As a critical department ensuring the sterility of hospital instruments,the Sterile Supply Center(SSC)directly impacts the sterility status of clinical instruments through its sterilization qualification rate.Geriatri...As a critical department ensuring the sterility of hospital instruments,the Sterile Supply Center(SSC)directly impacts the sterility status of clinical instruments through its sterilization qualification rate.Geriatric patients,due to physiological decline and compromised immune function,constitute a high-risk group for hospital-acquired infections,with more stringent requirements for instrument sterility.This paper analyzes the current status and influencing factors of sterilization qualification rates in SSCs,explores the mechanistic association between sterilization qualification rates and infections in geriatric departments,and proposes targeted strategies to improve sterilization qualification rates.It highlights the pivotal role of SSC instrument sterilization in infection prevention and control for geriatric patients,providing theoretical basis and practical guidance for optimizing SSC management,reducing infection rates in geriatric departments,and ensuring the safety of elderly patients’medical care.These findings aim to enhance overall infection management standards in hospitals.展开更多
BACKGROUND The previous studies have primarily focused on the influence of botulinum toxin A(BoNT-A)injection on emotions during the period of peak motor symptom improvement in blepharospasm patients,based on facial f...BACKGROUND The previous studies have primarily focused on the influence of botulinum toxin A(BoNT-A)injection on emotions during the period of peak motor symptom improvement in blepharospasm patients,based on facial feedback hypothesis.AIM To evaluate the sustained anxiolytic and antidepressant effects of BoNT-A in blepharospasm patients beyond motor symptom control.METHODS We recruited benign essential blepharospasm patients with BoNT-A treatment and collected their data to compare scale scores of Jankovic Rating Scale,Blepharospasm Disability Index,Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),Hamilton Anxiety Scale and Hamilton Depression Scale between pretreatment(baseline)and pre-reinjection(treatment),to further assess the effects of repeated treatments with BoNT by using sub-group analyses in the certain special states.RESULTS A total of 21 eligible blepharospasm patients were with the mean age of 58.4 years and a male-to-female ratio of 1:6.Significantly decreases in the subscale scores of SDS and SAS,including SDS well-being index,decreased capacity and hard to decide,SAS inability to sit still and headache were showed at post-a single BoNT-A injection when scale scores of Jankovic Rating Scale and Blepharospasm Disability Index were matched between baseline and posttreatment.With each additional BoNT-A injection,the odds ratio of patients with the moderate depressive symptoms decreased by 92.6%.Moreover,BoNT treatment remained a decrease in the subscale scores of SDS and SAS in patients with repeated injections.CONCLUSION This study is to demonstrate that repeated BoNT-A injection have a long-lasting relief for anxiety and depressive symptoms in blepharospasm even after its motor symptom-modulating effects have diminished.展开更多
The temporal pole(TP),one of the most expanded cortical regions in humans relative to other primates,plays a crucial role in human language processing.It is also one of the most structurally and functionally asymmetri...The temporal pole(TP),one of the most expanded cortical regions in humans relative to other primates,plays a crucial role in human language processing.It is also one of the most structurally and functionally asymmetric regions.However,whether the functional architecture of the TP is shared by humans and macaques is an open question.We used spectral clustering algorithms to define a cross-species fine-grained TP atlas with different anatomical connectivity patterns.We identified three similar subregions,two ventral and one dorsal,within the TP in both humans and macaques.The parcellation scheme for the TP was validated using functional gradient mapping,anatomical connectivity and resting-state functional connectivity pattern analysis,and functional characterization.Furthermore,in conjunction with the Allen Human Brain Atlas,we revealed the molecular basis for the functional connectivity patterns of each human TP subregion.In addition,we compared the hemispheric asymmetry in mean gray matter volume,anatomical connectivity fingerprints,and whole brain functional connectivity patterns to reveal the evolutionary differences in the TP and found different asymmetric patterns between humans and macaques.In conclusion,our findings reveal that the asymmetry in structure and connectivity may underpin the hemispheric functional specialization of the brain and provide a novel insight into understanding the evolutionary origin of the TP.展开更多
Penetrance is a crucial indicator for accurately assessing disease risk and plays a vital role in disease research,gene therapy,and genetic counseling.However,with penetrance data dispersed across various sources,effi...Penetrance is a crucial indicator for accurately assessing disease risk and plays a vital role in disease research,gene therapy,and genetic counseling.However,with penetrance data dispersed across various sources,efficiently accessing and consolidating this information becomes a challenge.A comprehensive platform that integrates penetrance is urgently needed.Here,we present PenCards,a global,community-contributed public archive of variant penetrance,by first collecting penetrance data from all published literature and then using large international cohorts to specifically calculate the penetrance of autism-related variants.PenCards contains a total of 244,531 variants,including 239,244 single nucleotide variants,4994 insertions and deletions,and 293 copy number variants,covering approximately 300 phenotypes.We also provide a submission portal for the dynamic updating of penetrance.Additionally,to help users efficiently access genetic information,we comprehensively integrate over 150 variant-and gene-level resources.In summary,PenCards is a powerful platform designed to advance genetic research and diagnostics.PenCards is publicly available at https://genemed.tech/pencards/.展开更多
Objectives Quality of life(QoL) is a priority outcome in older adults suffering from cardiovascular diseases. Frailty and poor nutritional status may affect the QoL through mobility disorders and exhaustion. The objec...Objectives Quality of life(QoL) is a priority outcome in older adults suffering from cardiovascular diseases. Frailty and poor nutritional status may affect the QoL through mobility disorders and exhaustion. The objective of this study was to determine if physical frailty and nutritional status were associated with QoL, in older cardiology patients. Methods Cross sectional, observational study conducted in a cardiology department from a university hospital. Participants(n = 100) were aged 70 and older. Collected data included age, sex, cardiac diseases, New York Heart Association(NYHA) classification, comorbidities(Charlson Index) and disability. A Short Physical Performance Battery(SPPB), including walking speed assessment was performed;handgrip strength were measured as well as Fried’s frailty phenotype. Nutritional status was assessed using the Mini Nutritional Assessment(MNA) and Body Mass Index(BMI), inflammation by C-reactive protein(CRP). QoL was assessed using the EORTC–QLQ questionnaire. Univariate and multivariate analyses were performed to study the associations between all recorded parameters and QoL. Results In participants(mean age: 79.3 ± 6.7 years;male: 59%), Charlson index, arrhythmia, heart failure, NYHA class III-IV, MNA, disability, walking speed, SPPB score, frailty and CRP were significantly associated with QoL in univariate analysis. Multivariate analysis showed that NYHA class III-IV(P < 0.001), lower MNA score(P = 0.03), frailty(P < 0.0001), and higher CRP(P < 0.001) were independently associated with decreased QoL. Conclusions Frailty, nutritional status and inflammation were independently associated with poor QoL. Further studies are needed to assess the efficacy of nutritional and physical interventions on QoL in this population.展开更多
Parkinson’s disease is the second most common progressive neurodegenerative disorder,and few reliable biomarkers are available to track disease progression.The proteins,DNA,mRNA,and lipids carried by exosomes reflect...Parkinson’s disease is the second most common progressive neurodegenerative disorder,and few reliable biomarkers are available to track disease progression.The proteins,DNA,mRNA,and lipids carried by exosomes reflect intracellular changes,and thus can serve as biomarkers for a variety of conditions.In this study,we investigated alterations in the protein content of plasma exosomes derived from patients with Parkinson’s disease and the potential therapeutic roles of these proteins in Parkinson’s disease.Using a tandem mass tag-based quantitative proteomics approach,we characterized the proteomes of plasma exosomes derived from individual patients,identified exosomal protein signatures specific to patients with Parkinson’s disease,and identified N-acetyl-alpha-glucosaminidase as a differentially expressed protein.N-acetyl-alpha-glucosaminidase expression levels in exosomes from the plasma of patients and healthy controls were validated by enzyme-linked immunosorbent assay and western blot.The results demonstrated that the exosomal N-acetyl-alpha-glucosaminidase concentration was not only lower in Parkinson’s disease,but also decreased with increasing Hoehn-Yahr stage,suggesting that N-acetyl-alpha-glucosaminidase could be used to rapidly evaluate Parkinson’s disease severity.Furthermore,western blot and immunohistochemistry analysis showed that N-acetyl-alpha-glucosaminidase levels were markedly reduced both in cells treated with 1-methyl-4-phenylpyridinium and cells overexpressingα-synuclein compared with control cells.Additionally,N-acetyl-alpha-glucosaminidase overexpression significantly increased cell viability and inhibitedα-synuclein expression in 1-methyl-4-phenylpyridinium-treated cells.Taken together,our findings demonstrate for the first time that exosomal N-acetyl-alpha-glucosaminidase may serve as a biomarker for Parkinson’s disease diagnosis,and that N-acetyl-alpha-glucosaminidase may reduceα-synuclein expression and 1-methyl-4-phenylpyridinium-induced neurotoxicity,thus providing a new therapeutic target for Parkinson’s disease.展开更多
Objective Systematically integrate nurses’experience with“Internet Nursing Service”to analysis the nurses’experiences with“Internet Nursing Service”,and to provide a theoretical reference for formulating a more ...Objective Systematically integrate nurses’experience with“Internet Nursing Service”to analysis the nurses’experiences with“Internet Nursing Service”,and to provide a theoretical reference for formulating a more rational“Internet Nursing Service”model.Methods A systematic search in PubMed,Embase,Web of Science,the Cochrane Library,CINAHL,China National Knowledge Infrastructure(CNKI),Wanfang Database,and Chinese Biomedical Literature Database was conducted to collect qualitative research on nurses’experiences with“Internet Nursing Service,”with a retrieval time limit from December 2019 to June 2024.Qualitative meta-synthesis was performed through line-by-line coding of relevant quotes,organization of codes into descriptive themes,and development of analytical themes.Results A total of 19 studies were included,one study was rated as Grade A in quality evaluation,and the remaining studies were rated as Grade B.Collectively synthesized into three integrated results:Harvest and growth,Difficulties and challenges,and Expectations and support.Harvest and growth,include 1)manifestation of self-value,2)enhancing nursing capabilities,3)optimizing nursing resources;Difficulties and challenges,include 1)lack of safety guarantee,2)role conflict;Expectations and support include,1)expectation for professional knowledge and skill training,2)expectations for service platform optimization,3)expectation for reasonable charges,4)expectation for related policy support.Conclusion“Internet Nursing Service”model benefits both nurses and patients,but still full of challenges.It aids in the decentralization of medical resources.Management departments still need to encourage nurses to actively invest in“Internet Nursing Service”while ensuring their safety and interests.展开更多
Background: Falls in the elderly are a global public health problem with serious medical and socio-economic consequences, especially in low and middle-income countries. The aim of this study was to describe the charac...Background: Falls in the elderly are a global public health problem with serious medical and socio-economic consequences, especially in low and middle-income countries. The aim of this study was to describe the characteristics of falls among the elderly in trauma units in Senegal. Materials and Methods: This was a descriptive, prospective study from April 20, 2022 to October 30, 2022 among people aged at least 60 and admitted to the surgical emergency department of Idrissa Pouye Hospital in Dakar following a fall. Socio-demographic, clinical, therapeutic and evolutionary characteristics were collected and analyzed using Sphinx Plus 2 and Excel 2019 for Windows software. Results: Out of 730 elderly people seen during this period, 100 met the criteria, representing a prevalence of 13.69%. The average consultation time was 3.25 +/? 4 days. The average age was 73 +/? 8.43 years, with women predominating (74%). Medical expenses were mainly covered by the family (73%). Most falls occurred during the day (68%), at home (82%), especially in the bedroom (30%), with stumbling (32%) as the main mechanism. The majority of patients (86%) spent less than 30 minutes on the floor. Predisposing factors were dominated by visual disorders (56%) and precipitating factors were mainly environmental (62%). Geriatric syndromes were dominated by frailty (22%). Complications were dominated by fractures (86%), and almost half (47%) had lost their autonomy for post-fall Activities Daily Living (ADL). Prescription medication was almost systematic (98%), dominated by analgesics (98%). Surgery was indicated in 58% of patients. The average waiting time for surgery was 25.36 +/? 19 days. A death rate of 1% was recorded in the emergency department. Conclusion: Falls in the elderly are a frequent occurrence in traumatological emergencies, with etiological factors that are often multiple and interrelated, leading to significant morbidity. Raising awareness among people at risk and setting up an orthogeriatric service would help prevent falls and optimize care in the short and long term.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM),a chronic metabolic disease with a high global incidence,has become a serious public health challenge.China has the largest number of T2DM patients worldwide,imposing a signif...BACKGROUND Type 2 diabetes mellitus(T2DM),a chronic metabolic disease with a high global incidence,has become a serious public health challenge.China has the largest number of T2DM patients worldwide,imposing a significant economic burden on the healthcare system.T2DM is closely associated with insulin resistance,impaired pancreatic B cell function,and disordered glucose and lipid metabolism,which can lead to various complications,reducing patients'quality of life and increasing the risk of disability and death.Thus,finding effective preventive and intervention measures is crucial.Exercise therapy,a key part of diabetes management,has gained attention in recent years,with many studies indicating its benefits for blood glucose control and other aspects in diabetic patients.AIM To assess the effectiveness of combined resistance and aerobic exercise interventions on blood glucose control and metabolic indicators in patients with T2DM and to explore their application in diabetes management.METHODS Systematic searches were conducted using PubMed,EMBASE,Cochrane Library,and Chinese databases for relevant randomized controlled trials(RCTs).The inclusion criteria were participants aged≥18 years with T2DM and the intervention involved combined resistance and aerobic exercise for≥8 weeks.The primary outcome indicators were fasting blood glucose,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglycerides(TG),glycated hemoglobin A1c(HbA1c),and total cholesterol(TC)levels.Data analysis was performed using RevMan software,and the interventional effects were assessed using weighted mean differences or standardized mean differences(SMD).RESULTS Six RCTs meeting the inclusion criteria were included,with a total sample size of 366 participants.The meta-analysis results showed that combined resistance and aerobic exercise significantly improved several metabolic indicators in patients with T2DM.Specific results were as follows:(1)For fasting blood glucose,combined exercise was more effective than aerobic exercise alone[SMD=1.22;95%confidence interval(95%CI):0.70,1.74;P<0.00001];(2)LDL-C levels were significantly reduced by the combined intervention(SMD=1.45;95%CI:1.18-1.72;P<0.00001);(3)The combined intervention significantly increased HDL-C levels(SMD=1.42;95%CI:0.98-1.87;P<0.00001);(4)The combined intervention significantly reduced TG levels(SMD=1.12;95%CI:0.85-1.39;P<0.00001;(5)No statistically significant difference was observed in HbA1c between the combined and the aerobic exercise group(SMD=-0.03;95%CI:-1.09 to 1.04;P<0.00001);and(6)The combined exercise intervention group significantly reduced TC levels(SMD=2.66;95%CI:1.93-3.38;P<0.00001).The subgroup analysis results suggest that the effect of exercise interventions may be influenced by various factors,including the patient's age,baseline blood glucose levels,and exercise intensity.CONCLUSION Combined resistance and aerobic exercise intervention significantly improved fasting blood glucose,LDL-C,HDL-C,TG,and TC levels in patients with T2DM,especially in terms of blood glucose control and cardiovascular risk,demonstrating better outcomes than aerobic exercise alone.展开更多
BACKGROUND Physical inactivity is a significant yet underappreciated risk factor for cardiovascular disease(CVD),particularly among older adults.The aim of this study was to analyze the global burden of CVD attributab...BACKGROUND Physical inactivity is a significant yet underappreciated risk factor for cardiovascular disease(CVD),particularly among older adults.The aim of this study was to analyze the global burden of CVD attributable to physical inactivity in individuals aged 70 years and older from 1990 to 2021 using the Global Burden of Disease data.METHODS We assessed trends in disability-adjusted life years(DALYs)and deaths,decomposed changes into population growth,aging,and epidemiological factors,and examined health inequalities across sociodemographic index(SDI)regions.RESULTS From 1990 to 2021,a substantial rise in DALYs was observed,especially in low and middle SDI regions,with a 120.06% increase in the low SDI region,but a 23.10% decline in the high SDI region.Decomposition analysis identified population aging and growth as primary drivers for the burden,contributing 66.39% and 83.56% to the increase in middle and low SDI regions,respectively.By contrast,epidemiological improvements alleviated burden in the high SDI region(54.91%).Gender disparities persisted,with women experiencing a higher burden.Inequality analysis indicated a shift in CVD burden towards the low SDI region,with declining concentration indices for DALYs(-0.03 to-0.13)and deaths(-0.07 to-0.15).The Bayesian age-period-cohort projections suggest continued increases in DALYs and deaths through 2050,with women disproportionately affected.CONCLUSIONS These findings highlight the urgent need for targeted interventions promoting physical activity,improving healthcare access,and implementing region-specific prevention strategies.展开更多
BACKGROUND Petersen’s hernia occurring through the epiploic foramen of the greater omentum,is an uncommon type of internal hernia.When it presents with complications such as chylous ascites,which is the lymphatic flu...BACKGROUND Petersen’s hernia occurring through the epiploic foramen of the greater omentum,is an uncommon type of internal hernia.When it presents with complications such as chylous ascites,which is the lymphatic fluid accumulation in the abdominal cavity,it is particularly rare.Following laparoscopic total gastrectomy and Roux-en-Y anastomosis,the incidence of this condition is exceedingly low.CASE SUMMARY A 62-year-old male patient developed Petersen’s hernia following laparoscopic total gastrectomy(LTG)for gastric cancer,after Roux-en-Y anastomosis.Intestinal torsion and obstruction were experienced by the patient,along with a small amount of chylous ascites.Imaging studies and clinical assessment confirmed the diagnosis.Emergency surgery was performed promptly for the patient in the operating room.The twisted small intestine was reduced and the defect in Petersen’s space was repaired.The procedure was successful in the correction of the intestinal torsion and approximation of the hernia without the need for bowel resection.The patient’s condition significantly improved following the surgery.The ascites evolved from a milky white appearance to a pale yellow,with a substantial decrease in the triglyceride levels in the ascitic fluid,implying a favorable recovery trajectory.The patient was monitored closely and received appropriate care postoperatively,including nutritional support and fluid management.CONCLUSION This report illustrates the significance of recognizing Petersen’s hernia as a potential complication following gastrectomy for gastric cancer.It highlights the fundamental role of early surgical intervention in the effective management of such complications.The favorable outcome in this patient illustrates that prompt and appropriate surgical management can deter the necessity for more extensive procedures such as bowel resection.展开更多
Background Previous studies have shown a relationship between elevated blood urea nitrogen(BUN)level and poor outcomes in several diseases,but data on the prognostic significance of postoperative BUN in elderly patien...Background Previous studies have shown a relationship between elevated blood urea nitrogen(BUN)level and poor outcomes in several diseases,but data on the prognostic significance of postoperative BUN in elderly patients undergoing valve replacement surgery(VRS)remained sparse.Methods BUN was measured immediately after VRS.A total of 3118 elderly patients were enrolled and divided into four groups according to the quartiles of postoperative BUN:Q1,<5.6 mmol/L;Q2,5.6-6.8 mmol/L;Q3,6.8-8.4 mmol/L and Q4,≥8.4 mmol/L.The associations of postoperative BUN with in-hospital and 1-year mortality were evaluated.Results The incidence of inhospital death(1.0%vs.3.3%vs.3.3%vs.8.4%,P<0.001)and major adverse clinical events(5.1%vs.7.8%vs.9.9%vs.19.1%,P<0.001)was significantly higher in patients with a high BUN level.BUN was independently associated with all-cause in-hospital mortality[odds ratio(OR):1.11,95%confidential interval(CI):1.07-1.16,P<0.001].The receiver operating characteristic(ROC)curve showed that BUN>9 mmol/L had a sensitivity of 48.4%and specificity of 81.8% for predicting in-hospital death[area under curve(AUC):0.705,95%CI:0.658-0.753,P<0.001].Kaplan-Meier survival curves showed that patients with BUN>9 mmol/L had a higher one-year mortality than those without(log-rank test:91.7,P<0.001).Multivariate analysis showed that BUN>9 mmol/L was an independent predictor for one-year mortality[hazard ratio(HR):1.67,95%CI:1.23-2.28,P=0.001].Conclusions This study provided strong evidence that increased postoperative BUN level was associated with poor prognosis in elderly patients undergoing VRS.展开更多
BACKGROUND Patients with type 2 diabetes mellitus(T2DM)face a heightened risk of future cardiovascular events.It is therefore important to stratify these patients according to their future cardiovascular event risk to...BACKGROUND Patients with type 2 diabetes mellitus(T2DM)face a heightened risk of future cardiovascular events.It is therefore important to stratify these patients according to their future cardiovascular event risk to allow early intervention and improve prognosis.Recent proposals have indicated that nontraditional lipoprotein ratios may be superior predictors of cardiovascular events compared to traditional lipid parameters.However,further evidence is required for widespread clinical ap-plication.AIM To elucidate the associations of nontraditional lipoprotein ratios with future cardiovascular events in patients with T2DM.METHODS This study performed post-hoc analysis of data obtained during a clinical trial involving 10182 participants.To ascertain the correlations between nontraditional lipoprotein ratios and future cardiovascular events,including major adverse cardiovascular events(MACEs)and congestive heart failure(CHF).We employed univariable and multivariable-adjusted Cox proportional hazards regression models.Potential dose-response relationships and threshold values were explored by conducting restricted cubic spline analyses and two-piecewise linear regression models.Possible relevant interactions influencing independent relationships were tested using subgroup and interaction analyses.RESULTS After adjustment for confounding factors,all nontraditional lipoprotein ratios studied were strongly associated with MACE risk in patients with T2DM.In comparison with patients in the lowest quartile,the hazard ratios(95%confidence intervals)of those in the highest quartile were 1.50(1.29-1.73),1.51(1.30-1.74),1.50(1.29-1.73),and 1.30(1.12-1.50)for total cholesterol/high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol/HDL-C,non-HDL-C/HDL-C,and remnant cholesterol/HDL-C,respectively.Similar findings were noted for CHF.Dose-response relationships between nontraditional lipoprotein ratios and MACE were observed,with threshold values of 7.29,6.29,and 2.15 for total cholesterol/HDL-C,non-HDL-C/HDL-C,and remnant cholesterol/HDL-C,respectively.However,no notable dose-response relationships were detected between nontraditional lipoprotein ratios and CHF.CONCLUSION Elevated nontraditional lipoprotein ratios may independently predict the risk of MACE and CHF in patients with T2DM.展开更多
BACKGROUND The incidence of gastric cancer in the elderly is increasing;however,standardized surgical approaches are lacking.AIM To investigate the effects of radical surgery on the trauma response,postoperative compl...BACKGROUND The incidence of gastric cancer in the elderly is increasing;however,standardized surgical approaches are lacking.AIM To investigate the effects of radical surgery on the trauma response,postoperative complications,and long-term prognosis in elderly patients with gastric cancer.METHODS Between January 2020 and December 2023,110 gastric cancer patients admitted to the Department of Oncology Jiangnan University Medical Center were cate-gorized into a control group(40 cases)and an observation group(70 cases)based on surgical method differences.The control and observation group received palli-ative surgery and radical surgery,respectively,and were further divided into open(25 cases)and laparoscopic(45 cases)surgery.Surgical outcomes,trauma indicators,complication rates,and long-term survival at 6 months,1-,and 2-years were compared.RESULTS Laparoscopic surgery showed superior surgical outcomes compared to the open surgery and control groups(P<0.05).Trauma indicators were lowest in the lapa-roscopic group and highest in the control group(P<0.05).No significant difference was observed in the complication rates between the open and laparo-scopic groups(P>0.05),but both were higher than those in the control group(P<0.05).No significant differences were found in survival rates at different follow-up periods between the laparoscopic and open groups(P>0.05);however,both groups showed higher survival rates than the control group(P<0.05).CONCLUSION Radical surgery in elderly patients with gastric cancer reduces surgical trauma response,facilitates postoperative recovery,and improves long-term survival rates,albeit with an increased risk of complications.Laparoscopic radical surgery further minimizes postoperative trauma,with no significant difference in complication rates and survival prognosis compared with open radical surgery.展开更多
In the present study,we aimed to investigate the clinical potential of sacubitril/valsartan compared with valsartan in patients with newly diagnosed hypertensive acute heart failure(H-AHF).A total of 63 patients were ...In the present study,we aimed to investigate the clinical potential of sacubitril/valsartan compared with valsartan in patients with newly diagnosed hypertensive acute heart failure(H-AHF).A total of 63 patients were retrospectively enrolled from our hospital,with 32 patients assigned to the sacubitril/valsartan group and 31 patients to the valsartan group.Clinical characteristics,laboratory examinations,and echocardiographic data at baseline,during hospitalization,and follow-up were collected to assess.The results demonstrated that patients treated with sacubitril/valsartan achieved better control of systolic and diastolic blood pressures than those treated with valsartan.Sacubitril/valsartan also resulted in more significant reductions in N-terminal pro-brain natriuretic peptide(NT-proBNP),high-sensitivity troponin I(hs-TnI),and creatinine,as well as an increase in estimated glomerular filtration rate(eGFR).Moreover,sacubitril/valsartan significantly improved left ventricular ejection fraction(LVEF),the E/e'ratio[the ratio between the early diastolic filling velocity(E-wave)and early diastolic mitral annular velocity(E')],and reduced left atrial dimension(LAD)and left ventricular mass index(LVMI).Additionally,sacubitril/valsartan might offer potential benefits in managing cardiac arrhythmias such as atrial fibrillation,ventricular or supraventricular premature beats,and left bundle branch block(LBBB).No fatal or nonfatal adverse effects were observed in the sacubitril/valsartan group,although one patient in the valsartan group experienced angioedema.In conclusion,after short-term administration,sacubitril/valsartan proved to be more effective than valsartan in lowering blood pressure,improving cardiac function and remodeling,and enhancing biomarker profiles.Furthermore,it had favorable effects on renal function and cardiac arrhythmias in newly diagnosed H-AHF patients.展开更多
This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter...This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.展开更多
BACKGROUND Some studies have demonstrated that combination treatment with anlotinib and albumin-bound paclitaxel has superior efficacy in stage IV non-small cell lung cancer(NSCLC).Howbeit,there is limited research on...BACKGROUND Some studies have demonstrated that combination treatment with anlotinib and albumin-bound paclitaxel has superior efficacy in stage IV non-small cell lung cancer(NSCLC).Howbeit,there is limited research on the effects of combination therapy.AIM To determine the efficacy of anlotinib plus albumin-paclitaxel in stage IV NSCLC.METHODS Forty-two patients diagnosed with stage IV NSCLC who were treated at our hospital from January 2022 to February 2023 were selected as study subjects.According to the research protocol,the patients were divided into two groups:conventional therapy(albumin paclitaxel,n=20)and combination therapy(anlotinib plus albumin paclitaxel,n=22).The clinical effect,serum tumor markers,progression-free survival,overall survival,immune function,quality of life,mental state,and toxic side effects were compared between the two groups.RESULTS The disease remission rate,disease control rate,CD3^(+),CD4^(+),CD4^(+)/CD8^(+)and Karnofsky Performance Scale(KPS)score in combined therapy were higher than conventional therapy.After treatment,levels of carcinoembryonic antigen,cytokeratin 19 fragment antigen 21-1,and vascular endothelial growth factor,self-rating anxiety scale,and self-rating depression scale score were all lower in combination therapy compared to conventional therapy.In addition,there was no remarkable difference in adverse reactions between the two groups.CONCLUSION Anlotinib combined with albumin-paclitaxel demonstrated therapeutic efficacy in stage IV NSCLC,reducing depression,anxiety,and tumor biomarker levels,while enhancing immune function,prolonging survival,and improving quality of life.展开更多
Background:QiShenYiQi(QSYQ)is commonly accepted to treat ischemic stroke(IS)in clinical settings,yet the underlying mechanism of action of QSYQ is largely unknown.Methods:By combining systems pharmacology with experim...Background:QiShenYiQi(QSYQ)is commonly accepted to treat ischemic stroke(IS)in clinical settings,yet the underlying mechanism of action of QSYQ is largely unknown.Methods:By combining systems pharmacology with experimental assessment,we examined the key targets,bioactive components,and mechanisms of QSYQ against IS.Results:Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform predicted a total number of 254 targets that were potentially related to QSYQ,whereas 699 targets associated with IS were gathered from Therapeutic Target Database,Comparative Toxicogenomics Database,Gene Cards,Online Mendelian Inheritance in Man,and National Center for Biotechnology Information databases,and 83 of these targets overlap with QSYQ-related targets.Importantly,through the analysis of Gene Ontology functional annotation,Kyoto Encyclopedia of Genes and Genomes pathway enrichment,and protein-protein interaction network,we identified 20 related signaling pathways along with 4 hub genes.Subsequently,our molecular docking results revealed that QSYQ might interact with PTGS2,PTGS1,SCN5A,and HSP90AB1.We observed dose-dependent beneficial effects of QSYQ in significantly improving neurological function and alleviating histopathological damage in middle cerebral artery occlusion model,while decreasing infarct volume.Notablely,QSYQ markedly downregulates tumor necrosis factor-α,interleukin-6,and interleukin-1 beta.Overall,this study demonstrates the synergetic effects of QSYQ on regulating multi-targets in IS through inhibiting inflammatory processes and neuronal apoptosis,these findings may expand the understanding of QSYQ and provide guidance for its clinical application in treating IS.Conclusion:Current study reveals the protective roles of QSYQ against IS through modulating PTGS2/PTGS1/SCN5A/HSP90AB1 and TNF signaling pathways.展开更多
BACKGROUND Depression is a common comorbidity in patients with chronic obstructive pulmonary disease(COPD).Research indicates that COPD affects cardiac au-tonomic control,and heart rate variability(HRV)serves as a sim...BACKGROUND Depression is a common comorbidity in patients with chronic obstructive pulmonary disease(COPD).Research indicates that COPD affects cardiac au-tonomic control,and heart rate variability(HRV)serves as a simple,non-invasive measure of autonomic nerve activity.However,the relationship between HRV and lung function,as well as the impact of depressive symptoms,remains un-clear.METHODS A retrospective cross-sectional study involving 120 COPD patients hospitalized from January 2018 to January 2024 at our institution was conducted.Demographic and clinical characteristics were collected,and depressive symptoms were asse-ssed using the Beck Depression Inventory(BDI).Patients were categorized into a depressed group(BDI≥16)and a non-depressed group(BDI<16).A control group consisting of 60 healthy volunteers who underwent check-ups at the same institution was also included.Statistical analyses were performed using SPSS 26.0 software.Pearson correlation coefficients were calculated to determine and compare the relationships between HRV parameters,lung function measures,and RESULTS Of the 120 patients with COPD,35.8%(43/120)were diagnosed with depression,compared to 5.0%(3/60)in the control group.The HRV index in COPD patients was significantly lower than that in the control group(P<0.05),and the value in the depressed group was significantly lower than that in the non-depressed group(P<0.05).Similarly,the COPD group had a significantly lower pulmonary forced vital capacity(FVC),first-second expiratory volume(FEV1)and FEV1/FVC ratios than the control group(P<0.05),and the depressed group was significantly lower than that in the non-depressed group(P<0.05).Pearson correlation analysis revealed that the standard deviation of normal R-R intervals,standard deviation of the mean of 5-minute normal R-R intervals,root mean square of successive differences of normal R-R intervals,percentage of normal R-R intervals greater than 50 ms,high-frequency,and low-frequency indices showed positive correlations with lung function parameters(P<0.05)and negative correlations with BDI scores(P<0.05).CONCLUSION Compared to patients without COPD,the incidence of depressive symptoms is higher among patients with COPD and is negatively correlated with the patients’HRV indices.In contrast,HRV indices are positively correlated with the patients’pulmonary function parameters.Patients and healthcare professionals should enhance their awareness of depression,actively conduct depression assessment screenings,and incorporate HRV indices into disease management.This approach aims to improve the psychological health of patients and ultimately enhance their prognosis and quality of life.展开更多
Acute pancreatitis recurrence should always alert clinicians to primary hyperparathyroidism,especially in younger patients and those with a hereditary condition.When parathyroid abnormalities are adequately recognized...Acute pancreatitis recurrence should always alert clinicians to primary hyperparathyroidism,especially in younger patients and those with a hereditary condition.When parathyroid abnormalities are adequately recognized and addressed,more recurrent attacks of acute pancreatitis are unlikely to occur.展开更多
文摘As a critical department ensuring the sterility of hospital instruments,the Sterile Supply Center(SSC)directly impacts the sterility status of clinical instruments through its sterilization qualification rate.Geriatric patients,due to physiological decline and compromised immune function,constitute a high-risk group for hospital-acquired infections,with more stringent requirements for instrument sterility.This paper analyzes the current status and influencing factors of sterilization qualification rates in SSCs,explores the mechanistic association between sterilization qualification rates and infections in geriatric departments,and proposes targeted strategies to improve sterilization qualification rates.It highlights the pivotal role of SSC instrument sterilization in infection prevention and control for geriatric patients,providing theoretical basis and practical guidance for optimizing SSC management,reducing infection rates in geriatric departments,and ensuring the safety of elderly patients’medical care.These findings aim to enhance overall infection management standards in hospitals.
基金Supported by the Special Funds of Jiangsu Provincial Key Research and Development Projects,No.BE2019612Scientific Research Project Cooperated by Lanzhou Biotechnology Development Co.,Ltd.+3 种基金the Key R&D Program of Jiangsu Science and Technology Project,No.BE2022049 and No.BE2022049-1National Natural Science Foundation of China,No.82171249Nanjing Rehabilitation Medicine Center ProjectJiangsu Provincial Health Commission Special Fund for Aging and Health.
文摘BACKGROUND The previous studies have primarily focused on the influence of botulinum toxin A(BoNT-A)injection on emotions during the period of peak motor symptom improvement in blepharospasm patients,based on facial feedback hypothesis.AIM To evaluate the sustained anxiolytic and antidepressant effects of BoNT-A in blepharospasm patients beyond motor symptom control.METHODS We recruited benign essential blepharospasm patients with BoNT-A treatment and collected their data to compare scale scores of Jankovic Rating Scale,Blepharospasm Disability Index,Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),Hamilton Anxiety Scale and Hamilton Depression Scale between pretreatment(baseline)and pre-reinjection(treatment),to further assess the effects of repeated treatments with BoNT by using sub-group analyses in the certain special states.RESULTS A total of 21 eligible blepharospasm patients were with the mean age of 58.4 years and a male-to-female ratio of 1:6.Significantly decreases in the subscale scores of SDS and SAS,including SDS well-being index,decreased capacity and hard to decide,SAS inability to sit still and headache were showed at post-a single BoNT-A injection when scale scores of Jankovic Rating Scale and Blepharospasm Disability Index were matched between baseline and posttreatment.With each additional BoNT-A injection,the odds ratio of patients with the moderate depressive symptoms decreased by 92.6%.Moreover,BoNT treatment remained a decrease in the subscale scores of SDS and SAS in patients with repeated injections.CONCLUSION This study is to demonstrate that repeated BoNT-A injection have a long-lasting relief for anxiety and depressive symptoms in blepharospasm even after its motor symptom-modulating effects have diminished.
基金supported by the Yunnan Fundamental Research Projects(202501AV070005 and 202201BE070001-004).
文摘The temporal pole(TP),one of the most expanded cortical regions in humans relative to other primates,plays a crucial role in human language processing.It is also one of the most structurally and functionally asymmetric regions.However,whether the functional architecture of the TP is shared by humans and macaques is an open question.We used spectral clustering algorithms to define a cross-species fine-grained TP atlas with different anatomical connectivity patterns.We identified three similar subregions,two ventral and one dorsal,within the TP in both humans and macaques.The parcellation scheme for the TP was validated using functional gradient mapping,anatomical connectivity and resting-state functional connectivity pattern analysis,and functional characterization.Furthermore,in conjunction with the Allen Human Brain Atlas,we revealed the molecular basis for the functional connectivity patterns of each human TP subregion.In addition,we compared the hemispheric asymmetry in mean gray matter volume,anatomical connectivity fingerprints,and whole brain functional connectivity patterns to reveal the evolutionary differences in the TP and found different asymmetric patterns between humans and macaques.In conclusion,our findings reveal that the asymmetry in structure and connectivity may underpin the hemispheric functional specialization of the brain and provide a novel insight into understanding the evolutionary origin of the TP.
基金supported by the National Natural Science Foundation of China(32070591,82371552,and W2512102)the Scientific Research Program of FuRong Laboratory(2023SK2093-1)+2 种基金the Central South University Research Programme of Advanced Interdisciplinary Study(2023QYJC010)the Natural Science Foundation of Hunan Province(2023JJ30975)the Fundamental Research Funds for the Central Universities of Central South University(2025ZZTS0834).
文摘Penetrance is a crucial indicator for accurately assessing disease risk and plays a vital role in disease research,gene therapy,and genetic counseling.However,with penetrance data dispersed across various sources,efficiently accessing and consolidating this information becomes a challenge.A comprehensive platform that integrates penetrance is urgently needed.Here,we present PenCards,a global,community-contributed public archive of variant penetrance,by first collecting penetrance data from all published literature and then using large international cohorts to specifically calculate the penetrance of autism-related variants.PenCards contains a total of 244,531 variants,including 239,244 single nucleotide variants,4994 insertions and deletions,and 293 copy number variants,covering approximately 300 phenotypes.We also provide a submission portal for the dynamic updating of penetrance.Additionally,to help users efficiently access genetic information,we comprehensively integrate over 150 variant-and gene-level resources.In summary,PenCards is a powerful platform designed to advance genetic research and diagnostics.PenCards is publicly available at https://genemed.tech/pencards/.
文摘Objectives Quality of life(QoL) is a priority outcome in older adults suffering from cardiovascular diseases. Frailty and poor nutritional status may affect the QoL through mobility disorders and exhaustion. The objective of this study was to determine if physical frailty and nutritional status were associated with QoL, in older cardiology patients. Methods Cross sectional, observational study conducted in a cardiology department from a university hospital. Participants(n = 100) were aged 70 and older. Collected data included age, sex, cardiac diseases, New York Heart Association(NYHA) classification, comorbidities(Charlson Index) and disability. A Short Physical Performance Battery(SPPB), including walking speed assessment was performed;handgrip strength were measured as well as Fried’s frailty phenotype. Nutritional status was assessed using the Mini Nutritional Assessment(MNA) and Body Mass Index(BMI), inflammation by C-reactive protein(CRP). QoL was assessed using the EORTC–QLQ questionnaire. Univariate and multivariate analyses were performed to study the associations between all recorded parameters and QoL. Results In participants(mean age: 79.3 ± 6.7 years;male: 59%), Charlson index, arrhythmia, heart failure, NYHA class III-IV, MNA, disability, walking speed, SPPB score, frailty and CRP were significantly associated with QoL in univariate analysis. Multivariate analysis showed that NYHA class III-IV(P < 0.001), lower MNA score(P = 0.03), frailty(P < 0.0001), and higher CRP(P < 0.001) were independently associated with decreased QoL. Conclusions Frailty, nutritional status and inflammation were independently associated with poor QoL. Further studies are needed to assess the efficacy of nutritional and physical interventions on QoL in this population.
基金supported by the Science and Technology(S&T)Program of Hebei Province,No.22377798D(to YZ).
文摘Parkinson’s disease is the second most common progressive neurodegenerative disorder,and few reliable biomarkers are available to track disease progression.The proteins,DNA,mRNA,and lipids carried by exosomes reflect intracellular changes,and thus can serve as biomarkers for a variety of conditions.In this study,we investigated alterations in the protein content of plasma exosomes derived from patients with Parkinson’s disease and the potential therapeutic roles of these proteins in Parkinson’s disease.Using a tandem mass tag-based quantitative proteomics approach,we characterized the proteomes of plasma exosomes derived from individual patients,identified exosomal protein signatures specific to patients with Parkinson’s disease,and identified N-acetyl-alpha-glucosaminidase as a differentially expressed protein.N-acetyl-alpha-glucosaminidase expression levels in exosomes from the plasma of patients and healthy controls were validated by enzyme-linked immunosorbent assay and western blot.The results demonstrated that the exosomal N-acetyl-alpha-glucosaminidase concentration was not only lower in Parkinson’s disease,but also decreased with increasing Hoehn-Yahr stage,suggesting that N-acetyl-alpha-glucosaminidase could be used to rapidly evaluate Parkinson’s disease severity.Furthermore,western blot and immunohistochemistry analysis showed that N-acetyl-alpha-glucosaminidase levels were markedly reduced both in cells treated with 1-methyl-4-phenylpyridinium and cells overexpressingα-synuclein compared with control cells.Additionally,N-acetyl-alpha-glucosaminidase overexpression significantly increased cell viability and inhibitedα-synuclein expression in 1-methyl-4-phenylpyridinium-treated cells.Taken together,our findings demonstrate for the first time that exosomal N-acetyl-alpha-glucosaminidase may serve as a biomarker for Parkinson’s disease diagnosis,and that N-acetyl-alpha-glucosaminidase may reduceα-synuclein expression and 1-methyl-4-phenylpyridinium-induced neurotoxicity,thus providing a new therapeutic target for Parkinson’s disease.
基金supported by the General Project of the Cultivation Project of the Chinese Hospital Reform and Development Research Institute of Nanjing University(NDYG2022072)。
文摘Objective Systematically integrate nurses’experience with“Internet Nursing Service”to analysis the nurses’experiences with“Internet Nursing Service”,and to provide a theoretical reference for formulating a more rational“Internet Nursing Service”model.Methods A systematic search in PubMed,Embase,Web of Science,the Cochrane Library,CINAHL,China National Knowledge Infrastructure(CNKI),Wanfang Database,and Chinese Biomedical Literature Database was conducted to collect qualitative research on nurses’experiences with“Internet Nursing Service,”with a retrieval time limit from December 2019 to June 2024.Qualitative meta-synthesis was performed through line-by-line coding of relevant quotes,organization of codes into descriptive themes,and development of analytical themes.Results A total of 19 studies were included,one study was rated as Grade A in quality evaluation,and the remaining studies were rated as Grade B.Collectively synthesized into three integrated results:Harvest and growth,Difficulties and challenges,and Expectations and support.Harvest and growth,include 1)manifestation of self-value,2)enhancing nursing capabilities,3)optimizing nursing resources;Difficulties and challenges,include 1)lack of safety guarantee,2)role conflict;Expectations and support include,1)expectation for professional knowledge and skill training,2)expectations for service platform optimization,3)expectation for reasonable charges,4)expectation for related policy support.Conclusion“Internet Nursing Service”model benefits both nurses and patients,but still full of challenges.It aids in the decentralization of medical resources.Management departments still need to encourage nurses to actively invest in“Internet Nursing Service”while ensuring their safety and interests.
文摘Background: Falls in the elderly are a global public health problem with serious medical and socio-economic consequences, especially in low and middle-income countries. The aim of this study was to describe the characteristics of falls among the elderly in trauma units in Senegal. Materials and Methods: This was a descriptive, prospective study from April 20, 2022 to October 30, 2022 among people aged at least 60 and admitted to the surgical emergency department of Idrissa Pouye Hospital in Dakar following a fall. Socio-demographic, clinical, therapeutic and evolutionary characteristics were collected and analyzed using Sphinx Plus 2 and Excel 2019 for Windows software. Results: Out of 730 elderly people seen during this period, 100 met the criteria, representing a prevalence of 13.69%. The average consultation time was 3.25 +/? 4 days. The average age was 73 +/? 8.43 years, with women predominating (74%). Medical expenses were mainly covered by the family (73%). Most falls occurred during the day (68%), at home (82%), especially in the bedroom (30%), with stumbling (32%) as the main mechanism. The majority of patients (86%) spent less than 30 minutes on the floor. Predisposing factors were dominated by visual disorders (56%) and precipitating factors were mainly environmental (62%). Geriatric syndromes were dominated by frailty (22%). Complications were dominated by fractures (86%), and almost half (47%) had lost their autonomy for post-fall Activities Daily Living (ADL). Prescription medication was almost systematic (98%), dominated by analgesics (98%). Surgery was indicated in 58% of patients. The average waiting time for surgery was 25.36 +/? 19 days. A death rate of 1% was recorded in the emergency department. Conclusion: Falls in the elderly are a frequent occurrence in traumatological emergencies, with etiological factors that are often multiple and interrelated, leading to significant morbidity. Raising awareness among people at risk and setting up an orthogeriatric service would help prevent falls and optimize care in the short and long term.
基金Supported by Research Project of Zhejiang Provincial Science and Technology Plan for Traditional Chinese Medicine,No.2024ZL753and Research Project of Zhejiang Provincial Medical and Health Science and Technology Plan,No.2024KY1406.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM),a chronic metabolic disease with a high global incidence,has become a serious public health challenge.China has the largest number of T2DM patients worldwide,imposing a significant economic burden on the healthcare system.T2DM is closely associated with insulin resistance,impaired pancreatic B cell function,and disordered glucose and lipid metabolism,which can lead to various complications,reducing patients'quality of life and increasing the risk of disability and death.Thus,finding effective preventive and intervention measures is crucial.Exercise therapy,a key part of diabetes management,has gained attention in recent years,with many studies indicating its benefits for blood glucose control and other aspects in diabetic patients.AIM To assess the effectiveness of combined resistance and aerobic exercise interventions on blood glucose control and metabolic indicators in patients with T2DM and to explore their application in diabetes management.METHODS Systematic searches were conducted using PubMed,EMBASE,Cochrane Library,and Chinese databases for relevant randomized controlled trials(RCTs).The inclusion criteria were participants aged≥18 years with T2DM and the intervention involved combined resistance and aerobic exercise for≥8 weeks.The primary outcome indicators were fasting blood glucose,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglycerides(TG),glycated hemoglobin A1c(HbA1c),and total cholesterol(TC)levels.Data analysis was performed using RevMan software,and the interventional effects were assessed using weighted mean differences or standardized mean differences(SMD).RESULTS Six RCTs meeting the inclusion criteria were included,with a total sample size of 366 participants.The meta-analysis results showed that combined resistance and aerobic exercise significantly improved several metabolic indicators in patients with T2DM.Specific results were as follows:(1)For fasting blood glucose,combined exercise was more effective than aerobic exercise alone[SMD=1.22;95%confidence interval(95%CI):0.70,1.74;P<0.00001];(2)LDL-C levels were significantly reduced by the combined intervention(SMD=1.45;95%CI:1.18-1.72;P<0.00001);(3)The combined intervention significantly increased HDL-C levels(SMD=1.42;95%CI:0.98-1.87;P<0.00001);(4)The combined intervention significantly reduced TG levels(SMD=1.12;95%CI:0.85-1.39;P<0.00001;(5)No statistically significant difference was observed in HbA1c between the combined and the aerobic exercise group(SMD=-0.03;95%CI:-1.09 to 1.04;P<0.00001);and(6)The combined exercise intervention group significantly reduced TC levels(SMD=2.66;95%CI:1.93-3.38;P<0.00001).The subgroup analysis results suggest that the effect of exercise interventions may be influenced by various factors,including the patient's age,baseline blood glucose levels,and exercise intensity.CONCLUSION Combined resistance and aerobic exercise intervention significantly improved fasting blood glucose,LDL-C,HDL-C,TG,and TC levels in patients with T2DM,especially in terms of blood glucose control and cardiovascular risk,demonstrating better outcomes than aerobic exercise alone.
基金supported by the Jiangsu Commission of Health(LR2022004&LKZ2023005)the Project of Zhongda Hospital Affiliated to Southeast University for Cultivating Academic Talent(CZXM-GSPRC22)+2 种基金the Zhongda Hospital Affiliated to Southeast University,Jiangsu Province High-Level Hospital Pairing Assistance Construction Funds(ZDLYG10)the Zhongda Hospital Affiliated to Southeast University,Jiangsu Province High-Level Hospital Construction Funds(GSP-LCYJFH17)the Nanjing Commission of Health(YKK24257).
文摘BACKGROUND Physical inactivity is a significant yet underappreciated risk factor for cardiovascular disease(CVD),particularly among older adults.The aim of this study was to analyze the global burden of CVD attributable to physical inactivity in individuals aged 70 years and older from 1990 to 2021 using the Global Burden of Disease data.METHODS We assessed trends in disability-adjusted life years(DALYs)and deaths,decomposed changes into population growth,aging,and epidemiological factors,and examined health inequalities across sociodemographic index(SDI)regions.RESULTS From 1990 to 2021,a substantial rise in DALYs was observed,especially in low and middle SDI regions,with a 120.06% increase in the low SDI region,but a 23.10% decline in the high SDI region.Decomposition analysis identified population aging and growth as primary drivers for the burden,contributing 66.39% and 83.56% to the increase in middle and low SDI regions,respectively.By contrast,epidemiological improvements alleviated burden in the high SDI region(54.91%).Gender disparities persisted,with women experiencing a higher burden.Inequality analysis indicated a shift in CVD burden towards the low SDI region,with declining concentration indices for DALYs(-0.03 to-0.13)and deaths(-0.07 to-0.15).The Bayesian age-period-cohort projections suggest continued increases in DALYs and deaths through 2050,with women disproportionately affected.CONCLUSIONS These findings highlight the urgent need for targeted interventions promoting physical activity,improving healthcare access,and implementing region-specific prevention strategies.
文摘BACKGROUND Petersen’s hernia occurring through the epiploic foramen of the greater omentum,is an uncommon type of internal hernia.When it presents with complications such as chylous ascites,which is the lymphatic fluid accumulation in the abdominal cavity,it is particularly rare.Following laparoscopic total gastrectomy and Roux-en-Y anastomosis,the incidence of this condition is exceedingly low.CASE SUMMARY A 62-year-old male patient developed Petersen’s hernia following laparoscopic total gastrectomy(LTG)for gastric cancer,after Roux-en-Y anastomosis.Intestinal torsion and obstruction were experienced by the patient,along with a small amount of chylous ascites.Imaging studies and clinical assessment confirmed the diagnosis.Emergency surgery was performed promptly for the patient in the operating room.The twisted small intestine was reduced and the defect in Petersen’s space was repaired.The procedure was successful in the correction of the intestinal torsion and approximation of the hernia without the need for bowel resection.The patient’s condition significantly improved following the surgery.The ascites evolved from a milky white appearance to a pale yellow,with a substantial decrease in the triglyceride levels in the ascitic fluid,implying a favorable recovery trajectory.The patient was monitored closely and received appropriate care postoperatively,including nutritional support and fluid management.CONCLUSION This report illustrates the significance of recognizing Petersen’s hernia as a potential complication following gastrectomy for gastric cancer.It highlights the fundamental role of early surgical intervention in the effective management of such complications.The favorable outcome in this patient illustrates that prompt and appropriate surgical management can deter the necessity for more extensive procedures such as bowel resection.
基金supported by grants from the initial funding of National Natural Science Foundation of China(No.8227020480)。
文摘Background Previous studies have shown a relationship between elevated blood urea nitrogen(BUN)level and poor outcomes in several diseases,but data on the prognostic significance of postoperative BUN in elderly patients undergoing valve replacement surgery(VRS)remained sparse.Methods BUN was measured immediately after VRS.A total of 3118 elderly patients were enrolled and divided into four groups according to the quartiles of postoperative BUN:Q1,<5.6 mmol/L;Q2,5.6-6.8 mmol/L;Q3,6.8-8.4 mmol/L and Q4,≥8.4 mmol/L.The associations of postoperative BUN with in-hospital and 1-year mortality were evaluated.Results The incidence of inhospital death(1.0%vs.3.3%vs.3.3%vs.8.4%,P<0.001)and major adverse clinical events(5.1%vs.7.8%vs.9.9%vs.19.1%,P<0.001)was significantly higher in patients with a high BUN level.BUN was independently associated with all-cause in-hospital mortality[odds ratio(OR):1.11,95%confidential interval(CI):1.07-1.16,P<0.001].The receiver operating characteristic(ROC)curve showed that BUN>9 mmol/L had a sensitivity of 48.4%and specificity of 81.8% for predicting in-hospital death[area under curve(AUC):0.705,95%CI:0.658-0.753,P<0.001].Kaplan-Meier survival curves showed that patients with BUN>9 mmol/L had a higher one-year mortality than those without(log-rank test:91.7,P<0.001).Multivariate analysis showed that BUN>9 mmol/L was an independent predictor for one-year mortality[hazard ratio(HR):1.67,95%CI:1.23-2.28,P=0.001].Conclusions This study provided strong evidence that increased postoperative BUN level was associated with poor prognosis in elderly patients undergoing VRS.
文摘BACKGROUND Patients with type 2 diabetes mellitus(T2DM)face a heightened risk of future cardiovascular events.It is therefore important to stratify these patients according to their future cardiovascular event risk to allow early intervention and improve prognosis.Recent proposals have indicated that nontraditional lipoprotein ratios may be superior predictors of cardiovascular events compared to traditional lipid parameters.However,further evidence is required for widespread clinical ap-plication.AIM To elucidate the associations of nontraditional lipoprotein ratios with future cardiovascular events in patients with T2DM.METHODS This study performed post-hoc analysis of data obtained during a clinical trial involving 10182 participants.To ascertain the correlations between nontraditional lipoprotein ratios and future cardiovascular events,including major adverse cardiovascular events(MACEs)and congestive heart failure(CHF).We employed univariable and multivariable-adjusted Cox proportional hazards regression models.Potential dose-response relationships and threshold values were explored by conducting restricted cubic spline analyses and two-piecewise linear regression models.Possible relevant interactions influencing independent relationships were tested using subgroup and interaction analyses.RESULTS After adjustment for confounding factors,all nontraditional lipoprotein ratios studied were strongly associated with MACE risk in patients with T2DM.In comparison with patients in the lowest quartile,the hazard ratios(95%confidence intervals)of those in the highest quartile were 1.50(1.29-1.73),1.51(1.30-1.74),1.50(1.29-1.73),and 1.30(1.12-1.50)for total cholesterol/high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol/HDL-C,non-HDL-C/HDL-C,and remnant cholesterol/HDL-C,respectively.Similar findings were noted for CHF.Dose-response relationships between nontraditional lipoprotein ratios and MACE were observed,with threshold values of 7.29,6.29,and 2.15 for total cholesterol/HDL-C,non-HDL-C/HDL-C,and remnant cholesterol/HDL-C,respectively.However,no notable dose-response relationships were detected between nontraditional lipoprotein ratios and CHF.CONCLUSION Elevated nontraditional lipoprotein ratios may independently predict the risk of MACE and CHF in patients with T2DM.
文摘BACKGROUND The incidence of gastric cancer in the elderly is increasing;however,standardized surgical approaches are lacking.AIM To investigate the effects of radical surgery on the trauma response,postoperative complications,and long-term prognosis in elderly patients with gastric cancer.METHODS Between January 2020 and December 2023,110 gastric cancer patients admitted to the Department of Oncology Jiangnan University Medical Center were cate-gorized into a control group(40 cases)and an observation group(70 cases)based on surgical method differences.The control and observation group received palli-ative surgery and radical surgery,respectively,and were further divided into open(25 cases)and laparoscopic(45 cases)surgery.Surgical outcomes,trauma indicators,complication rates,and long-term survival at 6 months,1-,and 2-years were compared.RESULTS Laparoscopic surgery showed superior surgical outcomes compared to the open surgery and control groups(P<0.05).Trauma indicators were lowest in the lapa-roscopic group and highest in the control group(P<0.05).No significant difference was observed in the complication rates between the open and laparo-scopic groups(P>0.05),but both were higher than those in the control group(P<0.05).No significant differences were found in survival rates at different follow-up periods between the laparoscopic and open groups(P>0.05);however,both groups showed higher survival rates than the control group(P<0.05).CONCLUSION Radical surgery in elderly patients with gastric cancer reduces surgical trauma response,facilitates postoperative recovery,and improves long-term survival rates,albeit with an increased risk of complications.Laparoscopic radical surgery further minimizes postoperative trauma,with no significant difference in complication rates and survival prognosis compared with open radical surgery.
基金Key R&D Projects in Shandong Province(Grant No.2017G006029).
文摘In the present study,we aimed to investigate the clinical potential of sacubitril/valsartan compared with valsartan in patients with newly diagnosed hypertensive acute heart failure(H-AHF).A total of 63 patients were retrospectively enrolled from our hospital,with 32 patients assigned to the sacubitril/valsartan group and 31 patients to the valsartan group.Clinical characteristics,laboratory examinations,and echocardiographic data at baseline,during hospitalization,and follow-up were collected to assess.The results demonstrated that patients treated with sacubitril/valsartan achieved better control of systolic and diastolic blood pressures than those treated with valsartan.Sacubitril/valsartan also resulted in more significant reductions in N-terminal pro-brain natriuretic peptide(NT-proBNP),high-sensitivity troponin I(hs-TnI),and creatinine,as well as an increase in estimated glomerular filtration rate(eGFR).Moreover,sacubitril/valsartan significantly improved left ventricular ejection fraction(LVEF),the E/e'ratio[the ratio between the early diastolic filling velocity(E-wave)and early diastolic mitral annular velocity(E')],and reduced left atrial dimension(LAD)and left ventricular mass index(LVMI).Additionally,sacubitril/valsartan might offer potential benefits in managing cardiac arrhythmias such as atrial fibrillation,ventricular or supraventricular premature beats,and left bundle branch block(LBBB).No fatal or nonfatal adverse effects were observed in the sacubitril/valsartan group,although one patient in the valsartan group experienced angioedema.In conclusion,after short-term administration,sacubitril/valsartan proved to be more effective than valsartan in lowering blood pressure,improving cardiac function and remodeling,and enhancing biomarker profiles.Furthermore,it had favorable effects on renal function and cardiac arrhythmias in newly diagnosed H-AHF patients.
基金Supported by National High Level Hospital Clinical Research Funding Project,No.BJ-2023-206.
文摘This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.
基金Supported by Zhangjiakou Key R&D Program Projects,No.2021108D.
文摘BACKGROUND Some studies have demonstrated that combination treatment with anlotinib and albumin-bound paclitaxel has superior efficacy in stage IV non-small cell lung cancer(NSCLC).Howbeit,there is limited research on the effects of combination therapy.AIM To determine the efficacy of anlotinib plus albumin-paclitaxel in stage IV NSCLC.METHODS Forty-two patients diagnosed with stage IV NSCLC who were treated at our hospital from January 2022 to February 2023 were selected as study subjects.According to the research protocol,the patients were divided into two groups:conventional therapy(albumin paclitaxel,n=20)and combination therapy(anlotinib plus albumin paclitaxel,n=22).The clinical effect,serum tumor markers,progression-free survival,overall survival,immune function,quality of life,mental state,and toxic side effects were compared between the two groups.RESULTS The disease remission rate,disease control rate,CD3^(+),CD4^(+),CD4^(+)/CD8^(+)and Karnofsky Performance Scale(KPS)score in combined therapy were higher than conventional therapy.After treatment,levels of carcinoembryonic antigen,cytokeratin 19 fragment antigen 21-1,and vascular endothelial growth factor,self-rating anxiety scale,and self-rating depression scale score were all lower in combination therapy compared to conventional therapy.In addition,there was no remarkable difference in adverse reactions between the two groups.CONCLUSION Anlotinib combined with albumin-paclitaxel demonstrated therapeutic efficacy in stage IV NSCLC,reducing depression,anxiety,and tumor biomarker levels,while enhancing immune function,prolonging survival,and improving quality of life.
基金supported by the National Natural Science Foundation of China(No.82274313)Projects of Shaanxi Administration of Traditional Chinese Medicine(2022-SLRH-YQ-010)Key Laboratory of Traditional Chinese Medicine and Pharmacology.
文摘Background:QiShenYiQi(QSYQ)is commonly accepted to treat ischemic stroke(IS)in clinical settings,yet the underlying mechanism of action of QSYQ is largely unknown.Methods:By combining systems pharmacology with experimental assessment,we examined the key targets,bioactive components,and mechanisms of QSYQ against IS.Results:Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform predicted a total number of 254 targets that were potentially related to QSYQ,whereas 699 targets associated with IS were gathered from Therapeutic Target Database,Comparative Toxicogenomics Database,Gene Cards,Online Mendelian Inheritance in Man,and National Center for Biotechnology Information databases,and 83 of these targets overlap with QSYQ-related targets.Importantly,through the analysis of Gene Ontology functional annotation,Kyoto Encyclopedia of Genes and Genomes pathway enrichment,and protein-protein interaction network,we identified 20 related signaling pathways along with 4 hub genes.Subsequently,our molecular docking results revealed that QSYQ might interact with PTGS2,PTGS1,SCN5A,and HSP90AB1.We observed dose-dependent beneficial effects of QSYQ in significantly improving neurological function and alleviating histopathological damage in middle cerebral artery occlusion model,while decreasing infarct volume.Notablely,QSYQ markedly downregulates tumor necrosis factor-α,interleukin-6,and interleukin-1 beta.Overall,this study demonstrates the synergetic effects of QSYQ on regulating multi-targets in IS through inhibiting inflammatory processes and neuronal apoptosis,these findings may expand the understanding of QSYQ and provide guidance for its clinical application in treating IS.Conclusion:Current study reveals the protective roles of QSYQ against IS through modulating PTGS2/PTGS1/SCN5A/HSP90AB1 and TNF signaling pathways.
基金Supported by the Zhangjiakou City Science and Technology Research Plan,No.1821110D.
文摘BACKGROUND Depression is a common comorbidity in patients with chronic obstructive pulmonary disease(COPD).Research indicates that COPD affects cardiac au-tonomic control,and heart rate variability(HRV)serves as a simple,non-invasive measure of autonomic nerve activity.However,the relationship between HRV and lung function,as well as the impact of depressive symptoms,remains un-clear.METHODS A retrospective cross-sectional study involving 120 COPD patients hospitalized from January 2018 to January 2024 at our institution was conducted.Demographic and clinical characteristics were collected,and depressive symptoms were asse-ssed using the Beck Depression Inventory(BDI).Patients were categorized into a depressed group(BDI≥16)and a non-depressed group(BDI<16).A control group consisting of 60 healthy volunteers who underwent check-ups at the same institution was also included.Statistical analyses were performed using SPSS 26.0 software.Pearson correlation coefficients were calculated to determine and compare the relationships between HRV parameters,lung function measures,and RESULTS Of the 120 patients with COPD,35.8%(43/120)were diagnosed with depression,compared to 5.0%(3/60)in the control group.The HRV index in COPD patients was significantly lower than that in the control group(P<0.05),and the value in the depressed group was significantly lower than that in the non-depressed group(P<0.05).Similarly,the COPD group had a significantly lower pulmonary forced vital capacity(FVC),first-second expiratory volume(FEV1)and FEV1/FVC ratios than the control group(P<0.05),and the depressed group was significantly lower than that in the non-depressed group(P<0.05).Pearson correlation analysis revealed that the standard deviation of normal R-R intervals,standard deviation of the mean of 5-minute normal R-R intervals,root mean square of successive differences of normal R-R intervals,percentage of normal R-R intervals greater than 50 ms,high-frequency,and low-frequency indices showed positive correlations with lung function parameters(P<0.05)and negative correlations with BDI scores(P<0.05).CONCLUSION Compared to patients without COPD,the incidence of depressive symptoms is higher among patients with COPD and is negatively correlated with the patients’HRV indices.In contrast,HRV indices are positively correlated with the patients’pulmonary function parameters.Patients and healthcare professionals should enhance their awareness of depression,actively conduct depression assessment screenings,and incorporate HRV indices into disease management.This approach aims to improve the psychological health of patients and ultimately enhance their prognosis and quality of life.
文摘Acute pancreatitis recurrence should always alert clinicians to primary hyperparathyroidism,especially in younger patients and those with a hereditary condition.When parathyroid abnormalities are adequately recognized and addressed,more recurrent attacks of acute pancreatitis are unlikely to occur.
