Objective:To evaluate the value of acid-base indicators and strong ion gap (SIG) in the prognostic diagnosis of patients with acute paraquat poisoning (APP).Methods:The medical records of 78 APP patients admitted to the First People′s Hospital of Lianyungang from March 2021 to March 2024 were analyzed retrospectively. The patients were divided into the death group ( n=56) and the survival group ( n=22) according to their prognosis. Clinical data, acid-base indicators, and SIG levels were compared between the two groups. Logistic regression analysis was used to identify the influencing factors of prognosis in APP patients and construct a nomogram. Receiver operating characteristic (ROC) curve was established to analyze the diagnostic value of combined acid-base indicators and SIG for the prognosis of APP patients. Results:There were no statistically significant differences in gender, age, body mass index, time from poisoning to treatment, history of diabetes, or history of hypertension between the two groups (all P>0.05). The levels of anion gap (AG), bicarbonate ion (HCO 3-), lactic acid (Lac), and SIG in the death group were higher than those in the survival group (all P<0.05). Logistic regression analysis showed that AG, HCO 3-, Lac, and SIG levels were influencing factors for the prognosis of APP patients (all P<0.05). ROC curve results indicated that the area under the curve (AUC) of AG, HCO 3-, Lac, and SIG combined in predicting the prognosis of APP patients was significantly higher than that of single prediction. Conclusions:Acid-base indicators and SIG have good diagnostic value for the prognosis of APP patients.

Objective:To evaluate the value of acid-base indicators and strong ion gap (SIG) in the prognostic diagnosis of patients with acute paraquat poisoning (APP).Methods:The medical records of 78 APP patients admitted to the First People′s Hospital of Lianyungang from March 2021 to March 2024 were analyzed retrospectively. The patients were divided into the death group ( n=56) and the survival group ( n=22) according to their prognosis. Clinical data, acid-base indicators, and SIG levels were compared between the two groups. Logistic regression analysis was used to identify the influencing factors of prognosis in APP patients and construct a nomogram. Receiver operating characteristic (ROC) curve was established to analyze the diagnostic value of combined acid-base indicators and SIG for the prognosis of APP patients. Results:There were no statistically significant differences in gender, age, body mass index, time from poisoning to treatment, history of diabetes, or history of hypertension between the two groups (all P>0.05). The levels of anion gap (AG), bicarbonate ion (HCO 3-), lactic acid (Lac), and SIG in the death group were higher than those in the survival group (all P<0.05). Logistic regression analysis showed that AG, HCO 3-, Lac, and SIG levels were influencing factors for the prognosis of APP patients (all P<0.05). ROC curve results indicated that the area under the curve (AUC) of AG, HCO 3-, Lac, and SIG combined in predicting the prognosis of APP patients was significantly higher than that of single prediction. Conclusions:Acid-base indicators and SIG have good diagnostic value for the prognosis of APP patients.

Objective Previous studies on the association between lipid profiles and chronic kidney disease(CKD)have yielded inconsistent results and no defined thresholds for blood lipids. Methods A prospective cohort study including 32,351 subjects who completed baseline and follow-up surveys over 5 years was conducted.Restricted cubic splines and Cox models were used to examine the association between the lipid profiles and CKD.A regression discontinuity design was used to determine the cutoff value of lipid profiles that was significantly associated with increased the risk of CKD. Results Over a median follow-up time of 2.2(0.5,4.2)years,648(2.00%)subjects developed CKD.The lipid profiles that were significantly and linearly related to CKD included total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),TC/HDL-C,and TG/HDL-C,whereas low-density lipoprotein cholesterol(LDL-C)and LDL-C/HDL-C were nonlinearly correlated with CKD.TC,TG,TC/HDL-C,and TG/HDL-C showed an upward jump at the cutoff value,increasing the risk of CKD by 0.90%,1.50%,2.30%,and 1.60%,respectively,whereas HDL-C showed a downward jump at the cutoff value,reducing this risk by 1.0%.Female and participants with dyslipidemia had a higher risk of CKD,while the cutoff values for the different characteristics of the population were different. Conclusion There was a significant association between lipid profiles and CKD in a prospective cohort from Northwest China,while TG,TC/HDL-C,and TG/HDL-C showed a stronger risk association.The specific cutoff values of lipid profiles may provide a clinical reference for screening or diagnosing CKD risk.

Objective:To investigate the effects of compound Duzhong Jiangu Granules on joint function and gut microbiota in patients with Kashin-Beck disease.Methods:A single group pre- and post-experimental design was conducted, the patients with Kashin-Beck disease were selected as the subjects in Xunyi County, Xianyang City, Shaanxi Province; and treated with oral administration of compound Duzhong Jiangu Granules (12 g/bag, 1 bag/time, 3 times/day) for a period of 1 month. The improvement of joint function was evaluated using the joint dysfunction index scoring method before and after treatment. Morning stool samples of patients were collected and the changes in gut microbiota were analyzed before and after treatment using 16S rDNA sequencing technology.Results:A total of 87 patients with Kashin-Beck disease were included, including 44 males and 43 females; the age was (60.38 ± 7.12) years old, and the body mass index was (23.67 ± 3.59) kg/m 2. The comprehensive scores of joint dysfunction index for patients with Kashin-Beck disease before and after treatment were (7.27 ± 2.05) and (5.86 ± 2.01) points, respectively, and the difference was statistically significant ( t = 5.88, P < 0.001). The sequencing results of gut microbiota showed that there were statistically significant differences in the alpha diversity (chao1, observed species index) and beta diversity of gut microbiota in patients with Kashin-Beck disease before and after treatment ( Z = - 5.08, - 5.03, R = 0.09, P < 0.001). In the distribution of gut microbiota, Firmicutes was the dominant phylum, with relative abundances of 50.21% and 52.09% before and after treatment, respectively; the Bifidobacterium was the dominant bacterial genus, with relative abundances of 16.83% and 18.81% before and after treatment, respectively. At the genus level, a total of 17 gut microbiota genera were screened out, among which the relative abundances of Hafnia-Obesumbacterium, Gammaproteobacteria_unclassified, Acinetobacter, Pantoea, Leuconostoc, and Akkermanisia were significantly higher than before treatment ( Z = - 2.40, - 2.24, - 2.06, - 3.59, - 2.24, - 2.11, P < 0.05). The relative abundances of Dubosiella, Selenomonas, Anaeroplasma, Lachnospiraceae_ NK4A136_group, Rikenella, Prevotella, Megasphaera, Lactobacillus, Prevotella-9, Phascolarctobacterium, and Desulfovibrio were significantly lower than before treatment ( Z = - 9.38, - 2.61, - 2.18, - 8.43, - 2.45, - 2.46, - 2.49, - 7.29, - 2.29, - 2.55, - 2.08, P < 0.05). Conclusions:Compound Duzhong Jiangu Granules can effectively improve the joint function of patients with Kashin-Beck disease, and alter the diversity and richness of the gut microbiota community. It may reduce clinical symptoms in patients by regulating the structure of gut microbiota.

Background::Studies have found that the ratio of total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) was associated with the development of chronic kidney disease (CKD). However, the relationship in different genders was rarely discussed. The aim of this study was to explore this relationship and assess its predictive power for both males and females.Methods::Based on a prospective cohort platform in northwest China, 32,351 participants without CKD were collected in the baseline and followed up for approximately 5 years. Cox proportional hazard model and restricted cubic spline regression analysis were performed to investigate the association between TC, HDL-C, TC/HDL-C and CKD in adult female and male. The clinical application value of the indicators in predicting CKD was evaluated by the receiver operator characteristic curve.Results::During a mean follow-up of 2.2 years, 484 males and 164 females developed CKD. After adjusted for relevant confounders, for every one standard deviation increase in TC, HDL-C and TC/HDL-C, the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for CKD were 1.17 (1.05-1.31), 0.84 (0.71-0.99), and 1.15 (1.06-1.25) for males, 0.94 (0.78-1.13), 0.58 (0.35-0.95), and 1.19 (1.01-1.40) for females, respectively. The results also showed that TC, HDL-C, and TC/HDL-C were associated with CKD in a linear dose-response relationship. The TC/HDL-C had the largest area under the curve (AUC) compared to TC and HDL-C, and the AUC among the females was larger than that among males.Conclusions::The TC/HDL-C was significantly associated with CKD in adult males and females and has better clinical value in predicting CKD than TC and HDL-C, especially in females.

Background::Studies have found that the ratio of total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) was associated with the development of chronic kidney disease (CKD). However, the relationship in different genders was rarely discussed. The aim of this study was to explore this relationship and assess its predictive power for both males and females.Methods::Based on a prospective cohort platform in northwest China, 32,351 participants without CKD were collected in the baseline and followed up for approximately 5 years. Cox proportional hazard model and restricted cubic spline regression analysis were performed to investigate the association between TC, HDL-C, TC/HDL-C and CKD in adult female and male. The clinical application value of the indicators in predicting CKD was evaluated by the receiver operator characteristic curve.Results::During a mean follow-up of 2.2 years, 484 males and 164 females developed CKD. After adjusted for relevant confounders, for every one standard deviation increase in TC, HDL-C and TC/HDL-C, the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for CKD were 1.17 (1.05-1.31), 0.84 (0.71-0.99), and 1.15 (1.06-1.25) for males, 0.94 (0.78-1.13), 0.58 (0.35-0.95), and 1.19 (1.01-1.40) for females, respectively. The results also showed that TC, HDL-C, and TC/HDL-C were associated with CKD in a linear dose-response relationship. The TC/HDL-C had the largest area under the curve (AUC) compared to TC and HDL-C, and the AUC among the females was larger than that among males.Conclusions::The TC/HDL-C was significantly associated with CKD in adult males and females and has better clinical value in predicting CKD than TC and HDL-C, especially in females.

The syndrome of dampness stagnancy due to spleen deficiency (DSSD) is relatively common globally. Although the pathogenesis of DSSD remains unclear, evidence has suggested that the gut microbiota might play a significant role. Radix Astragali, used as both medicine and food, exerts the effects of tonifying spleen and qi. Astragalus polysaccharide (APS) comprises a macromolecule substance extracted from the dried root of Radix Astragali, which has many pharmacological functions. However, whether APS mitigates the immune disorders underlying the DSSD syndrome via regulating gut microbiota and the relevant mechanism remains unknown. Here, we used DSSD rats induced by high-fat and low-protein (HFLP) diet plus exhaustive swimming, and found that APS of moderate molecular weight increased the body weight gain and immune organ indexes, decreased the levels of interleukin-1β (IL-1β), IL-6, and endotoxin, and suppressed the Toll-like receptor 4/nuclear factor-‍κB (TLR4/NF-‍κB) pathway. Moreover, a total of 27 critical genera were significantly enriched according to the linear discriminant analysis effect size (LEfSe). APS increased the diversity of the gut microbiota and changed its composition, such as reducing the relative abundance of Pseudoflavonifractor and Paraprevotella, and increasing that of Parasutterella, Parabacteroides, Clostridium XIVb, Oscillibacter, Butyricicoccus, and Dorea. APS also elevated the contents of short-chain fatty acids (SCFAs). Furthermore, the correlation analysis indicated that 12 critical bacteria were related to the body weight gain and immune organ indexes. In general, our study demonstrated that APS ameliorated the immune disorders in DSSD rats via modulating their gut microbiota, especially for some bacteria involving immune and inflammatory response and SCFA production, as well as the TLR4/NF-κB pathway. This study provides an insight into the function of APS as a unique potential prebiotic through exerting systemic activities in treating DSSD.
Rats ; Animals ; NF-kappa B/metabolism* ; Spleen ; Gastrointestinal Microbiome ; Toll-Like Receptor 4 ; Polysaccharides/pharmacology* ; Astragalus Plant/metabolism* ; Immune System Diseases/drug therapy* ; Body Weight

Objective This study focused on the low voltage and low concentration contrast agent technology in vascular imaging of stroke patients.Methods Totally144 patients of ischemic stroke confirmed from January 2022 to January 2023 were enrolled.They were divided into four groups according to different imaging methods:conventional group(tube voltage 120kV,iodine concentration 370mgI/ml),low voltage group(tube voltage 80kV,iodine concentration 370mgI/ml),low concentration group(tube voltage 120kV,iodine concentration 320mgI/ml)and dual-low group(tube voltage 80kV,iodine concentration 320mgI/ml),the post-processing technology adopted ASiR algorithm for 3D reconstruction.Then to compare contrast signal-to-noise ratio(CNR)and signal-to-noise ratio(SNR)of the reconstructed image,image quality score,CT values of internal carotid artery(ICA),anterior cerebral artery(AA)A1,middle cerebral artery(MA)M1,posterior cerebral artery(PA)P1,vertebral artery(VA)and basilar artery(BA),mean iodine intake and radiation dose parameters including volume CT dose index(CTDIvol)and dose length product(DLP).Results The CNR and SNR values in dual-low group were significantly less than the other three groups(P<0.05),while image quality score and CT value of each artery were no differences among the four groups(P>0.05).What's more,CTDIvol,DLP and iodine intake volume in dual-low group were significantly less than the others(P<0.05).Conclusion The dual-low technology scanning could obtain satisfactory head and neck CT angiography for stroke patients.

Background Current evidence on whether occupational sulfur dioxide (SO₂) exposure affects the risk of hypertension is still limited, and the research results of the effect of environmental SO₂ exposure on risk of hypertension remain inconsistent. Objective To analyze the association between self-reported occupational exposure to SO₂ and the risk of hypertension, and the potential dose-response relationship between the years of exposure to SO₂ and the risk of hypertension. Methods Based on the Jinchang cohort, a nested case-control study design was adopted. A total of 841 newly diagnosed hypertension patients were followed up as the case group, and the control group was selected with 1∶1 individual matching based on non-occupational factors and occupational factors, respectively. The former matching conditions included age ±2 years old, same gender, working age ±2 years, and home address in the same sub-district. The latter was limited to working in the same workshop on the basis of the former conditions. Finally, the former included 717 controls and the latter included 488 controls. A unified questionnaire was used to collect general demographic characteristics, lifestyle habits, history of diabetes, family history of hypertension, and information on occupational exposure to SO₂ (self-reported history of occupational exposure to SO₂ and years of exposure to SO₂). Conditional logistic regression model was used to analyze the association between occupational exposure to SO₂ and hypertension, and the dose-response relationship between the years of SO₂ exposure and the risk of hypertension. Results In the nested case-control study matching with the non-occupational factors, the OR of hypertension in workers with self-reported occupational exposure to SO₂ was 2.39 (95%CI: 1.68-3.39); while when matching with the occupational factors, the OR of hypertension in workers with self-reported occupational exposure to SO₂ was 1.48 (95%CI: 1.04-2.12). The results of the dose-response relationship showed that as the SO₂ exposure years increased from 1-9 years, 10-19 years, 20-29 years, and 30 years and above, in the nested case-control study matching with non-occupational factors, the ORs of hypertension were 1.85 (95%CI: 0.68-5.08), 1.46 (95%CI: 0.58-3.67), 1.64 (95%CI: 1.00-2.67), and 4.95 (95%CI: 2.63-9.31), respectively; in the nested case-control study matching with occupational factors, the ORs of hypertension were 0.98 (95%CI: 0.40-2.41), 1.84 (95%CI: 0.72-4.70), 1.37 (95%CI: 0.82-2.29), and 2.44 (95%CI: 1.37-4.35), respectively. The two dose-response relationships were positive by χ² trend test (P_trend<0.05). Conclusion Self-reported occupational exposure to SO₂ is associated with the risk of hypertension in the study population, and the hypertension risk increases with the increase of SO₂ exposure years.

Objective:To explore the effect of clinical pharmacist-led safety management in clinical use of oral anticoagulants (OACs) on reducing medication errors (MEs) in hospitalized patients.Methods:On July 1st, 2018, the working group on the safe application of anticoagulants, composing clinical pharmacists majoring in cardiology, cardiac surgery, neurology, geriatrics, orthopedics, respiratory, and vascular surgery, was established at the Department of Pharmacy, Zhongshan Hospital Affiliated to Fudan University to comprehensively strengthen the intervention in the OACs prescription MEs for inpatients in relevant departments. Two percent of patients who were treated with OACs and aged ≥18 years during hospitalization in the above departments were screened using stratified sampling method and divided into pre-intervention group (patients were admitted in January 2017 to June 2018) and post-intervention group (patients were admitted in July 2018 to December 2019). The medical records of patients in the 2 groups were collected using the hospital information system, and the occurrence of MEs in the prescription link was analyzed retrospectively.Results:A total of 296 and 325 patients were included in the pre- and post-intervention groups respectively. There was no significant difference in terms of gender, age, inpatient department, anticoagulation indications, OACs class, comorbidities, and concomitant medications in patients between the 2 groups (all P>0.05). The most frequently used anticoagulants in the 2 groups both were warfarin, which was used in 75.3% (223/296) and 71.4% (232/325) of the patients respectively, and followed by rivaroxaban, which was used in 17.6% (52/296) and 23.7% (77/325) of the patients respectively. Among the 296 patients in the pre-intervention group, 75 times of MEs related to OACs were found in the prescription for 72 (24.3%) patients, of which 30, 39, 5, and 1 times of MEs graded C, D, E, and F in severity respectively, and the incidence of severe MEs (grade E and F) was 2.0% (6/296). Among the 325 patients in the post-intervention group, 49 times of MEs related to OACs were found in the prescription for 47 (14.5%) patients, of which 22 times of MEs were grade C and 27 were grade D, and no severe ME was found. The incidences of overall MEs and severe MEs in the post-intervention group were significantly lower than those in the pre-intervention group (all P<0.05). Four types of MEs were all found in the prescription of OACs in the 2 groups, including choosing inappropriate drugs (all presented as not selecting drugs based on drug interactions), wrong drug dose, drug omission, and wrong dosing frequency. The incidences of the above 4 types of MEs were 11.5% (34/296), 8.1% (24/296), 4.7% (14/296), and 0.7% (2/296) in the pre-intervention group, and 5.5% (18/325), 6.2% (20/325), 3.1% (10/325), and 0.3% (1/325) in the post-intervention group, respectively. The incidence of choosing inappropriate drugs in the post-intervention group was significantly lower than that in the pre-intervention group [5.5% (18/325) vs. 11.5% (34/296), χ2=7.143, P=0.008]. Conclusion:The safety management of OACs in clinical application led by clinical pharmacists can reduce the MEs in prescriptions of OACs for inpatients, especially the incidence of severe MEs and choosing inappropriate drugs, and improve the safety of OACs in application.