Independent Influencing Factors Research Articles

A real-world study of first-line albumin-bound paclitaxel in the treatment of advanced pancreatic cancer in China

Objective: To observe and evaluate the clinical efficacy and safety of albumin-bound paclitaxel as first-line treatment for patients with advanced pancreatic cancer in China, and to explore the prognosis-related molecules in pancreatic cancer based on next-generation sequencing (NGS) of tumor tissues. Methods: From December 2018 to December 2020, patients with locally advanced or metastatic pancreatic cancer were recruited to accept albumin-bound paclitaxel as first-line treatment in the oncology departments of 24 hospitals in East China. The primary endpoints were overall survival (OS) and treatment related adverse events, and the secondary endpoint was progression-free survival (PFS). Adverse effects were graded using Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). NGS sequencing on the primary or metastatic tissue samples of pancreatic cancer obtained through surgical resection or biopsy was performed. Results: This study recruited 229 patients, including 70 patients with locally advanced pancreatic cancer (LAPC) and 159 patients with metastatic pancreatic cancer (mPC). The disease control rate was 79.9% and the objective response rate is 36.3%.The common adverse effects during treatment were anaemia (159 cases), leucopenia (170 cases), neutropenia (169 cases), increased aminotransferases (110 cases), and thrombocytopenia (95 cases), and the incidence of grade 3-4 neutropenia is 12.2% (28/229). The median follow-up time was 21.2 months (95% CI: 18.5-23.1 months). The median PFS (mPFS) was 5.3 months (95% CI: 4.37-4.07 months) and the median OS (mOS) was 11.2 months (95% CI: 9.5-12.9 months). The mPFS of patients with LAPC was 7.4 months (95% CI: 6.6-11.2 months), and their mOS was 15.5 months (95% CI: 12.6-NA months). The mPFS of patients with mPC was 3.9 months (95% CI: 3.4-5.1 months), and their mOS was 9.3 months (95% CI: 8.0-10.8 months). Multivariate Cox regression analysis showed that clinical stage (HR=1.47, 95% CI: 1.06-2.04), primary tumor site (HR=0.64, 95% CI: 0.48-0.86), Eastern Cooperative Oncology Group Performance Status (ECOG PS) score (HR=2.66, 95% CI: 1.53-4.65), and whether to combine radiotherapy (HR=0.65, 95% CI: 0.42-1.00) were independent influencing factors for the PFS of these patients. The primary tumor site (HR=0.68, 95% CI: 0.48-0.95), ECOG score (HR=5.82, 95% CI: 3.14-10.82), and whether to combine radiotherapy (HR=0.58, 95% CI: 0.35-0.96) were independent influencing factors of the OS of these patients. The most frequent gene mutations in these advanced stage pancreatic patients were KRAS (89.66%), TP53 (77.01%), CDKN2A (32.18%), and SMAD4 (21.84%) by NGS of tumor tissues from 87 pancreatic cancer patients with sufficient specimens. Further analysis revealed that mutations in CDKN2B, PTEN, FGF6, and RBBP8 genes were significantly associated with an increased risk of death (P＜0.05). Conclusion: Albumin-bound paclitaxel as first-line treatment demonstrated feasible anti-tumor efficacy and manageable safety for patients with advanced pancreatic cancer in China.

Expression and clinical significance of FAT1 gene in pancreatic adenocarcinoma

Objective: To analyze the expression of FAT1 gene in pancreatic adenocarcinoma and its relationship with clinicopathological features, prognosis, and immunotherapy for pancreatic adenocarcinoma. Methods: (1) Bioinformatics analysis: based on FAT1 mRNA expression and clinical data of 179 cases of pancreatic adenocarcinoma in the TCGA database, and FAT1 mRNA expression data of 328 cases of normal pancreatic tissues in the GTEx database. We analyzed the differences in FAT1 mRNA expression in pancreatic adenocarcinoma and normal pancreatic tissues and the relationship between FAT1 mRNA expression and the degree of differentiation, clinical stage, prognosis, immune cell infiltration, and immune checkpoint-associated genes in pancreatic adenocarcinoma. FAT1-related differentially expressed genes were analyzed by applying Limma 3.40.2 software package, and GO and KEGG enrichment analysis was performed on the differentially expressed genes. Immunohistochemical (IHC) of FAT1 in pancreatic adenocarcinoma and normal pancreatic tissues was analyzed by HPA database. (2) Validation of own tissue samples: tissue samples and clinical and prognostic data of 192 patients with pancreatic ductal adenocarcinoma admitted to Zhejiang Cancer Hospital from March 8, 2010 to September 30, 2020 were collected. IHC was performed on the tissue samples to verify the protein expression of FAT1 in pancreatic adenocarcinoma and its relationship with immune-related proteins, the degree of differentiation of pancreatic adenocarcinoma, clinical staging, and prognosis. Results: (1) Bioinformatics analysis: the FAT1 mRNA expression of 179 pancreatic adenocarcinoma tissues from the TCGA database was 5.55±1.04, which was higher than that of 328 normal pancreatic tissues with FAT1 mRNA from the GTEx database (2.95±0.53, P＜0.001). FAT1-specific IHC images showed that FAT1 expression was generally high in pancreatic adenocarcinoma tissues, and FAT1 expression shifted from the cell membrane to the cytoplasm. The FAT1 mRNA expression in the highly differentiated group (31 cases), the moderately differentiated group (96 cases), and the lowly differentiated group (52 cases) were 4.99±1.46, 5.51±0.80, and 5.68±1.08, the expression of pancreatic adenocarcinoma tissues were all higher than that of normal pancreatic tissues (all P＜0.001), and the FAT1 mRNA expression of the moderately differentiated group and the poorly differentiated group were all higher than that of the highly differentiated group (all P＜0.001). The median progression-free survival time (PFS) and median overall survival time (OS) of the 90 patients in the FAT1 mRNA low-expression group were 16.5 and 24 months, respectively, which were longer than those of the 89 patients in the FAT1 mRNA high-expression group (median PFS and OS were 13 and 18 months, respectively; P-values were 0.011 and 0.005, respectively). Multifactorial Cox regression analysis showed that FAT1 mRNA expression level was an independent influencing factor for OS in pancreatic adenocarcinoma patients (HR=1.47, 95% CI: 1.09-1.99). Correlation analysis showed that FAT1 mRNA expression in pancreatic adenocarcinoma was positively correlated with B-cell infiltration, CD8+ T-cell infiltration, neutrophil infiltration, macrophage infiltration, and myeloid dendritic cell infiltration (ρ=0.27, P＜0.001; ρ=0.28, P＜0.001; ρ=0.32, P＜0.001; ρ=0.21, P=0.004; ρ=0.32, P＜0.001), and also positively correlated with mRNA expression of CD274, HAVCR2, and PDCD1LG2 (r=0.327, P＜0.001; r=0.231, P=0.002; r=0.258, P＜0.001). GO and KEGG enrichment analyses showed that FAT1 mRNA expression levels were associated with activation of the Wnt signaling pathway (P=0.029), the PI3K/Akt pathway (P<0.001), and other tumor microenvironment-related pathways. (2) Validation of own tissue samples: among 192 pancreatic adenocarcinoma tissues, FAT1 was highly expressed in 58 cases (30.21%), and the proportion of FAT1-expressing positive tumor cells was positively correlated with the combined positive score of PD-L1 and the number of CD3+ T-cells infiltration (r=0.154, P=0.032; r=0.287, P＜0.001), and the protein expression of FAT1 had no correlation with the differentiation degree of pancreatic adenocarcinoma (ρ=0.082, P=0.254). The median OS of 58 patients in the FAT1 high-expression group and 134 patients in the FAT1 low-expression group were 18.89 and 25.84 months, respectively, and the difference was not statistically significant (χ²=1.93, P=0.165). Conclusion: FAT1 gene is highly expressed in pancreatic adenocarcinoma tissues, may play an oncogenic role in pancreatic adenocarcinoma, may be an adverse influence on overall survival and progression-free survival of patients; FAT1 gene may be involved in multiple immune-related pathways and promote tumor immune escape.

Prognostic Prediction Model for Endovascular Treatment of Acute Anterior Circulation Ischemic Stroke Based on RAPID Software

To construct a universally applicable nomogram using computed tomography perfusion (CTP) parameters based on Rapid processing of PerfusIon and Diffusion (RAPID) software for evaluating the prognosis of acute anterior circulation large vessel occlusion (LVO) treated by endovascular therapy. A total of 130 patients were divided into two groups: a group with a good prognosis [Rankin Rating Scale (mRS) score ≤ 2 points] and a group with a poor prognosis (mRS score >2 points). The least absolute shrinkage and selection operator (LASSO) logistic regression method was used to screen the predictive factors, and a nomogram chart prediction model was established. There were 52 patients in the good prognosis group and 78 patients in the poor prognosis group. Logistic regression analysis showed that age, baseline National Institute of Health Stroke Scale score, and volumes of cerebral blood flow (VCBF)<30% were independent influencing factors for the prognosis of patients [OR=1.065, 95% CI: 1.007-1.126; OR=1.097, 95% CI: 1.008-1.193; OR=1.107, 95% CI: 1.024-1.197; P all<0.05]. Our nomogram model showed good discrimination and calibration. The ROC curve analysis showed that the area under the curve of the prediction model was 0.809 (95% CI: 0.733-0.885, P<0.001), and the calibration curve was close to the ideal curve. Our nomogram can be used as a simple and reasonable tool to predict the prognosis of acute anterior circulation LVO treated by endovascular therapy. The CTP parameter VCBF<30% obtained by RAPID software was an important predictive factor in this model.

Serum IL-6 and TGF-β1 concentrations as diagnostic biomarkers in elderly male patients with osteoporosis.

This research is intended to evaluate the correlations of serum IL-6 and TGF-β1 concentrations with bone density and turnover markers as well as their diagnostic value in elderly male patients with osteoporosis (OP). A retrospective analysis was conducted on 335 elderly men (≥ 60years; 90 with normal bone mass, 120 osteopenia cases, and 125 OP cases). Lumbar spine/femoral neck BMD values were measured using dual-energy X-ray absorptiometry. Correlations of serum IL-6 and TGF-β1 concentrations with bone density and bone turnover markers in OP patients were analyzed utilizing Pearson or Spearman correlation coefficients. Independent influencing factors for OP were identified by logistic multivariate regression analysis. The diagnostic value of serum IL-6 and TGF-β1 was assessed with ROC curves and MedCalc software. Smoking history, drinking history, lumbar spine BMD, femoral neck BMD, PINP, and β-CTX markedly differed among the normal bone mass, osteopenia, and OP groups. Elevated IL-6 and reduced TGF-β1 concentrations were observed in serum samples of OP. Serum IL-6 concentrations was inversely associated with bone density markers but positively lined to bone turnover markers. Conversely, serum TGF-β1 was positively related to bone density markers but negatively associated with bone turnover markers. Smoking history, PINP, and IL-6, were identified as independent risk factors while lumbar spine BMD, femoral neck BMD, and TGF-β1 were independent protective markers for OP. The combined assessment of serum IL-6 and TGF-β1 showed superior diagnostic performance for OP. Serum IL-6 in combination with TGF-β1 exhibits good diagnostic performance for OP. Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Associations of HMGB1, sTNFR-1 and NLR with Premature Delivery Secondary to Infection in Pregnant Women Undergoing Cervical Cerclage

Background: Although cervical cerclage has improved with the rapid development of medical technology, there remains a distinct probability of adverse pregnancy outcomes. To investigate the associations of changes in the high mobility group box 1 (HMGB1), soluble tumor necrosis factor receptor 1 (sTNFR-1) and peripheral blood neutrophil-to-lymphocyte ratio (NLR) with premature delivery secondary to infection in pregnant patients undergoing cervical cerclage. Methods: Sixty-seven pregnant patients with premature delivery after cervical cerclage, who were treated at the Affiliated Matern &amp; Child Care Hospital of Nantong University from January 2022 to October 2023, were enrolled, including 43 with premature delivery secondary to infection (infectious group) and 24 with idiopathic premature delivery (non-infectious group). The pre-delivery serum levels of HMGB1, sTNFR-1 and the peripheral blood level of NLR were compared between the 2 groups. Further, the clinical value of these 3 indicators in predicting premature delivery secondary to infection among pregnant patients undergoing cervical cerclage was assessed by receiver operating characteristic (ROC) curve analysis. Results: The infectious group exhibited significantly higher serum levels of HMGB1, sTNFR-1 and peripheral blood level of NLR compared to those in the non-infectious group, demonstrating significant differences (p &lt; 0.05). Logistic regression analysis revealed that HMGB1 and NLR were independent influencing factors for premature delivery (p &lt; 0.05). According to the ROC curve analysis results, the changes in HMGB1, sTNFR-1 and NLR levels may reflect the risk of premature delivery secondary to infection among pregnant patients undergoing cervical cerclage. The area under the curve (AUC), sensitivity and specificity of combined detection were all markedly higher than those of independent detection. Conclusions: HMGB1, sTNFR-1 and NLR levels are risk factors for third-trimester premature delivery among pregnant patients undergoing cervical cerclage. Timely combined detection of serum HMGB1, sTNFR-1 and peripheral blood NLR during the third trimester can improve the clinical diagnostic acumen, which enables early prevention to help lower the risk of premature delivery.

The correlation analysis between the pedicle screw placement palpation and torque

BackgroundThis study endeavored to investigate the influencing factors of pedicle screw torque measured during surgery and the correlation between manual palpation scores and screw torque. MethodsThis investigation was a prospective study designed to gather data from patients who underwent spinal internal fixation performed by the same surgical team at the Department of Orthopedics, affiliated with the First Hospital of Guangzhou University of Chinese Medicine, spanning from January 2020 to September 2023. The sample comprised 51 individuals (18 males and 33 females; mean age: 60.78±11.48 years). All participants underwent bone mineral density (BMD) and comprehensive radiological testing to evaluate the affected spinal segments. Intraoperatively, parameters such as the surgeon's tactile perception, a visual analogue scale for manual palpation, and peak screw torque values were documented. Patients were subsequently stratified into three categories based on the resistance encountered during screw placement. Demographic variables (age, height, weight) and BMD measurements of patients within each category were compared. Factors exhibiting significant differences were subjected to multivariate logistic regression analysis (MLRA). Concurrently, the relationship between manual palpation scores and torque values was examined. ResultsThe results of the univariate analysis indicated that age (P=0.042), height (P=0.047), BMD of the lumbar (P<0.01), BMD of the femoral neck (P=0.02), BMD of the hip (P=0.02), and P1NP (P=0.044) were statistically significant. The results of MLRA revealed that BMD of the lumbar was an independent influencing factor for torque (P=0.000<0.05). Additionally, the manual palpation score and torque value of group A were significantly lower than those of the other two groups (P<0.001). There was a significant positive correlation between the intraoperative screw placement palpation and torque. ConclusionsThe BMD of the lumbar is an independent factor that influences the measured torque applied to pedicle screws during surgery. A significant and robust positive correlation exists between the intraoperative screw placement tactile sensation and the torque experienced. It is advisable to reinforce the screw channel with bone cement when the tactile score is ≤2.5 and the torque is ≤ 1.3 N.m.

Risk factors of the low anterior resection syndrome (LARS) after ileostomy reversal in rectal cancer patient

This study is aimed at identifying risk factors of Low Anterior Resection Syndrome following ileostomy reversal in rectal cancer patients who had undergone preventive ileostomy. This retrospective analysis was conducted on a cohort of 605 patients treated at the Fourth Hospital of Hebei Medical University between January 2018 and December 2021. These patients were grouped based on LARS score, and Clinical and follow-up data were collected to conduct univariate analyses of potential factors influencing LARS occurrence based on variable type. Variables with statistical significance were included in a logistic regression model to analyze potential influences on the occurrence of LARS. Univariate and Multivariate logistic regression analysis showed that N2 stage (OR = 2.290 95%CI: 1.076–4.873, P = 0.031), chemoradiotherapy (OR = 2.271, 95%CI: 1.246–4.138, P = 0.007), and anastomosis height (OR = 0.836, 95%CI: 0.717–0.975, P = 0.022) were independent influences on the occurrence of LARS. In model 3 (adjusting for all covariates), the relationship between anastomotic height and patient LARS status showed a negative correlation. In subgroup analyses, there were significant differences in the effect of anastomotic height on LARS in subgroups with different hemoglobin concentrations. A high occurrence rate of LARS is observed in rectal cancer patients with preventive ileostomy reversal. N2 stage, history of chemoradiotherapy, and anastomotic height are independent influence factors for the occurrence of major LARS after ileostomy reversal.

Prognostic factors of immunosuppression therapy combined with eltrombopag in the treatment of childhood severe aplastic anemia

Objective: To analyze the influence factors on the efficacy of immunosuppression therapy (IST) combined with eltrombopag and IST alone in the treatment of childhood severe aplastic anemia (SAA). Methods: A retrospective cohort study. A total of 124 children with SAA who were initially treated with IST in Beijing Children's Hospital from March 2017 to May 2020 were enrolled. Clinical characteristics, laboratory examination and prognosis data were collected at the time of enrollment. According to the treatment plan, the children were divided into the eltrombopag combined with IST group (eltrombopag group) and the IST group. Binary Logistic regression model was used to analyze the factors affecting the efficacy of the two groups at 6 months of treatment, and the factors affecting the efficacy of the eltrombopag group at the end of follow-up. Results: There were 75 cases (45 males and 30 females) in the eltrombopag group. The age of diagnosis was 5.9 (3.5, 8.5) years. There were 49 patients in the IST group, including 23 males and 26 females, whose age at diagnosis was 6.2 (4.4, 8.8) years. The absolute lymphocyte count before treatment in the eltrombopag group was significantly lower than that in the IST group (1.1 (0.4, 1.6)×109 vs. 2.1 (1.4, 2.8)×109/L). Absolute reticulocyte count in the eltrombopag group was significantly higher than that of IST group (26.9 (8.7, 54.2)×109 vs. 9.5 (4.0, 19.0)×109/L) (both P<0.05). Influencing factors of 6-month response: a comparison between response and un-response groups in the eltrombopag treated patients showed that, before treatment, hemoglobin (69 (61, 78) vs. 64 (59, 68) g/L), platelet (10 (6, 16)×109 vs. 6 (3, 8)×109/L), absolute reticulocyte count (ARC) (34.0 (15.8, 57.3)×109 vs. 6.5 (4.6, 16.8)×109/L) and the response rate to granulocyte colony stimulating factor (G-CSF) after treatment (82.4% (47/57) vs. 9/18) were significantly different (all P<0.05). Logistic regression model analysis showed that ARC (OR=1.09, 95%CI 1.02-1.18) and absolute neutrophil count were independent influencing factors of 6-month response rate in the eltrombopag group (OR=0.00, 95%CI 0.00-0.89). ARC was also the independent influencing factors of the end of follow-up response rate in the eltrombopag group (OR=1.04, 95%CI 1.01-1.07). Conclusions: Pre-treatment blood count and response to G-CSF were predictors of overall response to eltrombopag combined with IST. The higher the ARC before treatment, the higher the total response rate and complete response.

Comparison of clinical features of patients with or without severe gastrointestinal complications in aggressive gastrointestinal lymphomas.

Aggressive primary gastrointestinal non-Hodgkin lymphoma (PGINHL) is an uncommon and heterogeneous group of lymphoid malignancies, that differs from indolent lymphoma and has a high incidence of severe gastrointestinal complications (GICs). To investigate and compare the clinicopathological characteristics, treatments and outcomes in the GICs and No-GICs group with aggressive PGINHL. This retrospective analysis was performed on aggressive PGINHL patients between January 2013 and December 2021 at our hospital. The independent influence factors of GICs were obtained by univariate and multivariate Logistic regression analysis, the selected variables significantly related to GICs were selected as the final predictors to construct nomogram. Kaplan-Meier curves further analyzed the survival of patients in GICs and No-GICs groups. Survival analysis of GICs group was performed using Cox regression. We focused on 124 aggressive PGINHL cases, which had a relatively high incidence 48.4% (60/124 cases) of GICs, the most common histological type in GICs group was diffuse large B-cell lymphoma (DLBCL) (n = 49, 81.7%). In the GICs group, small intestine was the most common anatomic site of lesion (43.3%), followed by large intestine (31.7%), and then stomach and esophagus (25.0%). Multivariate Logistic regression analysis showed that the independent risk factors for GICs were the small intestine [odd ratio (OR) = 3.33; 95% confidence interval (CI): 1.47-9.41; P = 0.009), aggressive B-cell (OR = 0.09; 95%CI: 0.01-0.83; P = 0.033), maximum tumor diameter (OR = 1.25; 95%CI: 1.07-1.47; P = 0.005), invaded deep serous layer (OR = 3.38; 95%CI: 1.24-9.19; P = 0.017). We developed a nomogram to predict risk of GICs in aggressive PGINHL patients based on independent risk factors. The value of area under curve calculated by receiver operating characteristic curve was 0.815, and calibration curve and decision curve analysis further indicated that the prediction effect was superior. The majority of patients with GICs were given combination therapy (chemotherapy combined with surgery or radiation). Event-free survival and overall survival in GICs group were no worse than those in the No-GICs group. The complication rate of GICs in patients with aggressive PGINHL was relatively high, particularly in PGI-DLBCL. The independent risk factors for GICs were the small intestine, PGI-TNKL, bulky tumor, and depth of invasion. A combination treatment, involving surgery, improved survival in the GICs group.

Analysis of influencing factors of clinical pregnancy rate in second cycle intrauterine insemination.

To explore the factors influencing the clinical pregnancy rate in the Reproductive Center of the Affiliated Hospital of North Sichuan Medical College in the second cycle, a retrospective analysis of the clinical data of 175 patients who underwent the second cycle of intrauterine insemination (175 cycles) from July 2019 to July 2022 was performed. According to whether the patients reached clinical pregnancy, they were divided into the pregnant group (32 cycles) and non-pregnant group (143 cycles). The age, infertility years, infertility factors, infertility type, number of sinus follicles, intimal thickness, intimal type, basal follicle-stimulating hormone, basal luteinizing hormone, basal estradiol, stimulation regimen, season, body mass index, and male semen quality were statistically analyzed between the 2 groups. The number of intrauterine insemination (IUI) in the second cycle was 175, and the clinical pregnancy rate was 18.3% (32/175). The age of the pregnant group was lower than that of the non-pregnant group [(26.7 ± 1.07) vs (30.56 ± 0.51), P = .05]. The clinical pregnancy rate in patients aged ≤30 years was significantly higher than that in patients aged > 30 years [28.6% vs 7.1%, P < .05]. Among infertility factors, the pregnancy rate of patients who underwent IUI due to female factors was significantly higher than that of male factors, combined factors (both male and female), and unexplained infertility, and the differences were statistically significant [37.1% vs 22.4%, 18.2%, 3.2%, P < .05]. In multivariate logistic regression analysis, age and infertility factors were independent influencing factors of clinical pregnancy rate in the second cycle of IUI. In, while in artificial insemination, female age and infertility factors were important factors affecting the clinical pregnancy rate of the second cycle of IUI. If the outcome of the first cycle is not pregnant, the female age is <30 years, infertility is the female factor, and the second cycle of IUI can be considered.

Disparities in SGLT2i utilization among heart failure patients with different ejection fraction in China: findings from chinese cardiovascular association database-heart failure center registry

Abstract Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended for heart failure (HF) patients regardless of left ventricular ejection fraction (LVEF). Although Chinese HF guidelines still recommend traditional renin–angiotensin–aldosterone system inhibitors, beta blockers, mineralocorticoid receptor antagonists, the Chinese Cardiovascular Association (CCA) HF Center Registry has launched a project to promote the guideline-directed medical therapy (GDMT) for HF patients in China. However, data on the utilization of GDMT in Chinese HF patients is scarce, especially SGLT2i. Purpose We aimed to investigate the usage status of SGLT2i in HF patients with different LVEFs and explore associated factors with SGLT2i adoption in hospitalized HF Chinese patients. Methods This is a retrospective real world study using data from the CCA Database-HF Center Registry. The study included HF patients hospitalized in 52 secondary or tertiary hospitals, including 26 accredited heart failure centers (HFC) and 26 non-accredited heart failure centers (NHFC). Centers that meet the 25 quality control standards established by CCA can be accredited as HFC. We evaluated the use rate of SGLT2i overall and by HF type, as well as the change of SGLT2i usage rate at discharge during the study period from 1st July 2022 to 31st March 2023. LASSO and multivariable logistic regression were also used to explore associated factors of SGLT2i adoption at discharge. Result We included 8,843 hospitalized HF patients: 5,326 (60.2%) were male, 2,980 (33.7%) HFrEF, 1,624 (18.4%) HFmrEF, 3,653 (41.3%) HFpEF and 586 (6.6%) lacked EF data. Overall, SGLT2i were adopted in 3,666 (41.5%) HF patients at discharge (58.1% in HFrEF, 45.3% in HFmrEF, 28.8% in HFpEF). Overall, the usage rate of SGLT2i at discharge rose from 35.2% to 50.2%. Specifically, for HFrEF patients, there was a rise from 56.2% to 64.4%. For HFmrEF and HFpEF patients, the usage rate increased from 37.5% to 54.4% and from 22.2% to 35.7%, respectively (Figure 1). The usage rate of SGLT2i was higher in HFC compared with NHFC (47.1% vs. 35.8%, p&amp;lt;0.001). In multivariable logistic regression, older age, new-onset heart failure, hospital location, etc. were associated with a lower usage rate of SGLT2i at discharge. In contrast, HFC, dilated cardiomyopathy, obesity, etc. were associated with a higher utilization rate of SGLT2i (Figure 2). HF classification by LVEF was also an independent influencing factor even after adjusting other factors; when HFrEF was used as a reference, the use rate of SGLT2i was lower in HFmrEF (OR 0.79, 95% CI 0.69 - 0.91) and HFpEF (OR 0.44, 95% CI 0.39 - 0.49). Conclusion In clinical practice in China, the usage rate of SGLT2i for HF treatment is increasing but needs to be further improved. Disparities exist in usage rates among HF patients with different LVEFs. Addressing this disparity necessitates a targeted approach, emphasizing increased utilization in HF patients regardless of LVEF.SGLT2i usage rate in HFFactors affecting SGLT2i adoption in HF

Analysis factors influencing left ventricular thrombus in patients with non-ischemic heart failure

Objective: To explore the influencing factors of left ventricular thrombus (LVT) in patients with non-ischemic heart failure (NIHF) and to construct a nomogram prediction model for NIHF patients with LVT. Methods: This study was a case-control study. A total of 2 592 patients with NIHF hospitalized in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2018 to July 2022 were selected. Fifty-one patients with LVT identified by echocardiography and cardiac magnetic resonance were classified into LVT group. One hundred and sixty patients were selected as the non-LVT group using a 1∶3 propensity score matching based on age and gender. Multivariate logistic regression analysis was used to explore the influencing factors of LVT in patients with NIHF. A nomogram prediction model was constructed, and the area under (AUC) the receiver operating characteristic (ROC) curve was calculated to evaluate the predictive effect of the model. Results: A total of 211 patients were enrolled, with a median age of 40 years old and 160 males (76%). Compared with non-LVT group, LVT group had lower systolic blood pressure ((112±20) mmHg vs. (120±19) mmHg; 1 mmHg=0.133 kPa), lower left ventricular ejection fraction (LVEF; (27±12)% vs. (39±14)% ), lower proportion of patients with history of hypertension (28% (14/51) vs. 44% (70/160)) and atrial fibrillation (8% (4/51)vs.39% (62/160)), higher proportion of patients with New York Heart Association functional class Ⅲ to Ⅳ (class Ⅲ: 59% (30/51) vs. 41% (66/160); class Ⅳ: 28% (14/51) vs. 19% (31/160)), and larger left ventricular end-systolic diameter (LVESD; (56±14) mm vs. (50±15) mm). The levels of hemoglobin ((152±23) g/L vs. (142±30) g/L), D-dimer (508 (300, 1 105) μg/L vs. 158 (68, 379) μg/L), and N-terminal pro-brain natriuretic peptide (3 429 (2 462, 4 734) ng/L vs. 1 288 (422, 2 544) ng/L) were higher in LVT group than in non-LVT group (P all<0.05). LVT group had a higher proportion of patients using beta-blockers (92% (47/51) vs. 78% (124/160)), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers or angiotensin receptor neprilysin inhibitors (88% (45/51) vs. 72% (115/160)), and anticoagulant drugs (98% (50/51) vs. 32% (51/160)) than non-LVT group (all P <0.05). Multivariate logistic regression showed that reduced LVEF (OR=1.08, 95%CI 1.02-1.15, P=0.008), decreased LVESD (OR=1.07, 95%CI 1.01-1.12, P=0.013), and increased D-dimer levels (OR=5.40, 95%CI 1.98-14.74, P=0.001) were independent influencing factors for LVT in patients with NIHF. The ROC curve showed that the AUC of the nomogram for predicting LVT in patients with NIHF was 0.793 (95%CI 0.710-0.876, P<0.001). Conclusion: Reduced LVEF, decreased LVESD, and elevated D-dimer are associated with LVT in NIHF patients. The predictive model developed based on the above indicators has certain value in predicting LVT in NIHF patients.

Nonlinear association between alanine aminotransferase to high-density lipoprotein cholesterol ratio and risk of gestational diabetes mellitus

Previous studies have indicated a potential association between the alanine aminotransferase to high-density lipoprotein cholesterol (ALT/HDL-C) ratio and the risk of Type 2 Diabetes Mellitus, but its relation with gestational diabetes mellitus (GDM) remains uncertain. This study aims to investigate the correlation between the ALT/HDL-C ratio in early pregnancy and the risk of GDM. This study is a secondary analysis based on an open-source cohort study. A total of 590 single pregnant women attending two hospitals in Korea up to 14 weeks gestation were included between November 2014 and July 2016. Logistic regression analysis, subgroup analysis, and smooth curve fitting were employed to explore the association between the ALT/HDL-C ratio and GDM risk. The predictive capability of the ALT/HDL-C ratio for GDM was assessed using ROC curve analysis. The average age of participants was 32.06 ± 3.80 years, with a GDM incidence rate of 6.27%. Multifactorial logistic regression analysis revealed that the serum ALT/HDL-C ratio is an independent influencing factor for GDM (OR = 1.08, 95% CI: 1.02–1.16). Furthermore, a non-linear relationship between the ALT/HDL-C ratio and GDM risk was observed, with a turning point at 5.51. The effect size (OR) on the left and right sides of the turning point were 0.75 (95% CI: 0.37–1.59) and 1.55 (95% CI: 1.18-2.00), respectively. Additionally, when combined with age, pre-pregnancy body mass index, parity, and insulin resistance index in a prediction model for GDM, the ALT/HDL-C ratio demonstrated improved sensitivity of prediction by reaching up to 67.6%, specificity of prediction by reaching up to 87.3%, and an area under curve value of 0.819 (95%CI: 0.743–0.894). In early pregnancy, the serum ALT/HDL-C ratio shows a positive correlation with maternal risk in a nonlinear manner. The combination of ALT/HDL-C ratio with maternal characteristics and metabolic indicators provides good predictive value for GDM. This study may facilitate optimization of GDM prevention in pregnant women and enable timely and effective intervention to enhance their prognosis.

Futile recanalization after endovascular treatment in acute ischemic stroke with large ischemic core

BackgroundEndovascular therapy (EVT) is the treatment of choice for acute ischemic stroke (AIS) with large vessel occlusion. However, in many patients, successful EVT recanalization does not correspond to a clinical improvement, called futile recanalization (FR). We aimed to identify stroke risk factors and patient characteristics associated with FR in AIS with large core infarct (LCI).MethodsA total of 137 patients with AIS with LCI treated by EVT at a single stroke center were retrospectively included from January 2016 to June 2023. LCI was defined by Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECT) < 6. Patient age, sex, modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), time to treatment, risk factors, and radiologic findings were collected, and potential associations with FR were analyzed. FR was defined as successful reperfusion with modified Thrombolysis in Cerebral Infarction (mTICI) ≥ 2b but without functional independence at 90 days (mRS ≥ 3). A multivariate logistic regression analysis was conducted on the clinical characteristics of patients, based on the presence or absence of FR, and the factors influencing FR.ResultsOf 137 patients, 120 showed successful recanalization (mTICI ≥ 2b). All patients were divided into FR (n = 80) and no FR (n = 40) groups. Older age (odds ratio [OR] 1.052, 95% confidence interval [CI] 1.002–1.105; p = 0.041), the higher the initial NIHSS score (OR 1.181, 95% CI 1.037–1.344; p = 0.012), and prior intravenous plasminogen activator (OR 0.310, 95% CI 0.118–0.813, p = 0.017) were independent influencing factors of FR.ConclusionsThe older age, the higher the initial NIHSS, and not receiving intravenous plasminogen activator were independently associated with FR in AIS with LCI. These factors could identify poor responders to EVT recanalization.

Diagnostic value of baseline 18F-FDG PET/CT and peripheral blood inflammatory markers for aggressive lymphoma in non-Hodgkin's lymphoma.

This study aims to investigate the diagnostic value of baseline F18 fluorodeoxyglucose (FDG) PET/computed tomography (CT) parameters and peripheral blood inflammatory markers in aggressive lymphoma of non-Hodgkin lymphoma (NHL) and the correlation between peripheral blood inflammatory markers and maximum standardized uptake value (SUVmax). We conducted a retrospective analysis including 121 patients with NHL. Patients were divided into aggressive lymphoma group and indolent lymphoma group. Mann-Whitney U test, chi-square test and multivariate stepwise logistic regression were used to analyse. Subsequently, receiver operating characteristic (ROC) curve analysis was conducted to evaluate the diagnostic performance. Additionally, Spearman correlation analysis was utilized to explore the correlation between peripheral blood inflammatory markers and SUVmax. Leptin mass criterion uptake value (SUL)max, SUVmax, SUVavg, SUVpeak, focal SUVmax/liver SUVmax, focal SUVmax/ mediastinal SUVmax, SULavg, SULpeak, systemic immune-inflammation, neutrophil ratio, total lesion glycolysis, neutrophils versus lymphocyte ratio, platelet-to-lymphocyte ratio, hemoglobin-to-white blood cell ratio, lactate dehydrogenase and lymphocyte ratio between two groups were statistically significant (P < 0.05). SUVmax was an independent influencing factor, and the area under the ROC curve was 0.862. There was a positive correlation between the platelet-to-lymphocyte ratio and SUVmax (r = 0.239; P = 0.008). PET/CT parameters and peripheral blood inflammatory markers have certain value in the diagnosis of aggressive lymphoma in NHL, among which SUVmax is an independent influencing marker and is positively correlated with PLR.

Development and Validation of a Nomogram Prediction Model for Moderate-to-Severe Acute Radiation Dermatitis in Patients with Breast Cancer: A Retrospective Study.

Aims/Background Acute radiation dermatitis is the most common complication of radiotherapy in patients with breast cancer, with mild severity relieved by symptomatic treatment and moderate-to-severe severity leading to compromised skin integrity and affecting the patient's quality of life. Therefore, this study aims to develop a prediction model for moderate-to-severe acute radiation dermatitis in patients with breast cancer to reduce its severity. Methods A retrospective analysis of 713 patients receiving radiotherapy for breast cancer at the Affiliated Cancer Hospital of Xinjiang Medical University from January 2019 to December 2023 was conducted, with January 2019 to December 2021 serving as the training group (497 patients) and January 2022 to December 2023 serving as the validation group (216 patients). Patients in the training group were classified as having mild (383 patients) or moderately severe (114 patients) acute radiation dermatitis. Binary logistic regression was used to analyze the independent effects on moderately severe acute radiation dermatitis in patients with breast cancer, and a predictive model of the bar-folding plot was constructed and validated. Results Univariable analysis revealed that age, body mass index, targeted therapy, oral tamoxifen use, hyperlipidemia, diabetes, positive regional lymph node metastasis, value-added index, and triple-negative breast cancer were factors influencing moderate-to-severe acute radiation dermatitis in patients with breast cancer. Multivariate analysis showed that body mass index, hyperlipidemia, diabetes, positive regional lymph node metastasis, and value-added index were independent influencing factors for moderate-to-severe acute radiation dermatitis in patients with breast cancer. A nomogram prediction model was constructed, and the area under the receiver operating characteristic curve of the model was 0.814 and 0.743 for internal and external validation, respectively. The calibration curve showed that the model predicted moderate-to-severe acute radiation dermatitis better, and the decision curve analysis curve showed that the model had a high clinical benefit. Conclusion This risk prediction model can predict moderate-to-severe acute radiation dermatitis in patients with breast cancer, and help clinical providers screen high-risk patients and reduce acute radiation dermatitis severity.

Study on the variation characteristics of serum lymphocyte subsets, immunoglobulins, and complement levels in patients with cheilitis

Objective: To analyze the variations of serum lymphocyte subsets, immunoglobulins, and complement levels in patients with cheilitis, and to explore the associations between the changes in serum immune levels and the onset of cheilitis. Methods: A retrospective analysis was conducted on 153 patients with cheilitis who visited the Department of Stomatology, The First Affiliated Hospital of Zhengzhou University from January 2017 to December 2023. They were compared with 50 healthy individuals who visited the physical examination department during the same period. The changes of serum lymphocyte subsets, immunoglobulins, and complement levels in patients with cheilitis were analyzed. Main detection indicators as the percentage of total T lymphocytes (T%), helper/inducer T lymphocytes (CD4+T%), absolute numbers of total T lymphocytes (T#), absolute numbers of helper/inducer T lymphocytes (CD4+T#), percentage of natural killer cells (NK%), absolute numbers of B lymphocytes (B#), immunoglobulins IgG, IgM and complement C3, C4 were included. Multivariate logistic regression was used to explore the relationship between serum lymphocyte subsets, immunoglobulins, complement levels and cheilitis. Subgroup analysis was further conducted on patients with cheilitis based on gender, age, cheilitis type and severity. Results: The levels of T% [69.54% (64.41%, 75.14%)], CD4+T% [(35.09±7.10)%], T# [1 328.00 (1 054.00, 1 560.50)], and CD4+T# [653.00 (505.00, 831.50)] in the cheilitis group were significantly lower than those in the control group respectively [72.33% (69.41%, 75.47%), (39.07±5.84)%, 1 483.50 (1 245.75, 1 805.25), 769.00 (687.25, 933.00), with the corresponding statistical test results of Z=-2.64, P=0.008; t=3.58, P<0.001; Z=-2.80, P=0.005; Z=-3.80, P<0.001]. The level of NK% [16.21% (12.16%, 21.29%)] was significantly higher in the cheilitis group compared to the control group [14.61% (10.97%, 17.87%)] (Z=-2.28, P=0.023). IgG [12.29 (10.77, 13.73) g/L] and IgM levels [1.18 (0.86, 1.58) g/L] were significantly higher in the cheilitis group than in the control group respectively [11.52 (10.16, 12.91) g/L, 0.99 (0.77, 1.26) g/L] (Z=-2.24, P=0.025; Z=-2.10, P=0.036), while complement C3 [(1.09±0.17) g/L] and C4 levels [0.23 (0.19, 0.28) g/L] were significantly lower in the cheilitis group compared to the control [(1.18±0.17) g/L, 0.31(0.24, 0.35) g/L] (t=3.10, P=0.002; Z=-4.79, P<0.001). Logistic regression analysis showed that elevated IgG (P=0.021), decreased C4 (P<0.001), decreased CD4+T% (P=0.003), and decreased T# (P=0.035) were independent influencing factors for the occurrence of cheilitis. The rate of abnormal lymphocyte immune analysis in the cheilitis group [68.0% (104/153)] was significantly higher than that in the control group [24.0% (12/50)] (χ2=29.76, P<0.001). The rate of abnormal immunoglobulin and complement detection in the cheilitis group [41.8% (64/153)] was significantly higher than that in the control group [4.0% (2/50)] (χ2=24.58, P<0.001). The rate of detection abnormalities in female patients with cheilitis [51.5% (53/103)] was significantly higher than in male ones [22.0% (11/50)] (χ2=12.00, P=0.001). Patients with granulomatous cheilitis had significantly lower levels of T# [1 136.50 (663.75, 1 310.50)] and B# [162.50 (104.00, 225.50)] compared to those with chronic cheilitis [1 366.00 (1 063.03, 1 602.00), 202.48 (148.00, 298.00)] (Z=-2.35, P=0.019; Z=-2.16, P=0.031). Conclusions: Patients with cheilitis exhibit a certain degree of imbalance on cellular immunity, humoral immunity, and innate immunity, which may be related to the onset of cheilitis.

Construction and validation of a predictive model for the return to work of patients with permanent colorectal stoma: a cross-sectional study

BackgroundThe issue of patients returning to work is increasingly garnering attention from countries worldwide. This study aims to investigate the risk factors associated with patients returning to work after undergoing permanent enterostomies. Additionally, it seeks to establish and validate a nomogram prediction model, thereby providing a more effective reference for patients aiming to return to work.MethodsThis study was a cross-sectional investigation conducted between September 2022 and September 2023. We conveniently selected 293 postoperative patients with permanent colorectal stomas due to colorectal cancer from three tertiary hospitals in Liaoning Province. Participants were categorized into Returned and Non-Returned groups based on their return to work status. Data were collected using a general information questionnaire, a Stoma Acceptance Questionnaire, and the Ostomy Adjustment Inventory. Binary logistic regression analysis was performed using SPSS 25.0 software to identify independent influencing factors. A predictive model was constructed using R Studio 4.3.0 software. Internal validation was conducted through 1,000 rounds of Bootstrap resampling, and model performance was assessed using Receiver Operating Characteristic (ROC) curves, the Hosmer-Lemeshow (H-L) test, and calibration curves.ResultsAfter surgery, the return-to-work rate for patients with permanent colorectal stomas was 29.69%. Age, education level, postoperative time, stoma complication, adjuvant therapy, stoma acceptance score, and ostomy adjustment inventory score were identified as independent factors influencing the return-to-work status of these patients (P < 0.05). These factors were incorporated into a logistic regression model generated by R software, resulting in a ROC curve with an area under the curve (AUC) of 0.916 (95% CI: 0.884–0.947). The Youden index was 0.731, and the cutoff value was 0.228. Sensitivity and specificity were 0.920 and 0.811, respectively. The H-L test demonstrated good model fit (χ2 = 12.858, P = 0.117, P > 0.05). Calibration curves indicated a close alignment between predicted and actual probabilities.ConclusionsThe postoperative return-to-work rate is low in patients with permanent enterostomies. The prediction model developed in this study demonstrates strong performance and offers predictive value, providing a scientific foundation for assessing patients’ return to work. Caregivers should prioritize the early identification of various patient types for proactive intervention to enhance the rate of postoperative return to work.

Correlation between abdominal visceral fat and the risk of endometrial cancer in patients with polycystic ovary syndrome

Objective: To explore the correlation between abdominal fat and the occurrence risk of endometrial cancer (EC) in patients with polycystic ovary syndrome (PCOS). Methods: The clinical information of 120 PCOS patients receiving treatment in our hospital from March 2019 to April 2022 were included in this study. Patients were divided into two groups, endometrial cancer (EC, n=35) and normal group (NM, n=85). Statistical analysis included t-test, c2-test, and Pearson's correlation coefficient. We analysed the data using logistic regression. The predictive accuracy and discriminative ability of the prediction model were assessed by the area under the receiver operating characteristic (ROC) curve (AUC) and calibration curves. Results: The incidence rate of EC in women with PCOS is 10.91% (12/110). Significant differences were found in waist circumference, hypertension, diabetes, hyperlipidemia, body mass index (BMI), waist-hip ratio (WHR), insulin resistance index (HOMA-IR), visceral fat area (VFA) oestrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 (HER2), estradiol (E2), and luteinizing hormone (LH) between the two groups (P&lt;0.05). No statistical difference was found in age, hip circumference, menopause, use of intrauterine device, progesterone (P) and follicle-stimulating hormone (FSH) between the groups (P&gt;0.05). Multivariate logistic regression analysis showed that BMI, HOMA-IR, VFA and HER2 were independent influencing factors of EC in PCOS patients (P&lt;0.05). The AUC of BMI, HOMA-IR, VFA, HER2 were 0.878 (95%CI: 0.810~0.946), 0.831 (95%CI: 0.751~0.911), 0.816 (95%CI: 0.704~0.929) and 0.737 (95%CI: 0.634,0.840), respectively. The model had more diagnostic effectiveness (AUC=0.973). Conclusions: In PCOS disease, high-level BMI, HOMA-IR, VFA, and positive HER2 show an increased risk in the incidence of EC. These findings suggest that BMI, HOMA-IR, VFA, and HER2 are potential markers for Risk assessment of EC. HER2: Human epidermal growth factor receptor-2, E2: estradiol, P: progesterone, LH: Luteinizing hormone, FSH: Follicle-stimulating hormone. Keywords: Polycystic ovary syndrome; Abdominal visceral fat; Endometrial cancer; Occurrence risk.

Prevalence and Correlations of Premenstrual Dysphoric Disorder: A Sample of Adult Working Women.

Premenstrual dysphoric disorder (PMDD) represents a significant psychiatric condition affecting women of reproductive age. It is characterized by cyclical emotional and physical symptoms that considerably impair psychosocial functioning. This study aims to investigate the prevalence of PMDD among adult working women and identify associated etiological factors. From January 2022 to March 2022, a cross-sectional study utilizing cluster sampling methodology was conducted to investigate the prevalence of PMDD among adult working women in six communities in Hangzhou (China). A total of 1710 participants were selected for research through a questionnaire-based survey. To elucidate the factors associated with PMDD, logistic regression analysis was employed. Among 1710 working women, 52 had PMDD, representing an incidence of 3.04%. Age (odds ratio (OR) = 3.196, p = 0.002), age at menarche (OR = 0.362, p = 0.011), income (OR = 0.449, p = 0.043), menstrual cycle (OR = 2.352, p = 0.022), menstrual symptoms (OR = 0.317, p = 0.003), physical activity (OR = 2.234, p = 0.028), and caffeine intake (OR = 2.318, p = 0.022) were independent influencing factors of PMDD in adult working women. The study highlights that PMDD, which has a prevalence of 3.04% in the surveyed population, is a notable concern among adult working women. Key factors, such as age, age at menarche, income level, menstrual cycle characteristics, menstrual symptom presence, physical activity, and caffeine intake, significantly contribute to the likelihood of developing PMDD. These findings underscore the importance of recognizing and monitoring the above risk factors by clinicians to identify and manage PMDD in working women.