Independent Protective Factor Research Articles

Prevalence and associated risk factors of Helicobacter pylori infection in community households in Lanzhou city

BACKGROUND Helicobacter pylori (H. pylori ) infection exhibits a familial clustering phenomenon. AIM To investigate the prevalence of H. pylori infection, identify associated factors, and analyze patterns of transmission within families residing in the community. METHODS From July 2021 to September 2021, a total of 191 families (519 people) in two randomly chosen community health service centers in the Chengguan District of Lanzhou in Gansu Province, were recruited to fill out questionnaires and tested for H. pylori infection. Individuals were followed up again from April 2023 and June 2023 to test for H. pylori infection. The relationship between variables and H. pylori infection was analyzed using logistic regression and generalized linear mixed models. RESULTS In 2021, the individual-based H. pylori infection rate was found to be 47.0% (244/519), which decreased to 38.1% (177/464) in 2023. Additionally, the rate of individual-based H. pylori new infection was 22.8% (55/241). The family-based H. pylori infection rate in 2021 was 76.9% (147/191), which decreased to 67.1% (116/173) in 2023, and the rate of family-based H. pylori new infection was 38.6% (17/44). Individual H. pylori infection was positively correlated with age, body mass index (BMI), eating food that was excessively hot, frequent acid reflux, bloating, and halitosis symptoms, and negatively correlated with family size and nut consumption. New individual H. pylori infection was positively correlated with BMI, other types of family structures, drinking purified water, and frequent heartburn symptoms, while negatively correlated with the use of refrigerators and following a regular eating schedule. A larger living area was an independent protective factor for H. pylori infection in households. Frequently consuming excessively hot food and symptoms of halitosis were independent risk factors for H. pylori infection in individuals; frequent consumption of nuts was an independent protective factor for H. pylori infection. Other types of family structure, drinking purified water, and frequent heartburn symptoms were independent risk factors for new individual H. pylori infection; the use of a refrigerator was an independent protective factor for new H. pylori infections. CONCLUSION The household H. pylori infection rate in Lanzhou is relatively high and linked to socio-demographic factors and lifestyles. Eradication efforts and control of related risk factors are recommended in the general population.

Post-transplant complications revealed by mycophenolate mofetil related transporters and metabolic enzymes gene polymorphisms in pediatric patients with hematological disorders

BackgroundHaploidentical hematopoietic stem cell transplantation (Haplo-HSCT) serves as an important option for patients without an HLA matched donor in treating hematological disorders, while patients may experience various complications after transplantation. Mycophenolate mofetil (MMF), a cornerstone drug for graft-versus-host disease (GvHD) prophylaxis, effectively reduces the incidence of acute GvHD, and the efficacy of MMF varies among individuals associated with MMF-related transporters and metabolic enzymes single nucleotide polymorphisms (SNPs). However, limited studies have systematically reported the correlations between the MMF-related SNPs and post-transplant complications.MethodsHere, we conducted a retrospective study involving 90 pediatric patients with hematological disorders who underwent haplo-HSCT at a single center. All patients were subjected to MMF-related SNP testing, combined with common clinical characteristics, to be correlated with post-transplant complications.ResultsWe observed that all 15 MMF-related SNPs were in Hardy-Weinberg equilibrium. Based on multivariate Cox regression analysis of post-transplant complications, we discovered that SLCO1B1 (521T > C) variant genotype was an independent protective factor for chronic GvHD (HR = 0.25, 95% confidence interval (CI) (0.08–0.84)). For viral infection, CYP2C8 (1291 + 106T > C) variant genotype was an independent risk factor for cytomegalovirus infection (HR = 2.98, 95% CI (1.18–7.53)). As to hemorrhagic cystitis, SLCO1B1 (1865 + 4846T > C) variant genotype was an independent protective factor, while older age was considered as an independent risk factor (HR = 0.41, 95% CI (0.19–0.85); HR = 2.52, 95% CI (1.14–5.54), respectively). No statistical significance was discovered between common clinical characteristics and MMF-related SNPs with other complications, including grade II-IV/III-IV acute GvHD, Epstein-Barr virus infection, peri-engraftment syndrome, and capillary leak syndrome. We also discovered SLCO1B1 (597 C > T) and SLC29A1 (-162 + 228 A > C) variant genotypes are both independent factors for cumulative incidence of relapse after haplo-HSCT (HR = 4.02, 95% CI (1.42–11.44); HR = 0.18, 95% CI (0.07–0.43), respectively).ConclusionsOur findings highlight the significance of MMF-related transporters and metabolic enzymes SNPs in the development of post-transplant complications, contributing to facilitating personalized risk assessment and improving the clinical management in haplo-HSCT patients.

Combined inflammation-related biomarkers and clinicopathological features for the prognosis of stage II/III colorectal cancer by machine learning

BackgroundInflammation-related biomarkers, such as systemic inflammation score (SIS) and neutrophil–lymphocyte ratio (NLR), are associated with colorectal cancer prognosis. However, the combined role of SIS, NLR, and clinicopathological factors in stage II/III colorectal cancer remains unclear. This study developed a nomogram to predict long-term prognosis for these patients.MethodsThis retrospective study included 1540 patients (training set) from the First Affiliated Hospital of Kunming Medical University and 152 patients (testing set) from The Honghe Third People's Hospital. Cox regression identified independent prognostic factors, and machine learning established predictive models. Model performance was evaluated by the C-index, area under the curve (AUC), and decision curve analysis (DCA).ResultsIn the training set, a total of 1540 patients with stage II/III colorectal cancer were included. More than 70 years old (HR = 1.830, p = 0.000); SIS = 2 (HR = 1.693, p = 0.002); Preoperative CEA more than 5 ng/mL (HR = 1.614, p = 0.000); and Moderately differentiated (HR = 1.438, p = 0.011); or Low/undifferentiated (HR = 2.126, p = 0.000); The pN1 (HR = 2.040, p = 0.000) and pN2 (HR = 3.297, p = 0.000) stages were considered independent prognostic risk factors of stage II/III colorectal cancer. Negative perineural invasion (HR = 0.733, p = 0.014) and NLR less than 4 (HR = 0.696, p = 0.022) were considered independent prognostic protective factors of stage II/III colorectal cancer. A nomogram was established based on SIS, NLR, and the clinicopathological results for predicting and validating the overall survival in the training and testing sets. The C-index of the training set was 0.746, and the C-index of the testing set was 0.708, indicating the high prediction efficiency of the nomogram.ConclusionsA nomogram combining SIS, NLR, and clinicopathological factors provides an effective, cost-efficient tool for predicting the prognosis of stage II/III colorectal cancer. Future studies will validate its long-term predictive performance in larger, multicenter cohorts.

A nomogram model to predict non-retrieval of short-term retrievable inferior vena cava filters

ObjectiveTo develop and validate a nomogram for predicting non-retrieval of the short-term retrievable inferior vena cava (IVC) filters.MethodsIn this study, univariate and multivariate logistic regression analyses were performed to identify predictive factors of short-term retrievable filter (Aegisy or OptEase) non-retrieval, and a nomogram was then established based on these factors. The nomogram was created based on data from a training cohort and validated based on data from a validation cohort. The predictive value of the nomogram was estimated using area under the curve (AUC) and calibration curve analysis (Hosmer-Lemeshow test).ResultsA total of 1,321 patients who had undergone placement of short-term retrievable filters (Aegisy or OptEase) were included in the analysis. The overall retrieval rate was 68.7%. Age, proximal and distal deep vein thrombosis (DVT) vs. distal DVT, active cancer, history of long-term immobilization, VTE was detected in the intensive care unit, active/recurrent bleeding, IVC thrombosis, and history of venous thromboembolism were independent predictive risk factors for non-retrieval of filters. Interventional therapy for DVT, acute fracture, and interval of ≥14 days between filter placement and patient discharge were independent protective factors for non-retrieval of filters. The nomogram based on these factors demonstrated good ability to predict the non-retrieval of filters (training cohort AUC = 0.870; validation cohort AUC = 0.813.ConclusionThis nomogram demonstrated strong predictive accuracy and discrimination capability. This model may help clinicians identify patients who are not candidates for short-term retrievable filter placement and help clinicians make timely, individualized decisions in filter choice strategies.

Different antiplatelet regimens for stenting versus coiling for acutely-ruptured cerebral aneurysms

To investigate the safety, efficacy and risk factors for complications of stenting with optional coiling versus coiling alone for acutely ruptured cerebral aneurysms (ARCAs) using different antiplatelet schemes, 2021 patients were prospectively enrolled into the stenting group (n = 967) and the coiling group (n = 1054). Four different antiplatelet regimens were used. The clinical and treatment data were analyzed and compared. In the stenting group, the common antiplatelet regimen was applied in 259 patients (26.8%), loading regimen in 210 (21.7%), intravenous tirofiban regimen in 240 (24.8%), and premedication free regimen in 258 (26.7%). The aneurysm occlusion degrees in the coiling vs. stenting group were not significantly (P > 0.05) different after treatment. Complications occurred in 168 (15.94%) and 171 (17.68%) patients in the coiling and the stenting group, respectively. Fifteen (1.55%) patients experienced stent-related ischemic complications. The only significant (P < 0.05) independent protective factor for complete occlusion was stent-assisted coiling in the stenting group but aneurysm daughter sac in the coiling group. Significant (P < 0.05) independent risk factors for poor mRS (3–6) were posterior circulation aneurysms and neurological bleeding complications in the stenting group and neurological complications in the coiling group. In the stenting group, the only independent risk factor was parent artery stenosis for neurological complications, Raymond grade III for neurological ischemic complications, and the ice cream technique for total complications in the stenting group. In conclusion, different antiplatelet schemes can be safely and efficiently used for intracranial stenting with optional coiling as compared with coiling alone for ARCAs.

Relationship between IgM deposition in the mesangial region and the prognosis of IgA nephropathy: a single-centre retrospective study

ObjectiveThe aim of this study was to investigate the prognostic value of mesangial IgM deposition in a long-term follow-up cohort of patients with immunoglobulin A nephropathy (IgAN).MethodsA retrospective analysis of clinicopathological data from 774 patients with primary IgAN at Hangzhou Hospital of Traditional Chinese Medicine between January 1, 2016, and December 31, 2018, was conducted. Patients were categorized into end-event and non-end-event groups according to whether they reached the renal composite endpoint, defined as a ≥ 50% decline in eGFR or progression to end-stage renal disease (ESRD). Risk factors for adverse renal outcomes were evaluated via univariate and multivariate Cox regression models. Patients were further divided into three groups on the basis of IgM deposition levels in the glomerular mesangial area: IgM-negative, low (IF < 2+), and high (IF ≥ 2+). Comparative analyses of clinical and histopathological characteristics, along with treatment regimens, were performed across these groups.ResultsCompared with the IgM-negative and low-deposition groups, the high-IgM deposition group exhibited significantly lower serum albumin and eGFR levels and higher cholesterol, 24-hour urine protein, and blood immunoglobulin M levels. Multivariate Cox regression analysis identified immunosuppressant use as an independent protective factor for IgAN prognosis, whereas low serum albumin, T2 lesions, and nephropathological IgM deposits were recognized as independent risk factors for the 5-year prognosis of patients with IgAN. Kaplan‒Meier survival curves revealed that patients with high IgM deposition had markedly poorer prognoses than those with negative or low IgM deposition.ConclusionIn addition to low serum albumin and T2 lesions, IgM deposition in the mesangial region has emerged as an independent risk factor for the 5-year prognosis of patients with IgAN.

The relationship between marital status and survival in primary bone cancer: a population-based study.

Previous studies have demonstrated a significant impact of marital status on the prognosis of various cancers; however, its specific influence on the prognosis of primary bone cancer remains insufficiently investigated. In this study, we aimed to investigate the survival differences between male and female in patients diagnosed with primary bone cancer. Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify suitable patients. Patients were categorized into married and unmarried groups, with a 1:1 propensity score matching (PSM) method used to balance baseline characteristics between the two groups. Kaplan-Meier curves and Log-rank tests were then employed to ascertain differences in overall survival (OS) and cancer-specific survival (CSS) between the groups, followed by gender-based subgroup analyses. A multivariate Cox regression was finally conducted to adjust for the effects of covariates. A total of 8,208 patients were included in this study, comprising 4,650 married and 3,558 unmarried individuals. Significant baseline characteristic differences were observed between the two groups before PSM. After PSM, 3,138 patients from each group were included, with balance maintained in all considered baseline characteristics. Before PSM, married patients had better OS [hazard ratio (HR) =0.93, 95% confidence interval (CI): 0.87-0.99, P=0.047] compared to unmarried patients, but no significant difference in CSS (HR =0.95, 95% CI: 0.88-1.03, P=0.21). Following PSM, married patients exhibited significantly better OS (HR =0.85, 95% CI: 0.79-0.92, P<0.001) and CSS (HR =0.92, 95% CI: 0.84-0.99, P=0.045) than unmarried patients. However, in subgroup analyses, the survival benefit attributed to marriage was observed only in females, not in males. In Cox regression, marriage was identified as an independent protective factor for OS (HR =0.86, 95% CI: 0.79-0.93, P<0.001) and CSS (HR =0.91, 95% CI: 0.82-0.97, P=0.04). In patients with primary malignant bone cancer, marriage is a protective factor for survival, but this effect appears to be limited to females.

Oncoplastic Surgery with Volume Replacement versus Mastectomy with Implant-Based Breast Reconstruction: Early Post-operative Complications in Patients with Breast Cancer.

Two common surgical approaches for breast cancer are breast-conserving surgery and mastectomy with implant-based breast reconstruction (MIBR). However, for large tumors, an alternative to MIBR is oncoplastic surgery with volume replacement (OPSVR). We performed a comprehensive analysis comparing OPSVR with MIBR, with our aim to focus on the 30-days post-operative complications between these two techniques. We conducted a retrospective cohort study using the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2020. Only breast cancer patients were included and were divided according to the surgical technique: OPSVR and MIBR. Logistic regression analysis was used to assess independent risk factors for total, surgical, and wound complications. A cohort of 8,403 breast cancer patients was analyzed. 683 underwent OPSVR and 7,720 underwent MIBR. From 2005 to 2020, the adoption of OPSVR gradually increased over the years (p<0.001), whereas MIBR decreased. OPSVR patients were older (57.04 vs. 51.89 years, p<0.001), exhibited a higher BMI (31.73 vs. 26.93, p<0.001), had a greater prevalence of diabetes mellitus (11.0% vs. 5.0%, p<0.001). They also had a higher ASA classification (2.33 vs. 2.15, p<0.001), shorter operative time (173.39 vs. 216.20 min, p<0.001), and a higher proportion of outpatient procedures (83.7% vs 39.5%, p<0.001). Outcome analysis demonstrated fewer total complications in the OPSVR patients, (4.2% vs. 10.9%, p<0.001), including lower rates of surgical complications (2.2% vs 8.0%, p<0.001) and wound complications (1.9% vs. 4.8%, p=0.005) compared to MIBR patients. Multivariate analysis identified OPSVR as an independent protective factor for total, surgical, and wound complications. OPSVR has become a favorable technique for patients with breast cancer. Even in patients with higher comorbidities, OPSVR demonstrates safe and better outcomes when compared to MIBR. It should be considered a reasonable and safe breast surgical option in the appropriate patient.

The diagnositic value of dynamic contrast-enhanced ultrasound for evaluation of tissue oxygen status in rat hepatoma model

BackgroundHypoxia is a characteristic of solid tumors, but whether significant hypoxia exists in the hepatocellular carcinoma remains unclear. This animal study aims to explore the value of dynamic contrast-enhanced ultrasound (CEUS) quantitative parameters to evaluate the oxygen status in two rat hepatoma models.Materials and methodsN1S1 and McA-RH7777 S-D rat orthotopic hepatoma models were established. Once the tumors reached a diameter of 10–15 mm, CEUS and oxygen partial pressure (pO2) polarography were performed. Immunohistochemical staining for HIF-1α and pimonidazole was conducted after euthanizing the rats. Correlation between quantitative CEUS parameters, pO2, and the immunohistochemical integrated optical density (IOD) was analyzed to assess the predictive ability of CEUS quantitative parameters for the tissue oxygen environment.ResultEleven N1S1 models and ten McA-RH7777 models were established successfully. There was no significant difference in pO2 (35.5 mmHg vs 32.2 mmHg, P = 0.917), IOD of HIF-1α (13.4 vs 20.0, P = 0.159) and pimonidazole (0.70 vs 1.30, P = 0.926) between the tumor and the peritumoral liver tissue. The pO2 values were correlated with CEUS quantitative parameters including mean time-intensity curves (mTIC) (P = 0.003), peak intensity (PKI) (P = 0.010), area under the curve (AUC) (P = 0.009), area under the wash-in curve (WiAUC) (P = 0.006), and arrival time (AT) (P = 0.033). The IOD of HIF-1α correlated with AUC (P = 0.022), WiAUC (P = 0.009), ascending slope (AS) (P = 0.044), and falling time (FT) (P = 0.009). Multiple linear regression indicated that the “short AT” was an independent protective factor for hypoxia (β = -2.347, 95% CI: -4.948, -0.394, P = 0.022), and CEUS had the ability to predict the tumor pO2 (P = 0.003).ConclusionNo evidence of significant hypoxia was identified in two rat orthotopic hepatoma models. Quantitative CEUS parameters correlated with the oxygen status of the tumor, which could be utilized to predict the tumor tissue pO2.

Analysis of influencing factors and construction of nomogram prediction model of postoperative kinesiophobia in patients undergoing total knee arthroplasty.

To explore the influencing factors of kinesiophobia and to establish a nomogram prediction model. A retrospective observational study was conducted in 354 patients who underwent TKA in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from December 2019 to December 2022. Sociodemographic characteristics, anesthesia methods, Tampa Scale for Kinesiophobia (TSK), numeric rating scale (NRS), hospital for special surgery (HSS), activities of daily living (ADL), and self-rating anxiety scale (SAS) were reviewed and analyzed. Logistic regression analysis was used to identify the influencing factors of kinesiophobia, and a nomogram model was established based on the identified influencing factors and verified by consistency index (C-index), calibration curve, and receiver operating characteristic (ROC) curve. Incidence of kinesiophobia in patients who received TEAS combined with western medicine (dexmedetomidine and remifentanil) was significantly lower than that in patients who received western medicine alone. The logistic regression analysis showed that family monthly income level, HSS, ADL, and combined TEAS and western medicine approach were independent protective factors for kinesiophobia (all P<0.05). The degree of pain and anxiety were independent risk factors for kinesiophobia (both P<0.05). A nomogram model was constructed with C-index of 0.721 (0.658, 0.784), and the area under curve (AUC) was 0.748 (95 %CI: 0.685-0.807). The calibration curve also showed good consistency between actual observations and nomogram model predictions. Family monthly income level, anesthesia methods, NRS, HSS, ADL, and SAS scores are influencing factors of kinesiophobia, and the nomogram model can be useful for predicting postoperative kinesiophobia.

Sex differences in prognosis of primary bone cancer: a propensity score-matched study

Abstract Objectives Sex differences in survival in primary bone cancer have not been fully explored. Hence, this study was conducted to investigate the impact of sex on survival outcomes in patients with primary bone cancer. Methods The Surveillance, Epidemiology, and End Results (SEER)-17 database was used to identify patients with primary bone cancer. One-to-one propensity score matching (PSM) was employed to balance baseline characteristics. Kaplan-Meier curves and log-rank tests were used to evaluate differences in cancer-specific survival (CSS) and overall survival (OS) between sexes. Multivariate Cox regression analysis was performed to verify the independent effect of sex on survival, and sensitivity analysis was performed to determine the robustness of the results. Results A total of 8,791 patients were included, with 4,928 males (56.1 %) and 3,863 females (43.9 %), and a median follow-up time of 38 months. After PSM, 3,812 males and 3,812 females were included in the study, with balanced baseline characteristics between the groups. Post-PSM, females show significantly better CSS (HR=0.88, 95 % CI, 0.81–0.96, p=0.004) and OS (HR=0.87, 95 % CI, 0.81–0.94, p&lt;0.001) compared to males. In multivariable Cox regression, the female sex was identified as an independent protective factor for both CSS (HR=0.86, 95 % CI, 0.79–0.94, p&lt;0.001) and OS (HR=0.83, 95 % CI, 0.77–0.89, p&lt;0.001). Conclusions Based on the analysis of SEER data with a large sample size, this study revealed that female patients with primary bone cancer have significantly better survival compared to males.

Predicting lymph node metastasis in papillary thyroid carcinoma with Hashimoto’s thyroiditis using regression and network analysis

The comprehensive study of the relationship between lymph node metastasis (LNM) and its associated factors in patients with concurrent papillary thyroid carcinoma (PTC) and Hashimoto’s thyroiditis (HT) remains insufficient. Building upon the initial investigation of factors associated with LNM in patients with concurrent PTC and HT, we further analyzed the complex relationships between different severity indicators of LNM and these associated factors. This study included patients confirmed PTC with HT who underwent total thyroidectomy at Xiangya Hospital, from January 2020 to December 2021. A total of 271 patients from 2020 were used as the training set, and 300 patients from 2021 as the validation set. Univariate analysis and regression modeling were used to identify key factors associated with LNM. Model reliability was assessed using the area under the receiver operating characteristic curve (AUC). Network analysis was employed to explore associations between LNM severity and its related factors. The regression model indicated that age, calcification, free triiodothyronine (FT3), and tumor maximum diameter (TMD) are independent factors for LNM. The severity model showed free thyroxine (FT4) and hemoglobin (Hb) are independent protective factors for the region and quantity of LNM, respectively, while TMD is an independent risk factor for both. Network analysis revealed TMD has a closer relationship with LNM severity compared to other associated factors. This study innovatively combined regression models and network analysis to investigate factors related to LNM in patients with PTC and HT, providing a theoretical basis for predicting preoperative LNM in future clinical practice.

Stent thrombosis in the setting of ST-segment elevation acute myocardial infarction in the contemporary practice: results from the TOTAL randomized trial.

The aim was to know the risk and predictive factors of stent thrombosis (ST) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) in the contemporary practice. The TOTAL [ThrOmbecTomy with percutaneous coronary intervention (PCI) versus PCI ALone] randomized trial, being the largest trial performed in the setting of STEMI with a general application of the recent recommendations, represents a unique opportunity to know the current real-world incidence of ST as well as its associated factors. A total of 10 064 patients that received ≥1 coronary stent in the TOTAL trial comprise the study population. The risk, predictive factors, and clinical implications of ST was studied. During 1-year follow-up, 155 patients (1.54%) suffered definitive or probable ST (59 acute, 67 subacute, and 29 late). Previous infarction, the number of stents, the previous use of clopidogrel, and the use of diuretics at discharge were independent predictors for ST, whereas the use of upfront glycoprotein IIb/IIIa inhibitors, radial access, and treatment with statins at discharge were independent protective factors. The number of stents, stent diameter, upfront treatment with IIb/IIIa inhibitors, previous treatment with clopidogrel, and treatment with statins at discharge were independently associated with the risk of early ST. Only previous infarction was associated with the risk of late ST. In the contemporary practice, ST still constitutes a frequent complication of primary PCI for STEMI, occurring in 1.5% of patients. Independent predictors are different depending on the time of ST.

Perinatal outcomes in pregnancies achieved after fertility treatments with and without diet-controlled GDM.

To evaluate the rates of adverse perinatal outcomes among women who conceived after fertility treatments with and without diet-controlled GDM. In this retrospective population-based cohort study, all pregnancies of non-diabetic and diet-controlled GDM women who conceived after fertility treatments (in-vitro fertilization - IVF and ovulation induction - OI) and delivered between the years 1996-2016 in a tertiary medical center, were included. Pregnancies of women with pre-gestational diabetes mellitus, and those complicated with gestational diabetes mellitus A2, multiple pregnancies, congenital malformations and those lacking prenatal care, were excluded. Demographical, clinical, and obstetrical characteristics were recorded, and pregnancy complications and adverse perinatal outcomes were compared between the groups. Multivariate logistic regression models were used to control for confounders. Statistical analyses were performed using logistic regression to control for potential confounders. A p-value of < 0.05 was considered statistically significant. During the study period, 6254 deliveries met the inclusion criteria, 10.23% of them (n = 640) had diet-controlled GDM. Pregnancies with diet-controlled GDM were found to be associated with significantly higher rates of hypertensive disorders of pregnancy (15.6% vs. 9.8%, p < 0.001), polyhydramnios (5.9% vs. 2.7%, p < 0.001), and cesarean deliveries (40.8% vs. 31.9%, p < 0.001). Diet-controlled GDM was also found to be an independent protective factor against perinatal mortality (aOR = 0.22, 95% Cl 0.05-0.92, P = 0.04) possibly due to the more intensive monitoring and management typically provided to women undergoing fertility treatments. This close care may mitigate some of the risks associated with ART, leading to improved perinatal outcomes. Among pregnancies achieved after fertility treatments, diet-controlled GDM was associated with reduced perinatal mortality and higher rates of certain pregnancy complications. These findings highlight the importance of close monitoring and careful management of women with diet-controlled GDM, as it may help mitigate risks associated with ART pregnancies. Further research is needed to understand the mechanisms behind these outcomes and to optimize management strategies for this specific population.

Increased FT3/FT4 ratio in a certain range is associated with decreased glycemic variability in patients with type 2 diabetes

Thyroid hormone (TH) plays a crucial role in regulating glucose metabolism. However, the potential impact of the FT3/FT4 ratio, which reflects peripheral sensitivity to thyroid hormones, on glycemic variability in patients with type 2 diabetes (T2DM), has not been previously reported. To investigate the correlation between the FT3/FT4 ratio and glycemic variability in individuals with T2DM. In this retrospective analysis, a total of 468 inpatients with T2DM underwent continuous glucose monitoring (CGM) systems for a period of 6–14 days. Baseline clinical characteristics, laboratory tests, and CGM parameters were documented to investigate the correlation between FT3/FT4 ratio and CGM parameters. The levels of HBA, MG, SD, CV, LAGE, MODD and TAR2Scale were all higher in FT3/FT4Q1 compared with FT3/FT4Q2, FT3/FT4Q3 and FT3/FT4Q4 (all P < 0.01). Additionally, TIR was lower in FT3/FT4Q1 compared with the other quartiles (P < 0.01). Smooth curve fitting and saturation effect analysis revealed that there are curve-like relationships between the FT3/FT4 ratio and SD, MAGE, MODD and TAR2Scale. The inflection points of the fitted curves were found to be at FT3/FT4 = 0.279, 0.237, 0.253 and 0.282 respectively (all P < 0.05). Prior to the inflection point, the FT3/FT4 ratio was negatively related to SD, MAGE, MODD and TAR2Scale (all P < 0.05). Furthermore, The FT3/FT4 ratio exhibits a negative linear correlation with HBA and MG, while demonstrating a positive linear relationship with TIR (all P < 0.05). Binary logistic regression demonstrated that the FT3/FT4 ratio was independently related to HBA (P = 0.001), MG (P = 0.01), TAR2Scale (P = 0.003), LAGE (P = 0.014) and MAGE (P < 0.001). The increased FT3/FT4 ratio within a certain range (FT3/FT4 ≤ 0.282) is associated with decreased blood glucose variability and increased TIR. The FT3/FT4 ratio may act as a potential independent protective factor for glycemic fluctuation and glycemic control in patients with T2DM when it increases within a specific range.

Clinical Significance of Optical Coherence Tomography-Guided Percutaneous Coronary Intervention for In-Stent Restenosis Within Drug-Eluting Stents: Impact on Patient Outcomes.

The evidence for optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) in improving the prognosis of individuals with in-stent restenosis (ISR) is lacking. This retrospective study enrolled 588 consecutive individuals with drug-eluting stent ISR undergoing PCI from March 2010 to March 2022. Two hundred seven (35.2%) underwent OCT guidance, and 381 (64.8%) underwent angiography guidance. Clinical outcomes were analyzed using survival curves. The primary clinical endpoint was 2-year major adverse cardiovascular events (MACEs), a composite of all-cause death, myocardial infarction, and target-vessel revascularization. Compared with angiography guidance, OCT guidance demonstrated a higher frequency of drug-coated balloon use and adjunctive therapeutic modalities, including predilation, postdilation, nonslip element balloons, and noncompliant balloons (P<0.05). Following PCI, the OCT-guided group achieved a significantly larger minimum lumen diameter (2.36 versus 2.15 mm, P<0.001) and a lower percentage diameter stenosis (17% versus 20%, P<0.001) than the angiography-guided group. Survival analysis revealed significantly lower 2-year MACEs in the OCT-guided group compared with the angiography-guided group (7% versus 15%, P=0.007), validated in the propensity matching analysis (7% versus 15%, P=0.001). Multiple sensitivity analyses showed that OCT-guided PCI treatment was an independent protective factor for 2-year MACEs in individuals with drug-eluting stent ISR. Compared with angiography guidance, OCT guidance is associated with a lower 2-year MACE risk among individuals with drug-eluting stent ISR. Therefore, OCT should be actively considered for guiding PCI treatment in individuals with drug-eluting stent ISR. Url: clinicaltrials.gov. Identifier: NCT03809754.

The Impact of Cytomegalovirus Infection on Ulcerative Colitis Relapse: A Multicenter Retrospective Cohort Study.

Cytomegalovirus (CMV) infection exacerbates intestinal inflammation in ulcerative colitis (UC) patients, yet the effect of CMV infection on UC relapse has not been fully elucidated. This study aimed to investigate the impact of CMV infection on UC relapse and identify associated risk factors. This multicenter retrospective cohort study included UC patients who visited research centers from January 2016 to December 2020. Univariate and multivariate Cox regression analyses were conducted to explore risk factors for UC relapse. Propensity score matching was used to balance the differences in the clinical characteristics between the groups. A total of 298 UC patients participated in this study, including 19 with CMV colitis, 37 with CMV viremia, and 242 CMV-negative patients. The 2-year cumulative recurrence rate was higher in patients with CMV colitis than that in CMV-negative patients (84.21% vs 51.65%, p = 0.01). Univariate and multivariate Cox regression analyses confirmed that fecal calprotectin ≥ 250µg/g, Montreal classification E3, CMV colitis, duration > 48 months, and serum albumin < 30 g/L were independent risk factors for UC relapse at 2 years, whereas the use of biologics for induction of remission was identified as an independent protective factor. Our study suggests that the risk of relapse increases among UC patients with CMV colitis over two years. Risk factors for UC relapse at 2 years include fecal calprotectin ≥ 250μg/g, Montreal classification E3, CMV colitis, UC duration > 48 months, and albumin < 30 g/L, whereas the use of biologics during induction is a protective factor.

Effects of Gut Microbiota and Metabolites on Pancreatitis: A Two-Sample Mendelian Randomization Study.

Acute and chronic pancreatitis (AP and CP) has a high incidence and poor prognosis. The early screening of at-risk populations still awaits further study. The limitation was mainly based on observational studies, with limited sample size and the presence of confounding factors. We used a two sample MR analysis based on publicly available data from Genome-Wide Association Studies (GWAS) to reveal the causal impact of gut microbiota and metabolites on pancreatitis. This study collected summary statistics regarding gut microbiota, metabolites, AP, and CP. Two-sample Mendelian randomization analysis was performed using MR-Egger, inverse variance weighted (IVW), MR-PRESSO, maximum likelihood, and weighted median. Two sample Mendelian randomization showed that only Eubacterium coprostanoligenes was an independent protective factor for AP among all gut microbiota, and the other microbiota were not significant for pancreatitis. Unsaturated fatty acids in metabolites are protective factors for both AP (OR=0.730, 95% Cl: 0.593-0.899, P = 0.003) and CP (OR=0.660, 95% Cl: 0.457-0.916, P = 0.013). Furthermore, carnitine was a protective factor but glucose was an independent risk factor for CP. This study provides for the first-time potential evidence which is the causal role of gut microbiota and metabolites on pancreatitis, which may be conducive to design microbiome and metabolite interventions on AP or CP in profound study in the future.

Significance of anatomical resection and wide surgical margin for HCC patients with MVI undergoing laparoscopic hepatectomy: A multicenter study

ObjectiveTo investigate the impact of surgical resection margin and hepatic resection type on prognosis and compare their prognostic significance on patients with hepatocellular carcinoma (HCC) with or without microvascular invasion (MVI) who underwent laparoscopic liver resection (LLR). MethodsA retrospective analysis was conducted on 320 patients with HCC who underwent LLR. According to the grading of MVI, patients were classified as M0, M1 and M2. Patients were divided into the anatomical resection (AR) and nonanatomical resection (NAR) groups according to the hepatic resection type. Survival and Cox regression analyses were performed to explore the effects of AR and NAR, wide and narrow resection margin on overall survival (OS) and time to recurrence (TTR). ResultsIn the whole cohort, narrow resection margin was an independent risk factor for OS and TTR, whereas NAR was not. Subgroup analysis showed that narrow resection margin and NAR were both independent risk factors for OS and TTR in HCC patients with MVI. The 5-year OS and TTR rates of the two groups (NAR-wide resection margin and AR-narrow resection margin) with M1 were 85.3 % versus 62 % and 34.4 % versus 60.2 %. Similarly, the 5-year OS and TTR rates of the two groups (NAR-wide resection margin and AR-narrow resection margin) with M2 were 80.2 % versus 47.9 % and 30.8 % versus 64.8 %. ConclusionsAnatomical hepatectomy and wide resection margin were independent protective factors for HCC patients with MVI receiving LLR. Nonetheless, wide resection margin had a greater impact on prognosis than anatomical hepatectomy.

Vegetarian Diet Reduced Gastroesophageal Reflux Disease in a Nationwide Longitudinal Survey in Taiwan.

This large, longitudinal follow-up cohort study aimed to explore how being a vegetarian and related factors impacted the incident gastroesophageal reflux disease (GERD) in a comprehensive Taiwanese cohort. The study cohort was enrolled from the Taiwan Biobank. Vegetarian status, duration of being a vegetarian, type of vegetarian diet, and whether or not the participants had GERD were recorded from self-reported surveys. Associations between vegetarian status, duration, and type of diet with incident GERD were analyzed with multivariate logistic regression with adjustments for confounding variables. After excluding participants with pre-existing GERD, we included 23,714 participants into the study. Multivariable analysis showed that vegetarian status (current vs. never; hazard ratio [HR], 0.697; 95% confidence interval [CI], 0.546 to 0.889; p = 0.004) was significantly inversely associated with incident GERD; conversely, ever being a vegetarian was not associated (p = 0.489). In addition, those who had been a vegetarian for 6 years or more had 0.72 times lower risk of GERD compared to those who had never been a vegetarian (HR, 0.717; 95% CI 0.558 to 0.922, p = 0.009). No significant differences were observed regarding the type of vegetarian diet with incident GERD. The results showed that following a vegetarian diet was an independent protective factor for incident GERD, with a significant protective effect observed in those who adhered to a vegetarian diet for at least 6 years. Future research is warranted to explore the underlying mechanisms and whether adopting a vegetarian diet can decrease the incidence of GERD.