Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-08-08
Abstract： Objective: Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm with diverse behaviors occurring in soft tissues and visceral organs. The clinical and pathological features of IMT in adult patients are not well understood. This study highlights the importance of comprehensive diagnostics, including histopathology, immunohistochemistry, and genetic testing, in managing IMTs. High ALK positivity in lung IMTs suggests targeted therapies’ benefit. ALK inhibitors should be considered for ALK-positive tumors. Regular follow-up is crucial due to relapse risk. Methods: We conducted a retrospective analysis of 74 patients diagnosed with IMTs at Peking Union Medical College Hospital between 2010 and 2023. Clinicopathological data, treatments, and outcomes were collected and analyzed. Results: Among the 74 patients (34 females, 40 males) at an average age of 50, the majority were asymptomatic. The most common tumor locations were the head and neck (24.1%), followed by lung (21.6%). Anaplastic lymphoma kinase (ALK) positivity was identified in 31% of cases, with the highest prevalence in lung IMTs (45.5%). Most patients underwent surgical resection, and some received postoperative treatments including radiotherapy, chemotherapy, or ALK inhibitors. The 1-year, 3-year, 5-year, and 10-year OS rates were 78.4%, 70.9%, 69.2%, and 69.2%, respectively. Limitations: This is a single-center retrospective study, and the characteristics of these patients may not be representative of all adult IMT patients. While the sample size of drug-treated patients is relatively small and heterogeneous, making further systematic analysis difficult. The mechanism of resistance to ALK inhibitors has not been determined. Conclusions: IMTs exhibit significant clinical heterogeneity, with lung IMTs demonstrated the highest rate of ALK positivity. While surgical resection remains the primary treatment modality, the observed rates of relapse and mortality underscore the necessity for more effective therapeutic strategies. ALK inhibitor such as crizotinib should be consideration for ALK positive patients. A deeper understanding of the molecular characteristics of IMTs may help to enhance diagnostic accuracy and inform the development of improved treatment options.
Peer Review Status:
Awaiting Review
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-08-06
Abstract： Background The organizational identity that rural doctors have towards the family doctor team will exert an impact on the work enthusiasm of rural doctors and the work quality of the family doctor team，which is related to the quality of the family doctor contracted service enjoyed by rural residents. Objective To explore the influencing elements of the organizational identity of rural doctors with respect to the family doctor team，and to provide practicable measures for the better operation of the family doctor team in rural districts and the improvement of the quality of the family doctor contracted service in rural areas. Methods From November to December in 2021，through the use of the stratified random sampling approach，a total of 1,004 rural doctors in 3 cities in Shandong Province were selected. By employing a self-designed questionnaire，the demographic characteristics，work situation and the organizational identity situation towards the family doctor team of rural doctors were investigated. Pearson correlation analysis was utilized to explore the correlation between the organizational identity of rural doctors and work-family conflict，work stability，business training and organizational isolation，and multiple hierarchical regression analysis was adopted to explore the influencing factors of the organizational identity of rural doctors. Results The organizational identity of rural doctors towards the family doctor team is relatively high，with a score of （3.757 ± 0.713） points. The results of the correlation analysis show that there is a positive correlation between business training and organizational isolation（r=0.156， P<0.01），and a negative correlation between organizational isolation and organizational identity（r=-0.287，P<0.01）. The regression analysis results indicate that business training（β=0.154，P<0.001） and organizational isolation（β=-0.262， P<0.001） are the influencing factors of the organizational identity of rural doctors towards the family doctor team. Conclusion Rural doctors have a relatively strong sense of identity towards the family doctor team. Doing a good job in the business training of rural doctors and reducing the degree of organizational isolation among family doctor team members will help to further strengthen the organizational identity of rural doctors towards the family doctor team.
Peer Review Status:Awaiting Review
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-08-02 Cooperative journals: 《中国全科医学》
Abstract： Background Cisplatin induced drug-induced liver injury is a common adverse reaction in tumor chemotherapy，which seriously disturbs the clinical treatment of patients. Hydrogen，as a selective antioxidant，has good adjunctive therapeutic effects in various injury related diseases，but its preventive effect and mechanism in cisplatin induced liver injury are not clear. Objective To study the protective effect and mechanism of hydrogen water on oxidative stress injury of hepatocytes induced by cisplatin. Methods From June 2022 to June 2023，human normal liver cell line WRL68 were divided into control group，cisplatin group，hydrogen water group，and hydrogen water plus cisplatin group. Control group was cultured with RPMI-1640 medium containing 10% fetal bovine serum for 48 h. Cisplatin group was cultured with RPMI-1640 medium containing 10% fetal bovine serum for 24 h，then added 3 μg/mL cisplatin and continued culturing for 24 h. Hydrogen water group was cultured with 0.6 mg/L hydrogen water medium for 48 h. Hydrogen water+cisplatin group was cultured with 0.6 mg/ L hydrogen water medium for 24h，then added 3 μg/mL cisplatin and continued culturing for 24 h. Then collect cells of each gorup，and hepatocyte activity was detected with CCK-8 method. Cell apoptosis was detected by flow cytometry. Mitochondrial membrane potential（MMP）was detected via Rhodamine 123 fluorescence staining method，and intracellular reactive oxygen species（ROS）levels were detected via DCFH-DA fluorescence probe staining method，the proteins and mRNA expression of nuclear factor erythroid 2-related factor 2（NFE2L2） and heme oxygenase-1（HMOX1） were detected by western blot and RT-qPCR. Results Compared with the control group，the apoptosis rate and ROS level of cisplatin group increased（P<0.05），while the relative levels of MMP，NFE2L2，HMOX1 protein and mRNA decreased（P<0.05）. There was no statistically significant difference in cell apoptosis rate and ROS level between hydrogen water group and control group（P>0.05），while the relative levels of MMP，NFE2L2，and HMOX1 proteins and mRNA increased（P<0.05）. Compared with cisplatin group，hydrogen water plus cisplatin group decreased in cell apoptosis rate and ROS level（P<0.05），while the relative levels of MMP，NFE2L2，HMOX1 proteins and mRNA increased（P<0.05）. Conclusion Hydrogen water can inhibit the oxidative stress injury in cisplatin induced hepatocytes via activating NFE2L2/HMOX1 signaling pathway，and improving mitochondrial membrane potential，then alleviate drug-induced liver injury.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-08-02 Cooperative journals: 《中国全科医学》
Abstract： Background There are many types of vestibular function examination，each with different targets and positive rates.Clinical opinions vary on how to appropriately select examination methods for vertigo patients.. Objective To explore the application value of vestibular function combined with audiological examination in peripheral vertigo diseases，and provide a reference basis for the diagnosis and differential diagnosis of clinical vertigo diseases. Methods Patients with dizziness or vertigo as the main complaint were selected from January 2021 to January 2022 in the Vertigo Clinic of Yibin First People's Hospital. All patients finished the examination within 7 days including pure tone audiometry（PTA），caloric test，video head impulse test（vHIT）and head-shaking test（HST）. The vestibular function examination and audiological examination results were compared. Results A total of 120 patients with vertigo who met the inclusion and exclusion criteria had complete case data，there were 40 cases of sudden deafness with vertigo（SDV），benign paroxysmal positional vertigo（BPPV），and vestibular migraine（VM）. The PTA in SDV patients was sensorineural deafness，with 25 cases with caloric test abnormalities（62.5%），16 cases with vHIT abnormalities（40%），28 cases with HST abnormalities（70.0%）. 9 BPPV patients had PTA abnormalities（22.5%），including 7 ears with sensorineural deafness，2 ears with conduction deafness，18 cases with caloric test abnormalities（45.0%），21 cases with vHIT abnormalities（52.5%），and 20 cases with HST abnormalities（50.0%）.There were 21 cases（52.5%）of PTA abnormalities in VM patients，all with sensorineural deafness，of which 26 ears had high-frequency hearing-light-moderate decline and 7 ears had low-frequency light-moderate decline. There were 16cases with caloric test abnormalities（40.0%），17 cases withvHIT abnormalities（42.5%），and 27 cases with HST abnormalities（67.5%）. The proportion of hearing abnormalities in the three groups was statistically significant difference（χ2 =50.26，P<0.001），and there were no statistically significant difference among the results of vestibular function examination（P>0.05）. Conclusion The vestibular function combined with audiological examination is helpful to the localization diagnosis of peripheral vertigo and to improve the detection rate and differential diagnosis of vertigo diseases.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-30 Cooperative journals: 《中国全科医学》
Abstract： Background The implementation of standardized teaching clinic activities by the faculty of standardized training of general practice residents（hereinafter referred to as residency training） is a key link in the cultivation of qualified general practitioners. And in July 2021，the Chinese Physicians' Association organized experts to revise the Specification for General Practice Teaching Clinic for Standardized Training of Residents in the Specialty of General Practice（for Trial Implementation），which is referenced by all the residency training bases of general practice across the country to carry out the teaching clinic. However，at this stage，the implementation of teaching clinic in each residency training base is still in the exploratory stage，and the degree of attention is insufficient，and the phenomenon of low quality and irregularity in the form of teaching clinic prevails. Objective To understand the current situation and influencing factors on the willingness of general practice residency faculty to conduct teaching clinics，not only to analyze the difficulties and confusions in conducting teaching clinics，but also provide reflections and recommendations. Methods From October 2021 to November 2023，a survey was conducted among general practitioners who participated in the provincial-level general practice residency training programs for regular and key instructors in Guangdong Province. A self-designed questionnaire was used to collect data from the included instructors，covering their basic information，work situation，and their willingness to teach. The electronic questionnaire was created using the "Questionnaire Star" platform，which also facilitated the online distribution and collection of the survey. Results The average age of general practice faculty was（40.7±14.1） years，724（72.18%） faculty members' institutions had general practice teaching clinics，792（78.96%） had a desire to teach，710（70.79%） had no experience in teaching，904 （90.13%） had self-assessed their competence in teaching as a score of 60-89，and 583（58.13%） had received no general practice teaching clinic faculty training，462（46.06%） expected faculty training to be conducted in the form of a combination of multiple types of training，417（41.58%） and 309（30.81%），respectively，believed that the teaching difficulty of general practice teaching clinics was to instruct general practice residents to independently receive patients in the general practice clinic and to teach in a tiered manner，and 377（37.59%） believed that the most difficult teaching objective to achieve was to instruct general practice residents in general practice clinical thinking and improve their clinical decision-making skills，216（21.54%） believed that the most needed training component for general practice residents was consultation skills，and 456（45.46%） believed that the reason their institution did not/would not conduct a teaching clinic was lack of time. Also，the results of the multifactorial logistic regression analysis showed that the availability of general practice teaching clinics at the institution where they are located，experience in teaching，self-assessment of teaching competence，and acceptance of faculty training in general practice teaching clinics were the factors influencing the willingness to teach in general practice faculty teaching clinics （P<0.05）. Conclusion Most of the general practice resident training faculty are willing to carry out general practice teaching clinics，but there are difficulties such as insufficient experience in teaching，training in teaching，and ability in teaching. So it is recommended to optimize and standardize general practice teaching clinics，strengthen the training of general practice concepts for general practice teaching clinic faculty，strengthen incentives for teaching，and improve the monitoring and feedback mechanism for resident faculty in order to improve the quality of general practice teaching clinics.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-30 Cooperative journals: 《中国全科医学》
Abstract： Background As a unique medical resource in China，Traditional Chinese medicine（TCM）has palyed an essential role in maintaining population health. However，facing the growing health demands，some problems of TCM at the grassroots become prominent，such as the unbalanced and inadequate development of TCM and the weak service capacity of TCM. Therefore，it is crutial to improve the rural TCM service system for rural revitalization and the construction of a healthy China. Objective To explore and evaluate the medical service capacity and efficiency of 394 village clinics in a district of Beijing，analyze the existing problems in the development of TCM，and provide reasonable suggestions for further promoting the development of TCM in village clinics. Methods First，descriptive statistical analysis was used to analyze the TCM provision capacity of the village clinic in 2019，including TCM related human，material and financial resources and services. Then， data envelopment analysis was employed to calculate the overall efficiency，pure technical efficiency and scale efficiency of the villiage clinic. The human resources and hardware construction were regared as input indicators，and capital return and service volume as output indicators. The comprehensive efficiency，technical efficiency and scale efficiency of the village clinic were calculated. Results Overall，394 village clinics in this district provided TCM services in 2019. There were 45 rural doctors mainly practicing TCM，471 sets of TCM diagnosis and treatment equipment. The income of Chinese herbal medicine and Chinese patent medicine was 1.224 5 and 34.161 9 million yuan，respectively. The number of TCM treatments was 64 716 times. Based on data envelopment analysis，264 village clinics were in a state of increasing return to scale，13 village clinics were in a state of decreasing return to scale，and only 7 village clinics were in a state of effective allocation of TCM resources. Besides，there were regional differences in the efficiency of TCM service among townships，towns and streets. Conclusion The village clinics in this district have some problems，including inadequate TCM rural doctors，insufficient TCM related equipment，evident disparities in medical income，and low efficiency of TCM service provision. Among them，the problem of scale efficiency is particularly prominent，which has become a key factor restricting the improvement of TCM service efficiency，resulting in the slow development of TCM in the region. These problems might be solved by a series of measures，such as enlarging TCM talents， optimizing the allocation of TCM relaed equipments，improving the health compensation mechanism，and strengthening the distinctive advantages of TCM，and then TCM in village clinics could devlelop with high-quality in the new era.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-30 Cooperative journals: 《中国全科医学》
Abstract： Calcium sensing receptor（CaSR）is a G-protein-coupled receptor that induces highly diffused messengers（IP3，Ca2+，cAMP）to activate various cellular responses. Recently，it has been suggested that CaSR mediates signal communication among endoplasmic reticulum，mitochondria，and nucleus，and this process is associated with myocardial injury. Cardiomyocytes are permanent cells and do not regenerate. Therefore，this paper will focus on the relevant regulatory mechanisms of CaSR in myocardial injury，comb out the complex intracellular signal transduction network mediated by CASR，and provide ideas for finding new therapeutic targets for myocardial injury.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-30 Cooperative journals: 《中国全科医学》
Abstract： The CAPDCA Model of Personalized Patient Education is a new individualized health education model，and its effectiveness has been fully confirmed by theoretical and clinical verification. This model puts forward feasible solutions for the problems existing in the current clinical implementation of health education，such as content fragmentation；inability to large-scale individualization；lack of comprehensive and continuous management；lack of doctor-patient shared decision#2;making and continuous improvement. This model is suitable for chronic disease patients with poor compliance and poor effect of traditional health education management. In order to describe the application method of this model in detail，this article shows the specific process of the application of this model in the management of an elderly diabetic patient with poor blood glucose control， and explains each step in detail. After the intervention by CAPDCA Model of Personalized Patient Education，the patient's blood glucose was gradually stabilized and reached the target levels of treatment，medication compliance was improved，personal quality of life was improved，and self-management ability of diabetes was enhanced. CAPDCA Model of Personalized Patient Education can provide a new method for individualized health education of diabetic patients and improve the effect of health education. This model is suitable for further promotion and application in clinical institutions.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-30 Cooperative journals: 《中国全科医学》
Abstract： Background Subjective symptoms are the main reason for visiting and readmissions in elderly patients， and symptoms of elderly patients are closely related to ageing. At present，few studies have focused on the age-related changes of symptoms in elderly patients，thus reducing the targete，dynamic and prospective management of symptoms in elderly patients. Objective To analyze the characteristics of hospitalization，incidence of high-frequency symptoms and age-related changes for elderly inpatients in recent 10 years，and to provide reference and direction for symptoms management，functional improvement in elderly inpatients. Methods We conducted a retrospective study. Elderly inpatients of Tongji Hospital，TongjiMedical College，Huazhong University of Science and Technology from 2014 to 2023 were included. The medical data retrieval and application platform of the hospital "IDu Cloud" was used for retrieval，and statistical data of the departments receiving treatment，the top 5 patients diagnosed with diseases and the symptoms of patients were extracted through the platform result analysis interface. The frequency of symptoms was defined as ≥ 5%. The high frequency symptoms of elderly hospitalized patients were divided into 6 categories：common，respiratory system，digestive system，nervous system，circulatory system，urinary system symptoms. Cases（%） were used to describe the distribution of hospitalization departments，disease diagnoses，and symptoms of elderly inpatients. The χ2 test was used to analyze the differences in high frequency symptoms among inpatients aged 50~<60 years（pre-elderly），60~<70 years（younger elderly），70~<80 years（middle-senior elderly），and ≥ 80 years（senior elderly）. Origin was used to plot scatter plots and graphs to describe the pattern of change in the incidence of inpatient symptoms with age. Results A total of 1 214 387 elderly inpatients were included in the study，including 465 488（38.33%）pre-elderly inpatients，422 935（34.83%）younger elderly inpatients，235 364（19.38%）middle-senior elderly inpatients，and 90 600（7.46%） senior elderly inpatients. The first inpatient department was cardiovascular medicine，the first disease diagnosis was malignant tumor chemotherapy in presenium，hypertension in the young and middle aged elderly，and coronary heart disease in advanced age. There were 12，14，19 and 23 kinds of high frequency symptoms in 50~<60 years old，60~<70 years old，70~<80 years old，and ≥ 80 years old inpatients，respectively. The most prominent symptoms were physical decline，weight loss，cough， chest tightness，and poor appetite. Respiratory symptoms showed a "high increase" trend with aging，the age-related changes of digestive symptoms showed heterogeneity，and neurological，circulatory and urinary symptoms showed a relatively "low increase" trend with aging. Conclusion The incidence of symptoms in elderly inpatients shows an overall increasing trend with age， and the rate of age-related changes varies for different symptoms. The diagnosis，the number and incidence of high-frequency symptoms in elderly inpatients after 70 years old changed significantly compared with those of the younger elderly，and the role of age-related changes became prominent. The age of 70 years may become an important turning point in the decline of the overall condition of elderly inpatients.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-30 Cooperative journals: 《中国全科医学》
Abstract： Background The personnel building of public health is the key to improving the public health system and enhancing the emergency response capability of public health emergencies. Objective The study aims to analyse the status， advantages and deficiencies of human resources for public health in Beijing after public health emergencies. Then，the study put forward suggestions to optimise the construction of human resources for public health in Beijing. Methods The data on the sum of public health workforce，disaggregated by age，academic qualifications and job title，was collected from 2016 to 2021 Basic Information Survey on Manpower of Health Institutions in Beijing and the Compendium of Statistics on Community Health Work in Beijing. The data was collated between June and September in 2022 with the aims of analysing the sum，structure and configuration of human resources for professional and grassroots-level public health in Beijing in the context of public health emergencies. Results From 2019 to 2021，the sum of human resources for public health in Beijing's professional public health institutions increased from 15 157 to 16 048. Additionally，the percentage of those with postgraduate qualifications increased by 0.93 percent，while the percentage of those with senior and intermediate titles increased by 2.29 and 3.87 percent，respectively. The sum of human resources for public health at the grassroots level increased from 3 701 to 4 017. Among these，the percentage of those with bachelor's degree or above increased by 5.36 percent，while the percentage of those with senior and intermediate titles increased by 0.72 and 1.70 percent，respectively. And the ratio of CDC force per 10 000 population decreased from 1.68 to 1.57，the number of health personnel in professional public health institutions per 1 000 population increased from 0.70 to 0.73， the number of grassroots public health personnel per 10 000 population increased from 1.72 to 1.84. Conclusion After the public health emergency，the sum of human resources for public health has increased in Beijing，yet staffing gaps persist. The echelon of public health institutions has been reinforced，although the quality of human resources for public health in different institutions varies considerably. Furthermore，the structure of titles of human resources for public health is becoming more logical. It is recommended that public health staffing standards be clarified to fill the gap in human resources for public health. Furthermore， it is essential to enhance the training methodology for human resources for public health and elevate the calibre of them. Additionally，there is a need to refine the mechanism for ensuring the advancement of the human resources for public health， with the objective of attracting and retaining talent.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： Background Hypertrophic cardiomyopathy （HCM） is a genetic disorder，characterized primarily by left ventricular outflow tract obstruction and asymmetric myocardial hypertrophy，which predisposes to sudden cardiac death and malignant arrhythmias. Although current pharmacological treatments can alleviate symptoms，they are not specific therapeutic approaches. With the increase in clinical studies on the novel targeted therapy of cardiac myosin inhibitors for HCM，there is currently a lack of systematic reviews evaluating the efficacy of these drugs. Objective To assess the efficacy and safety of cardiac myosin inhibitors in the treatment of HCM. Methods Systematic searches were conducted in PubMed，EMBase，the Cochrane Library，Web of Science，CNKI （China National Knowledge Infrastructure），Wanfang Data，VIP Database，and the China Biology Medicine disc，up to November 9，2023，for randomized controlled trials （RCTs） of cardiac myosin inhibitors，including Mavacamten and Aficamten in HCM. Review Manager 5.4.1 software was utilized to conduct the statistical analysis. Result A total of 6 RCTs were included［5 related to Mavacamten（4 original studies and 1 sub-study） and 1 related to Aficamten）］，involving 544 patients. The meta-analysis showed that，compared to placebo，the cardiac myosin inhibitors group exhibited significant reductions in peak gradient pressure under resting conditions in the left ventricular outflow tract （LVOT）（SMD=-1.24，95%CI=-1.44 to -1.04，P<0.000 01），and under Valsalva maneuver（SMD=-1.37，95%CI=-1.57 to -1.17，P<0.000 01），alongside at least a ≥ 1 level improvement in the NYHA functional classification（NYHA-FC）（RR=2.22，95%CI=1.77 to 2.78，P<0.000 01）. Secondary endpoints showed reductions in the myocardial markers NT-proBNP（SMD=-1.28，95%CI=-2.25 to -0.30），P=0.01］ and cardiac troponin（SMD=-0.68，95%CI=-1.32 to -0.04，P=0.04］，improvement in the Kansas City Cardiomyopathy Questionnaire（KCCQ） clinical score （SMD=0.42，95%CI=0.07 to 0.78，P=0.02），an increase in the rate of patients reaching the composite endpoint events（RR=1.92，95%CI=1.28 to 2.88，P=0.002），and a reduction in the number of patients needing or eligible for septal reduction therapy （SRT）（RR=0.29，95%CI=0.22 to 0.39，P<0.000 01）. Echocardiographic parameters indicated that cardiac myosin inhibitors could improve the left ventricular mass index（LVMI）（SMD=-0.82，95%CI -1.45 to -0.18，P=0.01），decrease the left atrial volume index（LAVI）（SMD=-0.58，95%CI=-0.90 to -0.27，P=0.0003），but could also lead to a reduction in the left ventricular ejection fraction（LVEF）（SMD=-0.46，95%CI =-0.65 to -0.27，P<0.000 01）. In terms of safety，the incidence of at least one adverse event in the cardiac myosin inhibitor group was higher than in the placebo group（RR=1.12，95%CI=1.02 to 1.22，P=0.02），but there was no statistically significant difference in other safety outcomes，including serious adverse events（RR=1.14，95%CI=0.62 to 2.07，P=0.67），atrial fibrillation（RR=1.27，95%CI=0.45 to 3.58，P=0.65），nausea （RR=1.77，95%CI=0.52 to 6.04），P=0.36），dizziness（RR=1.88，95%CI=0.75 to 4.71，P=0.18），and fatigue（RR=1.35，95%CI=0.51 to 3.63，P=0.55）compared to the placebo group. Conclusion Cardiac myosin inhibitors can improve the peak gradient pressure in the LVOT，enhance NYHA functional classification，reduce myocardial markers，alter cardiac structure，and improve patients' quality of life in HCM，with relatively high safety. They offer clinical benefits to patients with HCM but may reduce LVEF.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： Background Camrelizumab is a PD-1 inhibitor independently developed in China， which has been approved for use in the treatment of esophageal cancer. However， its efficacy and safety data in clinical practice are still lacking. Objective This study is aimed at assessing the Camrelizumab-based regimens' safety and efficacy for locally advanced and metastatic esophageal cancer in the real world，and explore whether the reactive cutaneous capillary endothelial proliferation（RCCEP） could predict the efficacy of carrelizumab under different treatment modalities. Methods Cases of locally advanced and metastatic esophageal cancer treated with camrelizumab-based regimens in the Fourth Hospital of Hebei Medical University between 1 November 2019 and 31 May 2022 were retrospectively examined. Progression free survival（PFS），overall survival（OS），disease control rate（DCR），objective remission rate（ORR）and adverse events were evaluated. Using the KaplanMeier approach to compute the median and estimated 95% confidence intervals（CI）for PFS and OS. Comparing the survival function of patients in the RCCEP group and without RCCEP group. Results A total of 70 patients were included in the study. In all patients， the efficacy was evaluated as CR 11（15.7%），PR 35（50.0%），SD 17（24.3%），PD 7（10%），ORR 65.7%（46/70） and DCR 90.0%（63/70）. In the 47 patients who receiving first-line to third-line treatment， the median PFS was 8.1 months（95%CI=6.46 to 9.74 months）and the 1-year PFS rate was 34.0%. The median OS was not reached， the 1-year OS rate of 76.3%. In the 23 patients who receiving neoadjuvant therapy， all patients achieved R0 resection， and 6 patients（26.1%）achieved pCR. In terms of safety， The most observed TRAEs included RCCEP（65.7%），nausea/vomiting（42.8%），anemia（37.1%），fatigue（37.1%）and alopecia（34.2%）. The incidence of adverse reactions ≥ grade 3 was 21.4%（15/70），mainly including leukopenia（5.7%），neutropenia（5.7%）and thrombocytopenia（4.3%）. Four patients developed immune related adverse reactions ≥ grade 3，including one case of grade 3 myocarditis，one case of grade 3 pneumonia，one case of grade 3 rash and one case of grade 4 nephritis. All patients were relieved after symptomatic or glucocorticoid treatment and no drug-related deaths occurred. RCCEP was associated with the efficacy of camrelizumab. The ORR（76.1% vs 45.8%，P=0.01） and DCR（97.8% vs 75.0%，P=0.009）of patients with RCCEP were higher than those without RCCEP. The median PFS（18 months vs 7.4 months， P=0.015）and OS（not reaching vs 15.7 months， P=0.000）of patients with RCCEP were significantly longer than those without RCCEP. Conclusion In the real world，camrelizumab-based regimens achieved good disease control and tolerance for treating locally advanced and metastatic esophageal carcinoma. In different treatment modalities，RCCEP could predicts the efficacy of camrelizumab.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： Background Grounded in the traditional Chinese medicine（TCM） theory of visceral outward manifestation describing the Lung and Large Intestine being Externally-Internally Related（Zang-Fu Xiang Guan），previous research has revealed that a self-formulated TCM prescription Qingfei Huayu Tongfu Formula positively treats sepsis-related acute respiratory distress syndrome（ARDS）. However，the effect of the therapeutic timing of Qingfei Huayu Tongfu Formula on the clinical outcomes and prognosis of sepsis-related ARDS remains unclear. Objective To explore the optimal timing of the Qingfei Huayu Tongfu Formula in the treatment of sepsis-associated ARDS and its impact on the treatment efficacy and prognosis.Methods A total of 208 patients with sepsis-associated ARDS diagnosed in the Department of Critical Care Medicine，Jiangsu Province Hospital of Chinese Medicine from 2021 to 2023，and treated with Qingfei Huayu Tongfu Formula were retrospectively recruited. According to the time of the first application of TCM decoction，those who took Qingfei Huayu Tongfu Formula within 48 hours of the diagnosis of sepsis-associated ARDS were included the early intervention group（n=109），and patients who took Qingfei Huayu Tongfu Formula after 48 hours were included in the late intervention group（n=85）. Fourteen patients were lost to follow-up. Clinical outcomes and prognosis were compared between groups. Results The 28-day all-cause mortality rate in the early intervention group was significantly lower than that of the late intervention group（13.8% vs 29.4%，P=0.0014）.The risk of death in the late intervention group was 2.11 times that of the early intervention group（HR=2.11，95%CI=1.13-3.91，P=0.019）. The median duration of mechanical ventilation was 12（8，23） days in the early intervention group，which was significantly shorter than 27（13，35） days in the late intervention group （P=0.035）. Intra-group comparisons showed improvements in oxygen index for both groups post-treatment（P<0.001）.C-reactive protein（CRP），procalcitonin（PCT），and white blood cell counts post-treatment were all significantly reduced in both groups compared to pre-treatment levels（P<0.05）. After the intervention，the mean oxygen index in the early intervention group was significantly higher than that of the late intervention group［（319.87±95.32） vs （259.55±99.72），P<0.001］. After the intervention，the median CRP in the early intervention group was significantly lower than that of the late intervention group［19.39（8.16，44.47） mg/L vs 38.01 （17.53，86.05） mg/L，P<0.001］. Similarly，the median PCT concentration post-treatment in the early intervention group was significantly lower than that of the late intervention group［0.175（0.089，0.75） ng/mL vs 0.46 （0.143，1.85）ng/mL，P=0.004］. Conclusion Early administration（within 48 hours after diagnosis） of the TCM formula Qingfei Huayu Tongfu Formula to treat sepsis-related ARDS can reduce the 28-day mortality and the length of mechanical ventilation，improve the oxygenation index，and reduce inflammatory responses.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-19 Cooperative journals: 《中国全科医学》
Abstract： Background China's aging population is expanding rapidly，highlighting the imperative of successful aging as a critical health management goal. Effective menopause management plays a crucial role but remains a significant challenge. Objective To construct a comprehensive health management evaluation indicator system for menopausal women based on the modified Delphi method. Methods Between September 2023 and February 2024，a preliminary construction of the comprehensive health management evaluation indicator system for menopausal women was executed via literature review and group discussion. 25 experts in the realms of climacteric health and related fields were selected as conference participants and correspondence subjects. Two rounds of electronic questionnaires using modified Delphi method were conducted，and the survey results were statistically analyzed using SPSS 24.0 software. Results The positive coefficients of the two rounds of expert correspondence were 100%，with the authoritative degree of expert opinions were 0.932 and 0.949，respectively. In the initial round，the primary and secondary indicators were assigned mean importance scores ranging from 4.44 to 4.84 and 4.00 to 4.88， respectively，alongside Kendall's W coefficients of concordance at 0.194（P=0.001） and 0.187（P<0.001）.The second round yielded mean importance scores for the primary and secondary indicators within the ranges of 4.44 to 4.84 and 3.84 to 4.96，with corresponding Kendall's W coefficients of 0.146（P=0.006）and 0.326（P<0.001），reflecting a notable enhancement in expert agreement for the secondary indicators. The tertiary indicators received mean rationality scores of 4.24 to 4.68（4.47±0.10） in the first round and 4.08 to 4.72（4.51±0.15）in the second，with Kendall's W coefficients of 0.063（P=0.025）and 0.129 （P<0.001），indicating a trend towards uniformity in expert opinions. The ultimate construction of the comprehensive health management evaluation indicator system for menopausal women encompasses five primary indicators：basic information， lifestyle，symptom assessment，laboratory tests，and key disease screenings. Additionally，it includes 34 secondary indicators such as age，duration since menopause，body mass index，and waist circumference，and so on. Each of these secondary indicators is meticulously subdivided and quantified to establish tertiary indicators，thereby providing a granular framework for assessment. Conclusion The indicator system，constructed through the modified Delphi method，is endowed with substantial authority and scientific rigor. It offers a holistic assessment of the health status of menopausal women，with a detailed classification and valuation of specific indicators. This systematic approach is conducive to comprehensive and stratified patient management by clinical practitioners，providing a valuable framework for clinical guidance and reference. Nonetheless，the efficacy of its practical application merits ongoing validation through empirical research.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-19 Cooperative journals: 《中国全科医学》
Abstract： Background Neutrophil-to-lymphocyte ratio（NLR）has been shown to have significant predictive value for all-cause mortality risk in Patients with Maintenance Hemodialysis（MHD）in previous studies，however，whetherC-reactive protein-to-albumin ratio（CAR）and the combination of NLR and CAR can enhance the predictive value for all#2;cause mortality risk in Patients with MHD has not been investigated. Objective To investigate the combined predictive value of NLR and CAR for all-cause mortality of MHD patients，and to provide evidence for improving the quality of life of MHD patients. Methods The case data of 175 MHD patients in the blood purification center of Hainan General Hospital in January 2017 were included，the deadline was December 31，2021，with the outcome of all-cause death. Receiver operating characteristic（ROC） curves were plotted for the predictive value of NLR+CAR，NLR，and CAR for the risk of all-cause death in MHD patients. Kaplan-Meier survival curve was used to compare the cumulative survival rate between the two groups. Cox regression analysis was used to analyze the independent risk factors of 5-year all-cause death in MHD patients. Results The area under the ROC curve （AUC）of NLR for predicting the risk of all-cause death in MHD patients was 0.743（95%CI=0.669-0.817，P<0.001）. The AUC of CAR for predicting the risk of all-cause death in MHD patients was 0.710（95%CI=0.627-0.794，P<0.001）. The AUC of NLR+CAR for predicting the risk of all-cause death in MHD patients was 0.799（95%CI=0.732-0.867，P<0.001）. Kaplan#2;Meier survival curve analysis showed that patients with NLR>4.93 had lower cumulative survival than patients with NLR ≤ 4.93 （χ2 =32.753，P<0.001）. The patients with CAR>0.795 had a lower cumulative survival than patients with CAR ≤ 0.795 （χ2 =38.091，P<0.001）. According to the results of the multiple Cox regression equation，dialysis age（HR=0.984， 95%CI=0.976-0.992），ferritin（HR=0.984，95%CI=0.976-0.992），25-（OH）VD（HR=0.964，95%CI=0.941-0.987） and triglyceride（HR=0.984，95%CI=0.976-0.992）were protective factors for all-cause mortality in 5-year MHD patients； NLR>4.93（HR=2.071，95%CI=1.226-3.499）and CAR>0.795（HR=1.903，95%CI=1.155-3.136）were independent risk factors for all-cause death in 5-year MHD patients（P<0.05）. Conclusion Compared with NLR or CAR alone，the combination of NLR and CAR can better predict the risk of all-cause mortality in MHD patients. Increased NLR and CAR were independent risk factors for all-cause mortality in 5-year MHD patients.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-19 Cooperative journals: 《中国全科医学》
Abstract： Background The prevalence of non-alcoholic fatty liver disease（NAFLD） significantly increases in patients with type 2 diabetes mellitus（T2DM）. However，the correlation of NAFLD with visceral fat area（VFA） and thyroid nodules in T2DM patients has been rarely reported. Objective This study aims to investigate the influencing factors for NAFLD in T2DM patients，and the correlation of NAFLD with VFA，thyroid nodules，and thyroid function in this population. Methods Hospitalized T2DM patients in the Department of Endocrinology，the Fourth Affiliated Hospital of Guangxi Medical University（Liuzhou Worker's Hospital） from January 2018 to April 2023 were retrospectively recruited. They were divided into two groups based on abdominal ultrasound findings：NAFLD group and non-NAFLD group. General data，including VFA， subcutaneous fat area（SFA），insulin function，thyroid function，prevalence of thyroid nodules，blood glucose levels，lipid levels，and liver and kidney function were compared between the two groups. Additionally，patients were divided into visceral obesity group（VFA ≥ 100 cm2 ） and non-visceral obesity group（VFA < 100 cm2 ） based on VFA. Age，sex，prevalence of NAFLD and thyroid nodule were compared between the two groups. Pearson and Spearman correlation analyses were employed to investigate factors associated with NAFLD and VFA，as well as their correlation with thyroid nodules. Influencing factors for the volume of thyroid nodules were explored as well. Furthermore，binary logistic regression analysis was used to determine risk factors for both NAFLD and thyroid nodules in T2DM patients. Receiver operating characteristic（ROC） curve analysis evaluated the predictive value of BMI，waist-hip circumference，and waist-hip ratio，VFA，homeostatic model assessment for insulin resistance（HOMA-IR）in predicting NAFLD in T2DM patients and their optimal cut-off values. Results A total of 578 T2DM patients were enrolled in this study，including 293 （50.69%） patients in the NAFLD group and 285 in the non#2;NAFLD group. The age of the NAFLD group was significantly lower than that of non-NAFLD group(P<0.05). Compared to those of the non-NAFLD group，patients in the NAFLD group had significantly higher body weight，body mass index （BMI），waist circumference，hip circumference，VFA，SFA，glycated hemoglobin A1C （HbA1c），fasting insulin levels（FINS），fasting C-peptide levels（FCP），HOMA-IR，homeostasis model assessment of β-cell function（HOMA-β），free triiodothyronine levels（FT3），blood uric acid（UA），total cholesterol （TC），triglyceride（TG） and C-reactive protein（CRP），but significantly lower serum creatinine（Cr） （P<0.05）. There were 251 cases in the visceral obesity group and 327 cases in the non-visceral obesity group. The age of the visceral obesity group was significantly lower than that of the non-visceral obesity group （P<0.05）. The incidence of NAFLD was significantly higher in the visceral obesity group than that of non-visceral obesity group （P<0.05）. However，there was no significant difference in the prevalence of thyroid nodules between the visceral obesity group and non#2;visceral obesity group （P>0.05）. Spearman correlation analysis revealed that the occurrence of NAFLD in T2DM patients was positively correlated with body mass，BMI，waist circumference，hip circumference，waist-to-hip ratio， VFA，SFA，HbA1c，FINS，FCP，HOMA-IR，HOMA-β ，triiodothyronine （TT3），FT3，and CRP （P<0.05）， but negatively correlated with age （P<0.05）. VFA in T2DM patients was found to be significantly correlated with gender， age，height，body mass，BMI，waist circumference，hip circumference，waist-to-hip ratio，SFA，diastolic blood pressure （DBP），FINS，FCP，HOMA-IR，HOMA-β，TT3，FT3，CRP and NAFLD （P<0.05）. The thyroid nodule area showed a negative correlation with TSH and waist-to-hip ratio （P<0.05），while it showed positive correlations with sex，age，TT3 ，TT4 and thyroglobulin （P<0.05）. Univariate unconditional logistic regression analysis revealed that age，weight，BMI， waist circumference，hip circumference，VFA，SFA，HbA1c，FCP，HOMA-IR，FT3，Cr，UA，TC and TG were theinfluencing factors for NAFLD in T2DM patients. Binary logistic regression results demonstrated that body weight， VFA，SFA，FT3 and HOMA-IR were the risk factors for NAFLD in T2DM patients. Gender，age and FT4 were risk factors for thyroid nodules in T2DM patients （P<0.05）. ROC curve results showed that the area under the curve （AUC） of BMI，waist circumference，hip circumference，waist-to-hip ratio，VFA and HOMA-IR was 0.704，0.704，0.705，0.629，0.757，and 0.569，respectively. The optimal cut-off value，sensitivity and specificity of them were listed as follows：BMI （25.37 kg/m2）， waist circumference （84.5 cm），hip circumference （96.5 cm），waist-to-hip ratio （0.895），VFA （88.4 cm2 in female and 99.45 cm2 in male），and HOMA-IR （3.08）. Conclusion The prevalence of NAFLD and thyroid nodules in T2DM patients significantly increase，but not correlated. Obese T2DM patients，especially those with visceral obesity，are more likely to suffer from NAFLD，thyroid nodules，hyperlipidemia，hyperuricemia and other metabolic diseases. HOMA-IR is a risk factor for NAFLD in T2DM patients， but it is not a risk factor for thyroid nodules. BMI，waist circumference，hip circumference and VFA are predictive factors of NAFLD in T2DM patients，and VFA has the highest diagnostic value and HOMA-IR has the lowest value. VFA predicts NAFLD in T2DM patients with the optimal cut-off value of 88.4 cm2 ，which is equal in females and 99.45 cm2 in males.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-17 Cooperative journals: 《中国全科医学》
Abstract： Background The dual antiplatelet therapy of aspirin combined with ticagrelor is the preferred antiplatelet therapy for patients with ST segment elevation myocardial infarction （STEMI） who receive primary percutaneous coronary intervention（PPCI）. Compared with clopidogrel，ticagrelor can inhibit platelets faster and more effectively，and improve prognosis. However，there is still a lack of research on the application of reduced dose ticagrelor in STEMI patients receiving PPCI treatment. Objective To compare the different doses of ticagrelor on the efficacy and safety in patients with STEMI basedon propensity score matching（PSM）. Methods The patients with STEMI who underwent PPCI and antiplatelet therapy with ticagrelor at the Fifth Department of Cardiology，Second Hospital of Hebei Medical University from June 2019 to May 2021 were selected consecutively. According to the different maintenance doses of ticagrelor，patients were divided into a reduced dose group（n=60）and a standard group（n=180），using ticagrelor 60 mg/time（2 times/day）and 90 mg/time（2 times/ day），respectively. The PSM method was used to perform a 1:1 match between two groups，with matching variables including gender，age，medical history，Killip grade at admission，and intervention related parameters. Finally，54 patients were included in the each group. Follow-up was conducted on both groups at 1 month，3 months，and 6 months after discharge，and platelet parameters as well as clinical events were recorded and compared between the two groups of patients. Results There was no statistically significant difference in baseline data，intervention treatment parameters，and incidence of major adverse cardiovascular events（MACEs）during hospitalization between the two groups after PSM（P>0.05）. There was no statistically significant difference in the levels of platelet count（PLT），mean platelet volume（MPV），platelet distribution width（PDW）， and platelet aggregation rate（PAR）between baseline and 1 month after discharge（P>0.05）. The level of MPV in the reduced dose group was higher than that of the standard group at discharge，and the level of PDW was lower than that of the standard group（P<0.05）. The levlel of PDW in the reduction group was higher than that of the standard group after 3 months of discharge （P<0.05）. The level of MPV in the reduction group was higher than that of the standard group after 6 months of discharge （P<0.05）. There was no statistically significant difference in the level of PLT between the two groups before and after discharge （P>0.05）. The levels of MPV in the two groups were higher than baseline at discharge，while the levels of PDW and PAR were lower than baseline（P<0.05）. The level of MPV in the reduction group was lower than that at discharge at 1 month，3 months， and 6 months，while the levels of PDW and PAR were higher than those at discharge（P<0.05）. There was no statistically significant difference in the incidence of MACEs and severe bleeding events between the two groups during the follow-up（P>0.05）. Conclusion Reduced dose of ticagrelor treatment is safe and effective for STEMI patients undergoing PPCI.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-17 Cooperative journals: 《中国全科医学》
Abstract： Background Sepsis is a systemic inflammatory response caused by an imbalance of the host immune response to infectious factors，potentially leading to life-threatening organ dysfunction. The application of immature platelet fraction（IPF）to assessing the severity and prognosis of sepsis has been previously analyzed. However，the application of IPF combined with other biomarkers to predict sepsis has been rarely reported. Objective To explore the predictive value of IPF combined with other biomarkers in the severity and prognosis of sepsis. Methods A total of 60 sepsis patients admitted to the Department of Critical Care Medicine，Zhongshan Hospital，Fudan University（Xiamen Branch）from November 2020 to November 2022 were retrospectively recruited for analyzing their clinical data. Patients were classified into the severe sepsis group （n=24） and septic shock group （n=36） based on the severity of sepsis. Divided by the Sequential Organ Failure Assessment （SOFA） score，60 sepsis patients were assigned into the low SOFA group（SOFA score<6 points，n=26）and high SOFA group（SOFA score ≥ 6 points，n=34）. According to the outcome，there were 39 cases in the survival group and 21 cases in the death group. IPF and other blood indicators，including neutrophil to albumin ratio（NAR），platelet to lymphocyte ratio （PLR），neutrophil to lymphocyte ratio（NLR），and lactate to albumin ratio（LAR）were compared. The receiver operating characteristic（ROC）curves of IPF combined with other biomarkers for predicting the severity and prognosis of sepsis were plotted，and the area under the curve（AUC）was calculated. Results The proportion of lung diseases（66.7% vs. 35.9%）， baseline Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE II）scores and baseline SOFA scores were significantly higher in the death group compared to those of the survival group（P<0.05）. Similarly，the proportion of lung diseases（61.8% vs. 26.9%），baseline APACHE II scores and mortality（50.0% vs. 15.4%）were significantly higher in the high SOFA group compared to those of the low SOFA group（P<0.05）. IPF at 48 hours of treatment was significantly higher in the septic shock group than that of the severe sepsis group，which was significantly higher in the high SOFA group compared to that of the low SOFA group，and significantly higher in the death group compared to that of the survival group（P<0.05）. Given the significant difference in 48-h IPF between groups，the laboratory indicators at this time point were selected for further research and analysis. The AUC of IPF in predicting septic shock，a high SOFA score and death was 0.70（cut-off value 3.95%，95% CI 0.55 to 0.83） and 0.72（cut-off value 7.70%，95% CI 0.60 to 0.86），0.73（cut-off value 7.70%，95% CI 0.58 to 0.89），respectively. The AUC of IPF + baseline APACHE II score + NLR，and IPF + baseline APACHE II score + LAR in predicting a high SOFA score was 0.91（95% CI 0.84 to 0.98）and 0.93（95% CI 0.84 to 0.99），respectively. The AUC of IPF + NAR + PLR in predicting the death in sepsis patients was 0.90（95% CI 0.81 to 0.98）. Conclusion IPF combined with different blood indicators can improve the ability to assess the severity and prognosis of sepsis in clinical practice. Specifically，48-hour IPF + baseline APACHE II score+48-hour NLR and 48-hour IPF + baseline APACHE II score+48-hour LAR have high efficacy in predicting the severity of sepsis；whereas 48-hour IPF+NAR+PLR shows a superior efficacy in predicting the prognosis of sepsis.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-17 Cooperative journals: 《中国全科医学》
FAN Haojie
LIU Lewei
XIA Lei
TIAN Yinghan
YANG Cheng
HAO Mingru
ZHAO Xin
SHEN Qingqing
MO Daming
GENG Feng
LIU Huanzhong
Abstract： Background The incidence of major depressive disorder（MDD）in adolescents is annually elevated. Non-suicidal self-injury（NSSI）is a common clinical manifestation of MDD. Evidence suggested that vitamin D and lipid levels are associated with MDD，but whether they are related to NSSI is unclear. Objective To compare the levels of 25（OH）D3 and blood lipids in MDD adolescents with or without NSSI behavior， and to explore their diagnostic value for NSSI. Methods A total of 129 MDD adolescents who received treatment in the Department of Psychiatry，Chaohu Hospital of Anhui Medical University and the Fourth People's Hospital of Hefei from October 2020 to March 2022 were recruited. They were assigned into NSSI group （n=77）and non-NSSI group（n=52）based on the diagnostic criteria of NSSI in the Diagnostic and Statistical Manual of Mental Disorders， Fifth Edition （DSM-5）. The Positive and Negative Suicide Ideation Inventory（PANSI），Insomnia Severity Index（ISI），and Center for Epidemiological Survey Depression Scale（CES-D）were used to evaluate the clinical symptoms. Fasting venous blood samples were collected to measure the levels of 25（OH）D3 and blood lipids， and compared between groups. In addition，multivariate logistic regression analysis was performed to identify influencing factors for NSSI behavior in MDD adolescents. The diagnostic value of 25（OH）D3 and lipid levels in NSSI behaviors was assessed by plotting the receiver operating characteristic（ROC） curves. Results The age of the NSSI group was significantly lower than that of the non-NSSI group，whereas the total scores of PANSI，ISI，and CES-D were significantly higher than those of the non-NSSI group（P<0.05）. The level of 25（OH）D3 in the NSSI group was significantly lower than that in the non-NSSI group，whereas the levels of total cholesterol（TC），high-density lipoprotein cholesterol（HDL-C），and low-density lipoprotein cholesterol（LDL-C） were significantly higher than those in the non-NSSI group（P<0.05）. Multivariate Logistic regression analysis showed that both LDL-C（OR=5.695，95%CI=2.422-13.388，P<0.001）and 25（OH）D3（OR=0.871，95%CI=0.768-0.987，P<0.05） were the influencing factors of MDD adolescents with NSSI. The area under curve（AUC）of LDL-C and 25（OH）D3 levels in assessing the risk of developing NSSI behavior in MDD adolescents was 0.73（95%CI=0.65-0.82，P<0.001）and 0.62 （95%CI=0.52-0.72，P=0.023），respectively. Their optimal cut-off value was 1.89 mmol/L and 19.15 μg/L，respectively. The AUC of 25（OH）D3 combined with LDL-C levels ［ln（p/1-p）=1.364X1-0.143X2-0.161，where X1 and X2 was LDL-C and 25（OH）D3，respectively］ in diagnosing NSSI behavior in MDD adolescents was 0.77（95%CI=0.69-0.85， P<0.001），with 77.92% of sensitivity and 67.31% of specificity. Conclusion 25（OH）D3 and lipid levels are out of normal ranges in MDD adolescents with NSSI. Measurement of LDL-C combined with 25（OH）D3 levels may provide information to predict the occurrence of NSSI behaviors in MDD adolescents. A regular measurement of LDL-C and 25（OH）D3 and a dynamic monitor is valuable to provide symptomatic supports.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-17 Cooperative journals: 《中国全科医学》
Abstract： Background With the aging population in China，the incidence of vascular cognitive impairment（VCI） will increase year by year. Non-dementia vascular cognitive impairment（VCIND）is the most common form of VCI. At present， the research shows that glycolipid metabolic diseases will accelerate the process of VCI，and the treatment of VCI focuses on controlling risk factors，but there is a lack of relevant research on VCIND caused by glycolipid metabolic diseases. Objective To analyze the factors influencing the occurrence of vascular cognitive impairment no dementia（VCIND）with glycolipid metabolic disease，construct a regression model，and conduct risk prediction. Methods A cross-sectional study was conducted to select410 patients with glycolipid metabolic diseases who were hospitalized in the encephalopathy center of Guangdong Provincial Hospital of Traditional Chinese Medicine from March to December 2023. Patients were divided into a cognitive normal group （MMSE>26 points）and a VCIND group（MMSE ≤ 26 points）according to the Mini-Mental State Examination Scale （MMSE）. Multi-factor Logistic regression was used to evaluate the influencing factors of VCIND in middle-aged and elderly patients with glycolipid metabolic diseases，and the risk prediction model of VCIND in glycolipid metabolic diseases was constructed. The predictive value of the model was evaluated via the receiver's operating characteristic（ROC）curve，and the area under the ROC curve（AUC）was calculated. Results Among the 410 patients，there were 209 cases in the cognitively normal group and 201 cases in VCIND. The results of multivariate Logistic regression analysis showed that low education level ［below primary school（OR=25.989，95%CI=5.656-119.33），primary school（OR=6.839，95%CI=3.919-11.933）， Fazekas grade（OR=1.700，95%CI=1.124-2.570）were independent risk factors for the occurrence of VCIND in patients with glycolipid metabolism（P<0.05）. Based on the results of multivariate Logistic regression analysis，the prediction model is logit （P）=-1.608+ primary school×1.923+ below primary school×3.285+Fazekas grading×0.531. The AUC of this risk prediction regression model is 0.767（95%CI=0.721-0.813，P<0.001）. Hosmer-Lemeshow goodness-of-fit test showed that the model has a good fitting effect（χ2 =13.404，P=0.099）. Conclusion Low literacy and Fazekas classification are independent risk factors for the development of VCIND in a population of patients with glycolipid metabolism. Establishing a risk prediction regression model based on the above risk factors has a good predictive value and helps to identify the high-risk group of developing VCIND in patients with glycolipid metabolism disease at an early stage.
Hits
Hits
Downloads
Comment