Objective:Our previous studies have indicated potentially higher proliferative activity of tumor cells in Chinese patients with mantle-cell lymphoma(MCL)than those in Western.Given the success and tolerability of R-DA...Objective:Our previous studies have indicated potentially higher proliferative activity of tumor cells in Chinese patients with mantle-cell lymphoma(MCL)than those in Western.Given the success and tolerability of R-DA-EDOCH immunochemotherapy in treating aggressive B-cell lymphomas,we designed a prospective,phase 3 trial to explore the efficacy and safety of alternating R-DA-EDOCH/R-DHAP induction therapy for young patients with newly diagnosed MCL.The primary endpoint was the complete remission rate(CRR)at the end of induction(EOI).Methods:A total of 55 patients were enrolled.The CRR at the EOI was 89.1%[95%confidence interval(CI)78%±96%],and the overall response rate was 98.1%(95%CI 90%±100%).Most patients with bone marrow involvement quickly attained minimal residual disease(MRD)negative status,with a 95.7%rate at the EOI.Results:The 3-year progression-free survival(PFS)and overall survival rates were 66.3%and 83.2%,respectively.No patients discontinued treatment because of adverse events.Univariate analysis identified pathologic morphology and TP53 mutations as risk factors for PFS.However,high tumor proliferative activity and certain cytogenetic abnormalities showed no significant adverse prognostic significance.Conclusions:Intensive therapy based on a high cytarabine dose and continuously administered EDOCH achieved a high MRDnegative rate and provides an optional induction choice for young patients with MCL with high-risk factors.展开更多
Necrotizing enterocolitis (NEC) in newborns is one of the life-threatening diseases. With the continuous advancement of perinatal medicine and neonatal intensive care technology, NEC has been on the rise year by year....Necrotizing enterocolitis (NEC) in newborns is one of the life-threatening diseases. With the continuous advancement of perinatal medicine and neonatal intensive care technology, NEC has been on the rise year by year. The etiology of NEC is not yet clear, and it may be the result of multiple risk factors working together, such as premature birth, infection, formula feeding, ischemia, hypoxia, dysbiosis of intestinal flora, and immune damage. Additionally, recent reports have documented factors such as immunoglobulin treatment for hemolytic jaundice, blood transfusion therapy, and rapid achievement of adequate feeding. This article comprehensively analyzes the current research progress on high-risk factors of NEC, and provides a reference for future prevention, diagnosis, and treatment directions.展开更多
BACKGROUND Bipolar disorder(BD),marked by recurring manic and depressive episodes,often coexists with anxiety disorder(AD),which increases treatment complexity and morbidity.Although quetiapine,an atypical antipsychot...BACKGROUND Bipolar disorder(BD),marked by recurring manic and depressive episodes,often coexists with anxiety disorder(AD),which increases treatment complexity and morbidity.Although quetiapine,an atypical antipsychotic,has demonstrated efficacy in treating BD and AD,further investigation is needed regarding its effectiveness and safety in patients with AD at high-risk factors for BD.AIM To explore the application and efficacy of quetiapine in combination therapy for patients with AD at high-risk factors for BD.METHODS This study included 67 patients,with two excluded,leaving 65 divided into Group A(sertraline treatment)and Group B(combination treatment).All patients received sertraline,with Group B additionally receiving quetiapine.Efficacy was assessed using the Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),and Bech-Rafaelsen Mania sale(BRMS)throughout the treatment period.Side effects and physiological indicators were also monitored.RESULTS No significant baseline differences existed between the two groups at treatment onset.Over the treatment course,Group B exhibited significantly lower HAMA scores than Group A at the end of weeks 1 and 24.HAMD scores gradually decreased over time,with Group B consistently showing lower scores than Group A.BRMS scores decreased significantly from baseline by week 8.In Group A,27.27%of patients received zolpidem treatment compared to 10.53%in Group B,which was a significant difference.Incidence of adverse reactions did not differ significantly between groups at treatment onset,but most patients experienced relief from adverse reactions within 4 weeks.CONCLUSION Combination of quetiapine and sertraline can more rapidly alleviate anxiety and depressive symptoms in patients with AD at high-risk factors for BD,improving treatment outcomes.展开更多
To investigate the high-risk factors for newborn hearing loss and to provide information for preventing the development of hearing loss and delaying its progression, from May 2003 to June 2006, neonates who failed to ...To investigate the high-risk factors for newborn hearing loss and to provide information for preventing the development of hearing loss and delaying its progression, from May 2003 to June 2006, neonates who failed to pass the universal newborn hearing screening （UNHS） were referred to Jinan Newborn Hearing Screening and Rehabilitation Center from 7 newborn hearing screening centers in seven cities of Shandong province. One-to-one pair-matched case-control method was employed for statistical analysis of the basic features of definitely identified cases. High-risk factors relating to the bilateral hearing loss were evaluated by univariate and multivariate Logistic regression analysis. Our results revealed that 721 transferred newborns who didn＇t pass the heating screening received audiological and medical evaluation and 367 were confirmed to have hearing loss. Of them, 177 neonates with hearing loss who met the matching requirements were included in the study as subjects. Univariate analysis showed that high-risk factors related to hearing loss incuded age of father, education backgrounds of parents, parity, birth weight, gestational weeks, craniofacial deformity, history of receiving treatment in neonatal intensive care unit （NICU）, neonatal disease, family history of otopathy and family history of congenital hearing loss. Multivariate Logistic regression analysis revealed that 4 independent risk factors were related to bilateral hearing loss, including parity （OR=16.285, 95% CI 3.379--78,481）, neonatal disease （OR=34;968, 95% CI 2.720 449.534）, family history of congenital hearing loss （OR=69.488, 95% CI 4.417--1093.300） and birth weight （OR=0.241, 95% CI 0.090--0.648）. It is concluded that parity, neonatal disease and family history of heating loss are the promoting factors of bilateral hearing loss in neonates and appropriate intervention measures should be taken to deal with the risk factors.展开更多
Objective： The aim of this study was to identify the risk factors for inpatient suicide in a general hospital. Methods： Thirty suicide victims were drawn from the adverse event reports of suicidal acts during hospit...Objective： The aim of this study was to identify the risk factors for inpatient suicide in a general hospital. Methods： Thirty suicide victims were drawn from the adverse event reports of suicidal acts during hospitalization in a general hospital from 2008 to 2014. Data were gathered from a focus group interview of 6 medical staff who had experienced inpatient suicide. Interpretative phenomenological analysis was used to analyze the data. Results： Five main themes regarding high-risk factors for inpatient suicide emerged from this study： mental disorders, diseases, the source of money to meet medical expenses, social support, and the hospital environment. Patients with mental disorders were at a high risk of suicide. Having a serious disease, paying high medical expenses alone, the loss of social support and unsafe hospital environments were also associated with an increased risk of suicide. Conclusions： This study puts forward different perspectives on the reasons that inpatients commit suicide and corresponding preventive measures based on these 5 main themes that could be implemented to avoid or reduce suicidal acts among inpatients during hospitalization.展开更多
A cross-sectional study using the snowball sampling method was conducted in May 2008 to investigate human immunodeficiency virus （HIV） infection status and related high risk factors among men who have sex with men ...A cross-sectional study using the snowball sampling method was conducted in May 2008 to investigate human immunodeficiency virus （HIV） infection status and related high risk factors among men who have sex with men （MSM） in Suzhou city of Jiangsu province. The researchers carried out a face-to-face questionnaire interview among MSM, and collected their blood samples to test for HIV and other sexually transmitted diseases （STDs）. Among the 280 respondents, 91.1% had homosexual acts in the past 6 months and 87.5% had multiple homosex- ual partners; 46.4% had heterosexual sex in the past 6 months and 33.1% had multiple heterosexual partners. The rate of continued condom use was 44.3% in homosexual sex in the past 6 months, while the rate in heterosexual sex was 33.9%. Laboratory test results showed that the prevalences of HIV and syphilis were 7.1% （20/280） and 15.0% （42/280）, respectively, but no HCV-positive person was found. In the multivariate logistic regression model, subjects with a monthly income of more than RMB $ 1,000 （OR=4.83,95% CI=1.44-16.22）, subjects who often went to bars for sexual partners （OR=2.25, 95%CI=1.21-4.20）, and subjects who had more than one sexual partner in the past 6 months （OR=0.49, 95%CI=0.25-0.97） and had sex with fixed sexual partners in the past 6 months （OR=0.42, 95%CI=0.25-0.75） were significantly associated with the rate of continued condom use in homosexual sex in the past 6 months. Unprotected sex and multiple sexual partners were more common among MSM in Suzhou city; furthermore, the prevalences of HIV infection and syphilis were relatively high. HIV preventive measures should be designed to address these risk factors and control the spread of HIV among MSM.展开更多
Objective： To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions. Methods： A questionn...Objective： To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions. Methods： A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature. After being exam- ined and validated by experts, the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital. Among the 47 patients enrolled into the study, the 14 who developed nosocomial pressure sores were allocated to the pressure sore group, and the remaining 33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group. Univariate and multivariate logistic regression analyses were employed to examine the differences in 22 indicators between the two groups in an attempt to identify the risk factors for pressure sores. Results： According to the univariate analyses, the maximum value of lactic acid in the arterial blood, the number of days of norepinephrine use, the number of days of mechanical ventilation, the number of days of blood purification, and the number of days of bowel incontinence were statistically greater in the pressure sore group than in the control group （P〈0.05）. The multivariate logistic regression analysis revealed that the number of days of norepinephrine use and the level of lactic acid in the arterial blood were high risk-factors for pressure sores （P〈0.05）. Conclusions： The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock. The adoption of measures specific to high-risk patient groups and risk factors, including the active control of primary diseases and the application of decompression measures during the treatment of the patients, are helpful for improving the quality of care in the prevention and control of pressure sores in critically ill patients.展开更多
BACKGROUND Alpha-fetoprotein(AFP)is one of the diagnostic standards for primary liver cancer(PLC);however,AFP exhibits insufficient sensitivity and specificity for diagnosing PLC.AIM To evaluate the effects of high-ri...BACKGROUND Alpha-fetoprotein(AFP)is one of the diagnostic standards for primary liver cancer(PLC);however,AFP exhibits insufficient sensitivity and specificity for diagnosing PLC.AIM To evaluate the effects of high-risk factors and the diagnostic value of AFP in stratified PLC.METHODS In total,289 PLC cases from 2013 to 2019 were selected for analysis.First,the contributions of high-risk factors in stratifying PLC were compared according to the following criteria:Child–Pugh score,clinical stage of liver cirrhosis,tumor size,and Barcelona Clinic Liver Cancer(BCLC)stage.Then,the diagnostic value of AFP was evaluated in different stratifications of PLC by receiver operating characteristic curves.For PLC cases in which AFP played little role,the diagnostic values of carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA 19-9),gamma-glutamyl transferase(GGT),and AFP were analyzed.RESULTS The roles of high-risk factors differed in stratified PLC.The incidence of smoking and drinking history was higher in PLC with Child–Pugh scores of C(P<0.0167).The hepatitis B virus(HBV)infection rate in PLC with cirrhosis was more than in PLC without cirrhosis(P<0.0167).Small tumors were more prone to cirrhosis than large tumors(P<0.005).BCLC stage D PLC was more likely to be associated with HBV infection and cirrhosis(P<0.0083).AFP levels were higher in PLC with cirrhosis,diffuse tumors,and BCLC stage D disease.In diagnosing PLC defined as Child–Pugh A,B,and C,massive hepatoma,diffuse hepatoma,BCLC stage B,C,and D,and AFP showed significant diagnostic value[all area under the curve(AUC)>0.700].However,these measures were meaningless(AUC<0.600)in small hepatomas and BCLC A stage PLC,but could be replaced by the combined detection of CEA,CA 19-9,GGT,and AFP(AUC=0.810 and 0.846,respectively).CONCLUSION Stratification of PLC was essential for precise diagnoses and benefited from evaluating AFP levels.展开更多
BACKGROUND Delirium is a neuropsychiatric syndrome characterized by acute disturbances of consciousness with rapid onset,rapid progression,obvious fluctuations,and preventable,reversible,and other characteristics.Pati...BACKGROUND Delirium is a neuropsychiatric syndrome characterized by acute disturbances of consciousness with rapid onset,rapid progression,obvious fluctuations,and preventable,reversible,and other characteristics.Patients with delirium in the intensive care unit(ICU)are often missed or misdiagnosed and do not receive adequate attention.AIM To analyze the risk factors for delirium in ICU patients and explore the applica-tion of emotional nursing with pain nursing in the management of delirium.METHODS General data of 301 critically ill patients were retrospectively collected,including histories(cardiovascular and cerebrovascular diseases,hypertension,smoking,alcoholism,and diabetes),age,sex,diagnosis,whether surgery was performed,and patient origin(emergency/clinic).Additionally,the duration of sedation,Richmond Agitation Sedation Scale score,combined emotional and pain care,ven-tilator use duration,vasoactive drug use,drainage tube retention,ICU stay du-ration,C-reactive protein,procalcitonin,white blood cell count,body tempe-rature,Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment score were recorded within 24 h after ICU admission.Patients were assessed for delirium according to confusion assessment method for the ICU,and univariate and multivariate logistic regre-ssion analyses were performed to identify the risk factors for delirium in the patients.RESULTS Univariate logistic regression analysis was performed on the 24 potential risk factors associated with delirium in ICU patients.The results showed that 16 risk factors were closely related to delirium,including combined emotional and pain care,history of diabetes,and patient origin.Multivariate logistic regression analysis revealed that no combined emotional and pain care,history of diabetes,emergency source,surgery,long stay in the ICU,smoking history,and high APACHE II score were independent risk factors for de-lirium in ICU patients.CONCLUSION Patients with diabetes and/or smoking history,postoperative patients,patients with a high APACHE II score,and those with emergency ICU admission need emotional and pain care,flexible visiting modes,and early intervention to reduce delirium incidence.展开更多
Background:Loneliness is a common experience for pregnant women and correlates with perinatal depression and negative pregnancy outcomes.Women experiencing a high-risk pregnancy are at greater risk for loneliness beca...Background:Loneliness is a common experience for pregnant women and correlates with perinatal depression and negative pregnancy outcomes.Women experiencing a high-risk pregnancy are at greater risk for loneliness because of uncertainty with disease and the medicalization of pregnancy.International studies have identified an association between perceived stress and loneliness in pregnant women.The aim of this study is to explore factors related to loneliness among women of high-risk pregnancy,and to examine the associated relationship of loneliness and perceived stress.Methods:Using convenience sampling,109 women with high-risk pregnancies were enrolled.Data collection involved questionnaires on general demographic characteristics,the 6-item Loneliness Scale(ULS-6),and the Chinese version of the Perceived Stress Scale(CPSS-14).Data analysis was performed using SPSS 28.0 statistical software.Results:The mean loneliness score was 9.95±2.99,and the mean perceived stress score was 22.84±5.80.Women with high-risk pregnancies exhibited statistically significant differences in loneliness scores compared to the control group across among age,marital status,educational attainment,per capita monthly household income,spousal relationship,in-law relationship,and parental relationship(P<0.05).Correlation analysis revealed a positive correlation between loneliness and perceived stress(r=0.456,P<0.01).Multivariate regression analysis indicated that per capita monthly household income,marital relationship,in-law relationship,and perceived stress were the primary factors influencing loneliness among women with high-risk pregnancies(P<0.05).Conclusion:The results highlight the need for specific interventions addressing loneliness among women with high-risk pregnancies.Such interventions should focus on improving spousal and in-law relationships,reducing perceived stress,and implementing support measures,such as financial counseling or assistance programs,for those with lower per capita household income.This study establishes a foundation for the creation of integrated support systems that bring together families and healthcare providers to strengthen maternal mental health.展开更多
Spinal cord injury represents a severe form of central nervous system trauma for which effective treatments remain limited.Microglia is the resident immune cells of the central nervous system,play a critical role in s...Spinal cord injury represents a severe form of central nervous system trauma for which effective treatments remain limited.Microglia is the resident immune cells of the central nervous system,play a critical role in spinal cord injury.Previous studies have shown that microglia can promote neuronal survival by phagocytosing dead cells and debris and by releasing neuroprotective and anti-inflammatory factors.However,excessive activation of microglia can lead to persistent inflammation and contribute to the formation of glial scars,which hinder axonal regeneration.Despite this,the precise role and mechanisms of microglia during the acute phase of spinal cord injury remain controversial and poorly understood.To elucidate the role of microglia in spinal cord injury,we employed the colony-stimulating factor 1 receptor inhibitor PLX5622 to deplete microglia.We observed that sustained depletion of microglia resulted in an expansion of the lesion area,downregulation of brain-derived neurotrophic factor,and impaired functional recovery after spinal cord injury.Next,we generated a transgenic mouse line with conditional overexpression of brain-derived neurotrophic factor specifically in microglia.We found that brain-derived neurotrophic factor overexpression in microglia increased angiogenesis and blood flow following spinal cord injury and facilitated the recovery of hindlimb motor function.Additionally,brain-derived neurotrophic factor overexpression in microglia reduced inflammation and neuronal apoptosis during the acute phase of spinal cord injury.Furthermore,through using specific transgenic mouse lines,TMEM119,and the colony-stimulating factor 1 receptor inhibitor PLX73086,we demonstrated that the neuroprotective effects were predominantly due to brain-derived neurotrophic factor overexpression in microglia rather than macrophages.In conclusion,our findings suggest the critical role of microglia in the formation of protective glial scars.Depleting microglia is detrimental to recovery of spinal cord injury,whereas targeting brain-derived neurotrophic factor overexpression in microglia represents a promising and novel therapeutic strategy to enhance motor function recovery in patients with spinal cord injury.展开更多
BACKGROUND Ischemic stroke is one of the leading global causes of disability and death.Despite advances in modern medical technology that improve acute treatment and rehabilitation measures,post-stroke anxiety and dep...BACKGROUND Ischemic stroke is one of the leading global causes of disability and death.Despite advances in modern medical technology that improve acute treatment and rehabilitation measures,post-stroke anxiety and depression(PSD)do not receive sufficient attention.AIM To systematically evaluate risk factors and early identification markers for PSD for more precise screening and intervention strategies in clinical practice.METHODS This retrospective study analyzed clinical data from 112 patients with ischemic stroke admitted between January 2022 and December 2024.Based on assessments using the Hamilton Rating Scale for Anxiety(HAMA)and Hamilton Rating Scale for Depression(HAMD)at 2 weeks(±3 days)post-stroke,patients were classified into the PSD group(HAMA≥7 and/or HAMD≥7)and the non-PSD group(HAMA<7 and HAMD<7).Observation indicators included psychological assessment,demographic and clinical characteristics,stroke-related clinical indicators,neuroimaging assessments,and laboratory biomarkers.Multivariate logistic regression analysis was used to identify independent risk factors for PSD,and receiver operating characteristic curve analysis was used to evaluate the diagnostic value of potential biomarkers.RESULTS Of the 112 patients,46(41.1%)were diagnosed with PSD.Multivariate analysis identified five independent risk factors:Female gender[Odds ratio(OR)=2.32,95%confidence interval(CI):1.56-3.45],history of mental disorders prior to stroke(OR=3.17,95%CI:1.89-5.32),infarct location in the frontal lobe or limbic system(OR=2.86,95%CI:1.73-4.71),stroke severity with National Institutes of Health Stroke Scale≥8 at admission(OR=2.54,95%CI:1.62-3.99),and low social support(Social Support Rating Scale<35,OR=2.18,95%CI:1.42-3.36).Subgroup analysis showed that depression patients more commonly had left hemisphere lesions(68.4%vs 45.2%),while anxiety patients more frequently presented with right hemisphere lesions(59.5%vs 39.5%).The PSD group exhibited larger infarct volumes(8.7 cm^(3) vs 5.3 cm^(3)),more severe white matter hyperintensities,and more pronounced frontal lobe atrophy.Analysis of inflammatory markers showed significantly elevated levels of interleukin-6(7.8 pg/mL vs 4.5 pg/mL)and tumor necrosis factor-alpha(15.6 pg/mL vs 9.8 pg/mL)in the PSD group,while hypothalamicpituitary-adrenal axis function assessment revealed higher cortisol levels(386.5±92.3 nmol/L vs 328.7±75.6 nmol/L)and flattened diurnal rhythm in the PSD group.CONCLUSION PSD is a complex neuropsychiatric consequence of stroke involving disruption of the frontal-limbic circuitry,neuroinflammatory responses,and dysfunction of the hypothalamic-pituitary-adrenal axis.展开更多
Strokes include both ischemic stroke,which is mediated by a blockade or reduction in the blood supply to the brain,and hemorrhagic stroke,which comprises intracerebral hemorrhage and subarachnoid hemorrhage and is cha...Strokes include both ischemic stroke,which is mediated by a blockade or reduction in the blood supply to the brain,and hemorrhagic stroke,which comprises intracerebral hemorrhage and subarachnoid hemorrhage and is characterized by bleeding within the brain.Stroke is a lifethreatening cerebrovascular condition characterized by intricate pathophysiological mechanisms,including oxidative stress,inflammation,mitochondrial dysfunction,and neuronal injury.Critical transcription factors,such as nuclear factor erythroid 2-related factor 2 and nuclear factor kappa B,play central roles in the progression of stroke.Nuclear factor erythroid 2-related factor 2 is sensitive to changes in the cellular redox status and is crucial in protecting cells against oxidative damage,inflammatory responses,and cytotoxic agents.It plays a significant role in post-stroke neuroprotection and repair by influencing mitochondrial function,endoplasmic reticulum stress,and lysosomal activity and regulating metabolic pathways and cytokine expression.Conversely,nuclear factor-kappa B is closely associated with mitochondrial dysfunction,the generation of reactive oxygen species,oxidative stress exacerbation,and inflammation.Nuclear factor-kappa B contributes to neuronal injury,apoptosis,and immune responses following stroke by modulating cell adhesion molecules and inflammatory mediators.The interplay between these pathways,potentially involving crosstalk among various organelles,significantly influences stroke pathophysiology.Advancements in single-cell sequencing and spatial transcriptomics have greatly improved our understanding of stroke pathogenesis and offer new opportunities for the development of targeted,individualized,cell typespecific treatments.In this review,we discuss the mechanisms underlying the involvement of nuclear factor erythroid 2-related factor 2 and nuclear factor-kappa B in both ischemic and hemorrhagic stroke,with an emphasis on their roles in oxidative stress,inflammation,and neuroprotection.展开更多
Nerve trauma commonly results in chronic neuropathic pain. This is by triggering the release of proinflammatory mediators from local and invading cells that induce inflammation and nociceptive neuron hyperexcitability...Nerve trauma commonly results in chronic neuropathic pain. This is by triggering the release of proinflammatory mediators from local and invading cells that induce inflammation and nociceptive neuron hyperexcitability. Even without apparent inflammation, injury sites are associated with increased inflammatory markers. This review focuses on how it might be possible to reduce neuropathic pain by reducing inflammation. Physiologically, pain is resolved by a combination of the out-migration of pro-inflammatory cells from the injury site, the down-regulation of the genes underlying the inflammation, up-regulating genes for anti-inflammatory mediators, and reducing nociceptive neuron hyperexcitability. While various techniques reduce chronic neuropathic pain, the best are effective on < 50% of patients, no technique reliably or permanently eliminates neuropathic pain. This is because most techniques are predominantly aimed at reducing pain, not inflammation. In addition, while single factors reduce pain, increasing evidence indicates significant and longer-lasting pain relief requires multiple factors acting simultaneously. Therefore, it is not surprising that extensive data indicate that the application of platelet-rich plasma provides more significant and longer-lasting pain suppression than other techniques, although its analgesia is neither complete nor permanent. However, several case reports indicate that platelet-rich plasma can induce permanent neuropathic pain elimination when the platelet concentration is significantly increased and is applied to longer nerve lengths. This review examines the primary triggers of the development and maintenance of neuropathic pain and techniques that reduce chronic neuropathic pain. The application of plateletrich plasma holds great promise for providing complete and permanent chronic neuropathic pain elimination.展开更多
BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite imp...BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.展开更多
Understanding water chemistry in karst regions is crucial for improving global water resource management and deepening our knowledge of the biogeochemical cycles shaping these sensitive environments.Despite advance-me...Understanding water chemistry in karst regions is crucial for improving global water resource management and deepening our knowledge of the biogeochemical cycles shaping these sensitive environments.Despite advance-ments in karst hydrology,significant gaps remain in long-term trends,underlying processes,and quantitative effects of environmental changes.This is especially true in areas like the Wujiang River(WJ)in China,where human activities such as reservoir construction and land use/cover changes have accelerated hydrochemical changes.We combined recent and historical monitoring data to provide a detailed analysis of the spatial and temporal characteristics,evolution,and controlling factors of major ions in WJ.These findings are important for local water management and contribute to global efforts to manage similar karst systems facing human-induced pressures.Our research shows clear seasonal differences in solute concentrations,with higher levels during the dry season.WJ’s water is rich in calcium,with Ca-HCO_(3) ion pairs being the most common.Reservoir monitor-ing stations show much higher levels of NO_(3)^(−)and SO_(4)^(2−)compared to river-type stations,likely due to longer hydraulic retention time and increased acid deposition.The study confirms the significant role of pH and water temperature in rock weathering processes.Land use/cover changes were identified as the primary drivers of solute variations(46.37%),followed by lithology(13.92%)and temperature(8.35%).Over the past two decades,in-tense carbonate weathering has been observed,especially during wet seasons.Among karstic provinces,Guizhou Province stands out with the highest ion concentrations,indicative of its extensive karst coverage and heightened weathering processes.展开更多
Landslides pose a formidable natural hazard across the Qinghai-Tibet Plateau(QTP),endangering both ecosystems and human life.Identifying the driving factors behind landslides and accurately assessing susceptibility ar...Landslides pose a formidable natural hazard across the Qinghai-Tibet Plateau(QTP),endangering both ecosystems and human life.Identifying the driving factors behind landslides and accurately assessing susceptibility are key to mitigating disaster risk.This study integrated multi-source historical landslide data with 15 predictive factors and used several machine learning models—Random Forest(RF),Gradient Boosting Regression Trees(GBRT),Extreme Gradient Boosting(XGBoost),and Categorical Boosting(CatBoost)—to generate susceptibility maps.The Shapley additive explanation(SHAP)method was applied to quantify factor importance and explore their nonlinear effects.The results showed that:(1)CatBoost was the best-performing model(CA=0.938,AUC=0.980)in assessing landslide susceptibility,with altitude emerging as the most significant factor,followed by distance to roads and earthquake sites,precipitation,and slope;(2)the SHAP method revealed critical nonlinear thresholds,demonstrating that historical landslides were concentrated at mid-altitudes(1400-4000 m)and decreased markedly above 4000 m,with a parallel reduction in probability beyond 700 m from roads;and(3)landslide-prone areas,comprising 13%of the QTP,were concentrated in the southeastern and northeastern parts of the plateau.By integrating machine learning and SHAP analysis,this study revealed landslide hazard-prone areas and their driving factors,providing insights to support disaster management strategies and sustainable regional planning.展开更多
BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different ...BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.展开更多
The discharge of micro-polluted water from sources such as agricultural runoff,urban stormwater,and treated effluents presents significant challenges to aquatic ecosystems.Constructed wetlands(CWs)have gained recog-ni...The discharge of micro-polluted water from sources such as agricultural runoff,urban stormwater,and treated effluents presents significant challenges to aquatic ecosystems.Constructed wetlands(CWs)have gained recog-nition as an eco-friendly solution for removing pollutants from various wastewater sources and are increasingly applied for micro-polluted water treatment.By reviewing 78 full-scale CW studies from Web of Science,it is summarized that the ranges of ammonium nitrogen(NH4+-N)concentrations in runoff,wastewater treatment plant effluent and polluted river were 0.1–6.6,0.3–12.3,and 0.2–41.1 mg/L,respectively.The ranges of ni-trate nitrogen concentrations were 0.2–14.2,0–5.7,and 0–2.6 mg/L,respectively.Removal efficiencies of CWs for micro-polluted water varied by CW types.The total nitrogen removal efficiencies for subsurface-flow CWs,free-water surface-flow CWs,and hybrid CWs ranged from 27.4%to 66.5%,16.8%to 89.8%,and 19.4%to 88.2%,respectively.The NH4+-N removal efficiencies ranged from 34.2%to 73.6%,38.4%to 89.4%and 13.5%to 94.2%,respectively.Additionally,other factors influencing contaminant removal efficiency such as hydraulic retention time,vegetation types,redox micro-environment and influent water quality were evaluated.Based on these findings,two strategies for improving the purification performance of CWs were proposed:the selection of incorporating electron donor substrates and the optimization of operation parameters.This paper serves as a synthesis of information to guide future research and full-scale CW applications in micro-polluted water treatment.展开更多
To achieve low-carbon regulation of electric vehicle(EV)charging loads under the“dual carbon”goals,this paper proposes a coordinated scheduling strategy that integrates dynamic carbon factor prediction and multiobje...To achieve low-carbon regulation of electric vehicle(EV)charging loads under the“dual carbon”goals,this paper proposes a coordinated scheduling strategy that integrates dynamic carbon factor prediction and multiobjective optimization.First,a dual-convolution enhanced improved Crossformer prediction model is constructed,which employs parallel 1×1 global and 3×3 local convolutionmodules(Integrated Convolution Block,ICB)formultiscale feature extraction,combinedwith anAdaptive Spectral Block(ASB)to enhance time-series fluctuationmodeling.Based on high-precision predictions,a carbon-electricity cost joint optimization model is further designed to balance economic,environmental,and grid-friendly objectives.The model’s superiority was validated through a case study using real-world data from a renewable-heavy grid.Simulation results show that the proposed multi-objective strategy demonstrated a superior balance compared to baseline and benchmark models,achieving a 15.8%reduction in carbon emissions and a 5.2%reduction in economic costs,while still providing a substantial 22.2%reduction in the peak-valley difference.Its balanced performance significantly outperformed both a single-objective strategy and a state-of-the-art Model Predictive Control(MPC)benchmark,highlighting the advantage of a global optimization approach.This study provides theoretical and technical pathways for dynamic carbon factor-driven EV charging optimization.展开更多
基金supported by grants from the National Natural Science Foundation of China(Grant Nos.82200215,82170193,and 82370197)the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(Grant No.2022-I2M-1-002)。
文摘Objective:Our previous studies have indicated potentially higher proliferative activity of tumor cells in Chinese patients with mantle-cell lymphoma(MCL)than those in Western.Given the success and tolerability of R-DA-EDOCH immunochemotherapy in treating aggressive B-cell lymphomas,we designed a prospective,phase 3 trial to explore the efficacy and safety of alternating R-DA-EDOCH/R-DHAP induction therapy for young patients with newly diagnosed MCL.The primary endpoint was the complete remission rate(CRR)at the end of induction(EOI).Methods:A total of 55 patients were enrolled.The CRR at the EOI was 89.1%[95%confidence interval(CI)78%±96%],and the overall response rate was 98.1%(95%CI 90%±100%).Most patients with bone marrow involvement quickly attained minimal residual disease(MRD)negative status,with a 95.7%rate at the EOI.Results:The 3-year progression-free survival(PFS)and overall survival rates were 66.3%and 83.2%,respectively.No patients discontinued treatment because of adverse events.Univariate analysis identified pathologic morphology and TP53 mutations as risk factors for PFS.However,high tumor proliferative activity and certain cytogenetic abnormalities showed no significant adverse prognostic significance.Conclusions:Intensive therapy based on a high cytarabine dose and continuously administered EDOCH achieved a high MRDnegative rate and provides an optional induction choice for young patients with MCL with high-risk factors.
文摘Necrotizing enterocolitis (NEC) in newborns is one of the life-threatening diseases. With the continuous advancement of perinatal medicine and neonatal intensive care technology, NEC has been on the rise year by year. The etiology of NEC is not yet clear, and it may be the result of multiple risk factors working together, such as premature birth, infection, formula feeding, ischemia, hypoxia, dysbiosis of intestinal flora, and immune damage. Additionally, recent reports have documented factors such as immunoglobulin treatment for hemolytic jaundice, blood transfusion therapy, and rapid achievement of adequate feeding. This article comprehensively analyzes the current research progress on high-risk factors of NEC, and provides a reference for future prevention, diagnosis, and treatment directions.
基金Supported by Huzhou City Science and Technology Plan Public Welfare Technology Application Research Project[Key Project],No.2020GZ42.
文摘BACKGROUND Bipolar disorder(BD),marked by recurring manic and depressive episodes,often coexists with anxiety disorder(AD),which increases treatment complexity and morbidity.Although quetiapine,an atypical antipsychotic,has demonstrated efficacy in treating BD and AD,further investigation is needed regarding its effectiveness and safety in patients with AD at high-risk factors for BD.AIM To explore the application and efficacy of quetiapine in combination therapy for patients with AD at high-risk factors for BD.METHODS This study included 67 patients,with two excluded,leaving 65 divided into Group A(sertraline treatment)and Group B(combination treatment).All patients received sertraline,with Group B additionally receiving quetiapine.Efficacy was assessed using the Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),and Bech-Rafaelsen Mania sale(BRMS)throughout the treatment period.Side effects and physiological indicators were also monitored.RESULTS No significant baseline differences existed between the two groups at treatment onset.Over the treatment course,Group B exhibited significantly lower HAMA scores than Group A at the end of weeks 1 and 24.HAMD scores gradually decreased over time,with Group B consistently showing lower scores than Group A.BRMS scores decreased significantly from baseline by week 8.In Group A,27.27%of patients received zolpidem treatment compared to 10.53%in Group B,which was a significant difference.Incidence of adverse reactions did not differ significantly between groups at treatment onset,but most patients experienced relief from adverse reactions within 4 weeks.CONCLUSION Combination of quetiapine and sertraline can more rapidly alleviate anxiety and depressive symptoms in patients with AD at high-risk factors for BD,improving treatment outcomes.
基金This project is supported by a grant from the National Natural Sciences Foundation (No. 30100207)a grant from the Top Ten Scientific Research Programs of Shandong Province (No. 2004GG3202003)
文摘To investigate the high-risk factors for newborn hearing loss and to provide information for preventing the development of hearing loss and delaying its progression, from May 2003 to June 2006, neonates who failed to pass the universal newborn hearing screening （UNHS） were referred to Jinan Newborn Hearing Screening and Rehabilitation Center from 7 newborn hearing screening centers in seven cities of Shandong province. One-to-one pair-matched case-control method was employed for statistical analysis of the basic features of definitely identified cases. High-risk factors relating to the bilateral hearing loss were evaluated by univariate and multivariate Logistic regression analysis. Our results revealed that 721 transferred newborns who didn＇t pass the heating screening received audiological and medical evaluation and 367 were confirmed to have hearing loss. Of them, 177 neonates with hearing loss who met the matching requirements were included in the study as subjects. Univariate analysis showed that high-risk factors related to hearing loss incuded age of father, education backgrounds of parents, parity, birth weight, gestational weeks, craniofacial deformity, history of receiving treatment in neonatal intensive care unit （NICU）, neonatal disease, family history of otopathy and family history of congenital hearing loss. Multivariate Logistic regression analysis revealed that 4 independent risk factors were related to bilateral hearing loss, including parity （OR=16.285, 95% CI 3.379--78,481）, neonatal disease （OR=34;968, 95% CI 2.720 449.534）, family history of congenital hearing loss （OR=69.488, 95% CI 4.417--1093.300） and birth weight （OR=0.241, 95% CI 0.090--0.648）. It is concluded that parity, neonatal disease and family history of heating loss are the promoting factors of bilateral hearing loss in neonates and appropriate intervention measures should be taken to deal with the risk factors.
基金supported by Huazhong University of Science and Technology independent innovation fund in 2013-chinical skills(No.01-18-530069)
文摘Objective： The aim of this study was to identify the risk factors for inpatient suicide in a general hospital. Methods： Thirty suicide victims were drawn from the adverse event reports of suicidal acts during hospitalization in a general hospital from 2008 to 2014. Data were gathered from a focus group interview of 6 medical staff who had experienced inpatient suicide. Interpretative phenomenological analysis was used to analyze the data. Results： Five main themes regarding high-risk factors for inpatient suicide emerged from this study： mental disorders, diseases, the source of money to meet medical expenses, social support, and the hospital environment. Patients with mental disorders were at a high risk of suicide. Having a serious disease, paying high medical expenses alone, the loss of social support and unsafe hospital environments were also associated with an increased risk of suicide. Conclusions： This study puts forward different perspectives on the reasons that inpatients commit suicide and corresponding preventive measures based on these 5 main themes that could be implemented to avoid or reduce suicidal acts among inpatients during hospitalization.
基金supported by National Natusal Seience Foundation of China (81001288)National S&T Major Project Foundation of China(No. 2008ZX10001-003+1 种基金 2009ZX10004-904)Universities National Science Foundation of Jiangsu Province (No. 09KJB330004)
文摘A cross-sectional study using the snowball sampling method was conducted in May 2008 to investigate human immunodeficiency virus （HIV） infection status and related high risk factors among men who have sex with men （MSM） in Suzhou city of Jiangsu province. The researchers carried out a face-to-face questionnaire interview among MSM, and collected their blood samples to test for HIV and other sexually transmitted diseases （STDs）. Among the 280 respondents, 91.1% had homosexual acts in the past 6 months and 87.5% had multiple homosex- ual partners; 46.4% had heterosexual sex in the past 6 months and 33.1% had multiple heterosexual partners. The rate of continued condom use was 44.3% in homosexual sex in the past 6 months, while the rate in heterosexual sex was 33.9%. Laboratory test results showed that the prevalences of HIV and syphilis were 7.1% （20/280） and 15.0% （42/280）, respectively, but no HCV-positive person was found. In the multivariate logistic regression model, subjects with a monthly income of more than RMB $ 1,000 （OR=4.83,95% CI=1.44-16.22）, subjects who often went to bars for sexual partners （OR=2.25, 95%CI=1.21-4.20）, and subjects who had more than one sexual partner in the past 6 months （OR=0.49, 95%CI=0.25-0.97） and had sex with fixed sexual partners in the past 6 months （OR=0.42, 95%CI=0.25-0.75） were significantly associated with the rate of continued condom use in homosexual sex in the past 6 months. Unprotected sex and multiple sexual partners were more common among MSM in Suzhou city; furthermore, the prevalences of HIV infection and syphilis were relatively high. HIV preventive measures should be designed to address these risk factors and control the spread of HIV among MSM.
文摘Objective： To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions. Methods： A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature. After being exam- ined and validated by experts, the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital. Among the 47 patients enrolled into the study, the 14 who developed nosocomial pressure sores were allocated to the pressure sore group, and the remaining 33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group. Univariate and multivariate logistic regression analyses were employed to examine the differences in 22 indicators between the two groups in an attempt to identify the risk factors for pressure sores. Results： According to the univariate analyses, the maximum value of lactic acid in the arterial blood, the number of days of norepinephrine use, the number of days of mechanical ventilation, the number of days of blood purification, and the number of days of bowel incontinence were statistically greater in the pressure sore group than in the control group （P〈0.05）. The multivariate logistic regression analysis revealed that the number of days of norepinephrine use and the level of lactic acid in the arterial blood were high risk-factors for pressure sores （P〈0.05）. Conclusions： The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock. The adoption of measures specific to high-risk patient groups and risk factors, including the active control of primary diseases and the application of decompression measures during the treatment of the patients, are helpful for improving the quality of care in the prevention and control of pressure sores in critically ill patients.
基金Supported by High-End Talent Funding Project in Hebei Province,No.A202003005Hebei Provincial Health Commission Office,No.G2019074+1 种基金Science and Technology Research Project of Hebei Higher Education Institutions(ZD2018090)Natural Science Foundation of Hebei Province,No.H2019209355。
文摘BACKGROUND Alpha-fetoprotein(AFP)is one of the diagnostic standards for primary liver cancer(PLC);however,AFP exhibits insufficient sensitivity and specificity for diagnosing PLC.AIM To evaluate the effects of high-risk factors and the diagnostic value of AFP in stratified PLC.METHODS In total,289 PLC cases from 2013 to 2019 were selected for analysis.First,the contributions of high-risk factors in stratifying PLC were compared according to the following criteria:Child–Pugh score,clinical stage of liver cirrhosis,tumor size,and Barcelona Clinic Liver Cancer(BCLC)stage.Then,the diagnostic value of AFP was evaluated in different stratifications of PLC by receiver operating characteristic curves.For PLC cases in which AFP played little role,the diagnostic values of carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA 19-9),gamma-glutamyl transferase(GGT),and AFP were analyzed.RESULTS The roles of high-risk factors differed in stratified PLC.The incidence of smoking and drinking history was higher in PLC with Child–Pugh scores of C(P<0.0167).The hepatitis B virus(HBV)infection rate in PLC with cirrhosis was more than in PLC without cirrhosis(P<0.0167).Small tumors were more prone to cirrhosis than large tumors(P<0.005).BCLC stage D PLC was more likely to be associated with HBV infection and cirrhosis(P<0.0083).AFP levels were higher in PLC with cirrhosis,diffuse tumors,and BCLC stage D disease.In diagnosing PLC defined as Child–Pugh A,B,and C,massive hepatoma,diffuse hepatoma,BCLC stage B,C,and D,and AFP showed significant diagnostic value[all area under the curve(AUC)>0.700].However,these measures were meaningless(AUC<0.600)in small hepatomas and BCLC A stage PLC,but could be replaced by the combined detection of CEA,CA 19-9,GGT,and AFP(AUC=0.810 and 0.846,respectively).CONCLUSION Stratification of PLC was essential for precise diagnoses and benefited from evaluating AFP levels.
文摘BACKGROUND Delirium is a neuropsychiatric syndrome characterized by acute disturbances of consciousness with rapid onset,rapid progression,obvious fluctuations,and preventable,reversible,and other characteristics.Patients with delirium in the intensive care unit(ICU)are often missed or misdiagnosed and do not receive adequate attention.AIM To analyze the risk factors for delirium in ICU patients and explore the applica-tion of emotional nursing with pain nursing in the management of delirium.METHODS General data of 301 critically ill patients were retrospectively collected,including histories(cardiovascular and cerebrovascular diseases,hypertension,smoking,alcoholism,and diabetes),age,sex,diagnosis,whether surgery was performed,and patient origin(emergency/clinic).Additionally,the duration of sedation,Richmond Agitation Sedation Scale score,combined emotional and pain care,ven-tilator use duration,vasoactive drug use,drainage tube retention,ICU stay du-ration,C-reactive protein,procalcitonin,white blood cell count,body tempe-rature,Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment score were recorded within 24 h after ICU admission.Patients were assessed for delirium according to confusion assessment method for the ICU,and univariate and multivariate logistic regre-ssion analyses were performed to identify the risk factors for delirium in the patients.RESULTS Univariate logistic regression analysis was performed on the 24 potential risk factors associated with delirium in ICU patients.The results showed that 16 risk factors were closely related to delirium,including combined emotional and pain care,history of diabetes,and patient origin.Multivariate logistic regression analysis revealed that no combined emotional and pain care,history of diabetes,emergency source,surgery,long stay in the ICU,smoking history,and high APACHE II score were independent risk factors for de-lirium in ICU patients.CONCLUSION Patients with diabetes and/or smoking history,postoperative patients,patients with a high APACHE II score,and those with emergency ICU admission need emotional and pain care,flexible visiting modes,and early intervention to reduce delirium incidence.
文摘Background:Loneliness is a common experience for pregnant women and correlates with perinatal depression and negative pregnancy outcomes.Women experiencing a high-risk pregnancy are at greater risk for loneliness because of uncertainty with disease and the medicalization of pregnancy.International studies have identified an association between perceived stress and loneliness in pregnant women.The aim of this study is to explore factors related to loneliness among women of high-risk pregnancy,and to examine the associated relationship of loneliness and perceived stress.Methods:Using convenience sampling,109 women with high-risk pregnancies were enrolled.Data collection involved questionnaires on general demographic characteristics,the 6-item Loneliness Scale(ULS-6),and the Chinese version of the Perceived Stress Scale(CPSS-14).Data analysis was performed using SPSS 28.0 statistical software.Results:The mean loneliness score was 9.95±2.99,and the mean perceived stress score was 22.84±5.80.Women with high-risk pregnancies exhibited statistically significant differences in loneliness scores compared to the control group across among age,marital status,educational attainment,per capita monthly household income,spousal relationship,in-law relationship,and parental relationship(P<0.05).Correlation analysis revealed a positive correlation between loneliness and perceived stress(r=0.456,P<0.01).Multivariate regression analysis indicated that per capita monthly household income,marital relationship,in-law relationship,and perceived stress were the primary factors influencing loneliness among women with high-risk pregnancies(P<0.05).Conclusion:The results highlight the need for specific interventions addressing loneliness among women with high-risk pregnancies.Such interventions should focus on improving spousal and in-law relationships,reducing perceived stress,and implementing support measures,such as financial counseling or assistance programs,for those with lower per capita household income.This study establishes a foundation for the creation of integrated support systems that bring together families and healthcare providers to strengthen maternal mental health.
基金supported by the National Natural Science Foundation of China,Nos.82072165 and 82272256(both to XM)the Key Project of Xiangyang Central Hospital,No.2023YZ03(to RM)。
文摘Spinal cord injury represents a severe form of central nervous system trauma for which effective treatments remain limited.Microglia is the resident immune cells of the central nervous system,play a critical role in spinal cord injury.Previous studies have shown that microglia can promote neuronal survival by phagocytosing dead cells and debris and by releasing neuroprotective and anti-inflammatory factors.However,excessive activation of microglia can lead to persistent inflammation and contribute to the formation of glial scars,which hinder axonal regeneration.Despite this,the precise role and mechanisms of microglia during the acute phase of spinal cord injury remain controversial and poorly understood.To elucidate the role of microglia in spinal cord injury,we employed the colony-stimulating factor 1 receptor inhibitor PLX5622 to deplete microglia.We observed that sustained depletion of microglia resulted in an expansion of the lesion area,downregulation of brain-derived neurotrophic factor,and impaired functional recovery after spinal cord injury.Next,we generated a transgenic mouse line with conditional overexpression of brain-derived neurotrophic factor specifically in microglia.We found that brain-derived neurotrophic factor overexpression in microglia increased angiogenesis and blood flow following spinal cord injury and facilitated the recovery of hindlimb motor function.Additionally,brain-derived neurotrophic factor overexpression in microglia reduced inflammation and neuronal apoptosis during the acute phase of spinal cord injury.Furthermore,through using specific transgenic mouse lines,TMEM119,and the colony-stimulating factor 1 receptor inhibitor PLX73086,we demonstrated that the neuroprotective effects were predominantly due to brain-derived neurotrophic factor overexpression in microglia rather than macrophages.In conclusion,our findings suggest the critical role of microglia in the formation of protective glial scars.Depleting microglia is detrimental to recovery of spinal cord injury,whereas targeting brain-derived neurotrophic factor overexpression in microglia represents a promising and novel therapeutic strategy to enhance motor function recovery in patients with spinal cord injury.
文摘BACKGROUND Ischemic stroke is one of the leading global causes of disability and death.Despite advances in modern medical technology that improve acute treatment and rehabilitation measures,post-stroke anxiety and depression(PSD)do not receive sufficient attention.AIM To systematically evaluate risk factors and early identification markers for PSD for more precise screening and intervention strategies in clinical practice.METHODS This retrospective study analyzed clinical data from 112 patients with ischemic stroke admitted between January 2022 and December 2024.Based on assessments using the Hamilton Rating Scale for Anxiety(HAMA)and Hamilton Rating Scale for Depression(HAMD)at 2 weeks(±3 days)post-stroke,patients were classified into the PSD group(HAMA≥7 and/or HAMD≥7)and the non-PSD group(HAMA<7 and HAMD<7).Observation indicators included psychological assessment,demographic and clinical characteristics,stroke-related clinical indicators,neuroimaging assessments,and laboratory biomarkers.Multivariate logistic regression analysis was used to identify independent risk factors for PSD,and receiver operating characteristic curve analysis was used to evaluate the diagnostic value of potential biomarkers.RESULTS Of the 112 patients,46(41.1%)were diagnosed with PSD.Multivariate analysis identified five independent risk factors:Female gender[Odds ratio(OR)=2.32,95%confidence interval(CI):1.56-3.45],history of mental disorders prior to stroke(OR=3.17,95%CI:1.89-5.32),infarct location in the frontal lobe or limbic system(OR=2.86,95%CI:1.73-4.71),stroke severity with National Institutes of Health Stroke Scale≥8 at admission(OR=2.54,95%CI:1.62-3.99),and low social support(Social Support Rating Scale<35,OR=2.18,95%CI:1.42-3.36).Subgroup analysis showed that depression patients more commonly had left hemisphere lesions(68.4%vs 45.2%),while anxiety patients more frequently presented with right hemisphere lesions(59.5%vs 39.5%).The PSD group exhibited larger infarct volumes(8.7 cm^(3) vs 5.3 cm^(3)),more severe white matter hyperintensities,and more pronounced frontal lobe atrophy.Analysis of inflammatory markers showed significantly elevated levels of interleukin-6(7.8 pg/mL vs 4.5 pg/mL)and tumor necrosis factor-alpha(15.6 pg/mL vs 9.8 pg/mL)in the PSD group,while hypothalamicpituitary-adrenal axis function assessment revealed higher cortisol levels(386.5±92.3 nmol/L vs 328.7±75.6 nmol/L)and flattened diurnal rhythm in the PSD group.CONCLUSION PSD is a complex neuropsychiatric consequence of stroke involving disruption of the frontal-limbic circuitry,neuroinflammatory responses,and dysfunction of the hypothalamic-pituitary-adrenal axis.
基金supported by grants from the Zhejiang Provincial TCM Science and Technology Plan Project,No.2023ZL156(to YH)Ningbo Top Medical and Health Research Program,No.2022020304(to XG)+1 种基金the Natural Science Foundation of Ningbo,No.2023J019(to YH)Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province,No.2022E10026(to YH)。
文摘Strokes include both ischemic stroke,which is mediated by a blockade or reduction in the blood supply to the brain,and hemorrhagic stroke,which comprises intracerebral hemorrhage and subarachnoid hemorrhage and is characterized by bleeding within the brain.Stroke is a lifethreatening cerebrovascular condition characterized by intricate pathophysiological mechanisms,including oxidative stress,inflammation,mitochondrial dysfunction,and neuronal injury.Critical transcription factors,such as nuclear factor erythroid 2-related factor 2 and nuclear factor kappa B,play central roles in the progression of stroke.Nuclear factor erythroid 2-related factor 2 is sensitive to changes in the cellular redox status and is crucial in protecting cells against oxidative damage,inflammatory responses,and cytotoxic agents.It plays a significant role in post-stroke neuroprotection and repair by influencing mitochondrial function,endoplasmic reticulum stress,and lysosomal activity and regulating metabolic pathways and cytokine expression.Conversely,nuclear factor-kappa B is closely associated with mitochondrial dysfunction,the generation of reactive oxygen species,oxidative stress exacerbation,and inflammation.Nuclear factor-kappa B contributes to neuronal injury,apoptosis,and immune responses following stroke by modulating cell adhesion molecules and inflammatory mediators.The interplay between these pathways,potentially involving crosstalk among various organelles,significantly influences stroke pathophysiology.Advancements in single-cell sequencing and spatial transcriptomics have greatly improved our understanding of stroke pathogenesis and offer new opportunities for the development of targeted,individualized,cell typespecific treatments.In this review,we discuss the mechanisms underlying the involvement of nuclear factor erythroid 2-related factor 2 and nuclear factor-kappa B in both ischemic and hemorrhagic stroke,with an emphasis on their roles in oxidative stress,inflammation,and neuroprotection.
文摘Nerve trauma commonly results in chronic neuropathic pain. This is by triggering the release of proinflammatory mediators from local and invading cells that induce inflammation and nociceptive neuron hyperexcitability. Even without apparent inflammation, injury sites are associated with increased inflammatory markers. This review focuses on how it might be possible to reduce neuropathic pain by reducing inflammation. Physiologically, pain is resolved by a combination of the out-migration of pro-inflammatory cells from the injury site, the down-regulation of the genes underlying the inflammation, up-regulating genes for anti-inflammatory mediators, and reducing nociceptive neuron hyperexcitability. While various techniques reduce chronic neuropathic pain, the best are effective on < 50% of patients, no technique reliably or permanently eliminates neuropathic pain. This is because most techniques are predominantly aimed at reducing pain, not inflammation. In addition, while single factors reduce pain, increasing evidence indicates significant and longer-lasting pain relief requires multiple factors acting simultaneously. Therefore, it is not surprising that extensive data indicate that the application of platelet-rich plasma provides more significant and longer-lasting pain suppression than other techniques, although its analgesia is neither complete nor permanent. However, several case reports indicate that platelet-rich plasma can induce permanent neuropathic pain elimination when the platelet concentration is significantly increased and is applied to longer nerve lengths. This review examines the primary triggers of the development and maintenance of neuropathic pain and techniques that reduce chronic neuropathic pain. The application of plateletrich plasma holds great promise for providing complete and permanent chronic neuropathic pain elimination.
文摘BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.
基金supported by Guangdong Basic and Applied Basic Research Foundation(Nos.2023A1515110824 and 2025A1515011839)Shenzhen Science and Technology Program(No.RCBS20231211090638066).
文摘Understanding water chemistry in karst regions is crucial for improving global water resource management and deepening our knowledge of the biogeochemical cycles shaping these sensitive environments.Despite advance-ments in karst hydrology,significant gaps remain in long-term trends,underlying processes,and quantitative effects of environmental changes.This is especially true in areas like the Wujiang River(WJ)in China,where human activities such as reservoir construction and land use/cover changes have accelerated hydrochemical changes.We combined recent and historical monitoring data to provide a detailed analysis of the spatial and temporal characteristics,evolution,and controlling factors of major ions in WJ.These findings are important for local water management and contribute to global efforts to manage similar karst systems facing human-induced pressures.Our research shows clear seasonal differences in solute concentrations,with higher levels during the dry season.WJ’s water is rich in calcium,with Ca-HCO_(3) ion pairs being the most common.Reservoir monitor-ing stations show much higher levels of NO_(3)^(−)and SO_(4)^(2−)compared to river-type stations,likely due to longer hydraulic retention time and increased acid deposition.The study confirms the significant role of pH and water temperature in rock weathering processes.Land use/cover changes were identified as the primary drivers of solute variations(46.37%),followed by lithology(13.92%)and temperature(8.35%).Over the past two decades,in-tense carbonate weathering has been observed,especially during wet seasons.Among karstic provinces,Guizhou Province stands out with the highest ion concentrations,indicative of its extensive karst coverage and heightened weathering processes.
基金The National Key Research and Development Program of China,No.2023YFC3206601。
文摘Landslides pose a formidable natural hazard across the Qinghai-Tibet Plateau(QTP),endangering both ecosystems and human life.Identifying the driving factors behind landslides and accurately assessing susceptibility are key to mitigating disaster risk.This study integrated multi-source historical landslide data with 15 predictive factors and used several machine learning models—Random Forest(RF),Gradient Boosting Regression Trees(GBRT),Extreme Gradient Boosting(XGBoost),and Categorical Boosting(CatBoost)—to generate susceptibility maps.The Shapley additive explanation(SHAP)method was applied to quantify factor importance and explore their nonlinear effects.The results showed that:(1)CatBoost was the best-performing model(CA=0.938,AUC=0.980)in assessing landslide susceptibility,with altitude emerging as the most significant factor,followed by distance to roads and earthquake sites,precipitation,and slope;(2)the SHAP method revealed critical nonlinear thresholds,demonstrating that historical landslides were concentrated at mid-altitudes(1400-4000 m)and decreased markedly above 4000 m,with a parallel reduction in probability beyond 700 m from roads;and(3)landslide-prone areas,comprising 13%of the QTP,were concentrated in the southeastern and northeastern parts of the plateau.By integrating machine learning and SHAP analysis,this study revealed landslide hazard-prone areas and their driving factors,providing insights to support disaster management strategies and sustainable regional planning.
基金Supported by the National Natural Science Foundation of China,No.82402789Beijing Jishuitan Hospital Youcai Plan,No.KYYC202402+2 种基金Beijing Jishuitan Research Funding,No.HL202402and Beijing Natural Science Foundation,No.L232062No.L222063.
文摘BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.
基金supported by the Natural Science Foundation of China(No.52470105)the Young Taishan Scholars Program of Shandong Province(No.358202103017).
文摘The discharge of micro-polluted water from sources such as agricultural runoff,urban stormwater,and treated effluents presents significant challenges to aquatic ecosystems.Constructed wetlands(CWs)have gained recog-nition as an eco-friendly solution for removing pollutants from various wastewater sources and are increasingly applied for micro-polluted water treatment.By reviewing 78 full-scale CW studies from Web of Science,it is summarized that the ranges of ammonium nitrogen(NH4+-N)concentrations in runoff,wastewater treatment plant effluent and polluted river were 0.1–6.6,0.3–12.3,and 0.2–41.1 mg/L,respectively.The ranges of ni-trate nitrogen concentrations were 0.2–14.2,0–5.7,and 0–2.6 mg/L,respectively.Removal efficiencies of CWs for micro-polluted water varied by CW types.The total nitrogen removal efficiencies for subsurface-flow CWs,free-water surface-flow CWs,and hybrid CWs ranged from 27.4%to 66.5%,16.8%to 89.8%,and 19.4%to 88.2%,respectively.The NH4+-N removal efficiencies ranged from 34.2%to 73.6%,38.4%to 89.4%and 13.5%to 94.2%,respectively.Additionally,other factors influencing contaminant removal efficiency such as hydraulic retention time,vegetation types,redox micro-environment and influent water quality were evaluated.Based on these findings,two strategies for improving the purification performance of CWs were proposed:the selection of incorporating electron donor substrates and the optimization of operation parameters.This paper serves as a synthesis of information to guide future research and full-scale CW applications in micro-polluted water treatment.
基金Supported by State Grid Corporation of China Science and Technology Project:Research on Key Technologies for Intelligent Carbon Metrology in Vehicle-to-Grid Interaction(Project Number:B3018524000Q).
文摘To achieve low-carbon regulation of electric vehicle(EV)charging loads under the“dual carbon”goals,this paper proposes a coordinated scheduling strategy that integrates dynamic carbon factor prediction and multiobjective optimization.First,a dual-convolution enhanced improved Crossformer prediction model is constructed,which employs parallel 1×1 global and 3×3 local convolutionmodules(Integrated Convolution Block,ICB)formultiscale feature extraction,combinedwith anAdaptive Spectral Block(ASB)to enhance time-series fluctuationmodeling.Based on high-precision predictions,a carbon-electricity cost joint optimization model is further designed to balance economic,environmental,and grid-friendly objectives.The model’s superiority was validated through a case study using real-world data from a renewable-heavy grid.Simulation results show that the proposed multi-objective strategy demonstrated a superior balance compared to baseline and benchmark models,achieving a 15.8%reduction in carbon emissions and a 5.2%reduction in economic costs,while still providing a substantial 22.2%reduction in the peak-valley difference.Its balanced performance significantly outperformed both a single-objective strategy and a state-of-the-art Model Predictive Control(MPC)benchmark,highlighting the advantage of a global optimization approach.This study provides theoretical and technical pathways for dynamic carbon factor-driven EV charging optimization.
