Objective To explore the relationship between the triglyceride glucose-body mass index (TyG-BMI) and hypertension, type 2 diabetes, as well as their comorbidity, aiming to provide a scientific basis for the early identification and precise prevention of these three diseases. Methods This research collected data from subjects in the China Health and Retirement Longitudinal Study (CHARLS) database. According to the quartiles of TyG-BMI, the included subjects were divided into Q1 group, Q2 group, Q3 group, and Q4 group. Logistic regression was used to analyze the association between the TyG-BMI and the three diseases separately. Further, a restricted cubic spline model was employed to investigate the potential non-linear dose-response relationship between the TyG-BMI index and the three diseases. Subgroup analysis was conducted using interaction tests to investigate whether there was an interaction between TyG-BMI and subgroup factors such as age and gender. Results A total of 4 847 participants were included. There were 1 212 cases in Q1 group, 1 212 cases in Q2 group, 1 211 cases in Q3 group, and 1 212 cases in Q4 group. The logistic regression results indicate that, after adjusting for all confounding factors, participants in the Q4 group had a higher risk of developing type 2 diabetes, hypertension, and comorbidity of hypertension and type 2 diabetes in Model 3 (P<0.05). The results from the restricted cubic spline model demonstrated a linear relationship between the TyG-BMI index and the risk of type 2 diabetes (P for non-linearity >0.05), while a non-linear relationship was observed with hypertension (P for non-linearity <0.05) and the comorbidity of hypertension and type 2 diabetes (P for non-linearity <0.05). Subgroup analysis using interaction tests showed that compared to the Q1 group, factors such as age, gender, smoking, alcohol consumption, and dyslipidemia in the Q2, Q3, and Q4 groups did not significantly alter the relationship between TyG-BMI and type 2 diabetes, hypertension, and their comorbidity. Overall, there was no significant interaction between TyG-BMI and factors like age, gender, smoking, alcohol consumption, and dyslipidemia (P for interaction >0.05). Conclusions In middle-aged and elderly populations, the higher the TyG-BMI, the greater the risk of hypertension, type 2 diabetes, and their comorbidity. The TyG-BMI could be considered an important indicator for the early identification of hypertension, type 2 diabetes, and their comorbidities.
Objective To investigate the effects of enhanced recovery after surgery (ERAS) on postoperative function and pain in total hip arthroplasty (THA) patients with high comorbidity. Methods Patients with THA who were admitted between January 2020 and January 2022 were selected as the study objects, and a total of 223 patients with high comorbidity met the selection criteria. Patients were randomly divided into two groups using the random envelope method. During perioperative period, 112 cases in the ERAS group were treated according to the ERAS protocol and 111 cases in the control group with the traditional protocol. There was no significant difference in gender, age, body mass index, Charlson comorbidity index, preoperative diagnosis, the type and number of the comorbidities, preoperative visual analogue scale (VAS) score between the two groups (P>0.05). However, the Harris score of ERAS group was significantly lower than that of control group before operation (P<0.05). Preoperative and postoperative hospital stays were recorded. The VAS score was used to evaluate the pain before operation, at 1 day after operation, at the leaving bed time, at the day after discharge, and at 2 weeks after operation. Harris score was used to evaluate hip function before operation and at 2 weeks, 1 month, 3 months, 6 months, and 12 months after operation. The incidence of complications, 30-day readmission rate, mortality rate, and patient’s satisfaction were recorded. Results The length of preoperative hospital stay in ERAS group was significantly shorter than that in control group (P<0.05). But there was no significant difference in the length of postoperative hospital stay between groups (P>0.05). All patients in the two groups were followed up 12 months. The VAS score in the two groups after operation was lower than that before operation, and showed a gradually trend with the extension of time, with significant differences between different time points (P<0.05). VAS scores of ERAS group were significantly lower than those of control group at different time points after operation (P<0.05). The postoperative Harris scores in both groups were higher than those before operation, and showed a gradually increasing trend with the extension of time, with significant differences between different time points (P<0.05). Harris scores of ERAS group at 2 weeks, 1 month, and 3 months after operation were significantly higher than those of control group (P<0.05). Complications occurred in 2 cases (1.79%) of the ERAS group and 6 cases (5.41%) of the control group, with no significant difference in incidence (P>0.05). In the control group, 1 case was readmitted within 30 days after operation, and 1 case died of severe pneumonia within 1 year of follow-up. There was no readmission or death in ERAS group, and there was no significant difference in the above indexes between the two groups (P>0.05). At last follow-up, the satisfaction rate of patients in ERAS group was slightly higher than that in control group, but the difference was not significant (P>0.05). Conclusion For THA patients with high comorbidity, ERAS protocol can shorten preoperative waiting time, better reduce pain, and improve hip function.
ObjectivesTo compare the efficacy of acute physiology and chronic health evaluationⅡ (APACHEⅡ), national early warning score (NEWS), pulmonary embolism severity index (PESI) and Charlson comorbidity index (CCI) on pulmonary embolism (PE) prognosis.MethodsClinical data of patients with PE treated in The Second Xiangya Hospital of Central South University from 2010 to 2017 were retrospectively analyzed. They were divided into death group and survival group, and four clinical scores were calculated. The differences of risk factors between the two groups were compared. Logistic regression analysis was used to obtain the independent risk factors related to mortality. The ROC working curve was used to compare the capability of four clinical scores for PE mortality. SPSS 24.0 and Medcalc 18.2.1 software were used for statistical analysis. ResultsA total of 318 patients with PE were included, and the mortality rate was 13.2%. The APACHEⅡ, NEWS, PESI and CCI of the death group were higher than those of the survival group. There were significant differences between two groups (P<0.05). It was confirmed by logistic regression analysis that cerebrovascular disease, heart rate, leukocyte, troponin T, arterial partial pressure of oxygen, right ventricular dysfunction (RVD) were independent risk factors for 90-day mortality. The areas under the ROC curve of APACHEⅡ, CCI, PESI, NEWS were 0.886, 0.728, 0.715 and 0.731, respectively. The area under the ROC curve of APACHEⅡ was the largest, which was better than NEWS, CCI and PESI (P<0.05), and there was no significant difference among NEWS, CCI and PESI.ConclusionsAPACHEⅡ may be the best predictor of mortality in PE patients, which is superior to NEWS, CCI and PESI.
Atrial fibrillation (AF) and breast cancer are common diseases with high incidence, which can be promoted and maintained by a wide range of regulatory factors (changes of hormone secretion, chronic inflammation, dysfunctions in autonomic nervous system, coagulation system and endothelia). There may be a consistent pathophysiological link between the increased incidence of breast cancer and AF, which is currently seldomly reported. The development process of these two diseases are complex, and the occurrence of breast cancer may increase the incidence of AF. In this paper, we reviewed the relationship between breast cancer and AF based on the latest reports.
Adenoid hypertrophy in children with epilepsy is rarely reported. This paper analyzes the clinical characteristics and incidence of adenoid hypertrophy in children with epilepsy.Methods The clinical data in children with epilepsy from December 2014 to April 2020 in Shenzhen Children's hospital were analyzed retrospectively.Results There were 449 cases diagnosed with adenoid hypertrophy (2.74%) in 16387 children with epilepsy. Among 449 cases of adenoid hypertrophy, 276 males (61.47%) and 173 females (38.53%). The age distribution was: 28 days to 1 year old, 8 cases (2%); 1-3 years old, 78 cases (17%); 3-6 years old 167 cases (37%); 6-12 years old, 153 cases (34%); 12-18 years old, 43 cases (10%). In 40 patients the IgG antibody were positive for EB capsid antigen in 25 (62.5%). In 56 cases of EB virus DNA were detected by fluorescence quantitative PCR, 25 (44.64%) positive, and 21/44 cases (47.72%) were positive by general nucleic acid detection of enteroviruses. The neutrophil reduction rate in peripheral blood was 42.19% in 673 tests, lymphocyteincreased in 292 (43.38%), platelet count increased in 307 (45.61%), abnormal in platelet hematocrit in 311 (46.21%); the mean volume of RBC was decreased in319 (47.39%) tests. The content of \begin{document}${\rm{HCO}_3^-} $\end{document} was reduced in 20/55 cases (36.36%). 25-hydroxy vitamin D was 33 (44.5%) decreased in 74 cases. The blood glucose was measured in 146 cases, 60 (41.09%) increased, total cholesterol was 31 (40.78%) increased in 76 cases, serum C peptide was 12 (29.26%) increased in 41 cases.Conclusion Adenoid hypertrophy in children with epilepsy may be related to infection, inflammation or immune disorder, which may cause nutritional, metabolic or internal environment disorders. Therefore, there is need of nursing and health education, transferring to specialized centers for diagnosis and treatment.
Objective To explore the potential categories and influencing factors of chronic comorbidity treatment burden in maintenance hemodialysis (MHD) patients. Methods Convenience sampling method was used to select MHD patients between April and May 2023 at Northern Jiangsu People’s Hospital and Jiangdu People’s Hospital as the research subjects. The general information questionnaire, Chronic Disease Comorbidity Treatment Burden Scale, and Health Literacy Scale for Chronic Disease Patients were used for the questionnaire survey. The latent class analysis was used to explore the classification of chronic comorbidity treatment burden in MHD patients, and the multi-class logistic regression analysis was used to explore the influencing factors of comorbidity treatment burden. Results A total of 450 survey questionnaires were distributed, and 406 valid questionnaires were collected, with an effective response rate of 90.22%. According to the latent class analysis results, the comorbidity treatment burden of MHD patients was divided into three potential categories. Among them, there were 26 cases in the low-burden group, 194 cases in the medium-burden group, and 186 cases in the high-burden group. The results of the ordered multi-class logistic regression analysis showed that patient age, educational level, dialysis age, number of comorbidities, and level of economic support were potential factors affecting the comorbidity treatment burden in MHD patients (P<0.05). Conclusions The comorbidity treatment burden of MHD patients can be divided into three potential categories. The age, educational level, dialysis age, number of comorbidities, and level of economic support of patients are potential factors affecting the comorbidity treatment burden in MHD patients.
ObjectiveTo systematically evaluate the effect of repeated transcranial magnetic stimulation (rTMS) in treating epilepsy.MethodsThe randomized controlled trials (RCTs) of rTMS for epilepsy and related diseases were collected from PubMed, EMbase, Cochrane Library, CBM, CNKI, VIP, and Wanfang databases by computer. The retrieval time was from establishment to June 2019. Two researchers independently screened the literature, extracted the data and evaluated the deviation risks of the included studies. RevMan5.3 software was used for Meta analysis.ResultsA total of 21 RCTs were included, including 1 587 patients. The results showed that rTMS assisted antiepileptics drugs (AEDs) could improve the effective rate of epilepsy treatment [RR=1.28, 95% CI (1.19, 1.37)], significantly reduced HAMA, HAMD and NFDS scores in the treatment of patients with epilepsy combined with anxiety and depression [MD=?3.94, 95% CI (?4.25, ?3.63)], and improve DQ and GMFM-88 scores in children with cerebral palsy combined with epilepsy [MD=7.95, 95% CI (7.00, 8.90)]. In addition, using rTMS will not cause additional adverse reaction [peto OR=0.52, 95% CI (0.31, 0.84)].ConclusionsThe current evidence showed that rTMS combined AEDs can improve the efficient of AEDs therapy. When treat anxiety depression comorbidity, it can significantly reduce the anxiety depression score. In addition in children with cerebral palsy merger, it can improve muscle strength and development. And rTMS will not cause additional adverse reactions. Limited by the quantity and quality of the selected studies, the conclusions need to be verified by more high-quality studies.
Choroidal metastasis of lung cancer is rare in clinical, which is easy to missed diagnosis or misdiagnosis, special research and discussion are not much. This article mainly introduces the current situation of choroidal metastasis of lung cancer in China, the characteristics of clinical and ophthalmoscopic examination, angiography and imaging, the methods of early detection, early diagnosis and the progress of individualized comprehensive treatment. It is expected to attract the attention of thoracic surgeons, conducive to improve the quality of life and prognosis of patients.
Objective To explore impact of climate change on aortic dissection and to put forward a new way about prediction and prevention of aortic dissection. Methods We retrospectively analyzed the characteristics of acute aortic dissection patients came from Hebei province in Fuwai Hospital between 2010 and 2016 year. Meanwhile, we collected monthly maximum temperature, minimum temperature, average temperature, average pressure, amount of rainfall, sunshine, humidity and other meteorological data. Generalized model was implied to explore climate change and the incidence of aortic dissection. Results A total of 1 121 acute aortic dissection patients from Hebei province were admitted in Fuwai Hospital during the period of 6 years. There were 774 patients were type A aortic dissection, and 347 patients were type B aortic dissection. The average age was 51.4±12.0 years. There were 873 males and 248 females. There were 889 (79.3%) patients with hypertension, 99 (8.83%) with Marfan syndrome. It was found that temperature, humidity and air pressure were all statistically significant for indication aortic dissection through single variable analysis (P<0.01). The temperature was only variable by one-way analysis of variance (P<0.01). The lowest temperature has the best predictive effect on the occurrence of aortic dissection. The relative risk was 1.02 with 95% confidence interval 1.02 to 1.03. Conclusion The change of climatic conditions can affect the occurrence of aortic dissection, and the lowest temperature is an important trigger factor for aortic dissection onset.
Homocysteine is an intermediate product of methionine and cysteine metabolism, and plays a key role in methylation. Epilepsy is one of the common diseases of the nervous system, long-term repeated seizures will not only cause damage to the brain tissue, but also cause cognitive impairment. At present, the clinical treatment for epilepsy is still mainly to control symptoms, the fundamental etiology of epilepsy still needs to be improved, to explore the etiology of seizures, fundamentally control seizures, is still our long-term struggle direction. High homocysteine is associated with many diseases. Epidemiological studies have shown that the serum homocysteine level of 10% ~ 40% of epilepsy patients is higher than that of the normal population. By exploring the relationship between serum Hcy and epilepsy,We expect to provide help for the diagnosis and treatment of clinical epilepsy.