Samaranayake L. Commensal Oral Candida in Asian Cohorts. International Journal of Oral Science, 1 （1）： 2-5, 2009The oral carriage rate of Candida in healthy humans ranges from 40% to 60%. However for a prolonged pe...Samaranayake L. Commensal Oral Candida in Asian Cohorts. International Journal of Oral Science, 1 （1）： 2-5, 2009The oral carriage rate of Candida in healthy humans ranges from 40% to 60%. However for a prolonged period, the oral candidal prevalence in humans was documented essentially using data from studies in the West as their prevalence in inhabitants in different regions of the world,including Asia was not known. Yet, recent reports from a number of studies indicate the quality, quantity and prevalence of oral yeasts differ between Asia and other regions for reason that are still unclear. This mini review on such data from Asian studies on oral carriage of Candida provides another intriguing facet of the behavior of this ubiquitous yeast.展开更多
The paper addresses the youth＇s perception towards jobs and career opportunities in Saudi Arabia, based on the school-to-work transition model. The study is based on a sample survey covering 600 youth cohorts in Yanb...The paper addresses the youth＇s perception towards jobs and career opportunities in Saudi Arabia, based on the school-to-work transition model. The study is based on a sample survey covering 600 youth cohorts in Yanbu and Jeddah in the Kingdom of Saudi Arabia. The study reveals that school-to-work transition is not a smooth one and is influenced by the perception of youth towards employment and its various dimensions along with the ambitions towards career improvement. The 14 indicators framed in the paper reveal that essentiality, confidence to get a job that satisfies the needs, job availability, and qualifications are found to be important determinants of youth＇s attitude towards work; whereas, willingness to do any job did not get much acclaim. Job selection of youth is determined by location （especially hometown job）, sectoral preferences, training options, and work environment.展开更多
Tenofovir is one of the most commonly used antiretrovirals in adolescents and adults because of its potency and favorable pharmacokinetic and relative safety toxicological profile. It has been combined successfully wi...Tenofovir is one of the most commonly used antiretrovirals in adolescents and adults because of its potency and favorable pharmacokinetic and relative safety toxicological profile. It has been combined successfully with antiretroviral drugs from classes such as protease inhibitors, non-nucleoside reverse transcriptase inhibitors and nucleoside reverse transcriptase inhibitors to achieve virologic suppression in a high percentage of recipients. Despite its therapeutic success, quite a number of cohorts and clinical studies have associated tenofovir with the development of renal toxicity with few studies on the opposing end. This stimulated us to review reported cohorts and clinical studies on tenofovir renal toxicity. In this study it was observed that literature reported incidence of tenofovir renal toxicity falls within the range of 0.7%-17%. Available studies gave different appellations to tenofovir renaltoxicity, which include fanconis syndrome, proximal tubule dysfunction, acute renal failure, chronic renal failure, chronic kidney disease and nephrogenic diabetes insipidus. Markers of renal toxicity (tubulopathy) which include glycosuria, hyperaminoaciduria, proteinuria, hyperphosphaturia, hyperuricosuria, retinol-binding protein, beta2-microglobulinuria, decreased creatinine clearance and decreased glomerular filtration rate were also reported. In some studies renal biopsy demonstrated cytoplasmic vacuolization, apical localization of nuclei and reduction of the brush border on proximal tubule epithelial cells. This study observed that tenofovir renal toxicity could be reversible on discontinuation of tenofovir therapy despite contrary views by some studies. Regardless of tenofovir reported renal toxicity, it is well tolerated with a relative safety profile but it is advised that renal profile of patients should be evaluated before and routinely during tenofovir therapy.展开更多
BACKGROUND Within the normal range,elevated alanine aminotransferase(ALT)levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To investigate the associations ...BACKGROUND Within the normal range,elevated alanine aminotransferase(ALT)levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To investigate the associations between repeated high-normal ALT measurements and the risk of new-onset MAFLD prospectively.METHODS A cohort of 3553 participants followed for four consecutive health examinations over 4 years was selected.The incidence rate,cumulative times,and equally and unequally weighted cumulative effects of excess high-normal ALT levels(ehALT)were measured.Cox proportional hazards regression was used to analyse the association between the cumulative effects of ehALT and the risk of new-onset MAFLD.RESULTS A total of 83.13%of participants with MAFLD had normal ALT levels.The incidence rate of MAFLD showed a linear increasing trend in the cumulative ehALT group.Compared with those in the low-normal ALT group,the multivariate adjusted hazard ratios of the equally and unequally weighted cumulative effects of ehALT were 1.651[95%confidence interval(CI):1.199-2.273]and 1.535(95%CI:1.119-2.106)in the third quartile and 1.616(95%CI:1.162-2.246)and 1.580(95%CI:1.155-2.162)in the fourth quartile,respectively.CONCLUSION Most participants with MAFLD had normal ALT levels.Long-term high-normal ALT levels were associated with a cumulative increased risk of new-onset MAFLD.展开更多
Background:A quality diet and an active lifestyle are both important cornerstones of cardiovascular disease(CVD)prevention.However,despite their interlinked effects on metabolic health,the 2 behaviors are rarely consi...Background:A quality diet and an active lifestyle are both important cornerstones of cardiovascular disease(CVD)prevention.However,despite their interlinked effects on metabolic health,the 2 behaviors are rarely considered jointly,particularly within the context of CVD prevention.We examined the independent,interactive,and joint associations of diet and physical activity with CVD hospitalization,CVD mortality,and all-cause mortality.Methods:CVD-free Australian participants aged 4574 years(n=85,545)reported physical activity,diet,sociodemographic,and lifestyle characteristics at baseline(20062009)and follow-up(20122015),and data were linked to hospitalization and death registries(03/31/2019 for CVD hospitalization and all-cause mortality and 12/08/2017 for CVD mortality).Diet quality was categorized as low,medium,and high based on meeting dietary recommendations.Physical activity was operationalized as(a)total moderate-to-vigorous physical activity(MVPA)as per guidelines,and(b)the composition of MVPA as the ratio of vigorous-intensity physical activity(VPA)to total MVPA.We used a left-truncated cause-specific Cox proportional hazards model using time-varying covariates.Results:During a median of 10.7 years of follow-up,6576 participants were admitted to the hospital for CVD and 6581 died from all causes(876 from CVD during 9.3 years).A high-quality diet was associated with a 17%lower risk of all-cause mortality than a low-quality diet,and the highest MVPA category(compared with the lowest)was associated with a 44%and 48%lower risk of CVD and all-cause mortality,respectively.Multiplicative interactions between diet and physical activity were non-significant.For all outcomes,the lowest risk combinations involved a high-quality diet and the highest MVPA categories.Accounting for total MVPA,some VPA was associated with further risk reduction of CVD hospitalization and all-cause mortality.Conclusion:For CVD prevention and longevity,one should adhere to both a healthy diet and an active lifestyle and incorporate some VPA when possible.展开更多
Objective:To determine the stroke predictors for the 10-year of follow-up in Bogor City,Indonesia.Methods:The prospective study analyzed the data of 4445 stroke-free subjects aged 25 years and above that was part of&q...Objective:To determine the stroke predictors for the 10-year of follow-up in Bogor City,Indonesia.Methods:The prospective study analyzed the data of 4445 stroke-free subjects aged 25 years and above that was part of"the Bogor Cohort Study on Non-Communicable Disease Risk Factors".Data were collected by interview method with structured questionnaires,physical measurements three times a year,and laboratory examination every two years during a 10-year follow-up(2011-2021,without examination in 2020).The incidence of stroke is based on anamnesis results and examination by a neurologist.Other stroke predictor variables include characteristics,biological conditions,and risk behavior.We analysed 4445 stroke-free samples with Cox proportional hazard regression test.Results:During the 10-year observation,stroke incidence was 440 person-years per 100000 population(95%CI 370-530).During the follow-up of ten years,the main predictor of stroke was mental-emotional disorders with HR 4.2(95%CI 2.8-6.3)after adjustment by age,hypertension,obesity,abdominal obesity,and high LDL-cholesterol levels.Conclusions:Mental-emotional disorders are the strongest predictor of stroke incidence.Hence,psychological factors must be controlled in a stroke prevention program.展开更多
BACKGROUND Chronic hepatitis B(CHB)virus infection is a major cause of liver-associated morbidity and mortality,particularly in low-income countries.A better understanding of the epidemiological,clinical,and virologic...BACKGROUND Chronic hepatitis B(CHB)virus infection is a major cause of liver-associated morbidity and mortality,particularly in low-income countries.A better understanding of the epidemiological,clinical,and virological characteristics of CHB will guide appropriate treatment strategies and improve the control and management of CHB in Ethiopia.AIM To investigate the characteristics of CHB in Eastern Ethiopia and assess the efficacy and safety of antiviral treatment.METHODS This cohort study included 193 adults who were human immunodeficiency virus-negative with CHB between June 2016 and December 2019.Baseline assessments included chemistry,serologic,and viral markers.χ^(2) tests,Mann-Whitney U tests,and logistic regression analyses were used to identify the determinants of cirrhosis.Tenofovir disoproxil fumarate(TDF)was initiated using treatment criteria from the Ethiopian CHB pilot program.RESULTS A total of 132 patients(68.4%)were men,with a median age of 30 years[interquartile range(IQR):24-38].At enrollment,60(31.1%)patients had cirrhosis,of whom 35(58.3%)had decompensated cirrhosis.Khat use,hepatitis B envelope antigen positivity,and a high viral load were independently associated with cirrhosis.Additionally,66 patients(33.4%)fulfilled the treatment criteria and 59(30.6%)started TDF.Among 29 patients who completed 24 months of treatment,the median aspartate aminotransferase to platelet ratio index declined from 1.54(IQR:0.66-2.91)to 1.10(IQR:0.75-2.53)(P=0.002),and viral suppression was achieved in 80.9%and 100%of patients after 12 months and 24 months of treatment,respectively.Among the treated patients,12(20.3%)died within the first 6 months of treatment,of whom 8 had decompensated cirrhosis.CONCLUSION This study highlights the high prevalence of cirrhosis,initial mortality,and the efficacy of TDF treatment.Scaling up measures to prevent and control CHB infections in Ethiopia is crucial.展开更多
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...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.展开更多
Objective The aim of this study was to investigate the prospective association between physical activity(PA),independently or in conjunction with other contributing factors,and osteoporosis(OP)outcomes.Methods The Phy...Objective The aim of this study was to investigate the prospective association between physical activity(PA),independently or in conjunction with other contributing factors,and osteoporosis(OP)outcomes.Methods The Physical Activity in Osteoporosis Outcomes(PAOPO)study was a community-based cohort investigation.A structured questionnaire was used to gather the participants’sociodemographic characteristics.Bone mineral density(BMD)measurements were performed to assess OP outcomes,and the relationship between BMD and OP was evaluated within this cohort.Results From 2013 to 2014,8,471 participants aged 18 years and older were recruited from Tangshan,China’s Jidong community.Based on their PA level,participants were categorized as inactive,moderately active,or very active.Men showed higher physical exercise levels than women across the activity groups.BMD was significantly higher in the very active group than in the moderately active and inactive groups.Individuals aged>50 years are at a higher risk of developing OP and osteopenia.Conclusion The PAOPO study offers promising insights into the relationship between PA and OP outcomes,encouraging the implementation of PA in preventing and managing OP.展开更多
This study investigated the association of hypertension with cognitive impairment and determined whether better adherence to plant-based diet(PBD)patterns may modify the association.We analyzed 4485 elderly individual...This study investigated the association of hypertension with cognitive impairment and determined whether better adherence to plant-based diet(PBD)patterns may modify the association.We analyzed 4485 elderly individuals with normal cognition at baseline from the Chinese Longitudinal Healthy Longevity Survey(2011−2018).Cognitive function was assessed by the Mini-mental State Examination(MMSE),and cognitive impairment was defined as an MMSE score below 18 points.Diet patterns were assessed using the overall plant-based diet index(PDI),healthful plant-based diet index(hPDI),and unhealthful plant-based diet index(uPDI)derived from a simplified food frequency questionnaire(FFQ).Blood pressure was measured through physical examination.Cox proportional hazard regression and restricted cubic spline were performed.Participants with hypertension had an increased risk of cognitive impairment compared with normal group.The associations between hypertension and cognitive impairment were more pronounced among participants with lower PDI than those with higher PDI,among participants with lower hPDI than those with higher hPDI,and among participants with higher uPDI than those with lower uPDI.A healthful PBD pattern may attenuate hypertension-induced cognitive impairment,while an unhealthful PBD pattern may exacerbate hypertensioninduced cognitive impairment in elderly.Adherence to healthful PBD pattern could be used to prevent or mitigate adverse neurological effects in the hypertensive population.展开更多
Objective Previous studies on the association between lipid profiles and chronic kidney disease(CKD)have yielded inconsistent results and no defined thresholds for blood lipids.Methods A prospective cohort study inclu...Objective Previous studies on the association between lipid profiles and chronic kidney disease(CKD)have yielded inconsistent results and no defined thresholds for blood lipids.Methods A prospective cohort study including 32,351 subjects who completed baseline and follow-up surveys over 5 years was conducted.Restricted cubic splines and Cox models were used to examine the association between the lipid profiles and CKD.A regression discontinuity design was used to determine the cutoff value of lipid profiles that was significantly associated with increased the risk of CKD.Results Over a median follow-up time of 2.2(0.5,4.2)years,648(2.00%)subjects developed CKD.The lipid profiles that were significantly and linearly related to CKD included total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),TC/HDL-C,and TG/HDL-C,whereas lowdensity lipoprotein cholesterol(LDL-C)and LDL-C/HDL-C were nonlinearly correlated with CKD.TC,TG,TC/HDL-C,and TG/HDL-C showed an upward jump at the cutoff value,increasing the risk of CKD by 0.90%,1.50%,2.30%,and 1.60%,respectively,whereas HDL-C showed a downward jump at the cutoff value,reducing this risk by 1.0%.Female and participants with dyslipidemia had a higher risk of CKD,while the cutoff values for the different characteristics of the population were different.Conclusion There was a significant association between lipid profiles and CKD in a prospective cohort from Northwest China,while TG,TC/HDL-C,and TG/HDL-C showed a stronger risk association.The specific cutoff values of lipid profiles may provide a clinical reference for screening or diagnosing CKD risk.展开更多
BACKGROUND Blonanserin(BNS)is a well-tolerated and effective drug for treating schizophrenia.AIM To investigate which types of patients would obtain the most benefit from BNS treatment.METHODS A total of 3306 particip...BACKGROUND Blonanserin(BNS)is a well-tolerated and effective drug for treating schizophrenia.AIM To investigate which types of patients would obtain the most benefit from BNS treatment.METHODS A total of 3306 participants were evaluated in a 12-week,prospective,multicenter,open-label post-marketing surveillance study of BNS.Brief psychiatric rating scale(BPRS)scores were calculated to evaluate the effectiveness of BNS,and its safety was assessed with the incidence of adverse drug reactions.Linear regression was used to screen the influencing factors for the reduction of BPRS total score,and logistic regression was used to identify patients with a better response to BNS.RESULTS The baseline BPRS total score(48.8±15.03)decreased to 27.7±10.08 at 12 weeks(P<0.001).Extrapyramidal symptoms(14.6%)were found to be the most frequent adverse drug reactions.The acute phase,baseline BPRS total score,current episode duration,number of previous episodes,dose of concomitant antipsychotics,and number of types of sedative-hypnotic agents were found to be independent factors affecting the reduction of BPRS total score after treatment initiation.Specifically,patients in the acute phase with baseline BPRS total score≥45,current episode duration<3 months,and≤3 previous episodes derived greater benefit from 12-week treatment with BNS.CONCLUSION Patients in the acute phase with more severe symptoms,shorter current episode duration,fewer previous episodes,and a lower psychotropic drug load derived the greatest benefit from treatment with BNS.展开更多
BACKGROUND Intraoperative persistent hypotension(IPH)during pancreaticoduodenectomy(PD)is linked to adverse postoperative outcomes,yet its risk factors remain unclear.AIM To clarify the risk factors associated with IP...BACKGROUND Intraoperative persistent hypotension(IPH)during pancreaticoduodenectomy(PD)is linked to adverse postoperative outcomes,yet its risk factors remain unclear.AIM To clarify the risk factors associated with IPH during PD,ensuring patient safety in the perioperative period.METHODS A retrospective analysis of patient records from January 2018 to December 2022 at the First Affiliated Hospital of Nanjing Medical University identified factors associated with IPH in PD.These factors included age,gender,body mass index,American Society of Anesthesiologists classification,comorbidities,medication history,operation duration,fluid balance,blood loss,urine output,and blood gas parameters.IPH was defined as sustained mean arterial pressure<65 mmHg,requiring prolonged deoxyepinephrine infusion for>30 min despite additional deoxyepinephrine and fluid treatments.RESULTS Among 1596 PD patients,661(41.42%)experienced IPH.Multivariate logistic regression identified key risk factors:increased age[odds ratio(OR):1.20 per decade,95%confidence interval(CI):1.08-1.33](P<0.001),longer surgery duration(OR:1.15 per additional hour,95%CI:1.05-1.26)(P<0.01),and greater blood loss(OR:1.18 per 250-mL increment,95%CI:1.06-1.32)(P<0.01).A novel finding was the association of arterial blood Ca^(2+)<1.05 mmol/L with IPH(OR:2.03,95%CI:1.65-2.50)(P<0.001).CONCLUSION IPH during PD is independently associated with older age,prolonged surgery,increased blood loss,and lower plasma Ca^(2+).展开更多
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. Whil...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.展开更多
BACKGROUND Laparoscopic low anterior resection(LLAR)has become a mainstream surgical method for the treatment of colorectal cancer,which has shown many advantages in the aspects of surgical trauma and postoperative re...BACKGROUND Laparoscopic low anterior resection(LLAR)has become a mainstream surgical method for the treatment of colorectal cancer,which has shown many advantages in the aspects of surgical trauma and postoperative rehabilitation.However,the effect of surgery on patients'left coronary artery and its vascular reconstruction have not been deeply discussed.With the development of medical imaging technology,3D vascular reconstruction has become an effective means to evaluate the curative effect of surgery.AIM To investigate the clinical value of preoperative 3D vascular reconstruction in LLAR of rectal cancer with the left colic artery(LCA)preserved.METHODS A retrospective cohort study was performed to analyze the clinical data of 146 patients who underwent LLAR for rectal cancer with LCA preservation from January to December 2023 in our hospital.All patients underwent LLAR of rectal cancer with the LCA preserved,and the intraoperative and postoperative data were complete.The patients were divided into a reconstruction group(72 patients)and a nonreconstruction group(74 patients)according to whether 3D vascular reconstruction was performed before surgery.The clinical features,operation conditions,complications,pathological results and postoperative recovery of the two groups were collected and compared.RESULTS A total of 146 patients with rectal cancer were included in the study,including 72 patients in the reconstruction group and 74 patients in the nonreconstruction group.There were 47 males and 25 females in the reconstruction group,aged(59.75±6.2)years,with a body mass index(BMI)(24.1±2.2)kg/m^(2),and 51 males and 23 females in the nonreconstruction group,aged(58.77±6.1)years,with a BMI(23.6±2.7)kg/m^(2).There was no significant difference in the baseline data between the two groups(P>0.05).In the submesenteric artery reconstruction group,35 patients were type Ⅰ,25 patients were type Ⅱ,11 patients were type Ⅲ,and 1 patient was type Ⅳ.There were 37 type Ⅰ patients,24 type Ⅱ patients,12 type Ⅲ patients,and 1 type Ⅳ patient in the nonreconstruction group.There was no significant difference in arterial typing between the two groups(P>0.05).The operation time of the reconstruction group was 162.2±10.8 min,and that of the nonreconstruction group was 197.9±19.1 min.Compared with that of the reconstruction group,the operation time of the two groups was shorter,and the difference was statistically significant(t=13.840,P<0.05).The amount of intraoperative blood loss was 30.4±20.0 mL in the reconstruction group and 61.2±26.4 mL in the nonreconstruction group.The amount of blood loss in the reconstruction group was less than that in the control group,and the difference was statistically significant(t=-7.930,P<0.05).The rates of anastomotic leakage(1.4%vs 1.4%,P=0.984),anastomotic hemorrhage(2.8%vs 4.1%,P=0.672),and postoperative hospital stay(6.8±0.7 d vs 7.0±0.7 d,P=0.141)were not significantly different between the two groups.CONCLUSION Preoperative 3D vascular reconstruction technology can shorten the operation time and reduce the amount of intraoperative blood loss.Preoperative 3D vascular reconstruction is recommended to provide an intraoperative reference for laparoscopic low anterior resection with LCA preservation.展开更多
BACKGROUND With the continuous progress of surgical technology and improvements in medical standards,the treatment of gastric cancer surgery is also evolving.Proximal gastrectomy is a common treatment,but double-chann...BACKGROUND With the continuous progress of surgical technology and improvements in medical standards,the treatment of gastric cancer surgery is also evolving.Proximal gastrectomy is a common treatment,but double-channel anastomosis and tubular gastroesophageal anastomosis have attracted much attention in terms of surgical options.Each of these two surgical methods has advantages and disadvantages,so it is particularly important to compare and analyze their clinical efficacy and safety.AIM To compare the surgical safety,clinical efficacy,and safety of double-channel anastomosis and tubular gastroesophageal anastomosis in proximal gastrectomy.METHODS The clinical and follow-up data of 99 patients with proximal gastric cancer who underwent proximal gastrectomy and were admitted to our hospital between January 2018 and September 2023 were included in this retrospective cohort study.According to the different anastomosis methods used,the patients were divided into a double-channel anastomosis group(50 patients)and a tubular gastroesophageal anastomosis group(49 patients).In the double-channel anastomosis,Roux-en-Y anastomosis of the esophagus and jejunum was performed after proximal gastric dissection,and then side-to-side anastomosis was performed between the residual stomach and jejunum to establish an antireflux barrier and reduce postoperative gastroesophageal reflux.In the tubular gastroesophageal anastomosis group,after the proximal end of the stomach was cut,tubular gastroplasty was performed on the distal stump of the stomach and a linear stapler was used to anastomose the posterior wall of the esophagus and the anterior wall of the stomach tube.The main outcome measure was quality of life 1 year after surgery in both groups,and the evaluation criteria were based on the postgastrectomy syndrome assessment scale.The greater the changes in body mass,food intake per meal,meal quality subscale score,and total measures of physical and mental health score,the better the condition;the greater the other indicators,the worse the condition.The secondary outcome measures were intraoperative and postoperative conditions,the incidence of postoperative long-term complications,and changes in nutritional status at 1,3,6,and 12 months after surgery.RESULTS In the double-channel anastomosis cohort,there were 35 males(70%)and 15 females(30%),33(66.0%)were under 65 years of age,and 37(74.0%)had a body mass index ranging from 18 to 25 kg/m2.In the group undergoing tubular gastroesophageal anastomosis,there were eight females(16.3%),21(42.9%)individuals were under the age of 65 years,and 34(69.4%)had a body mass index ranging from 18 to 25 kg/m2.The baseline data did not significantly differ between the two groups(P>0.05 for all),with the exception of age(P=0.021).The duration of hospitalization,number of lymph nodes dissected,intraoperative blood loss,and perioperative complication rate did not differ significantly between the two groups(P>0.05 for all).Patients in the dual-channel anastomosis group scored better on quality of life measures than did those in the tubular gastroesophageal anastomosis group.Specifically,they had lower scores for esophageal reflux[2.8(2.3,4.0)vs 4.8(3.8,5.0),Z=3.489,P<0.001],eating discomfort[2.7(1.7,3.0)vs 3.3(2.7,4.0),Z=3.393,P=0.001],total symptoms[2.3(1.7,2.7)vs 2.5(2.2,2.9),Z=2.243,P=0.025],and other aspects of quality of life.The postoperative symptoms[2.0(1.0,3.0)vs 2.0(2.0,3.0),Z=2.127,P=0.033],meals[2.0(1.0,2.0)vs 2.0(2.0,3.0),Z=3.976,P<0.001],work[1.0(1.0,2.0)vs 2.0(1.0,2.0),Z=2.279,P=0.023],and daily life[1.7(1.3,2.0)vs 2.0(2.0,2.3),Z=3.950,P<0.001]were all better than those of the tubular gastroesophageal anastomosis group.The group that underwent tubular gastroesophageal anastomosis had a superior anal exhaust score[3.0(2.0,4.0)vs 3.5(2.0,5.0),Z=2.345,P=0.019]compared to the dual-channel anastomosis group.Hemoglobin,serum albumin,total serum protein,and the rate at which body mass decreased one year following surgery did not differ significantly between the two groups(P>0.05 for all).CONCLUSION The safety of double-channel anastomosis in proximal gastric cancer surgery is equivalent to that of tubular gastric surgery.Compared with tubular gastric surgery,double-channel anastomosis is a preferred surgical technique for proximal gastric cancer.It offers advantages such as less esophageal reflux and improved quality of life.展开更多
BACKGROUND Patients with BRAF V600E mutant metastatic colorectal cancer(mCRC)have a low incidence rate,poor biological activity,suboptimal response to conventional treatments,and a poor prognosis.In the previous cohor...BACKGROUND Patients with BRAF V600E mutant metastatic colorectal cancer(mCRC)have a low incidence rate,poor biological activity,suboptimal response to conventional treatments,and a poor prognosis.In the previous cohort study on mCRC conducted by our team,it was observed that integrated Chinese and Western medicine treatment could significantly prolong the overall survival(OS)of patients with colorectal cancer.Therefore,we further explored the survival benefits in the population with BRAF V600E mutant mCRC.AIM To evaluate the efficacy of integrated Chinese and Western medicine in the treatment of BRAF V600E mutant metastatic colorectal cancer.METHODS A cohort study was conducted on patients with BRAF V600E mutant metastatic colorectal cancer admitted to Xiyuan Hospital of China Academy of Chinese Medical Sciences and Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from January 2016 to December 2022.The patients were divided into two cohorts.RESULTS A total of 34 cases were included,with 23 in Chinese-Western medicine cohort(cohort A)and 11 in Western medicine cohort(cohort B).The median overall survival was 19.9 months in cohort A and 14.2 months in cohort B,with a statistically significant difference(P=0.038,hazard ratio=0.46).The 1-3-year survival rates were 95.65%(22/23),39.13%(9/23),and 26.09%(6/23)in cohort A,and 63.64%(7/11),18.18%(2/11),and 9.09%(1/11)in cohort B,respectively.Subgroup analysis showed statistically significant differences in median OS between the two cohorts in the right colon,liver metastasis,chemotherapy,and first-line treatment subgroups(P<0.05).CONCLUSION Integrated Chinese and Western medicine can prolong the survival and reduce the risk of death in patients with BRAF V600E mutant metastatic colorectal cancer,with more pronounced benefits observed in patients with right colon involvement,liver metastasis,combined chemotherapy,and first-line treatment.展开更多
Background: Guidelines are issued by most major organizations that focus on a specific disease entity. Guidelines should be a significant help to the practicing physician who may not be up-to-date with the recent medi...Background: Guidelines are issued by most major organizations that focus on a specific disease entity. Guidelines should be a significant help to the practicing physician who may not be up-to-date with the recent medical literature. Unfortunately, when conflicting guidelines for a specific disease are published, confusion results. Purpose: This article provides a suggested guideline outcome measure that would benefit the physician and patient. Methods: A review of 19 different guidelines for cardiovascular disease treatment is one example of the lack of specific outcomes that currently exist. The basic problem with most guidelines is that they do not state the expected end result (i.e., the benefit to the patient) if that guideline is followed. When guidelines use cardiovascular disease risk factors to dictate therapy, the end benefit is never stated so that the patient can make an appropriate choice of which (if any) guideline to follow. Results: A good example is guidelines published by the American Heart Association for reducing cardiovascular disease. These guidelines are risk factor based and only indicate that cardiovascular disease would be reduced if followed. No specific percentage in the reduction of the incidence of disease is given. In contrast, when elimination of the disease is the stated goal of the guideline, the end result is clear. To date, this goal has been stated by only one organization devoted to eliminating cardiovascular disease. Conclusion: Guidelines need to be written to provide the physician and the patient with a specific end point that is expected when the guideline is followed. Patient acceptance and compliance will be much improved if the patient knows the risk/benefit of following the guideline’s recommendations.展开更多
Introduction: Motorcyclists bear a disproportionate burden of morbidity and mortality from road accidents. In addition, the consequences of these accidents affect the ability of victims to return to work. This study a...Introduction: Motorcyclists bear a disproportionate burden of morbidity and mortality from road accidents. In addition, the consequences of these accidents affect the ability of victims to return to work. This study aimed to determine the prevalence and factors associated with non-return to work among surviving motorcyclists involved in road accidents 12 months after the event. Materials and Methods: It was a cross-sectional study conducted using data from a cohort of motorcyclists involved in accidents and recruited in five hospitals in Benin from July 2019 to January 2020. The dependent variable was non-return to work 12 months after the accident (yes vs no). The independent variables were categorized into two groups: baseline and 12-month follow-up variables. Logistic regression was used to determine the factors associated with non-return to work at 12 months among the participants. Results: Among the 362 participants, 55 (15.19%, 95% CI = 11.84 - 19.29) had not returned to work 12 months after the accident. Risk factors for non-return to work identified were: smoking (aOR = 4.41, 95% CI = 1.44 - 13.56, p = 0.010), hospitalization (aOR = 2.87, 95% CI = 1.14 - 7.24, p Conclusion: The prevalence of non-return to work at 12 months was high among surviving motorcyclists involved in road accidents in Benin. Integrated support for patients based on identified risk factors should effectively improve their return to work.展开更多
Background:The Historical Importance of Studies of Human Brain in Dementia Research The collection of brain and related tissue has a long history(1)In terms of dementia,a more systematic examination of the relationshi...Background:The Historical Importance of Studies of Human Brain in Dementia Research The collection of brain and related tissue has a long history(1)In terms of dementia,a more systematic examination of the relationship between brain pathology and clinical symptoms can be traced to Alois Alzheimer’s group in Munich in the early 1900s(2)The use of human brain tissue is essential to increase our understanding of dementia as it gives us the gold standard of disease pathogenesis and clues as to the molecular mechanisms that underpin the various diseases and conditions.展开更多
文摘Samaranayake L. Commensal Oral Candida in Asian Cohorts. International Journal of Oral Science, 1 （1）： 2-5, 2009The oral carriage rate of Candida in healthy humans ranges from 40% to 60%. However for a prolonged period, the oral candidal prevalence in humans was documented essentially using data from studies in the West as their prevalence in inhabitants in different regions of the world,including Asia was not known. Yet, recent reports from a number of studies indicate the quality, quantity and prevalence of oral yeasts differ between Asia and other regions for reason that are still unclear. This mini review on such data from Asian studies on oral carriage of Candida provides another intriguing facet of the behavior of this ubiquitous yeast.
文摘The paper addresses the youth＇s perception towards jobs and career opportunities in Saudi Arabia, based on the school-to-work transition model. The study is based on a sample survey covering 600 youth cohorts in Yanbu and Jeddah in the Kingdom of Saudi Arabia. The study reveals that school-to-work transition is not a smooth one and is influenced by the perception of youth towards employment and its various dimensions along with the ambitions towards career improvement. The 14 indicators framed in the paper reveal that essentiality, confidence to get a job that satisfies the needs, job availability, and qualifications are found to be important determinants of youth＇s attitude towards work; whereas, willingness to do any job did not get much acclaim. Job selection of youth is determined by location （especially hometown job）, sectoral preferences, training options, and work environment.
文摘Tenofovir is one of the most commonly used antiretrovirals in adolescents and adults because of its potency and favorable pharmacokinetic and relative safety toxicological profile. It has been combined successfully with antiretroviral drugs from classes such as protease inhibitors, non-nucleoside reverse transcriptase inhibitors and nucleoside reverse transcriptase inhibitors to achieve virologic suppression in a high percentage of recipients. Despite its therapeutic success, quite a number of cohorts and clinical studies have associated tenofovir with the development of renal toxicity with few studies on the opposing end. This stimulated us to review reported cohorts and clinical studies on tenofovir renal toxicity. In this study it was observed that literature reported incidence of tenofovir renal toxicity falls within the range of 0.7%-17%. Available studies gave different appellations to tenofovir renaltoxicity, which include fanconis syndrome, proximal tubule dysfunction, acute renal failure, chronic renal failure, chronic kidney disease and nephrogenic diabetes insipidus. Markers of renal toxicity (tubulopathy) which include glycosuria, hyperaminoaciduria, proteinuria, hyperphosphaturia, hyperuricosuria, retinol-binding protein, beta2-microglobulinuria, decreased creatinine clearance and decreased glomerular filtration rate were also reported. In some studies renal biopsy demonstrated cytoplasmic vacuolization, apical localization of nuclei and reduction of the brush border on proximal tubule epithelial cells. This study observed that tenofovir renal toxicity could be reversible on discontinuation of tenofovir therapy despite contrary views by some studies. Regardless of tenofovir reported renal toxicity, it is well tolerated with a relative safety profile but it is advised that renal profile of patients should be evaluated before and routinely during tenofovir therapy.
基金National Natural Science Foundation of China,No.72101236China Postdoctoral Science Foundation,No.2022M722900+1 种基金Collaborative Innovation Project of Zhengzhou City,No.XTCX2023006Nursing Team Project of the First Affiliated Hospital of Zhengzhou University,No.HLKY2023005.
文摘BACKGROUND Within the normal range,elevated alanine aminotransferase(ALT)levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To investigate the associations between repeated high-normal ALT measurements and the risk of new-onset MAFLD prospectively.METHODS A cohort of 3553 participants followed for four consecutive health examinations over 4 years was selected.The incidence rate,cumulative times,and equally and unequally weighted cumulative effects of excess high-normal ALT levels(ehALT)were measured.Cox proportional hazards regression was used to analyse the association between the cumulative effects of ehALT and the risk of new-onset MAFLD.RESULTS A total of 83.13%of participants with MAFLD had normal ALT levels.The incidence rate of MAFLD showed a linear increasing trend in the cumulative ehALT group.Compared with those in the low-normal ALT group,the multivariate adjusted hazard ratios of the equally and unequally weighted cumulative effects of ehALT were 1.651[95%confidence interval(CI):1.199-2.273]and 1.535(95%CI:1.119-2.106)in the third quartile and 1.616(95%CI:1.162-2.246)and 1.580(95%CI:1.155-2.162)in the fourth quartile,respectively.CONCLUSION Most participants with MAFLD had normal ALT levels.Long-term high-normal ALT levels were associated with a cumulative increased risk of new-onset MAFLD.
基金the Heart Foundation Australia(#101234,#101583)an Emerging Leader Fellowship from the National Health and Medical Research Council(2009254)an Early-Mid Career Researcher Grant under the New South Wales Cardiovascular Research Capacity Program.
文摘Background:A quality diet and an active lifestyle are both important cornerstones of cardiovascular disease(CVD)prevention.However,despite their interlinked effects on metabolic health,the 2 behaviors are rarely considered jointly,particularly within the context of CVD prevention.We examined the independent,interactive,and joint associations of diet and physical activity with CVD hospitalization,CVD mortality,and all-cause mortality.Methods:CVD-free Australian participants aged 4574 years(n=85,545)reported physical activity,diet,sociodemographic,and lifestyle characteristics at baseline(20062009)and follow-up(20122015),and data were linked to hospitalization and death registries(03/31/2019 for CVD hospitalization and all-cause mortality and 12/08/2017 for CVD mortality).Diet quality was categorized as low,medium,and high based on meeting dietary recommendations.Physical activity was operationalized as(a)total moderate-to-vigorous physical activity(MVPA)as per guidelines,and(b)the composition of MVPA as the ratio of vigorous-intensity physical activity(VPA)to total MVPA.We used a left-truncated cause-specific Cox proportional hazards model using time-varying covariates.Results:During a median of 10.7 years of follow-up,6576 participants were admitted to the hospital for CVD and 6581 died from all causes(876 from CVD during 9.3 years).A high-quality diet was associated with a 17%lower risk of all-cause mortality than a low-quality diet,and the highest MVPA category(compared with the lowest)was associated with a 44%and 48%lower risk of CVD and all-cause mortality,respectively.Multiplicative interactions between diet and physical activity were non-significant.For all outcomes,the lowest risk combinations involved a high-quality diet and the highest MVPA categories.Accounting for total MVPA,some VPA was associated with further risk reduction of CVD hospitalization and all-cause mortality.Conclusion:For CVD prevention and longevity,one should adhere to both a healthy diet and an active lifestyle and incorporate some VPA when possible.
基金supported by National Institute of Health Research and Development,Ministry of Health(No.024-11-416176).
文摘Objective:To determine the stroke predictors for the 10-year of follow-up in Bogor City,Indonesia.Methods:The prospective study analyzed the data of 4445 stroke-free subjects aged 25 years and above that was part of"the Bogor Cohort Study on Non-Communicable Disease Risk Factors".Data were collected by interview method with structured questionnaires,physical measurements three times a year,and laboratory examination every two years during a 10-year follow-up(2011-2021,without examination in 2020).The incidence of stroke is based on anamnesis results and examination by a neurologist.Other stroke predictor variables include characteristics,biological conditions,and risk behavior.We analysed 4445 stroke-free samples with Cox proportional hazard regression test.Results:During the 10-year observation,stroke incidence was 440 person-years per 100000 population(95%CI 370-530).During the follow-up of ten years,the main predictor of stroke was mental-emotional disorders with HR 4.2(95%CI 2.8-6.3)after adjustment by age,hypertension,obesity,abdominal obesity,and high LDL-cholesterol levels.Conclusions:Mental-emotional disorders are the strongest predictor of stroke incidence.Hence,psychological factors must be controlled in a stroke prevention program.
基金Supported by the Norwegian Research Council,220622/H10.
文摘BACKGROUND Chronic hepatitis B(CHB)virus infection is a major cause of liver-associated morbidity and mortality,particularly in low-income countries.A better understanding of the epidemiological,clinical,and virological characteristics of CHB will guide appropriate treatment strategies and improve the control and management of CHB in Ethiopia.AIM To investigate the characteristics of CHB in Eastern Ethiopia and assess the efficacy and safety of antiviral treatment.METHODS This cohort study included 193 adults who were human immunodeficiency virus-negative with CHB between June 2016 and December 2019.Baseline assessments included chemistry,serologic,and viral markers.χ^(2) tests,Mann-Whitney U tests,and logistic regression analyses were used to identify the determinants of cirrhosis.Tenofovir disoproxil fumarate(TDF)was initiated using treatment criteria from the Ethiopian CHB pilot program.RESULTS A total of 132 patients(68.4%)were men,with a median age of 30 years[interquartile range(IQR):24-38].At enrollment,60(31.1%)patients had cirrhosis,of whom 35(58.3%)had decompensated cirrhosis.Khat use,hepatitis B envelope antigen positivity,and a high viral load were independently associated with cirrhosis.Additionally,66 patients(33.4%)fulfilled the treatment criteria and 59(30.6%)started TDF.Among 29 patients who completed 24 months of treatment,the median aspartate aminotransferase to platelet ratio index declined from 1.54(IQR:0.66-2.91)to 1.10(IQR:0.75-2.53)(P=0.002),and viral suppression was achieved in 80.9%and 100%of patients after 12 months and 24 months of treatment,respectively.Among the treated patients,12(20.3%)died within the first 6 months of treatment,of whom 8 had decompensated cirrhosis.CONCLUSION This study highlights the high prevalence of cirrhosis,initial mortality,and the efficacy of TDF treatment.Scaling up measures to prevent and control CHB infections in Ethiopia is crucial.
基金supported by grants from the Beijing Nova Program (No. Z201100006820069)CAMS Innovation Fund for Medical Sciences (CIFMS, No. 2021-I2M-1-023, 2021-I2M-1-010)Talent Incentive Program of Cancer Hospital Chinese Academy of Medical Sciences (Hope Star)。
文摘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.
基金supported by the Integrated Project of Major Research Plan of the National Natural Science Foundation of China(No.92249303)National Natural Science Foundation of China(Nos.82371603,82230071,82102217)+3 种基金Shanghai Committee of Science and Technology Laboratory Animal Research Project(No.23141900600)Science and Technology Commission of Shanghai Municipality(21YF1413100)Shanghai Hospital Development Center(SHDC2023CRT013)Baoshan District Health Commission Talents(Excellent Academic Leaders)Program(BSWSYX-2024-05).
文摘Objective The aim of this study was to investigate the prospective association between physical activity(PA),independently or in conjunction with other contributing factors,and osteoporosis(OP)outcomes.Methods The Physical Activity in Osteoporosis Outcomes(PAOPO)study was a community-based cohort investigation.A structured questionnaire was used to gather the participants’sociodemographic characteristics.Bone mineral density(BMD)measurements were performed to assess OP outcomes,and the relationship between BMD and OP was evaluated within this cohort.Results From 2013 to 2014,8,471 participants aged 18 years and older were recruited from Tangshan,China’s Jidong community.Based on their PA level,participants were categorized as inactive,moderately active,or very active.Men showed higher physical exercise levels than women across the activity groups.BMD was significantly higher in the very active group than in the moderately active and inactive groups.Individuals aged>50 years are at a higher risk of developing OP and osteopenia.Conclusion The PAOPO study offers promising insights into the relationship between PA and OP outcomes,encouraging the implementation of PA in preventing and managing OP.
基金supported by the National Key R&D Program of China(2018YFC2000400)the National Natural Sciences Foundation of China(72061137004)+1 种基金the National Institute on Aging of National Institutes of Health(P01AG031719)Duke/DukeNUS(grant RECA(Pilot)/2019/0051 to Y.Z.).
文摘This study investigated the association of hypertension with cognitive impairment and determined whether better adherence to plant-based diet(PBD)patterns may modify the association.We analyzed 4485 elderly individuals with normal cognition at baseline from the Chinese Longitudinal Healthy Longevity Survey(2011−2018).Cognitive function was assessed by the Mini-mental State Examination(MMSE),and cognitive impairment was defined as an MMSE score below 18 points.Diet patterns were assessed using the overall plant-based diet index(PDI),healthful plant-based diet index(hPDI),and unhealthful plant-based diet index(uPDI)derived from a simplified food frequency questionnaire(FFQ).Blood pressure was measured through physical examination.Cox proportional hazard regression and restricted cubic spline were performed.Participants with hypertension had an increased risk of cognitive impairment compared with normal group.The associations between hypertension and cognitive impairment were more pronounced among participants with lower PDI than those with higher PDI,among participants with lower hPDI than those with higher hPDI,and among participants with higher uPDI than those with lower uPDI.A healthful PBD pattern may attenuate hypertension-induced cognitive impairment,while an unhealthful PBD pattern may exacerbate hypertensioninduced cognitive impairment in elderly.Adherence to healthful PBD pattern could be used to prevent or mitigate adverse neurological effects in the hypertensive population.
基金supported by the Municipal Science and Technology Program of Wuwei City,China(WW2202RPZ037)the Fundamental Research Funds for the Central Universities in China(Grant No.lzujbky-2018-69).
文摘Objective Previous studies on the association between lipid profiles and chronic kidney disease(CKD)have yielded inconsistent results and no defined thresholds for blood lipids.Methods A prospective cohort study including 32,351 subjects who completed baseline and follow-up surveys over 5 years was conducted.Restricted cubic splines and Cox models were used to examine the association between the lipid profiles and CKD.A regression discontinuity design was used to determine the cutoff value of lipid profiles that was significantly associated with increased the risk of CKD.Results Over a median follow-up time of 2.2(0.5,4.2)years,648(2.00%)subjects developed CKD.The lipid profiles that were significantly and linearly related to CKD included total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),TC/HDL-C,and TG/HDL-C,whereas lowdensity lipoprotein cholesterol(LDL-C)and LDL-C/HDL-C were nonlinearly correlated with CKD.TC,TG,TC/HDL-C,and TG/HDL-C showed an upward jump at the cutoff value,increasing the risk of CKD by 0.90%,1.50%,2.30%,and 1.60%,respectively,whereas HDL-C showed a downward jump at the cutoff value,reducing this risk by 1.0%.Female and participants with dyslipidemia had a higher risk of CKD,while the cutoff values for the different characteristics of the population were different.Conclusion There was a significant association between lipid profiles and CKD in a prospective cohort from Northwest China,while TG,TC/HDL-C,and TG/HDL-C showed a stronger risk association.The specific cutoff values of lipid profiles may provide a clinical reference for screening or diagnosing CKD risk.
文摘BACKGROUND Blonanserin(BNS)is a well-tolerated and effective drug for treating schizophrenia.AIM To investigate which types of patients would obtain the most benefit from BNS treatment.METHODS A total of 3306 participants were evaluated in a 12-week,prospective,multicenter,open-label post-marketing surveillance study of BNS.Brief psychiatric rating scale(BPRS)scores were calculated to evaluate the effectiveness of BNS,and its safety was assessed with the incidence of adverse drug reactions.Linear regression was used to screen the influencing factors for the reduction of BPRS total score,and logistic regression was used to identify patients with a better response to BNS.RESULTS The baseline BPRS total score(48.8±15.03)decreased to 27.7±10.08 at 12 weeks(P<0.001).Extrapyramidal symptoms(14.6%)were found to be the most frequent adverse drug reactions.The acute phase,baseline BPRS total score,current episode duration,number of previous episodes,dose of concomitant antipsychotics,and number of types of sedative-hypnotic agents were found to be independent factors affecting the reduction of BPRS total score after treatment initiation.Specifically,patients in the acute phase with baseline BPRS total score≥45,current episode duration<3 months,and≤3 previous episodes derived greater benefit from 12-week treatment with BNS.CONCLUSION Patients in the acute phase with more severe symptoms,shorter current episode duration,fewer previous episodes,and a lower psychotropic drug load derived the greatest benefit from treatment with BNS.
文摘BACKGROUND Intraoperative persistent hypotension(IPH)during pancreaticoduodenectomy(PD)is linked to adverse postoperative outcomes,yet its risk factors remain unclear.AIM To clarify the risk factors associated with IPH during PD,ensuring patient safety in the perioperative period.METHODS A retrospective analysis of patient records from January 2018 to December 2022 at the First Affiliated Hospital of Nanjing Medical University identified factors associated with IPH in PD.These factors included age,gender,body mass index,American Society of Anesthesiologists classification,comorbidities,medication history,operation duration,fluid balance,blood loss,urine output,and blood gas parameters.IPH was defined as sustained mean arterial pressure<65 mmHg,requiring prolonged deoxyepinephrine infusion for>30 min despite additional deoxyepinephrine and fluid treatments.RESULTS Among 1596 PD patients,661(41.42%)experienced IPH.Multivariate logistic regression identified key risk factors:increased age[odds ratio(OR):1.20 per decade,95%confidence interval(CI):1.08-1.33](P<0.001),longer surgery duration(OR:1.15 per additional hour,95%CI:1.05-1.26)(P<0.01),and greater blood loss(OR:1.18 per 250-mL increment,95%CI:1.06-1.32)(P<0.01).A novel finding was the association of arterial blood Ca^(2+)<1.05 mmol/L with IPH(OR:2.03,95%CI:1.65-2.50)(P<0.001).CONCLUSION IPH during PD is independently associated with older age,prolonged surgery,increased blood loss,and lower plasma Ca^(2+).
文摘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.
文摘BACKGROUND Laparoscopic low anterior resection(LLAR)has become a mainstream surgical method for the treatment of colorectal cancer,which has shown many advantages in the aspects of surgical trauma and postoperative rehabilitation.However,the effect of surgery on patients'left coronary artery and its vascular reconstruction have not been deeply discussed.With the development of medical imaging technology,3D vascular reconstruction has become an effective means to evaluate the curative effect of surgery.AIM To investigate the clinical value of preoperative 3D vascular reconstruction in LLAR of rectal cancer with the left colic artery(LCA)preserved.METHODS A retrospective cohort study was performed to analyze the clinical data of 146 patients who underwent LLAR for rectal cancer with LCA preservation from January to December 2023 in our hospital.All patients underwent LLAR of rectal cancer with the LCA preserved,and the intraoperative and postoperative data were complete.The patients were divided into a reconstruction group(72 patients)and a nonreconstruction group(74 patients)according to whether 3D vascular reconstruction was performed before surgery.The clinical features,operation conditions,complications,pathological results and postoperative recovery of the two groups were collected and compared.RESULTS A total of 146 patients with rectal cancer were included in the study,including 72 patients in the reconstruction group and 74 patients in the nonreconstruction group.There were 47 males and 25 females in the reconstruction group,aged(59.75±6.2)years,with a body mass index(BMI)(24.1±2.2)kg/m^(2),and 51 males and 23 females in the nonreconstruction group,aged(58.77±6.1)years,with a BMI(23.6±2.7)kg/m^(2).There was no significant difference in the baseline data between the two groups(P>0.05).In the submesenteric artery reconstruction group,35 patients were type Ⅰ,25 patients were type Ⅱ,11 patients were type Ⅲ,and 1 patient was type Ⅳ.There were 37 type Ⅰ patients,24 type Ⅱ patients,12 type Ⅲ patients,and 1 type Ⅳ patient in the nonreconstruction group.There was no significant difference in arterial typing between the two groups(P>0.05).The operation time of the reconstruction group was 162.2±10.8 min,and that of the nonreconstruction group was 197.9±19.1 min.Compared with that of the reconstruction group,the operation time of the two groups was shorter,and the difference was statistically significant(t=13.840,P<0.05).The amount of intraoperative blood loss was 30.4±20.0 mL in the reconstruction group and 61.2±26.4 mL in the nonreconstruction group.The amount of blood loss in the reconstruction group was less than that in the control group,and the difference was statistically significant(t=-7.930,P<0.05).The rates of anastomotic leakage(1.4%vs 1.4%,P=0.984),anastomotic hemorrhage(2.8%vs 4.1%,P=0.672),and postoperative hospital stay(6.8±0.7 d vs 7.0±0.7 d,P=0.141)were not significantly different between the two groups.CONCLUSION Preoperative 3D vascular reconstruction technology can shorten the operation time and reduce the amount of intraoperative blood loss.Preoperative 3D vascular reconstruction is recommended to provide an intraoperative reference for laparoscopic low anterior resection with LCA preservation.
文摘BACKGROUND With the continuous progress of surgical technology and improvements in medical standards,the treatment of gastric cancer surgery is also evolving.Proximal gastrectomy is a common treatment,but double-channel anastomosis and tubular gastroesophageal anastomosis have attracted much attention in terms of surgical options.Each of these two surgical methods has advantages and disadvantages,so it is particularly important to compare and analyze their clinical efficacy and safety.AIM To compare the surgical safety,clinical efficacy,and safety of double-channel anastomosis and tubular gastroesophageal anastomosis in proximal gastrectomy.METHODS The clinical and follow-up data of 99 patients with proximal gastric cancer who underwent proximal gastrectomy and were admitted to our hospital between January 2018 and September 2023 were included in this retrospective cohort study.According to the different anastomosis methods used,the patients were divided into a double-channel anastomosis group(50 patients)and a tubular gastroesophageal anastomosis group(49 patients).In the double-channel anastomosis,Roux-en-Y anastomosis of the esophagus and jejunum was performed after proximal gastric dissection,and then side-to-side anastomosis was performed between the residual stomach and jejunum to establish an antireflux barrier and reduce postoperative gastroesophageal reflux.In the tubular gastroesophageal anastomosis group,after the proximal end of the stomach was cut,tubular gastroplasty was performed on the distal stump of the stomach and a linear stapler was used to anastomose the posterior wall of the esophagus and the anterior wall of the stomach tube.The main outcome measure was quality of life 1 year after surgery in both groups,and the evaluation criteria were based on the postgastrectomy syndrome assessment scale.The greater the changes in body mass,food intake per meal,meal quality subscale score,and total measures of physical and mental health score,the better the condition;the greater the other indicators,the worse the condition.The secondary outcome measures were intraoperative and postoperative conditions,the incidence of postoperative long-term complications,and changes in nutritional status at 1,3,6,and 12 months after surgery.RESULTS In the double-channel anastomosis cohort,there were 35 males(70%)and 15 females(30%),33(66.0%)were under 65 years of age,and 37(74.0%)had a body mass index ranging from 18 to 25 kg/m2.In the group undergoing tubular gastroesophageal anastomosis,there were eight females(16.3%),21(42.9%)individuals were under the age of 65 years,and 34(69.4%)had a body mass index ranging from 18 to 25 kg/m2.The baseline data did not significantly differ between the two groups(P>0.05 for all),with the exception of age(P=0.021).The duration of hospitalization,number of lymph nodes dissected,intraoperative blood loss,and perioperative complication rate did not differ significantly between the two groups(P>0.05 for all).Patients in the dual-channel anastomosis group scored better on quality of life measures than did those in the tubular gastroesophageal anastomosis group.Specifically,they had lower scores for esophageal reflux[2.8(2.3,4.0)vs 4.8(3.8,5.0),Z=3.489,P<0.001],eating discomfort[2.7(1.7,3.0)vs 3.3(2.7,4.0),Z=3.393,P=0.001],total symptoms[2.3(1.7,2.7)vs 2.5(2.2,2.9),Z=2.243,P=0.025],and other aspects of quality of life.The postoperative symptoms[2.0(1.0,3.0)vs 2.0(2.0,3.0),Z=2.127,P=0.033],meals[2.0(1.0,2.0)vs 2.0(2.0,3.0),Z=3.976,P<0.001],work[1.0(1.0,2.0)vs 2.0(1.0,2.0),Z=2.279,P=0.023],and daily life[1.7(1.3,2.0)vs 2.0(2.0,2.3),Z=3.950,P<0.001]were all better than those of the tubular gastroesophageal anastomosis group.The group that underwent tubular gastroesophageal anastomosis had a superior anal exhaust score[3.0(2.0,4.0)vs 3.5(2.0,5.0),Z=2.345,P=0.019]compared to the dual-channel anastomosis group.Hemoglobin,serum albumin,total serum protein,and the rate at which body mass decreased one year following surgery did not differ significantly between the two groups(P>0.05 for all).CONCLUSION The safety of double-channel anastomosis in proximal gastric cancer surgery is equivalent to that of tubular gastric surgery.Compared with tubular gastric surgery,double-channel anastomosis is a preferred surgical technique for proximal gastric cancer.It offers advantages such as less esophageal reflux and improved quality of life.
基金Supported by National Natural Science Foundation of China,No.82174461Hospital Capability Enhancement Project of Xiyuan Hospital,CACMS,No.XYZX0201-22Technology Innovation Project of China Academy of Chinese Medical Sciences,No.CI2021A01811.
文摘BACKGROUND Patients with BRAF V600E mutant metastatic colorectal cancer(mCRC)have a low incidence rate,poor biological activity,suboptimal response to conventional treatments,and a poor prognosis.In the previous cohort study on mCRC conducted by our team,it was observed that integrated Chinese and Western medicine treatment could significantly prolong the overall survival(OS)of patients with colorectal cancer.Therefore,we further explored the survival benefits in the population with BRAF V600E mutant mCRC.AIM To evaluate the efficacy of integrated Chinese and Western medicine in the treatment of BRAF V600E mutant metastatic colorectal cancer.METHODS A cohort study was conducted on patients with BRAF V600E mutant metastatic colorectal cancer admitted to Xiyuan Hospital of China Academy of Chinese Medical Sciences and Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from January 2016 to December 2022.The patients were divided into two cohorts.RESULTS A total of 34 cases were included,with 23 in Chinese-Western medicine cohort(cohort A)and 11 in Western medicine cohort(cohort B).The median overall survival was 19.9 months in cohort A and 14.2 months in cohort B,with a statistically significant difference(P=0.038,hazard ratio=0.46).The 1-3-year survival rates were 95.65%(22/23),39.13%(9/23),and 26.09%(6/23)in cohort A,and 63.64%(7/11),18.18%(2/11),and 9.09%(1/11)in cohort B,respectively.Subgroup analysis showed statistically significant differences in median OS between the two cohorts in the right colon,liver metastasis,chemotherapy,and first-line treatment subgroups(P<0.05).CONCLUSION Integrated Chinese and Western medicine can prolong the survival and reduce the risk of death in patients with BRAF V600E mutant metastatic colorectal cancer,with more pronounced benefits observed in patients with right colon involvement,liver metastasis,combined chemotherapy,and first-line treatment.
文摘Background: Guidelines are issued by most major organizations that focus on a specific disease entity. Guidelines should be a significant help to the practicing physician who may not be up-to-date with the recent medical literature. Unfortunately, when conflicting guidelines for a specific disease are published, confusion results. Purpose: This article provides a suggested guideline outcome measure that would benefit the physician and patient. Methods: A review of 19 different guidelines for cardiovascular disease treatment is one example of the lack of specific outcomes that currently exist. The basic problem with most guidelines is that they do not state the expected end result (i.e., the benefit to the patient) if that guideline is followed. When guidelines use cardiovascular disease risk factors to dictate therapy, the end benefit is never stated so that the patient can make an appropriate choice of which (if any) guideline to follow. Results: A good example is guidelines published by the American Heart Association for reducing cardiovascular disease. These guidelines are risk factor based and only indicate that cardiovascular disease would be reduced if followed. No specific percentage in the reduction of the incidence of disease is given. In contrast, when elimination of the disease is the stated goal of the guideline, the end result is clear. To date, this goal has been stated by only one organization devoted to eliminating cardiovascular disease. Conclusion: Guidelines need to be written to provide the physician and the patient with a specific end point that is expected when the guideline is followed. Patient acceptance and compliance will be much improved if the patient knows the risk/benefit of following the guideline’s recommendations.
文摘Introduction: Motorcyclists bear a disproportionate burden of morbidity and mortality from road accidents. In addition, the consequences of these accidents affect the ability of victims to return to work. This study aimed to determine the prevalence and factors associated with non-return to work among surviving motorcyclists involved in road accidents 12 months after the event. Materials and Methods: It was a cross-sectional study conducted using data from a cohort of motorcyclists involved in accidents and recruited in five hospitals in Benin from July 2019 to January 2020. The dependent variable was non-return to work 12 months after the accident (yes vs no). The independent variables were categorized into two groups: baseline and 12-month follow-up variables. Logistic regression was used to determine the factors associated with non-return to work at 12 months among the participants. Results: Among the 362 participants, 55 (15.19%, 95% CI = 11.84 - 19.29) had not returned to work 12 months after the accident. Risk factors for non-return to work identified were: smoking (aOR = 4.41, 95% CI = 1.44 - 13.56, p = 0.010), hospitalization (aOR = 2.87, 95% CI = 1.14 - 7.24, p Conclusion: The prevalence of non-return to work at 12 months was high among surviving motorcyclists involved in road accidents in Benin. Integrated support for patients based on identified risk factors should effectively improve their return to work.
基金supported by a grant from the Alzheimer’s Society and Alzheimer’s Research UK
文摘Background:The Historical Importance of Studies of Human Brain in Dementia Research The collection of brain and related tissue has a long history(1)In terms of dementia,a more systematic examination of the relationship between brain pathology and clinical symptoms can be traced to Alois Alzheimer’s group in Munich in the early 1900s(2)The use of human brain tissue is essential to increase our understanding of dementia as it gives us the gold standard of disease pathogenesis and clues as to the molecular mechanisms that underpin the various diseases and conditions.
