Triceps skinfold thickness trajectories and the risk of all-cause mortality:A prospective cohort study

BACKGROUND The measurement of triceps skinfold(TSF)thickness serves as a noninvasive metric for evaluating subcutaneous fat distribution.Despite its clinical utility,the TSF thickness trajectories and their correlation with overall mortality have not been thoroughly investigated.AIM To explore TSF thickness trajectories of Chinese adults and to examine their associations with all-cause mortality.METHODS This study encompassed a cohort of 14747 adults sourced from the China Health and Nutrition Survey.Latent class trajectory modeling was employed to identify distinct trajectories of TSF thickness.Subjects were classified into subgroups reflective of their respective TSF thickness trajectory.We utilized multivariate Cox regression analyses and mediation examinations to explore the link between TSF thickness trajectory and overall mortality,including contributory factors.RESULTS Upon adjustment for multiple confounding factors,we discerned that males in the‘Class 2:Thin-stable’and‘Class 3:Thin-moderate’TSF thickness trajectories exhibited a markedly reduced risk of mortality from all causes in comparison to the‘Class 1:Extremely thin’subgroup.In the mediation analyses,the Geriatric Nutritional Risk Index was found to be a partial intermediary in the relationship between TSF thickness trajectories and mortality.For females,a lower TSF thickness pattern was significantly predictive of elevated all-cause mortality risk exclusively within the non-elderly cohort.CONCLUSION In males and non-elderly females,lower TSF thickness trajectories are significantly predictive of heightened mortality risk,independent of single-point TSF thickness,body mass index,and waist circumference.

Dipeptidyl peptidase-4 inhibitors and the risk of infection: A systematic review and meta-analysis of cardiovascular outcome trials

BACKGROUND Since adverse events during treatment affect adherence and subsequent glycemic control,understanding the safety profile of oral anti-diabetic drugs is imperative for type 2 diabetes mellitus(T2DM)therapy.AIM To evaluate the risk of infection in patients with T2DM treated with dipeptidyl-peptidase 4(DPP-4)inhibitors.METHODS Electronic databases were searched.The selection criteria included randomized controlled trials focused on cardiovascular outcomes.In these studies,the effects of DPP-4 inhibitors were directly compared to those of either other active anti-diabetic treatments or placebo.Six trials involving 53616 patients were deemed eligible.We calculated aggregate relative risks employing both random-effects and fixed-effects approaches,contingent upon the context.RESULTS The application of DPP-4 inhibitors showed no significant link to the overall infection risk[0.98(0.95,1.02)]or the risk of serious infections[0.96(0.85,1.08)],additionally,no significant associations were found with opportunistic infections[0.69(0.46,1.04)],site-specific infections[respiratory infection 0.99(0.96,1.03),urinary tract infections 1.02(0.95,1.10),abdominal and gastrointestinal infections 1.02(0.83,1.25),skin structure and soft tissue infections 0.81(0.60,1.09),bone infections 0.96(0.68,1.36),and bloodstream infections 0.97(0.80,1.18)].CONCLUSION This meta-analysis of data from cardiovascular outcome trials revealed no heightened infection risk in patients undergoing DPP-4 inhibitor therapy compared to control cohorts.

Correlation between serum free fatty acids levels and Gensini score in elderly patients with coronary heart disease

Objectives To investigate the relationship between serum fxee fatty acids （FFAs） levels and the severity of coronary artery lesions in elderly patients with coronary heart disease （CAD）. Methods A total of 172 elderly patients who underwent coronary angiography were divided into CAD group （n = 128） and non-CAD group （n = 44） according to the results of coronary angiography. Serum FFAs and lipid levels were measured and the Gensini score were calculated. Results No matter the differences between age, gender and the usage of stat- ins or not, there was no statistical significance in FFAs levels （P 〉 0.05）. In terms of the Gensini score, it was higher in patients aged 70-79 years than in patients 60-69 years old [15.00 （5.00, 34.00） vs. 10.00 （2.00, 24.00）, P 〈 0.05], higher in men than women [14.00 （4.00, 34.00） vs. 7.00 （2.50, 19.75）, P 〈 0.05], and higher in patients on statins [13.50 （4.25, 33.50）vs. 6.50 （2.00, 18.00）, P 〈 0.05]. The serum FFAs lev- els [449.50 （299.00, 624.75） mEq/L vs. 388.00 （258.50, 495.25） mEq/L, P 〈 0.05J and Gensini score [17.50 （8.00, 41.75） vs. 1.00 （0, 5.00）, P 〈 0.05] were higher in the CAD group than in the non-CAD group. In the CAD group, there was no statistical significance in FFAs levels among patients with different numbers of diseased coronary vessels （P 〉 0.05）. Furthermore, the FFAs levels were positively correlated with the Gensini score （r = 0.394, P = 0.005）. Regression analysis showed that the FFAs levels were related to the Gensini score independently after adjusting for the other risk factors. Conclusions The serum FFAs levels were associated with the Gensini score in elderly patients with CAD. It might indicate FFAs as a biomarker predicting the severity of coronary artery lesions.

A case of applying left bundle branch pacing combined with atrioventricular node ablation to treat atrial fibrillation-induced heart failure

The core treatment of rapid arrhythmiainduced heart failure(HF)is to control the ventricular rate to an optimized lower level,which is usually achieved with various anti-arrhythmic drugs.However,arrhythmias may not respond well to pharmaceutical treatment for various reasons.Iatrogenic atrioventricular(AV)node ablation needs to be performed under these extreme conditions to lower the patient’s heart rate.

Low density lipoprotein cholesterol level inversely correlated with coronary flow velocity reserve in patients with Type 2 diabetes

Objectives To evaluate the association of coronary artery endothelial function and plasma levels of low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) in patients with Type 2 Diabetes Mellitus (DM). Methods We investigated 90 participants from our institution between October 2007 to March 2010: non-DM(n = 60) and DM(n = 30). As an indicator of coronary endothelial dysfunction, we used non-invasive Doppler echocardiography to quantify coronary flow velocity reserve (CFVR) in the distal part of the left descending artery after rest and after intravenous adenosine administration. Results Plasma level of LDL-C was significantly higher in patients with DM than in non-DM (3.21 ±0.64 vs. 2.86 ±0.72 mmo/L, P < 0.05), but HDL-C level did not differ between the groups (1.01 ±0.17 vs. 1.05 ±0.19 mmo/L). Furthermore, the CFVR value was lower inDMpatients than non-diabetics (2.45 ±0.62 vs. 2.98 ±0.68, P < 0.001). Plasma levels of LDL-C were negatively correlated with CFVR in all subjects (r = ��0.35, P < 0.001; 95% confidence interval (CI): ��0.52 –��0.15) and in the non-DM(r = ��0.29, P < 0.05; 95% CI: ��0.51–��0.05), with an even stronger negative correlation in the DM group (r = ��0.42, P < 0.05; 95%CI: ��0.68 –��0.06). Age (β= ��0.019, s = 0.007, sβ= ��0.435, 95% CI: ��0.033 –��0.005, P = 0.008), LDL-C (β= ��0.217, s = 0.105, sβ= ��0.282, 95% CI: ��0.428 –��0.005, P = 0.045) remained independently correlated with CFVR in the DM group. However, we found no correlation between HDL-C level and CFVR in any group. Conclusions Diabetes may contribute to coronary artery disease (CAD) by inducing dysfunction of the coronary artery endothelium. Increased LDL-C level may adversely impair coronary endothelial function in DM. HDL-C may lose its endothelial-protective effects, in part as a result of pathological conditions, especially under abnormal glucose metabolism.

Two case of preoperative bridging therapy for patients undergoing non- cardiac surgery after coronary stent implantation

It has been reported that up to 12% of patients underwent non-cardiac surgery or invasive procedures within the first year after the coronary stent implantation. Premature dis- continuation of antiplatelet therapy is associated with a sig- nificant increase in mortality and major adverse cardiac events, in particular, stent thrombosis. Thus, postpone- ment of elective surgery is advocated during the first year after the coronary stent implantation.

Diabetes insipidus with impaired vision caused by germinoma and perioptic meningeal seeding:A case report

BACKGROUND Germinoma is a type of germ cell tumor that most frequently arises in the midline axis of the brain.Impaired vision is a clinical manifestation of germinnoma.Although rare,intracranial germinoma seeding to the perioptic arachnoid space is one cause of visual acuity decrease.CASE SUMMARY An 11yearold girl who presented with polyuria and polydipsia and subsequently developed diminution of vision.Imaging showed bilateral heterogeneous enhancement of the optic nerve sheaths and atrophy of the optic nerve,and transsphenoidal biopsy revealed a germinoma.The patient experienced poor visual recovery following chemotherapy and radiotherapy.Germinomas are rare and they are mostly identified in children and adolescents.The manifestations include diabetes insipidus,pituitary dysfunction,visual complaints,etc.The mechanisms that lead to visual loss include intracranial hypertension,compression of optic chiasma,and tumor invasion.A literature review was performed to summarize the cases with a tumor infiltrating the optic nerve.Most of the reported patients were adolescents and presented with anterior pituitary hormone deficiency.Enhancement of optic nerve sheaths and optic disc pallor could be identified in most of the cases.The purpose of this report is to provide awareness that in cases where a germinoma is associated with visual loss,though rare,perioptic meningeal seeding should be taken into consideration.CONCLUSION The case report suggests that children with diabetes insipidus need a complete differential diagnosis.

Research status of persistent vegetative state in recent 20 years:A bibliometric analysis

We searched PVS-related literature in the Web of Science Core Collection database,extracted and analyzed the data using the Science Citation Index Extended Edition,and included two types of literature:review and monograph.The search terms were subject=persistent vegetative state and publication year(2001-2021)and language=English.Statistical analysis of literature overview,countries and regions,institutions,authors,literature source publications,literature research direction,citation frequency,impact factor,H-index and keywords,etc.are carried out.Use VOS viewer 1.6.17 software to visually cluster the keywords in the titles and abstracts of the included literature and analyze the research direction and development trend.A total of 772 PVS-related documents published in the core collection database of Web of Science from 2001 to 2021 were included.The country with the largest number of publications was the United States(261 papers,33.80%),and the institution with the largest number of publications was the University of Liège,Belgium(40 papers,5.18%).The author with the largest number of published papers is Laureys S of the University of Liège,Belgium(39 papers,5.05%).The research directions of PVS are mainly neuroscience(350 articles,45.33%),rehabilitation(98 articles,12.69%),and internal medicine(9 articles,11.79%).The literature is mainly from Brain Injury.The annual average impact factor of the top 10 journals in 2020 was 4.55,and their publication volume accounted for 17.35%(134/772)of the total literature.The 772 articles were cited 23,503 times(21,400 self-citations were excluded),with an average of 30.44 citations per article.The H-index of the United States,the United Kingdom and Belgium are 48,27 and 27,which are significantly higher than other countries,and the citation frequencies are 8609,3451 and 3270,accounting for 36.60%,14.68%and 13.90%of the total citations,respectively.China's publication volume is in the middle,but only 8th in citation frequency and H-index(818 citations,H-index 16).We used the VOS viewer software to analyze and found that the keywords were mainly concentrated in four groups:"diagnosis-related","treatment-related","prognosis-related"and"disease-related".From 2001 to 2021,the United States,Italy and the United Kingdom have the largest number of PVS related literature publications.There is still a certain gap between China and western countries in terms of the number and quality of literature publications.

Research progress of Chinese and Western medicine on spastic cerebral palsy in children in recent ten years

In recent ten years,with more and more children with spastic cerebral palsy appearing around us,relevant clinical research has also become a research hotspot.However,at present,there is no radical plan for the treatment of children with spastic cerebral palsy in the world.This study summarizes the latest progress of traditional Chinese and Western medicine in the treatment of children with spastic cerebral palsy in recent years,hoping that the whole work can serve as a clinical and theoretical basis and provide certain reference significance.

Evidence and thinking on risk factors of hypertensive intracerebral hemorrhage: a meta-analysis

Background:To explore the related risk factors of hypertensive intracerebral hemorrhage(ICH)through meta-analysis,and to provide evidence-based medical basis for preventing ICH in hypertensive patients.Methods:The databases of CNKI,Wanfang,VIP,CBM,PubMed,Web of Science and Cochrane Library were searched by computer.Case control study on risk factors for hypertensive intracerebral hemorrhage were collected from the database establishment to October 2021.Two reviewers independently screened the literature,extracted the data,and evaluated the bias risk of the included studies.Meta-analysis was conducted on the results of the included studies using RevMan5.3 software.Results:A total of 7 studies were included,including 1512 patients.Meta-analysis results showed that:Smoking history(OR=6.23,95%CI(4.32,8.99),P<0.00001),drinking history(OR=7.24,95%CI(1.96,26.72),P=0.003),diabetes mellitus(OR=47.52,95%CI(10.31,219.31),P<0.00001),coronary heart disease(OR=9.90,95%CI(2.96,33.13),P=0.0002),daily salt intake(OR=10.21,95%CI(2.69,38.79),P=0.0006),failure to take medication regularly on time(OR=10.62,95%CI(5.40,20.91),P<0.00001),total cholesterol(OR=6.58,95%CI(2.45,17.65),P=0.0002),triglyceride(OR=8.63,95%CI(6.70,11.12),P<0.00001),body mass index(OR=6.63,95%CI(4.56,9.64),P<0.00001)and experiencing severe economic difficulties(OR=23.97,95%CI(14.82,38.77),P<0.00001)were risk factors for hypertensive intracerebral hemorrhage.Conclusion:Controlling smoking,drinking,reducing daily salt intake,controlling body weight,preventing diabetes and coronary heart disease,low-fat diet,controlling total cholesterol and triglyceride,taking antihypertensive drugs regularly and improving economic status can prevent hypertensive cerebral hemorrhage.

针刺领域真实世界研究的现状、思考和建议

In recent years,the importance of real-world research based on real-world data has been widely recognized in many countries and regions around the world.Oriented by real-world data,real-world research is conducted to obtain real-world evidence,which becomes a hot spot in clinical study.In such circumstances,how to use the diagnosis and treatment data of clinical practice to evaluate the effect and safety of acupuncture becomes future direction of acupuncture research.This paper analyzed the current situation of the real-world research in the field of acupuncture and put forward the influencing factors and the countermeasures to provide the references for the real-world research of acupuncture.

Analysis on the outcomes in randomized controlled trials of perimenopausal syndrome treated with acupuncture and moxibustion

Objective:To search systematically the application situation of the outcomes in the randomized controlled trials(RCTs) of perimenopausal syndrome treated with acupuncture and moxibustion so as to provide the foundation for the core outcome sets in treatment of periomenopausal syndrome with acupuncture and moxibustion.Methods:The articles of RTCs on perimenopausal syndrome treated with acupuncture and moxibustion were searched in China National knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform(Wanfang),VIP Chinese Journal Service Platform(VIP),Pubmed,Excerpt medica database(Embase)and Cochrane central register of controlled trials(CENTRAL) databases from January 1,2010 to December31,2020.Two reviewers screened the articles,extracted data and analyzed the application of outcomes in the eligible trials independently.Results:A total of 9391 articles were retrieved initially and 79 articles of them were eligible,including 43 articles in English and 36 articles in Chinese.115 outcomes were involved totally and collected according to 7 outcome domains,of which,the effective rate was the outcome with the highest use frequency.35 articles reported adverse events and 17 articles reported the effect in followup.Conclusion:At present,the outcomes of RCTs on perimenopausal syndrome in treatment with acupuncture and moxibustion are big in divergence,absent in normalization and lack of indicators for long-term prognosis and economics outcomes,as well as have the issues on the incomplete reports on the differentiation between the primary and the secondary outcomes,safety indicators and followup outcomes.It needs to construct the core outcome sets in line with the characteristics of acupuncture-moxibustion discipline so as to improve the quality of clinical trials of acupuncture and moxibustion.

Effect of CacO_(3) on volatilization of self-reduced zinc from blast furnace dust

To solve the problem of low reduction extraction rate of zinc from blast furnace dust,the effects of CacO3 addition,reduction temperature,and reduction time on self-reduction zinc extraction were studied through high-temperature reduction experiment,and the mechanism of how CaCO_(3) addition promotes zinc ferrite reduction was analyzed.The zinc removal rate can reach 98.82%when the blast furnace dust is reduced at 1000℃ for 25 min by adding 10 mass%CaCO_(3).At low temperature,CaCO_(3) can enhance the reduction and decomposition of ZnFe_(2)O_(4)(which is difficult to reduce)into ZnO and low-valent iron oxides.After CaCO_(3) is decomposed at high temperature,CO_(2) is produced to undergo gasification reaction with carbon in blast furnace dust,and co is generated to provide more reducing agents for the whole reduction system.CaO generated by decomposition can also catalyze the gasification reaction of carbon,thus improving the removal rate of zinc in the reduction process of dust.