Objective To investigate the relationship between the plasma neutrophil gelatinase-associated lipocalin (NGAL)and endothelin-1 (ET-1) levels and cognitive dysfunction in chronic obstructive pulmonary disease (COPD) patients.Methods A case-control study was performed,consisting of 128 patients with COPD(68 patients without cognitive dysfunction and 60 patients with cognitive dysfunction) and 70 normal controls.All patients with COPD were diagnosed by pulmonary function tests and plasma levels of NGAL and ET-1 were determined by enzyme immunoassay.The cognitive function was evaluated by the MMSE and MoCA.Results ①Compared with normal control,the levels of plasma NGAL and ET-1 were increased(NGAL:(2.20±0.60) μg/L vs (1.69±0.73) μg/L,P＜0.05;ET-1:(26.19± 10.55)pg/ml vs (13.05±2.37) pg/ml,P＜0.05) in COPD patients without cognitive dysfunction and in COPD patients with cognitive dysfunction(NGAL:(3.80±2.75) μg/L vs (1.69±0.73) μg/L,P＜0.01;ET-1:(37.82±0.29) pg/ml vs (13.05±2.37) pg/ml,P＜0.01).Compared with the COPD patients without cognitive dysfunction,the levels of plasma NGAL and ET-1 were also increased in COPD patients with cognitive dysfunction (all P＜0.05).②The plasma NGAL levels were correlated negatively with MMSE scores(r=-0.524,P＜0.05),and negatively correlated with MoCA scores (r=-0.527,P＜0.05).The plasma ET-1 levels were negatively correlated with MMSE scores(r=-0.549,P＜0.05),and negatively correlated with MoCA scores(r=-0.558,P＜0.05).The levels of NGAL and ET-1 were positively correlated(r=0.564,P＜0.05).Conclusion NGAL and ET-1 may be involved in the pathophysiological process of cognitive dysfunction in patients with COPD,which provides a certain clinical value for the assessment of cognitive dysfunction in patients with COPD.

Objective:To explore the association of the total gestational weight gain (GWG) and GWG in different trimesters with adverse pregnancy outcomes during the second pregnancy in women with history of gestational diabetes mellitus (GDM).Methods:This retrospective cohort study recruited 441 singleton pregnant women with a history of GDM who gave birth at Beijing Obstetrics and Gynecology Hospital of Capital Medical University from January 2017 to December 2018 as the GDM history group. Another 1 637 singleton pregnant women without a history of GDM who gave birth at the same period were selected through the mechanical sampling method as the control group. Independent sample t-test and Chi-square test were used to compare the differences in general conditions, GWG and perinatal outcomes between the two groups. Based on the Institute of Medicine guidelines for GWG, the subjects were further divided into three subgroups: inadequate GWG, adequate GWG and excessive GWG groups. Multivariate logistic regression analysis was used to compare the pregnancy outcome in women with the same GWG in different periods of pregnancy between the two groups. Results:(1) Women with GDM history had lower GWG before and after oral glucose tolerance test (OGTT) and the whole pregnancy than those without [(6.3±3.3) vs (7.9±3.7) kg, (4.8±2.6) vs (5.6± 2.6) kg, (11.8±4.6) vs (14.4± 4.6) kg; t=8.074, 5.183, 10.277; all P<0.001]. The incidence of GDM, gestational hypertension, and large for gestational age (LGA) in the GDM history group were higher than those in the control group [46.5% (205/441) vs 18.1% (296/1 637), 8.4% (37/441) vs 5.4% (88/1 637), 12.9% (57/441) vs 9.7% (158/1 637); χ2=153.181, 5.583, 4.013; all P<0.05]. (2) Before OGTT: pregnant women with GDM history of different GWG categories had a higher risk of developing GDM [ OR and 95% CI for inadequate, adequate and excessive GWG were 4.02 (2.35-6.88), 3.92 (2.65-5.79) and 3.33 (2.11-5.25), respectively, all P<0.001]. Except for women with inadequate GWG, pregnancy with a history of GDM also had a higher risk of preeclampsia [ OR and 95% CI were 3.62 (1.47-9.23) and 2.22 (1.07-5.57) for adequate and excessive GWG, respectively, both P<0.05]. After OGTT: pregnant women with GDM history of different GWG categories had a higher risk of developing GDM [ OR and 95% CI for inadequate, adequate and excessive GWG were 2.48 (1.60-3.84), 4.63 (2.92-7.35) and 4.22 (2.73-6.51), respectively, all P<0.001]. Pregnant women with a history of GDM with excessive GWG had an increased risk of preeclampsia ( OR=2.46, 95% CI: 1.10-5.51, P<0.05). During pregnancy: pregnant women with GDM history of different GWG categories had a higher risk of developing GDM [ OR and 95% CI were 3.02(2.00-4.59), 4.08(2.76-6.04) and 2.66(1.54-4.59) for inadequate, adequate and excessive GWG, respectively, all P<0.001]. Women with GDM history had an increased risk of large for gestational age (LGA) in those with inadequate GWG and postpartum hemorrhage in those with excessive GWG [ OR and 95% CI were 1.94 (1.09-4.21) and 2.93 (1.31-6.55), respectively, both P<0.05]. Conclusions:The total GWG and GWG in different periods during the second pregnancy in women with a history of GDM are lower than those without, but with a higher risk of adverse outcomes. Even in women with the same range of GWG, GDM history still increases the risk of adverse pregnancy outcomes.

Objective To study the clinical manifestation,diagnosis and treatment of the renal myxofibromata.Methods Combined with reviewing the relevant literature,we retrospectively analyzed the clinical data of a case of renal myxofibromata.A 47-year-old female patient was found left renal cystic lesion by ultrasound 8 months before admission.CT showed a 4 cm cystic and solid lesions in the lower pole of left kidney,which was similar to the results of ultrasound.The enhanced abdominal CT and dynamic contrast-enhanced ultrasound showed that the lesions could be enhanced slowly with uneven density.The patient underwent left kidney exploration under the general anaesthesia.During operation,a round solid mass about 5 cm in diameter can been seen in the low part of renal sinus,which was a bit hard.The mass was close with surrounding tissue.Then,the left kidney was excised.Results The surface of the mass was full and smooth with pale yellow luster.In the HE section,the tumor was composed with fibroma like cell,which demonstrated the inhomogeneous size,shape and irregular organization.The nucleus showed the spindle shape,with rare mitosis phase.Large quantity of mucus and vascular tissue could be observed in the tumor.Few fibroblast cells could also be found in the section.The pathological result was myxofibromata (immature) with malignant tendency.No special treatment was given after surgery.Recurrence was not recorded within 6 months following-up.Conclusions Commonly,the myxofibromata is a kind of benign tumor.Only a few can result in the malignant transformation and distant metastasis.Primary renal myxofibromata is extremely rare.The preoperative imagine manifestation is difficult to provide the accurate diagnosis.Pathologic result is the gold standard in diagnosing this disease.Actively surgical treatment and regular following-up after surgery should be considered.

Objective To observe the influence of phentolamine on N terminal B-type natriuretic peptide precursor(NT-proBNP),blood gas analysis,hypersensitive c-reactive protein and plasma D-dimer in patients with chronic cor pulmonale Methods One hundred and one cases patients with chronic cor pulmonale were randomly divided into two groups,51 patients in the treatment group,50 patients in the control group.All patients were treated with normal anti-infection,eliminating phlegm to smooth wheezing antithrombotic for one week,as the same time patients in the treatment group were treated with phentolamine for one week.Through observed the treatment effect of phentolamine to chronic cor pulmonale,the level of NT-proBNP,blood gas analysis,hypersensitive c-reactive protein and plasma D-dimer in patients with chronic cor pulmonale before and after the treatment were analyzed.Results Compared with before treatment,the levels of NT-proBNP,PCO2,hypersensitive c-reactive protein,plasma D dimer were lower than after one week in two groups,while the level of PO2 was higher.Treatment group:NT-proBNP (1 712.76±572.32) ng/L vs.(271.59±163.05) ng/L,t=20.42,P<0.05,PCO2 (66.34±5.81) mmHg vs.(52.58±5.82) mmHg,t=16.46,P<0.05,PO2 (59.28±6.13) mmHg vs.(73.64±6.10) mmHg,t=23.02,P<0.05,hypersensitive c-reactive protein 86.0(28.0) mg/L vs.23.0(12.0) mg/L,Z=-6.22,P<0.05 mg/L,plasma D-dimer (4 953.37±1 654.09) μg/L vs.(1 847.90±838.66) μg/L,t=17.11,P<0.05.Control group:NT-proBNP (1 527.24±658.70) ng/L vs.(612.58±357.59) ng/L,t=14.52,P<0.05,PCO2 (65.41±5.23) mmHg vs.(56.46±5.65) mmHg,t=13.04,P<0.05,PO2(60.57±5.84) mmHg vs.(67.21±5.19) mmHg,t=-10.06,P<0.05,hypersensitive c-reactive protein 79.0(29.0) mg/L vs.43.0(20.0) mg/L,Z=-6.16,,P<0.05,plasma D-dimer (4 408.02±1 682.83) μg/L vs.(2 598.28±1 242.73) μg/L,t=12.15,P<0.05.But the levels of NT-proBNP,PCO2,hypersensitive c-reactive protein and plasma D-dimer reduced significantly,the level of PO2 increased more significantly in treatment group(t(z)=-6.19,-3.39,-7.16,-3.56,5.70,all P<0.05).Conclusion Phentolamine can reduce the level of NT-proBNP,PCO2,hypersensitive c-reactive protein and plasma D-dimer and increased the level of PO2 in patients with chronic cor pulmonale.Phentolamine combined with routine treatment can improve the clinical efficacy of patients with chronic cor pulmonale.

Objective To systematically evaluate the clinical effect of prone position mechanical ventilation on the improvement of oxygenation in patients with severe pneumonia. Methods Pubmed, Embase, Cochrane Library, CNKI, Wanfang Data and VIP database were searched from the time of database built up until December 10th, 2017. All the published randomized controlled trials (RCTs) about the effects of prone position ventilation on the oxygenation of severe pneumonia patients were screened, and were confirmed by the literature reference citation retrieval. Inclusion and exclusion criteria had been used to review and rank the literature. After evaluating the quality of included studies, the data was extracted from RCTs and given a Meta-analysis using RevMen 5.1. Results Twelve RCTs with 650 cases were included. Eleven of them were Chinese literature while 1 was in English. Ten studies showed that the prone position ventilation had a significant influence on improving partial pressure of oxygen [weighted mean difference (WMD) =9.93, 95% confidence interval (95%CI) = 2.92-16.95, P = 0.006], publication bias was found in these studies. Seven studies showed that the prone position ventilation had a significant influence on partial pressure of carbon dioxide (WMD =9.99, 95%CI = 1.81-18.18, P = 0.02), publication bias was found in these studies. Seven studies showed that the prone position ventilation had a significant influence on oxygenation index (WMD = 31.22, 95%CI = 26.06-36.39, P < 0.000 01), publication bias was found in these studies. Two studies showed that the prone position ventilation had a significant influence on oxygen saturation of blood (WMD = 2.12, 95%CI = 1.24-3.00, P < 0.000 01), no publication bias was found in these studies. Conclusion Prone position ventilation can effectively improve the patients' oxygenation index, partial pressure of oxygen, and oxygen saturation of blood, and reduce the partial pressure of carbon dioxide.

Objective To investigate the status of body weight,total body fat and skeletal muscle in elderly patients with diabetes.Methods A total of 71 elderly diabetic patients (study group) who met entry criteria and signed informed consent were consecutively enrolled,and 70 healthy subjects (control group) matched for age and gender were selected into the study.Body weight,body mass index (BMI),waist-to-hip ratio (WHR),total body fat (TBF),abdominal fat (AF),visceral fat (VF),visceral fat area (VFA),fatfree mass (FFM),total body muscle (TBM),skeletal muscle (SM),skeletal muscle height index (SMHI) and grip strength (GS) were measured by anthropometry and multi-frequency bioelectric impedance analysis.The rate of low weight,overweight and obesity was judged by BMI;the rate of abdominal obesity by WHR;and the status of muscle by TBM,SM,MHI and GS.Results The two groups were comparable at baseline.Compared to the control group,the rate of low weight [36.6％ (26/71) vs.20.0％ (14/70),x2 =4.791,P=0.039],weight loss [(1.37± 1.57) kg vs.(0.82± 1.12) kg,t=2.402,P =0.018],ratio of people whoexperienced weight loss＞5％ in 3 months [22.5％ (16/71) vs.8.6％ (6/70),x2 =5.219,P=0.035],TBF％ [(32.3±5.0)％ vs.(30.3±5.2)％,t=2.294,P=0.023],WHR (0.91±0.55vs.0.87±0.51,t =2.661,P =0.009),the rate of abdominal obesity [49.3％ (35/71) vs.25.7％ (18/70),x2 =8.355,P=0.005],AF [(12.1±3.4) kg vs.(10.3±3.6) kg,t=2.981,P=0.003],VF [(2.9±0.8) kg vs.(2.5±0.9) kg,t=2.853,P=0.005] andVFA [(99.8±26.3) cm2 vs.(84.9±31.1) cm2,t=3.045,P=0.003] were increased significantly in study group,while the FFM [(34.9±7.5) kg vs.(37.9±5.6) kg,t=-2.691,P=0.008],SM [(25.8±4.5) kgvs.(27.3±3.5) kg,t=-2.140,P=0.034],SMHI [(9.4±1.8) kg/m2 vs.(10.2±1.5) kg/m2,t=-3.081,P=0.002] andGS [(29.3±6.6) kg vs.(31.8±5.7) kg,t=-2.406,P=0.017] were decreased significantly in study group.Conclusion Abnormal weight,abdominal obesity and loss of skeletal muscle were more likely to be observed in elderly patients with diabetes.

Objective:To visualize and analyze the literature related to the treatment of extremity lymphedema (EL) over the years 2012 to 2022 and to explore future research directions.Methods:Taking "lymphedema" and "treatment" as the themes, the study searched the Chinese and English literature related to EL treatment reported by Chinese scholars from 2012 to 2022 in Chinese National Knowledge Infrastructure (CNKI) and Web of Science (WOS) databases, and used CiteSpace software to visualize the literature, draw maps of authors, research institutes, keywords, etc., and carry out clustering and emergent word analysis on the keywords.Results:A total of 1 007 Chinese articles with 16 core authors and 236 English articles with 8 core Chinese authors were included. The author with the largest number of publications in Chinese was Liu Ningfei from the Ninth People’s Hospital of Shanghai Jiao Tong University School of Medicine (16 articles), and the author with the largest number of publications in WOS was Cheng Ming-Huei from Chang Gung Memorial Hospital Lin Kou Campus (Taiwan Province of China) (33 articles). The institution with the largest number of articles in Chinese was Sun Yat-sen University Cancer Center (16 articles), and the institution with the largest number of articles in English was Chang Gung University (Taiwan Province of China) (45 articles). "Breast cancer" "nursing care" and "quality of life" were the top 3 keywords in CNKI ; "breast cancer" "diagnosis" and "lower extremity" were the top 3 keywords in WOS. Cluster analysis of the keywords showed that 16 clusters in CNKI and 11 clusters in WOS covering evaluation indexes, treatment method and mechanism studies. The result of CNKI keyword emergence analysis showed that the top 10 emergent keywords were "postoperative breast cancer" "upper limb" "rehabilitation" "nursing care" "rehabilitation therapy" "intramuscular effect patch" "acupuncture therapy" "cervical cancer" "upper limb function" "lymphatic drainage". The result of WOS keyword emergence analysis showed that the top 10 emergent keywords were "prevalence" "extremity lymphedema" "therapy" "postmastectomy lymphedema" "transplantation" "cancer" "flap transfer" "mechanism" "surgical treatment" "reconstruction" .Conclusion:Surgical treatment, preventive nursing and lymphangiogenesis are the key research directions of EL treatment. Both traditional Chinese medicine and Western medicine have their own advantages in the treatment of EL, and the combination of traditional Chinese medicine and Western medicine can play a better role in the treatment. Multidisciplinary team can develop personalized solutions for patients.

Objective:To visualize and analyze the literature related to the treatment of extremity lymphedema (EL) over the years 2012 to 2022 and to explore future research directions.Methods:Taking "lymphedema" and "treatment" as the themes, the study searched the Chinese and English literature related to EL treatment reported by Chinese scholars from 2012 to 2022 in Chinese National Knowledge Infrastructure (CNKI) and Web of Science (WOS) databases, and used CiteSpace software to visualize the literature, draw maps of authors, research institutes, keywords, etc., and carry out clustering and emergent word analysis on the keywords.Results:A total of 1 007 Chinese articles with 16 core authors and 236 English articles with 8 core Chinese authors were included. The author with the largest number of publications in Chinese was Liu Ningfei from the Ninth People’s Hospital of Shanghai Jiao Tong University School of Medicine (16 articles), and the author with the largest number of publications in WOS was Cheng Ming-Huei from Chang Gung Memorial Hospital Lin Kou Campus (Taiwan Province of China) (33 articles). The institution with the largest number of articles in Chinese was Sun Yat-sen University Cancer Center (16 articles), and the institution with the largest number of articles in English was Chang Gung University (Taiwan Province of China) (45 articles). "Breast cancer" "nursing care" and "quality of life" were the top 3 keywords in CNKI ; "breast cancer" "diagnosis" and "lower extremity" were the top 3 keywords in WOS. Cluster analysis of the keywords showed that 16 clusters in CNKI and 11 clusters in WOS covering evaluation indexes, treatment method and mechanism studies. The result of CNKI keyword emergence analysis showed that the top 10 emergent keywords were "postoperative breast cancer" "upper limb" "rehabilitation" "nursing care" "rehabilitation therapy" "intramuscular effect patch" "acupuncture therapy" "cervical cancer" "upper limb function" "lymphatic drainage". The result of WOS keyword emergence analysis showed that the top 10 emergent keywords were "prevalence" "extremity lymphedema" "therapy" "postmastectomy lymphedema" "transplantation" "cancer" "flap transfer" "mechanism" "surgical treatment" "reconstruction" .Conclusion:Surgical treatment, preventive nursing and lymphangiogenesis are the key research directions of EL treatment. Both traditional Chinese medicine and Western medicine have their own advantages in the treatment of EL, and the combination of traditional Chinese medicine and Western medicine can play a better role in the treatment. Multidisciplinary team can develop personalized solutions for patients.

Background::Understanding willingness to undergo pulmonary function tests (PFTs) and the factors associated with poor uptake of PFTs is crucial for improving early detection and treatment of chronic obstructive pulmonary disease (COPD). This study aimed to understand willingness to undergo PFTs among high-risk populations and identify any barriers that may contribute to low uptake of PFTs.Methods::We collected data from participants in the "Happy Breathing Program" in China. Participants who did not follow physicians’ recommendations to undergo PFTs were invited to complete a survey regarding their willingness to undergo PFTs and their reasons for not undergoing PFTs. We estimated the proportion of participants who were willing to undergo PFTs and examined the various reasons for participants to not undergo PFTs. We conducted univariable and multivariable logistic regressions to analyze the impact of individual-level factors on willingness to undergo PFTs.Results::A total of 8475 participants who had completed the survey on willingness to undergo PFTs were included in this study. Out of these participants, 7660 (90.4%) were willing to undergo PFTs. Among those who were willing to undergo PFTs but actually did not, the main reasons for not doing so were geographical inaccessibility ( n = 3304, 43.1%) and a lack of trust in primary healthcare institutions ( n = 2809, 36.7%). Among the 815 participants who were unwilling to undergo PFTs, over half ( n = 447, 54.8%) believed that they did not have health problems and would only consider PFTs when they felt unwell. In the multivariable regression, individuals who were ≤54 years old, residing in rural townships, with a secondary educational level, with medical reimbursement, still working, with occupational exposure to dust, and aware of the abbreviation "COPD" were more willing to undergo PFTs. Conclusions::Willingness to undergo PFTs was high among high-risk populations. Policymakers may consider implementing strategies such as providing financial incentives, promoting education, and establishing community-based programs to enhance the utilization of PFTs.

Diagnosis of Parkinson's disease (PD) based on speech data has been proved to be an effective way in recent years. However, current researches just care about the feature extraction and classifier design, and do not consider the instance selection. Former research by authors showed that the instance selection can lead to improvement on classification accuracy. However, no attention is paid on the relationship between speech sample and feature until now. Therefore, a new diagnosis algorithm of PD is proposed in this paper by simultaneously selecting speech sample and feature based on relevant feature weighting algorithm and multiple kernel method, so as to find their synergy effects, thereby improving classification accuracy. Experimental results showed that this proposed algorithm obtained apparent improvement on classification accuracy. It can obtain mean classification accuracy of 82.5%, which was 30.5% higher than the relevant algorithm. Besides, the proposed algorithm detected the synergy effects of speech sample and feature, which is valuable for speech marker extraction.