BACKGROUND: Changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels may not fully translate into patient-reported health status in patients with heart failure (HF). We aimed to evaluate the correlation between NT-proBNP levels and patient-reported health status changes at one month after discharge of patients, and their associations with risk of death and rehospitalization in patients with acute HF. METHODS: We used data from the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study (PEACE 5p-HF Study). Patient-reported health status was measured by the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Patients who were hospitalized for HF and completed the KCCQ-12 and NT-proBNP tests before and one month after discharge were eligible in our study. We stratified patients into different groups based on NT-proBNP levels (i.e., improved, stable, and deteriorated) and KCCQ-12 scores (i.e., not deteriorated and deteriorated). We also examined the associations of the joint NT-proBNP and KCCQ-12 change with the risk of one-year and four-year clinical outcomes. RESULTS: A total of 2461 patients were included in the analysis. The mean age was 64.06 ± 13.51 years, and 36.37% (895/2461) of the study population were female. Among patients with improved NT-proBNP levels, 115 (10.95%) patients had deteriorated KCCQ-12 scores. The correlation between the change in the KCCQ-12 score and NT-proBNP level was weak ( r2 = 0.002, P = 0.013). Stratification by changes in the KCCQ-12 score revealed subgroups with distinctive risks, such that patients with deteriorated KCCQ-12 scores in any of the NT-proBNP change groups exhibited an increased risk of one-year all-cause death than participants with not deteriorated KCCQ-12 scores in any of the NT-proBNP change groups. Patients with improved NT-proBNP levels and deteriorated KCCQ-12 scores presented greater risks of one-year all-cause death (hazard ratio [HR]: 2.45, 95% confidence interval [CI]: 1.34-4.48) than patients with stable NT-proBNP levels and not deteriorated KCCQ-12 scores (HR [95% CI], 1.77 [1.25-2.53]). CONCLUSIONS: A discrepancy between changes in NT-proBNP levels and KCCQ-12 scores was common. The change in NT-proBNP levels was not sufficient to characterize critical aspects related to HF during one month after discharge of patients. Changes in the KCCQ-12 score exhibit complementary information to NT-proBNP levels for the prediction of clinical outcomes in patients with acute HF. REGISTRATION www.clinicaltrials.gov (No. NCT02878811).
Aged ; Female ; Humans ; Male ; Middle Aged ; Health Status ; Heart Failure/metabolism* ; Natriuretic Peptide, Brain/metabolism* ; Peptide Fragments/metabolism* ; Prospective Studies

Humans ; Aged ; Lung Diseases ; Pneumonia/drug therapy* ; Adrenal Cortex Hormones/therapeutic use* ; Pulmonary Disease, Chronic Obstructive/drug therapy* ; Administration, Inhalation ; Community-Acquired Infections/drug therapy*

AIM: To analyze the causes of blindness and low vision in patients with visual disability in Yangpu District of Shanghai from 2019 to 2022.METHODS:Cross-sectional study. A total of 1 604 patients who participated in the evaluation of visual disability in Shanghai Yangpu District Kongjiang Hospital, from April 2019 to December 2022 were selected for the study. The grade of visual disability and the main causes of blindness and low vision were determined by trained doctors.RESULTS:A total of 804 patients with visual disabilities were identified, with 87.31% aged 60 and above. The causes of visual disability were high myopic retinopathy(30.47%), age-related macular degeneration(23.26%), glaucoma(17.04%), and diabetic retinopathy(11.07%). Glaucoma(36.96%)is the leading cause of blindness.CONCLUSION: The majority of patients with visual disability are aged 60 years and above. More attention should be paid to the elderly population. Comprehensive prevention, treatment and rehabilitation measures should be applied in different diseases based on classification, so as to early reduce the occurrence of visual disability.

Purpose: Through meta-analysis, we aimed to assess the efficacy and safety of drug-coated balloons (DCB), compared with drugeluting stents (DES) or uncoated devices, in the treatment of de novo coronary lesions. Materials and Methods: Only randomized controlled trials were included. The primary outcomes were late lumen loss (LLL), target lesion revascularization (TLR), and major adverse cardiac events (MACEs). Subgroup analyses were conducted based on clinical indications, whether DCBs were used with a systematic or bailout stent, and types of DESs. Results: The present meta-analysis demonstrated that DCBs elicit significantly lower incidences of TLR, MACE, and LLL, compared with uncoated devices, and similar incidences, compared with DESs, in the treatment of de novo coronary lesions. Subgroup analysis indicated that DCBs used with a bailout stent achieved lower incidences of binary restenosis and myocardial infarction, compared with uncoated devices, and provided less LLL than DESs. DCBs showed similar rates of TLR and MACE, with significantly less LLL, than DESs in treating de novo small-vessel diseases. The clinical efficacy of DCBs was similar to that of secondgeneration DES. Conclusion Overall, DCB is favored over bare metal stent alone in treating de novo coronary lesions. DCBs appear to be a promising alternative to DESs in the treatment of de novo coronary lesions.

Objective:To evaluate the application effect of vascularized iliac crest-tensor fascia lata flap(VIC-TFLF) based on deep circumflex iliac artery and vein in mandibular and oral soft tissue defect reconstruction.Methods:Retrospective analysis of the clinical data of patients with mandible and oral soft tissue defects in Henan Provincial People’s Hospital from October 2020 to March 2022. All cases were performed with computer-aided design and three-dimensional printing to make the models and guide plates. VIC-TFLF was used to repair and reconstruct the oral and mandible defects, the tensor fascia lata flap was used to repair the intraoral soft tissue defect, and the fascia lata was exposed to the mouth directly. After operation, the color, texture and change of intraoral flap were observed, and the recovery and complications were followed up.Results:In this study, 7 patients were included, 4 males and 3 females, aged 27-64 years old, with an average of 50.1 years old. There were 5 cases of squamous cell carcinoma of mandible gingival and cheek, 1 case of postoperative defect of pleomorphic adenocarcinoma of mandible, and 1 case of postoperative defect of ameloblastoma of mandible. According to the defect range of soft and hard tissue after resection, the flap areas of tensor fascia lata were 6.0 cm×3.0 cm-8.0 cm×6.0 cm, and the iliac bones were 3.7 cm×2.4 cm-9.2 cm×2.5 cm. All the composite tissue flaps survived, without distal necrosis, delayed wound healing and marginal fistula. The patients were followed up for 4-19 months, with an average of 11.7 months. The morphology and functions of the mandible and oral soft tissue were well recovered. The surface of tensor fascia lata was exposed to the oral cavity directly, which showed signs of mucosalization within 1 week after operation. The mucosalization was basically completed within 1 month, which was close to normal oral mucosal appearance, and could be reconstructed to produce better oral mucosal appearance in the later period. The wounds in the donor site healed well, and there was no abnormality in lower limb movement and thigh flexion. Among them, 3 patients had numbness on the lateral thigh skin of the donor site 3-5 days after operation. After 6 months of follow-up, the numbness in 2 cases disappeared, and 1 case was significantly reduced.Conclusions:The VIC-TFLF could obtain great appearance and function, with fewer complications and relatively small damage to the donor site, in repair and reconstruction of mandibular defects combined with oral soft tissue defects.

Objective:To evaluate the application effect of vascularized iliac crest-tensor fascia lata flap(VIC-TFLF) based on deep circumflex iliac artery and vein in mandibular and oral soft tissue defect reconstruction.Methods:Retrospective analysis of the clinical data of patients with mandible and oral soft tissue defects in Henan Provincial People’s Hospital from October 2020 to March 2022. All cases were performed with computer-aided design and three-dimensional printing to make the models and guide plates. VIC-TFLF was used to repair and reconstruct the oral and mandible defects, the tensor fascia lata flap was used to repair the intraoral soft tissue defect, and the fascia lata was exposed to the mouth directly. After operation, the color, texture and change of intraoral flap were observed, and the recovery and complications were followed up.Results:In this study, 7 patients were included, 4 males and 3 females, aged 27-64 years old, with an average of 50.1 years old. There were 5 cases of squamous cell carcinoma of mandible gingival and cheek, 1 case of postoperative defect of pleomorphic adenocarcinoma of mandible, and 1 case of postoperative defect of ameloblastoma of mandible. According to the defect range of soft and hard tissue after resection, the flap areas of tensor fascia lata were 6.0 cm×3.0 cm-8.0 cm×6.0 cm, and the iliac bones were 3.7 cm×2.4 cm-9.2 cm×2.5 cm. All the composite tissue flaps survived, without distal necrosis, delayed wound healing and marginal fistula. The patients were followed up for 4-19 months, with an average of 11.7 months. The morphology and functions of the mandible and oral soft tissue were well recovered. The surface of tensor fascia lata was exposed to the oral cavity directly, which showed signs of mucosalization within 1 week after operation. The mucosalization was basically completed within 1 month, which was close to normal oral mucosal appearance, and could be reconstructed to produce better oral mucosal appearance in the later period. The wounds in the donor site healed well, and there was no abnormality in lower limb movement and thigh flexion. Among them, 3 patients had numbness on the lateral thigh skin of the donor site 3-5 days after operation. After 6 months of follow-up, the numbness in 2 cases disappeared, and 1 case was significantly reduced.Conclusions:The VIC-TFLF could obtain great appearance and function, with fewer complications and relatively small damage to the donor site, in repair and reconstruction of mandibular defects combined with oral soft tissue defects.

Objective    To evaluate the effectiveness of the artificial intelligence-assisted diagnosis and treatment system in distinguishing benign and malignant lung nodules and the infiltration degree. Methods    Clinical data of 87 patients with pulmonary nodules admitted to the First Affiliated Hospital of Xiamen University from January 2019 to August 2020 were retrospectively analyzed, including 33 males aged 55.1±10.4 years, and 54 females aged 54.5±14.1 years. A total of 90 nodules were included, which were divided into a malignant tumor group (n=80) and a benign lesion group (n=10), and the malignant tumor group was subdivided into an invasive adenocarcinoma group (n=60) and a non-invasive adenocarcinoma group (n=20). The malignant probability and doubling time of each group were compared and its ability to predict the benign and malignant nodules and the invasion degree was analyzed. Results    Between the malignant tumor group and the benign lesion group, the malignant probability was significantly different, and the malignant probability could better distinguish malignant nodules and benign lesions (87.2%±9.1% vs. 28.8%±29.0%, P=0.000). The area under the curve (AUC) was 0.949. The maximum diameter of nodules in the benign lesion group was significantly longer than that in the malignant tumor group (1.270±0.481 cm vs. 0.990±0.361 cm, P=0.026); the doubling time of benign lesions was significantly longer than that of malignant nodules (1 083.600±258.180 d vs. 527.025±173.176 d, P=0.000), and the AUC was 0.975. The maximum diameter of the nodule in the invasive adenocarcinoma group was longer than that of the non-invasive adenocarcinoma group (1.350±0.355 cm vs. 0.863±0.271 cm, P=0.000), and there was no statistical difference in the probability of malignancy between the invasive adenocarcinoma group and the non-invasive adenocarcinoma group (89.7%±5.7% vs. 86.4%±9.9%, P=0.082). The AUC was 0.630. The doubling time of the invasive adenocarcinoma group was significantly shorter than that of the non-invasive adenocarcinoma group (392.200±138.050 d vs. 571.967±160.633 d, P=0.000), and the AUC was 0.829. Conclusion    The malignant probability and doubling time of lung nodules calculated by the artificial intelligence-assisted diagnosis and treatment system can be used in the assessment of the preoperative benign and malignant lung nodules and the infiltration degree.

Objective To analyze the pattern of recurrence risk and investigate the association between pathological staging and recurrence risk in patients with esophageal squamous cell carcinoma (ESCC) treated with neoadjuvant chemoradiotherapy (CRT). Methods Clinical data of 174 patients with advanced thoracic ESCC treated with neoadjuvant CRT between 2002 and 2015 were retrospectively analyzed. All patients received preoperative concurrent platinum-based chemotherapy with conformal radiotherapy (40-50. 4 Gy,conventional fractionation) combined with surgery. Kaplan-Meier method was utilized to analyze the survival,the log-rank test was conducted to compare the differences between groups,and the Cox regression model was used for multivariate analysis. Results The median follow-up time was 53. 9 months. A total of 44. 8% of patients achieved pathological complete response, and 59 patients ( 33. 9%) recurred after neoadjuvent CRT.The postoperative recurrence rate was 22. 2% for patients with pathological stage 0/I,38. 7% for stageⅡand 68. 2% for stageⅢ(P=0. 000).The 5-year recurrence-free survival (RFS) rates were 74. 7%, 61. 4% and 20. 9% for patients with pathological stage 0/Ⅰ,ⅡandⅢ,respectively (P=0. 000).In total,20. 5% of patients with pathological stage 0/I orⅡrecurred after postoperative 3 years, whereas all patients with pathological stageⅢrecurred within postoperative 2 years. Multivariate analysis demonstrated that age,clinical TNM staging,chemotherapy regimen,and pathological response after CRT were independent prognostic factors affecting the RFS ( P= 0. 027, 0. 047, 0. 010, 0. 005). Conclusions Pathological stage is significantly correlated with the recurrence risk in ESCC patients after neoadjuvant CRT.Risk-based surveillance strategies can be defined according to different pathologial staging.

Objective To analyze the outcomes and prognostic factors in patients with esophageal cancer after concurrent chemoradiotherapy.Methods A total of 135 patients with esophageal squamous cell carcinoma were enrolled in the clinical study from January 2008 to June 2015.The patients were treated with two-dimensional radiotherapy (56 patients) or three-dimensional radiotherapy (79 patients).The radiotherapy was delivered at a total dose of 60-64 Gy (1.8-2.0 Gy per fraction).The concurrent chemotherapy regimen consisted of fluorouracil plus cisplatin or paclitaxel plus cisplatin and was performed on days 1 and day 29 of radiotherapy.The Kaplan-Meier method was used to calculate overall survival (OS)and progression-free survival (PFS) rates,the log-rank test was used for survival difference analysis and univariate prognostic analysis,and the Cox model was used for multivariate prognostic analysis.Results The 1-,3-,and 5-year sample sizes were 96,31,16,respectively.The 1-,3-,and 5-year OS rates were 74.0％,39.0％,and 28.6％,respectively;the median OS time was 25 months.The 1-,3-,and 5-year PFS rates were 57.3％,27.3％,and 16.6％,respectively;the median PFS time was 15 months.The univariate analysis indicated that clinical stage,radiotherapy method,and M stage were prognostic factors for OS and PFS (P =0.006,0.000,and 0.032;P=0.017,0.004,and O.000).The multivariate analysis showed that clinical stage and radiotherapy method were independent prognostic factors for OS and PFS (P=0.006 and 0.000;P =0.033 and 0.023).Conclusions For non-surgical treatment of patients with esophageal cancer,concurrent chemoradiotherapy is a preferred strategy and has proven to be effective and tolerable.

Objective: To assess the trends in clinical characteristics, treatment, and outcomes for hospitalized patients undergoing percutaneous coronary intervention (PCI) in central-western urban hospitals of China in 2001, 2006 and 2011. Methods: We used a 2-stage, random sampling strategy to create a Chinese central-western urban hospital representative sample of 2152 patients undergoing PCI at 26 hospitals in China PEACE- retrospective CathPCI study and calculated the weighted data of clinical information in each year. Results: Between 2001 and 2011, the admission rate for PCI increased by 46 folds. Compared with 2001, the patients undergoing PCI were more likely to be female, older than 80 years, and to have history of diabetes, dyslipidemia and PCI in 2011. The proportion of trans-radial PCIs increased from 3.5% in 2001 to 87.6% in 2011 (Ptrend < 0.0001); the proportion of drug eluting stents (DES) among all the implanted stents increased from 16.4% in 2001 to 95.7% in 2011 (Ptrend < 0.0001), largely due to increased use of domestic DES. Less than 5% of medical record of admission for PCI documented door time and balloon time. The median length of stay decreased from 13 days in 2001 to 10 days in 2011 (Ptrend < 0.0001). In-hospital mortality did not change signiifcantly, but both any bleeding and access bleeding events were decreased signiifcantly over time (Ptrend < 0.05). Conclusion: There has been a rapid increase in the volume and significant change in treatment patterns of PCI over the 10-year period from 2001 to 2011 in Chinese central-western urban hospitals. We identiifed quality gaps that represent opportunities to improve medical care.