allergic diseases.Elevated CHI3L1 expression has been noted in various allergic conditions,including asthma,allergic rhinitis,and allergic dermatitis.Plasma CHI3L1 levels are strongly correlated with disease incidence and progression,making it valuable for predicting disease onset and prognosis.Consequently,CHI3L1 has been studied as a potential therapeutic target and diagnostic marker.Conclusion:This review highlights the growing importance of CHI3L1 as a biomarker for allergic diseases,with particular emphasis on its potential in asthma,where it correlates with disease severity.
文摘Aim： To evaluate whether the response to sildenafil administration in patients with arterial erectile dysfunction （ED） was related to their peak systolic velocity （PSV）, peripheral atherosclerosis, cardiovascular risk factors （RF） and/or comorbidities at low cardiovascular risk. Methods： We enrolled 97 patients with 1-2 RF and comorbidities, combined with arterial ED alone （group A, n = 27）, ED plus atherosclerotic carotid artery （group B, n = 23）, ED plus lower limb artery abnormalities （group C, n = 25）, and ED plus carotid and lower limb artery abnormalities （group D, n = 22）. Sildenafil efficacy （100 mg twice a week for 12 weeks） was also examined in patients with ≥ 3 RF, peripheral a（herosclerosis and no cardiovascular comorbidities （group E, n = 20）. Results： Median PSV was 24.1, 21.0, 19.3, 14.5 and 17.5 cm/s in groups A, B, C, D and E, respectively. Sildenafil response was higher in group A patients （77.8%）, intermediate in groups B and C （65.2% and 56%） and lowest in groups D （45.4%） and E （50%）, and the response in latter two groups was significantly lower than in the other three groups. In addition, sildenafil response was nega- tively influenced by： 〉 3 RF, peripheral atherosclerosis and no systemic comorbidity, or presence of 1-2 RF associated with extended atherosclerosis and comorbidities. The number of comorbidifies was positively related to atherosclerosis localization or extension （25, 35, 38 and 47 in groups A, B, C and D, respectively）. Conclusion： Low sildenafil efficacy in patients with arterial ED was associated with extended atherosclerosis. These patients should undergo extensive ultrasonography and a full cardiovascular examination.
文摘BACKGROUND Hemorrhoidal disease(HD)is considered a low-severity pathology by both general population and physicians,but the lengthy conservative therapy and postoperative complications suggest otherwise.AIM To assess the effectiveness of different treatment options,both conservative and surgical,in contrast with some preexisting comorbidities.METHODS We conducted a retrospective,10-yearlong study between January 2011 and December 2021 in two surgical centers,a private and a state-owned hospital.We compared the efficacy and safety of several treatment options,such as open hemorrhoidectomy,stapled hemorrhoidopexy,rubber band ligation and infrared coagulation in terms of complication rates and types and their correlation with different preexisting comorbidities such as inflammatory bowel disease(IBD),use of anticoagulant medication(AM)and liver cirrhosis.We also conducted a 20-years long PubMed research(1.263 articles)for relevant comparisons.RESULTS Our study recorded 10940 patients with HD,10241 with conservative and 699 with surgical treatment.Out of these,the male-to-female ratio of 1.3,and a peak in age distribution between 59 and 68 years old(32%of patients).For the entire study,we recorded a 90%incidence of immediate pain,immediate bleeding in 1.5%(11 cases),delayed bleeding in 1.0%(7 cases),and 0.6%surgical site infections.Urinary retention was also present,with 0.2%of patients,anal stricture in 1%and fecal incontinence for 0.5%of patients(4 cases).We recorded no severe complications such as Fournier`s gangrene or rectovaginal perforations.IBD accounted for 6%of the patients,with ulcerative colitis in 12%and Chron`s disease in 10.5%.6.6%of the patients had AM,determining 4%immediate and 2%delayed bleeding,in surgically treated patients.CONCLUSION Our study determined that most common complications(pain,urinary retention,bleeding,and stricture)are correlated with each surgical technique and pre-existing comorbidities.
文摘Though it has been reported that in Western developed countries socioeconomic status is associated with non-communicable diseases (NCD), there are sparse evidence from Japan, midst an income gap that has been pointed out in recent years. Therefore, we examined the presence or absence of NCD and the number of comorbidities according to household income in Japanese, using data from the National Health and Nutrition Survey of 2010. 1287 men and 1659 women aged 20 - 79 years from households at 3 income levels (<2, 2 - 5.9, ≥6 million yen) were analyzed. Participants completed questionnaires regarding whether they had been diagnosed with NCD, as well as undergoing clinical laboratory tests. Logistic regression analyses were used for statistical analysis with adjustment for age, gender, household size, and population of municipalities. The prevalences of participants with high, medium, and low income were 22.3%, 57.6%, and 20.2%, respectively. Participants with the lowest income had the highest odds of hypertension (OR [95% confidence interval (CI)] = 1.71 [1.29 - 2.26], p p = 0.041), and stroke (5.07 [2.04 - 12.60] p < 0.001). Additionally, prevalences of participants with 2 or 3 NCD (hypertension, diabetes, and hypercholesterolemia) were 15.0% and 33.0% in high and low income levels, respectively. A low income could contribute to a high prevalence of NCD and large number of comorbidities among Japanese. Establishing a health policy in Japan is needed to enable an optimal health condition and lifestyle regardless of socioeconomic disparities.
