Homocysteinemia and Depression in Community-Dwelling Older Adults: The Cohort Longitudinal Study “InveCeAb” (Brain Aging in Abbiategrasso)

Depression is a major health problem, especially for elderly people. According to the “homocysteine hypothesis of depression”, high homocysteine levels may cause depression of mood via cerebrovascular diseases. Whilst biologically plausible, such hypothesis needs yet confirmation. We aimed at: 1) studying the relationships between homocysteinemia (HCY) and depression in a community-dwelling cohort of people aged 70 to 75 years at baseline;2) investigating plasma levels of HCY and 3) comparing these levels between males and females, in the same population. We exploited the data from four waves (2010, 2012, 2014 and 2018) of the longitudinal study “InveCeAb”, with specific regard towards mood assessment, by Geriatric Depression Scale (GDS) scoring, and diagnosis of clinically relevant or subthreshold depression. HCY plasma levels were measured in the waves 2012, 2014 and 2018. Sample attrition was due mainly to death or overall worsening. No statistically significant differences were found in plasma homocysteine levels in each wave, according to depressive symptoms. No correlations were found between plasma HCY levels in each wave with their corresponding GDS scores, even after adjustment for folate and cobalamin blood concentrations. Dichotomized levels of HCY (≤15 vs >15 μM/l) were not associated with dichotomized GDS scores (≤4 vs higher), clinically relevant and subthreshold depression diagnosis and any antidepressive use, in any wave. First (2012) HCY levels increased with participants’ increasing age, cross-sectionally. Listwise HCY concentrations decreased along the 3 waves. HCY levels were always higher in males than in females. Our results may challenge the “homocysteine hypothesis” of depression, whilst supporting the role of high homocysteinemia as a marker of overall bad health.

Plant-based dietary patterns and risk of esophageal cancer:A prospective cohort study spanning 17 years

Objective: Plant-based diets have multiple health benefits for cancers;however, little is known about the association between plant-based dietary patterns and esophageal cancer(EC).This study presents an investigation of the prospective associations among three predefined indices of plant-based dietary patterns and the risk of EC.Methods: We performed endoscopic screening for 15,709 participants aged 40-69 years from two high-risk areas of China from January 2005 to December 2009 and followed the cohort until December 31, 2022. The overall plant-based diet index(PDI), healthful plant-based diet index(h PDI), and unhealthful plant-based diet index(u PDI), were calculated using survey responses to assess dietary patterns. We applied Cox proportional hazard regression to estimate the multivariable hazard ratios(HRs) and 95% confidence intervals(95% CIs) of EC across 3plant-based diet indices and further stratified the analysis by subgroups.Results: The final study sample included 15,184 participants in the cohort. During a follow-up of 219,365person-years, 176 patients with EC were identified. When the highest quartile was compared with the lowest quartile, the pooled multivariable-adjusted HR of EC was 0.50(95% CI, 0.32-0.77) for h PDI. In addition, the HR per 10-point increase in the h PDI score was 0.42(95% CI, 0.27-0.66) for ECs. Conversely, u PDI was positively associated with the risk of EC, and the HR was 1.80(95% CI, 1.16-2.82). The HR per 10-point increase in the u PDI score was 1.90(95% CI, 1.26-2.88) for ECs. The associations between these scores and the risk of EC were consistent in most subgroups. These results remained robust in sensitivity analyses.Conclusions: A healthy plant-based dietary pattern was associated with a reduced risk of EC. Emphasizing the healthiness and quality of plant-based diets may be important for preventing the development of EC.

Clinical characteristics and outcome of autoimmune pancreatitis based on serum immunoglobulin G4 level:A single-center,retrospective cohort study

BACKGROUND Autoimmune pancreatitis(AIP)has been linked with elevated immunoglobulin(Ig)G4 levels.The characteristics and outcomes of AIP based on serum markers have not been fully evaluated.AIM To compare clinical features,treatment efficacy,and outcome of AIP based on serum IgG4 levels and analyze predictors of relapse.METHODS A total of 213 patients with AIP were consecutively reviewed in our hospital from 2006 to 2021.According to the serum IgG4 level,all patients were divided into two groups,the abnormal group(n=148)with a high level of IgG4[>2×upper limit of normal(ULN)]and the normal group(n=65).The t-test or Mann-Whitney U test was used to compare continuous variables.Categorical parameters were compared by theχ^(2) test or Fisher’s exact test.Kaplan-Meier curves Zhou GZ et al.Clinical characteristics and outcome of AIP WJG https://www.wjgnet.com 5126 September 21,2023 Volume 29 Issue 35 and log-rank tests were established to assess the cumulative relapse rates.Univariate and multivariate analyses were used to investigate potential risk factors of AIP relapse.RESULTS Compared with the normal group,the abnormal group had a higher average male age(60.3±10.4 vs 56.5±12.9 years,P=0.047);higher level of serum total protein(72.5±7.9 g/L vs 67.2±7.5 g/L,P<0.001),IgG4(1420.5±1110.9 mg/dL vs 252.7±106.6 mg/dL,P<0.001),and IgE(635.6±958.1 IU/mL vs 231.7±352.5 IU/mL,P=0.002);and a lower level of serum complement C3(100.6±36.2 mg/dL vs 119.0±45.7 mg/dL,P=0.050).In addition,a lower number of cases with abnormal pancreatic duct and pancreatic atrophy(23.6%vs 37.9%,P=0.045;1.6%vs 8.6%,P=0.020,respectively)and a higher rate of relapse(17.6%vs 6.2%,P=0.030)were seen in the abnormal group.Multivariate analyses revealed that serum IgG4[(>2×ULN),hazard ratio(HR):3.583;95%confidence interval(CI):1.218–10.545;P=0.020]and IgA(>1×ULN;HR:5.908;95%CI:1.199–29.120;P=0.029)and age>55 years(HR:2.383;95%CI:1.056–5.378;P=0.036)were independent risk factors of relapse.CONCLUSION AIP patients with high IgG4 levels have clinical features including a more active immune system and higher relapse rate.Several factors,such as IgG4 and IgA,are associated with relapse.

Distribution of winter-spring snow over the Tibetan Plateau and its relationship with summer precipitationin Yangtze River

The distribution of winter-spring snow cover over the Tibetan Plateau （TP） and its relationship with summer precipitation in the middle and lower reaches of Yangtze River Valley （MLYRV） during 2003-2013 have been investigated with the moderate-resolution imaging spectrometer （MODIS） Terra data （MOD10A2） and precipitation observations. Results show that snow cover percentage （SCP） remains approximately 20% in winter and spring then tails off to below 5% with warmer temperature and snow melt in summer. The lower and highest percentages present a declining tendency while the middle SCP exhibits an opposite variation. The maximum value appears from the middle of October to March and the minimum emerges from July to August. The annual and winter-spring SCPs present a decreasing tendency. Snow cover is mainly situated in the periphery of the plateau and mountainous regions, and less snow in the interior of the plateau, basin and valley areas in view of snow cover frequency （SCF） over the TP. Whatever annual or winter-spring snow cover, they all have remarkable declining tendency during 2003-2013, and annual snow cover presents a decreasing trend in the interior of the TP and increasing trend in the periphery of the TP. Hie multi-year averaged eight-day SCP is negatively related to mean precipitation in the MLYRV. Spring SCP is negatively related to summer precipitation while winter SCP is positively related to summer precipitation in most parts of the MLYRV. Hence, the influence of winter snow cover on precipitation is much more significant than that in spring on the basis of correlation analysis. The oscillation of SCF from southeast to northwest over the TP corresponds well to the beginning,development and cessation of the rain belt in eastern China.

Winter-Spring Precipitation Variability in Pakistan

This study investigates the spatial-temporal variability of winter-spring (February-March-April) precipitation (WSP) in Pakistan over the period of 1961-2006 by making use of Empirical Orthogonal Function (EOF). The EOF analysis is based on ground observed data, reanalysis NCEP/NCAR of various geopotential heights and NOAA extended reconstructed sea surface temperatures (ERSST.v3). The significant modes are obviously variable at interannual time scale. The leading mode shows the node of maximum spatial variability anchored over the Peshawar Valley and Azad Kashmir (PVAK) axis. The pattern is associated with strong (weak) westerly jet over the Middle East. The pattern is also found closely associated with post monsoon and early winter El Nino. The Nino4 index can be an appropriate predictor for the first consistent single node pattern. The second significant mode represents a tripole pattern with areas of prominent variability over northwestern Pakistan, Quetta-Kalat region and northeastern Punjab. The pattern is found to be pro-NAO and in relation to this pattern, warm and stable SST anomalies appearing in the southern mid-latitudes of Indian and Atlantic basins.

Midday Napping,Nighttime Sleep,and Mortality:Prospective Cohort Evidence in China

Objective In developed countries,midday napping and nighttime sleep duration have been linked to long-term survival;however,little is known about such effects in less developed regions.Therefore,this study aimed to assess the associations of midday napping and nocturnal sleep with mortality in middle-aged and older Chinese adults.Methods A nationwide cohort of 15,524 adults aged≥45 years was enrolled from 28 provincial regions across China's Mainland and followed up from 2011 to 2018,using data from the Chinese Health and Retirement Longitudinal Study.Midday napping and nighttime sleep duration were assessed using standardized questionnaires.Cox proportional hazards models with random intercepts for the surveyed provinces were used to estimate hazard ratios(HRs)of all-cause mortality,adjusting for sociodemographic characteristics,behavioral factors,and health status.Results A total of 1,745 deaths occurred during a median follow-up of 7.1 years,and the mean(standard deviation)age was 59(10.1)years at baseline.Compared with non-nappers,over 60 min nappers had a higher risk of all-cause mortality[HR:1.35,95%confidence interval(CI):1.17–1.56],while no significant associations were observed among<30 min nappers.Compared with sleep duration of 6–8 h/night,both short(<6 h)and long(≥8 h)sleep duration were significantly associated with increased mortality,with corresponding HR(95%CI)estimates of 1.21(1.05–1.38)and 1.26(1.10–1.44),respectively.We observed significant patterns for greater risks associated with longer nap duration,with a Ptrend value<0.001 for all-cause mortality.No significant evidence of an additive interaction was identified between midday napping and nighttime sleep.Conclusion Long midday napping and inappropriate nighttime sleep were independently associated with an increased risk of all-cause mortality in middle-aged and older Chinese populations.Biological studies are needed to validate our findings and clarify the mechanisms underlying this association.

The relationship between physical activity in early pregnancy and hypertensive disorders of pregnancy: a cohort study in Chinese women

BACKGROUND:We aimed to examine prospective associations between diff erent intensities and diff erent types of physical activity(PA)in early pregnancy and hypertensive disorders of pregnancy(HDP)among Chinese women.METHODS:A total of 6,820 pregnant women from the Tongji-Shuangliu Birth Cohort were included in this study.The pregnancy physical activity questionnaire(PPAQ)was used to assess PA,including household/caregiving,occupational,sports/exercise,and transportation activities in the first trimester of pregnancy.The diagnosis of HDP was collected,including gestational hypertension(GH)and preeclampsia(PE).Data were analyzed by unconditional multivariate logistic regression,and the odds ratio(OR)and 95%confi dence interval(CI)were calculated.RESULTS:A total of 178(2.6%)of the 6,820 women were diagnosed with HDP,of which 126(1.8%)were GH and 52(0.8%)were PE.Overall,we found no association between PA in early pregnancy and PE.A trend toward lower risk was found only among women with GH and among those with higher levels of moderate-to-vigorous intensity physical activity(MVPA)(adjusted OR 0.54,95%CI 0.31–0.96).No association was observed between PA and HDP in early pregnancy,regardless of diff erent intensities or types of PA.CONCLUSION:MVPA in the first trimester is an influencing factor of HDP.Encouraging pregnant women to engage in MVPA in the fi rst trimester may help to prevent GH.

Stair climbing,genetic predisposition,and the risk of incident type 2 diabetes:A large population-based prospective cohort study

Background:Cross-sectional evidence and small-scale trials suggest positive effects of stair climbing on cardiometabolic disease and glucose regulation.However,few studies have examined the long-term association between stair climbing and the incidence of type 2 diabetes(T2D).We aimed to prospectively evaluate the association of stair climbing with T2D and assess modifications by genetic predisposition to T2D.Methods:We included 451,699 adults(mean age=56.3±8.1 years,mean±SD;55.2%females)without T2D at baseline in the UK Biobank and followed up to March 31,2021.Stair climbing information was collected through the touchscreen questionnaire.Genetic risk score for T2D consisted of 424 single nucleotide polymorphisms.Results:During a median follow up of 12.1 years,14,896 T2D cases were documented.Compared with participants who reported no stair climbing,those who climbed stairs regularly had a lower risk of incident T2D(10-50 steps/day:hazard ratio(HR)=0.95,95%confidence interval(95%CI):0.89-1.00;60-100 steps/day:HR=0.92,95%CI:0.87-0.98;110-150 steps/day:HR=0.86,95%CI:0.80-0.91;>150 steps/day:HR=0.93,95%CI:0.87-0.99,p for trend=0.0007).We observed a significant interaction between stair climbing and genetic risk score on the subsequent T2D risk(p for interaction=0.0004),where the risk of T2D showed a downward trend in subjects with low genetic risk and those who reported stair climbing activity of 110-150 steps/day appeared to have the lowest overall T2D risk among those with intermediate to high genetic risk.Conclusion:A higher number of stairs climbed at home was associated with lower T2D incidence risk,especially among individuals with a low genetic predisposition to T2D.These findings highlight that stair climbing,as incidental physical activity,offers a simple and low-cost complement to public health interventions for T2D prevention.

Edible mushrooms as a potent therapeutics of subclinical thyroid dysfunction among adults,especially in obese individuals:a prospective cohort study

Background:Mushrooms are a good source of many nutrients which are potentially beneficial for chronic diseases.We speculated that due to its abundant nutrients edible mushrooms might have a beneficial effect on the prevention of subclinical thyroid dysfunction(SCTD).Therefore,we designed a large-scale cohort study to examine whether mushrooms consumption is a protective factor for SCTD in adults.Methods:This prospective cohort study investigated 6631 participants(mean age:(45.0±10.2)years;55.1%men).Edible mushrooms consumption was measured at baseline using a validated food frequency questionnaire.SCTD was defined as abnormal serum thyroid-stimulating hormone levels and normal free thyroxine.Cox proportional hazards regression models were used to examine the association of edible mushrooms consumption with incident SCTD.Results:During follow-up period,a total of 262 new cases of SCTD were identified,the incidence rate of subclinical hypothyroidism was 8.9/1000 person-years and subclinical hyperthyroidism was 7.2/1000 person-years.After adjusting potential confounding factors,the multivariable hazard ratios(95%confidence intervals)for subclinical hypothyroidism were 1.00(reference)for almost never,0.53(0.29,0.97)for 1-3 times/week and 0.30(0.10,0.87)for≥4 times/week(P for trend=0.02).It also showed edible mushrooms consumption was inversely associated with subclinical hypothyroidism in obese individuals but not non-obese individuals,the final hazard ratios(95%confidence intervals)were 0.14(0.03,0.73)(P for trend<0.01).Conclusions:This population-based prospective cohort study has firstly demonstrated that higher edible mushrooms consumption was significantly associated with lower incidence of subclinical hypothyroidism among general adult population,especially in obese individuals.

Who Is More Vulnerable?The Age-Period-Cohort Effect of Psychological Distress among Urban Residents in China

How does psychological distress evolve over time?This study utilizes cross-sectional data from the China General Social Survey from 2010 to 2017 to explore the differences in psychological distress among Chinese residents at various ages,periods,and cohorts.The dummy variable method and random effects hierarchical age-period-cohort model were employed to isolate the age,period,and cohort effects that impacted the psychological distress of Chinese urban residents.First,in terms of the age effect,the psychological distress experienced by residents tends to increase initially and then decrease with age.Middle-aged individuals,around 40 years old,often face a particularly severe form of psychological distress known as the“midlife crisis.”Additionally,middle-aged people who have larger families may experience more significant psychological distress due to increased family burdens.Second,in terms of the period effect,the psychological distress experienced by residents has been on the rise due to the continued development of society.Those who are at a disadvantage in market competition and work longer hours may be particularly vulnerable to increased psychological distress.Thirdly,the cohort effect refers to the different social behaviors and attitudes exhibited by individuals of different generations.In terms of this effect,psychological distress initially decreased and then increased among those born between 1945 and 1990.Individuals born in the 1980s and 1990s experienced higher levels of psychological distress,with internet use having a greater negative impact.Additionally,the positive effect of income on their psychological distress was reduced.The psychological distress of Chinese urban residents is affected by a variety of time-related factors,which are closely related to Chinese clan culture,market competition and social changes.The heavy family burden imposed by traditional clan culture,the different working conditions created by market competition,and the emergence of new lifestyles,such as internet use during social changes,have led to diverse psychological distress experiences among residents across different ages,time periods,and cohorts.In the future,longitudinal studies are needed to strengthen the robustness of the conclusions and consider the long-term impact of the COVID-19 pandemic.Mental health support should pay specific attention to the psychological distress of middle-aged individuals,long-time workers,and internet users.

LipoCol Forte capsules reduce the risk of liver cancer:A propensity score-matched,nationwide,population-based cohort study

BACKGROUND Liver cancer is among the top five most common cancers globally. Lipid-lowering drugs such as statins can lower the risk of liver cancer, but may also cause liver damage. LipoCol Forte capsules(LFC), a red yeast rice product, have demonstrated significant antihypercholesterolemic effects and a good safety profile in clinical studies.AIM To evaluate whether LFC lowers the risk of liver cancer in adults in this propensity score-matched, nationwide, population-based cohort study.METHODS We used data from Taiwan’s National Health Insurance Research Database, which includes electronic medical records for up to 99.99% of Taiwan’s population. LFC users and LFC non-users were matched 1:1 by propensity scores between January 2010 and December 2017. All had followup data for at least 1 year. Statistical analyses compared demographic distributions including sex, age, comorbidities, and prescribed medications. Cox regression analyses estimated adjusted hazard ratios(aHRs) after adjusting for potential confounders.RESULTS We enrolled 33231 LFC users and 33231 non-LFC users(controls). No significant differences between the study cohorts were identified regarding comorbidities and medications [standardized mean difference(SMD) < 0.05]. At follow-up, the overall incidence of liver cancer was significantly lower in the LFC cohort compared with controls [aHR 0.91;95% confidence interval(CI): 0.86-0.95;P < 0.001]. The risk of liver cancer was significantly reduced in both females(aHR 0.87;95%CI: 0.8-0.94;P < 0.001) and males(aHR 0.93;95%CI: 0.87-0.98;P < 0.01) in the LFC cohort compared with their counterparts in the non-LFC cohort. The antitumor protective effects applied to patients with comorbidities(including hypertension, ischemic stroke, diabetes mellitus, hyperlipidemia, hepatitis B infection and hepatitis C infection). Those using LFC for more than 84 drug days had a 0.64-fold lower risk of liver cancer compared with controls(P < 0.001). Compared with controls, the risk of developing liver cancer in the LFC cohort progressively decreased over time;the lowest incidence of liver cancer occurred in LFC users followed-up for more than 6 years(27.44 vs 31.49 per 1,000 person-years;aHR 0.75;95%CI: 0.68-0.82;P < 0.001).CONCLUSION This retrospective cohort study indicates that LFC has a significantly protective effect on lowering the risk of liver cancer, in a dose-dependent and time-dependent manner.

中医辨证治疗前庭性偏头痛的多中心前瞻性队列研究

目的:评价中医辨证治疗前庭性偏头痛的临床疗效,探讨中医辨证用药规律。方法:采用前瞻性队列研究方法,选取前庭性偏头痛患者197例,根据是否采用中医辨证治疗为暴露因素,分为中药组与西药组,分别为123例与74例。观察两组治疗第4、8、12周的眩晕复发率及相关结局指标。结果:治疗第4、8、12周,眩晕复发率中药组依次为14.9%、18.4%、29.7%,西药组依次为12.3%、32.8%、55.6%,其中第8、12周两组比较差异有统计学意义(P<0.05);治疗后第4周,眩晕残障量表评分(dizziness handicap inventory,DHI)、VAS评分改善情况西药组优于中药组,但差异无统计学意义(P>0.05),第8、12周DHI、VAS评分改善情况中药组均优于西药组(P<0.05);共收集门诊处方273首,涉及中药76味,使用频率前十位的中药依次为天麻、法半夏、柴胡、茯神、远志、茯苓、酸枣仁、煅龙骨、珍珠母、黄芩。结论:中医辨证治疗前庭性偏头痛在改善眩晕症状,控制眩晕复发方面优势明显,但起效速度方面不及西药治疗。临床用药以疏肝解郁、重镇安神为主,安神之法应贯穿治疗始终。

Acupuncture for stroke cohort construction:a protocol describing a multicenter,prospective,real-world cohort construction study

Background:Acupuncture for stroke has been endorsed by the World Health Organization,and the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018 lists acupuncture for stroke as a Level II recommendation with Level B evidence.The efficacy of acupuncture in the treatment of acute ischaemic stroke needs to be approved by more high-quality studies.However,there are currently no real-world studies of acupuncture for stroke.Methods:Stroke patients who meet the study criteria and are hospitalized from February 2021 to March 2022 in 23 medical institutions across China,including the First Teaching Hospital of Tianjin University of Chinese Medicine.The number of patients planned to be recruited is 3,000.Due to the impact of COVID-19,we have applied to the competent authorities for an extension(recruit patients until December 2022).Basic patient information and treatment information will be registered at admission,at discharge,and on the following dates after the onset of the disease:90±7 days,180±7 days,and 360±7 days after the onset of the disease.Establish a database for statistical analysis.Discussion:This study proposes to conduct a prospective cohort study of acupuncture intervention for stroke in a real-world medical setting.Analysis of the effect pattern of acupuncture intervention on the recovery of neurological function system and swallowing disorder in stroke patients.Evaluate the long-term effects of acupuncture intervention for stroke and recurrence of cardiovascular and cerebrovascular events.

慢性高血压及其合并妊娠期糖尿病的患病率和妊娠结局

目的:随着中国生育政策全面放开、女性妊娠年龄逐步提高、育龄期超重和肥胖比例逐步增加,慢性高血压(chronic hypertension,CHTN)合并妊娠期糖尿病(gestational diabetes mellitus,GDM)的孕妇比例呈现增多趋势,发生不良妊娠结局风险显著增加。本研究拟分析CHTN及其合并GDM的患病率,并比较二者的不良妊娠结局,旨在为制订干预措施提供依据。方法:本研究为前瞻性研究。根据2016年1月1日至2020年12月31日期间共378366例大型孕妇队列,筛选出CHTN孕妇1418例,其中单纯CHTN 1027例,CHTN合并GDM 391例。应用SAS9.4统计分析孕妇的基本情况、临床资料和妊娠结局,并分析影响CHTN及其合并GDM患者妊娠结局的危险因素。结果:妊娠合并CHTN的患病率为3.8‰,CHTN合并GDM的患病率为1.0‰。CHTN合并GDM患者占所有CHTN孕妇总数的27.57%(391/1418)。母亲年龄,妊娠次数,产次,既往剖宫产次数,入队列时收缩压、舒张压和平均动脉压在CHTN合并GDM与单纯CHTN 2组间的差异均有统计学意义(均P<0.05)。在调整孕妇年龄、妊娠次数、产次等可能的混杂因素后,二元Logistic回归分析结果显示:CHTN合并GDM孕妇发生剖宫产的危险是CHTN孕妇的1.348倍(OR=1.348,95%CI 1.043~1.741),发生胎盘粘连的危险是CHTN孕妇的2.029倍(OR=2.029,95%CI 1.190~3.462),发生子痫前期的危险是CHTN孕妇的1.540倍(OR=1.540,95%CI 1.101~2.152),结局为巨大儿的危险是CHTN孕妇的2.670倍(OR=2.670,95%CI 1.398~5.100)。结论:CHTN孕妇合并GDM的风险较高,CHTN合并GDM患者的妊娠结局与仅患有CHTN的孕妇在剖宫产、胎盘粘连、子痫前期及巨大儿发生方面存在差异。CHTN合并GDM患者的孕期保健,特别是其血压及血糖的管理更需要重点关注。

术前新型冠状病毒感染患者慢性术后疼痛发生率及其危险因素分析:一项双向队列研究

目的探究术前新型冠状病毒感染(corona virus disease 2019,COVID⁃19)患者慢性术后疼痛(chronic postsurgical pain,CPSP)发生现况,并进一步分析CPSP的危险因素。方法本研究为一项双向队列研究,研究对象来源于一项已完成随访的前瞻性队列研究。回顾性纳入2022年12月1日—2023年2月28日北京协和医院术前合并COVID⁃19且接受手术治疗患者的临床资料,并前瞻性对入组患者随访至术后6个月,主要结局指标为CPSP。采用多因素Logistic回归模型分析COVID⁃19相关暴露指标与CPSP的相关性。结果共入选符合纳入与排除标准的手术患者4117例,术前均合并COVID⁃19。其中急性期轻症4002例,重症62例,危重症53例。术后6个月时伴有长新冠综合征1298例(31.53%),CPSP发生率为5.59%(95%CI:4.88%~6.28%)。多因素Logistic回归分析校正年龄、性别、合并症、麻醉方法、手术种类等混杂因素后发现,急性期危重症COVID⁃19(aOR=3.35,95%CI:1.48~7.62,P<0.001)、有术后长新冠综合征(aOR=2.50,95%CI:1.90~3.29,P<0.001)与CPSP相关。结论本研究首次明确急性期危重症及术后存在长新冠综合征与术前COVID⁃19患者CPSP具有相关性。

2型糖尿病住院患者药物治疗管理模式的效果评价

目的:对2型糖尿病(T2DM)住院患者药物治疗管理模式进行效果评估,探索适合我国的药学服务模式。方法:研究对象为2022年10月1日-2023年9月30日北京同仁医院内分泌科入院的T2DM患者,将符合纳入标准的患者分为临床药师管理组和常规管理组。临床药师管理组,在常规开展医嘱审核、出院教育、用药咨询等工作外,还会深度参与患者个体化方案制定,给予详细的用药指导和健康教育等,出院后定期随访。比较两组患者出院3个月时的血糖、血压、血脂控制情况等。结果:纳入临床药师管理组221例,其中女性98例,男性123例,中位年龄59(43.5,67.0)岁;常规管理组217例,女性74例,男性143例,中位年龄55(42.0,56.0)岁。临床药师管理组患者宜优选使用的二甲双胍、GLP-1Ra、SGLT2i、他汀类药物应用率均显著高于常规管理组(P<0.05);进一步的亚组分析结果显示,临床药师管理组的动脉粥样硬化心血管疾病(ASCVD)患者、糖尿病肾病(DKD)患者中宜优选药物的应用率较常规管理组明显升高(P<0.05);出院后,临床药师管理组患者糖化血红蛋白(HbA1c)、血压、低密度脂蛋白胆固醇(LDL-c)的达标率较常规管理组均明显提高(P<0.05);但在住院药品费用方面、不良反应方面无明显差异(P>0.05)。结论:临床药师对T2DM住院患者开展药物治疗管理模式的药学服务,有利于优化药物治疗方案,提高临床治疗效果。

老年高血压人群腰围身高比与新发脑梗死的关系

目的研究腰围身高比(WHtR)与老年人新发脑梗死的相关性。方法纳入开滦地区研究人群9096例老年高血压患者,以首次发生脑梗死为终点事件,采取前瞻性队列研究方法进行研究,依据观察对象WHtR值以0.05为间距等距分为四组,分别为G1组(WHtR<0.45)、G2组(0.45≤WHtR<0.50)、G3组(0.50≤WHtR<0.55)及G4组(WHtR≥0.55),用寿命表方法统计各人群的累积终点事件发生率,采用Cox比例风险分析方法,探讨WHtR在新发脑梗死中的作用。模型一为单一因子Cox比例风险分析模式,只考察WHtR对脑梗死发生风险的作用;在此基础上,模型二为校正性别、年龄、体重及血清超敏C反应蛋白、收缩压、血清甘油三酯、抽烟史、血清空腹血糖、饮酒情况、高密度脂蛋白胆固醇、舒张压、体育运动、低密度脂蛋白胆固醇、文化程度、服降压药史后观察WHtR对新发脑梗死的作用。结果随访时间为(9.3±2.7)年,期间共新发脑梗死848例。以G2组为对照,单因素Cox比例风险回归模型分析显示G1组、G3组和G4各组发生脑梗死的HR(95%CI)分别为1.00(0.67~1.50)、1.29(1.05~1.60)、1.36(1.12~1.66);多因素Cox比例风险回归模型分析显示G1组、G3组和G4各组发生脑梗死的HR(95%CI)分别为1.09(0.72~1.65)、1.24(0.99~1.54)、1.31(1.05~1.62)。结论老年高血压人群当0.45≤WHtR<0.50时脑卒中发病风险最低,WHtR≥0.55与新发脑梗死风险增加相关。

胃肠间质瘤患者服用甲磺酸伊马替尼仿制药和原研药的血药浓度及安全性评估

目的:比较胃肠间质瘤患者服用甲磺酸伊马替尼仿制药与原研药的血药浓度和不良反应,为临床医生和患者选择药物提供参考。方法:收集河北医科大学第四医院2020年12月至2023年12月,在门诊使用甲磺酸伊马替尼药物的胃肠间质瘤患者,分为原研药甲磺酸伊马替尼片组,仿制药甲磺酸伊马替尼片组,以及仿制药甲磺酸伊马替尼胶囊组。通过高效液相色谱质谱联用仪检测患者用药后的伊马替尼及其代谢产物N-去甲基伊马替尼的血液稳态谷浓度。收集患者用药后的所有不良反应,并根据常见不良反应评估标准5.0版(CTCAE 5.0)确定不良反应等级。分析3组患者血药浓度和服药后不良反应的差异。结果:原研药组和两个仿制药组伊马替尼稳态谷浓度,N-去甲基伊马替尼稳态谷浓度,以及伊马替尼和N-去甲基伊马替尼稳态谷浓度之和,差异均无统计学意义(P均>0.05)。原研药和两个仿制药组不良反应等级也无显著差异(P均>0.05)。结论:甲磺酸伊马替尼原研药和两个仿制药安全性无显著差异。

我国公共卫生科技创新的现状与挑战

近年来,我国公共卫生领域科技创新紧密结合国家重大战略需求,形成了具有我国特色的优势学科领域,建设了若干高水平的科技创新平台和研究基地,并取得系列重大成果。但与发达国家和我国现代公共卫生体系及能力建设目标相比,特别是结合新时期健康中国建设战略需求和重大公共卫生挑战,我国在公共卫生关键科技问题的发展水平上仍存在短板,同时公共卫生科技创新也面临着某些体制机制因素的制约。本文提出了未来我国公共卫生科技创新的重点方向,并聚焦体制机制提出加强公共卫生科技创新的对策建议。

起始联合降脂策略对心内科门诊“极高危ASCVD”患者疗效及安全性观察——真实世界的前瞻性队列研究

目的:在真实世界的前瞻性队列研究中观察心内科门诊“极高危ASCVD”患者在治疗起始阶段采用联合降脂策略的疗效与安全性。方法:连续入组2021年1月至6月在湘雅医院心内科高脂血症专病门诊就诊的“极高危ASCVD”患者,根据其实际降脂策略分为三组:阿托伐他汀单药组;阿托伐他汀联合依折麦布组;阿托伐他汀联合依洛尤单抗组。主要观察终点为治疗一个月后低密度脂蛋白胆固醇(LDL-C)、脂蛋白a[Lp(a)]、非-HDL-C变化,次要终点为总胆固醇(TC)、甘油三酯(TG)、LDL-C、超敏C反应蛋白(hs-CRP)变化及安全性指标。结果:无论哪种联合方式,在“极高危ASCVD”患者降脂起始阶段联合降脂治疗的疗效均显著优于阿托伐他汀单药组:LDL-C、Log[Lp(a)]、非-HDL-C、TC的降幅更大,差异均有统计学意义(均P<0.05)。在两种联合降脂方案中,阿托伐他汀联合依洛尤单抗与联合依折麦布相比,LDL-C、Log[Lp(a)]的降幅更大,差异均有统计学意义(P<0.05),TC、TG有一定的降幅,差异无统计学意义(P>0.05)。以“LDL-C<1.4 mmol/L或<1.8 mmol/L”作为降脂达标的标准时,两组联合降脂治疗的LDL-C达标率均高于阿托伐他汀单药组,差异均有统计学意义(均P<0.05);阿托伐他汀联合依洛尤单抗组的LDL-C达标率高于阿托伐他汀联合依折麦布组,差异均有统计学意义(均P<0.05)。单独或联合“LDL下降超过50%”的降幅为达标标准,三组均无人能达标。治疗后三组间的肝脏转氨酶水平变化差异均无统计学意义(均P<0.05);三组间心肌酶同工酶(CK-MB)均下降,但差异无统计学意义(P<0.05)。与阿托伐他汀单药组相比,两联合降脂组治疗组的血糖均下降,差异具有统计学意义(P<0.05);阿托伐他汀联合依折麦布组的血糖比阿托伐他汀联合依洛尤单抗组的降幅更大,差异有统计学意义(P<0.05)。结论:起始联合降脂治疗1个月对心内科门诊“极高危ASCVD”患者的降脂效果及LDL-C的达标率优于阿托伐他汀单药组。以LDL-C<1.4 mmol/L或<1.8 mmol/L为降脂达标目标时,阿托伐他汀联合依洛尤单抗组治疗1个月后LDL-C达标率高于联合依折麦布组;以“LDL下降超过50%”的降幅作为降脂达标标准时,1个月内很难达标。门诊“极高危ASCVD”患者采用起始联合的降脂治疗1个月无不良反应。起始联合降脂策略可用于心内科门诊“极高危ASCVD”患者中LDL-C数值需早期达标的人群,阿托伐他汀联合依洛尤单抗可用于需在1个月内LDL-C<1.4 mmol/L或<1.8 mmol/L的人群。