OBJECTIVES: To analyze the multimorbidity patterns and core diseases among hospitalized patients in different age groups and to explore the impacts of multimorbidity patterns on hospitalization costs. METHODS: Electronic medical records of adult inpatients (aged ≥18 years) from Ningbo Medical Center Lihuili Hospital between January 1, 2018, and June 30, 2023 were collected. The multimorbidity status involving 53 specific diseases was analyzed across different age groups. Association rule mining was used to identify common multimorbidity patterns. Complex network analysis was used to identify core diseases within the multimorbidity networks. Generalized estimating equations (GEE) were used to analyze the impact of different multimorbidity patterns on hospitalization costs. RESULTS: The prevalence of multimorbidity among the 359 402 adult inpatients was 38.51%, with higher rates observed in males (43.60%) and elderly patients (58.29%). Association rule mining identified 15 common multimorbidity patterns, which exhibited differences across age groups. The most prevalent multimorbidity pattern overall was "diabetes→hypertension" (support=7.04%, confidence=62.17%, lift=2.17). In the young adult group, the most prevalent pattern was "dyslipidemia→chronic liver disease" (support=1.19%, confidence=53.17%, lift=6.04). In the middle-aged group, it was "diabetes→hypertension" (support=4.84%, confidence=50.28%, lift=2.15). In the elderly group, it was "coronary heart disease, diabetes→hypertension" (support=2.38%, confidence=77.43%, lift=1.63). Complex network analysis revealed that the core diseases within multimorbidity networks differed across age groups. The core disease identified in the young adult group was chronic liver disease (degree centrality=50, betweenness centrality=0.055, closeness centrality=0.963). Core diseases in the middle-aged group included hypertension, chronic liver disease, and diabetes (all with degree centrality=52, betweenness centrality=0.022, closeness centrality=1.000). Core diseases in the elderly group comprised hypertension, diabetes, malignant tumors, chronic liver disease, thyroid disease, anemia, and arrhythmia (all with degree centrality=52, betweenness centrality=0.009, closeness centrality=1.000). Generalized estimating equations analysis indicated that, most multimorbidity patterns were significantly associated with increased hospitalization costs. However, the magnitude of cost increase varied across different multimorbidity patterns. Specifically, hospitalization costs for patients with patterns such as "heart failure→hypertension", "stroke→hypertension", "malignant tumor, diabetes→hypertension", "stroke, diabetes→hypertension", and "diabetes, heart failure→hypertension" were more than double those of patients without any target diseases. CONCLUSIONS Multimorbidity patterns and core diseases among hospitalized patients differ significantly across age groups, and different patterns exert varying impacts on hospitalization costs. These findings underscore the necessity for age-stratified and multimorbidity pattern specific management strategies.
Humans ; Multimorbidity ; Male ; Hospitalization/economics* ; Female ; Aged ; Middle Aged ; Adult ; Age Factors ; Young Adult ; Adolescent ; Diabetes Mellitus/epidemiology* ; Electronic Health Records ; Aged, 80 and over ; Hospital Costs ; China/epidemiology* ; Hypertension/economics* ; Liver Diseases/epidemiology*

Cellular dysfunction caused by vesicle transport is associated with a variety of diseases.The trans-Golgi network(TGN)to endosome transport is an important pathway of vesicle transport,and its defects leading to protein balance disorders has been linked to many diseases such as cancer,neurodegenerative diseases and diabetes mellitus.Gol-gi-associated gamma-adaptin ear-containing ADP-ribosylation factor-binding protein 2(GGA2)is a crucial protein in-volved in TGN-endosomal transport.It plays a significant role in the regulation of several diseases,including cancer,Al-zheimer disease,type 2 diabetes mellitus and cerebral ischemia,by mediating protein transport with important biological significance.This article provides an overview of the molecular structure of GGA2,its role in regulating clathrin-mediated protein transport between TGN and endosomes,and its potential implications for a variety of diseases.

Objective To evaluate the short-term clinical effect of arthroscopic repair of rotator cuff injury with all-suture anchor using a prospective and single-cohort clinical trial.Methods Twenty-five patients with rotator cuff injuries(1.5 cm0.05).Conclusion Arthroscopic rotator cuff repair with all-suture anchor is feasible and safe,and has good short-term clinical effect.

Breast cancer （BC） ranks first in the incidence rate of female malignant tumor， the notable features of which include high invasive behavior， high malignant degree and poor prognosis. Resveratrol， a plant antioxidant， has been identified as a potential therapeutic agent for the occurrence and progress of BC. This article explores the mechanism of resveratrol intervention in BC by evaluating several in vitro and in vivo studies. It was found that resveratrol can weaken the proliferation and survival ability of BC cells， suppress their growth， metastasis， and invasion， and reverse their resistance to adriamycin by promoting cell apoptosis， regulating autophagy， inhibiting glycolysis and regulating the tumor microenvironment， expressions of matrix metalloproteinases， epithelial-mesenchymal transition and drug-resistant proteins， etc. The limited number of clinical trial studies on resveratrol， mainly focusing on prevention effect of it on breast cancer， may be one of the reasons that affect the comprehensive evaluation of the anti-cancer efficacy of resveratrol.

Breast cancer （BC） ranks first in the incidence rate of female malignant tumor， the notable features of which include high invasive behavior， high malignant degree and poor prognosis. Resveratrol， a plant antioxidant， has been identified as a potential therapeutic agent for the occurrence and progress of BC. This article explores the mechanism of resveratrol intervention in BC by evaluating several in vitro and in vivo studies. It was found that resveratrol can weaken the proliferation and survival ability of BC cells， suppress their growth， metastasis， and invasion， and reverse their resistance to adriamycin by promoting cell apoptosis， regulating autophagy， inhibiting glycolysis and regulating the tumor microenvironment， expressions of matrix metalloproteinases， epithelial-mesenchymal transition and drug-resistant proteins， etc. The limited number of clinical trial studies on resveratrol， mainly focusing on prevention effect of it on breast cancer， may be one of the reasons that affect the comprehensive evaluation of the anti-cancer efficacy of resveratrol.

Objective To explore the effect of deep learning image reconstruction(DLIR)algorithm combined with"double low"[low voltage(kV)and low contrast agent dosage]technique on the image quality of coronary computed tomography angiography(CCTA)in overweight patients compared with adaptive statistical iterative reconstruction(ASIR-V)and filtered back projection(FBP).Methods Fifty-two patients with body mass index(BMI)between 25.1 kg/m2and 28 kg/m2 who underwent CCTA scanning were prospectively selected,all of whom scanned on a GE Revolution APEX-CT with a tube voltage of 80 kV,a smart mA(500-1 300 mA),a noise index of 30,and a contrast dosage of 0.5 mL/kg;four groups of images were reconstructed for each patient,FBP,50％ASIR-V,DLIR-M,and DLIR-H.The CT and SD values of the aorta(AO)root,the proximal segment of the right coronary artery(RCA),the left circumflex(LCX),the left anterior descending branch(LAD)and the pericardial fat were measured,and the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were calculated.Two doctors experienced in the diagnosis of cardiovascular disease were selected to subjectively score the reconstructed images using a double-blind method.The SD value,SNR value,CNR value and subjective scores of images in the four groups were compared.Results In the objective image quality evaluation,there were statistically significant differences in SD value,SNR value and CNR value of reconstructed images in the four groups(P＜0.05).As the four groups of reconstruction algorithms FBP,50％ASIR-V,DLIR-M,and DLIR-H were changed sequentially,the image SD value gradually decreased,the SNR value and CNR value gradually increased,and the DLIR-H group had the lowest SD value and the highest SNR and CNR values.In the subjective image quality evaluation,the subjective scores of the two doctors had good consistency(Kappa value=0.900),and the difference between them was statistically significant(P＜0.001).The subjective scores of DLIR-M and DLIR-H groups were higher.Conclusion DLIR algorithm combined with"double-low"technique can significantly improve the CCTA image quality of overweight patients,which is better than 50％ASIR-V and FBP.

Objective:To explore the risk factors of oral-mucosal pressure injury (OMPI) in patients with tracheal intubation in ICU and to establish a nomogram model.Methods:Using the convenient sampling method, a total of 640 patients with oral tracheal intubation admitted to ICU of the First Affiliated Hospital of Xinjiang Medical University from January to May 2023 were selected as the research objects. They were divided into the occurrence group ( n=286) and the non-occurrence group ( n=354) according to whether OMPI occurred or not. Binomial Logistic regression analysis was used to explore the risk factors for OMPI in patients with tracheal intubation in ICU. A risk nomogram model was created based on independent risk factors, and internal verification was conducted by Bootstrap repeated sampling method. Results:OMPI occurred in 286 of 640 ICU patients with tracheal intubation. Binomial Logistic regression analysis showed that high APACHEⅡ score, modified Beck oral score greater than or equal to 11 points, use of sedative drugs, prone ventilation, long retention time of tracheal catheter, low oxygenation index less than 200 mmHg (1 mmHg=0.133 kPa) and tracheal catheter fixation frequency of 1 time /24 h were the risk factors for OMPI in patients with tracheal intubation in ICU ( P<0.05). A risk nomogram model for OMPI in patients with tracheal intubation in ICU was established based on independent risk factors. The results showed that the predictive performance (area under the receiver operating characteristic curve of subjects was 0.918, 95% confidence interval was 0.897 to 0.938) and calibration (χ 2 value of 4.647, P=0.795) of the risk nomogram model for OMPI in patients with tracheal intubation in ICU were good. When the threshold probability was 0 to 1, the decision curve showed that the model had good clinical effectiveness. Conclusions:The OMPI risk nomogram model of tracheal intubation patients in ICU established in this study has good calibration and differentiation, which can be used as an effective tool for screening high-risk patients.

Objective: To investigate the effect of 18 F-deoxythymidine nucleoside ( 18 F-FLT) positron emission computed tomography (PET / CT) imaging to evaluate the radiosensitization effect of Olaparib on breast cancer model in nude mice． Methods : According to the random number table method，twenty-four BALB / C nude mice MCF- 7 breast cancer models were established and divided into four groups with 6 mice in each group，namely the control group，radiotherapy group，Olaparib group and Olaparib + radiotherapy group． 18 F-FLT micro PET / CT imaging was performed on nude mice before and 48 h after treatment，respectively．The changes of maximum standardized uptake value ( SUVmax ) ，total proliferation volume (TPV) and tumor volume before and after tumor treatment in four groups were compared．The tumors were extracted and weighed to observe the changes of tumor weight，and the expression of Ki-67 and PCNA was analyzed by immunohistochemistry staining．The correlation of tumor SUVmax with Ki-67 and PCNA was analyzed. Results : Before treatment，there were no significant differences in SUVmax ， TPV and tumor volume among the 4 groups (F = 0. 041，0. 061，0. 045，P＞0. 05) ．48 h after treatment，SUVmax in the control and Olaparib groups increased significantly ( t = －12. 111，P ＜0. 001 ; t = －3. 001，P = 0. 03 ) ， SUVmax was reduced in the radiotherapy and Olaparib + radiotherapy groups (t = 5. 829，P＜0. 01 ; t = 4. 448，P < 0. 01) ，while SUVmax ，TPV and tumor volume of tumors in the Olaparib + radiotherapy group were lower than those in the radiotherapy group (t = 3. 388，5. 884，5. 990，P＜0. 01) ．Tumor weight was significantly lower in the Olaparib + radiotherapy group than in the other three groups ( F = 44. 405，P ＜0. 001 ) ． Immunohistochemical staining showed that Ki-67 and PCNA were the least expressed in the Olaparib + radiotherapy group than in the other three groups (F = 16. 289，39. 645，P＜0. 001) ．SUVmax was positively correlated with Ki-67 and PCNA expression (r = 0. 920，0. 918，P＜0. 01) ． Conclusion 18 F-FLT Micro PET / CT imaging can evaluate the radiosensitizing effect of Olaparib on nude mouse breast cancer model.

Objective To observe the value of 3.0T multimodal MRI for preoperative evaluation of T stage and therapeutic efficacy of neoadjuvant for rectal cancer.Methods 3.0T multimodal MRI data,including T1WI,T2WI/diffusion weighted imaging(DWI),dynamic contrast enhanced MRI(DCE-MRI)and intravoxel incoherent motion DWI(IVIM-DWI)of 150 patients with rectal cancer were retrospectively analyzed,and the value of different sequences for evaluating T stage and therapeutic efficacy of neoadjuvant for rectal cancer were assessed.Results The sensitivity,specificity and accuracy of T1WI,T2WI/DWI,DCE-MRI and IVIM-DWI for evaluating T1-T2 and T3-T4 stage rectal cancer were all significantly different(all P＜0.05).The diagnostic efficacy of DCE-MRI and IVIM-DWI were all higher than that of T1WI and T2WI/DWI(all P＜0.05).Combination evaluation of DCE-MRI and IVIM-DWI for T stage of rectal cancer had good consistency with pathological results(Kappa=0.943,P＜0.05).Significant differences of volume transfer constant(Ktrans),true diffusion coefficient(D)and apparent diffusion coefficient(ADC)were found among different T stage rectal cancers(all P＜0.05).Totally 80 patients received neoadjuvant therapy,and significant differences of Ktrans,D and ADC were noticed between patients with good(n=32)or poor efficacy(n=48)(all P＜0.05).The area under the curve(AUC)of Ktrans,D and ADC for evaluating therapeutic efficacy of neoadjuvant for rectal cancer was 0.774,0.837 and 0.758,respectively,of the combination of above three was 0.929,higher than that of single indexes(all P＜0.05).Conclusion Combination of 3.0T DCE-MRI and IVIM-DWI was helpful for preoperative evaluating T stage and therapeutic efficacy of neoadjuvant for rectal cancer.

Objective:To investigate the radiosensitizing effect of silencing breast cancer susceptibility gene 1 (shBRCA1) expression on MDA-MB-231 breast cancer bearing nude mice by 3′-deoxy-3′- 18F-fluorothymidine ( 18F-FLT) microPET/CT imaging. Methods:Twenty-four BALB/c nude mice were divided into 4 groups ( n=6 in each group) according to the random number table method, namely negative control (NC) group, NC+ radiotherapy group, shBRCA1 group and shBRCA1+ radiotherapy group. 18F-FLT microPET/CT imaging was performed before and 24 h after radiotherapy. The changes of SUV max before and after radiotherapy were compared among 4 groups, and the total proliferative volume (TPV) of tumors in each group after treatment was also analyzed. The expression of Ki-67 in tumor tissues was analyzed by immunohistochemistry. Data were analyzed by paired t test, one-way analysis of variance, least significant difference t test and Pearson correlation analysis. Results:Breast cancer cells targeting the BRCA1 were constructed. Before radiotherapy, the differences of SUV max among the NC group, NC+ radiotherapy group, shBRCA1 group and shBRCA1+ radiotherapy group were not statistically significant (1.034±0.137, 1.031±0.152, 1.028±0.169 and 1.026±0.156; F=0.00, P=0.999). Twenty-four hours after the end of the four times of radiotherapy, the differences of SUV max among the 4 groups were statistically significant (1.367±0.100, 0.781±0.079, 1.306±0.213 and 0.597±0.129; F=44.77, P<0.001), with lower SUV max in the shBRCA1+ radiotherapy group compared with the NC+ radiotherapy group ( t=2.98, P=0.014). The SUV max of the NC+ radiotherapy group and shBRCA1+ radiotherapy group were reduced compared with those before radiotherapy ( t values: 5.82, 5.44, P values: 0.002, 0.003), while SUV max of the NC group and shBRCA1 group increased compared with those before radiotherapy ( t values: -4.47, -3.98, P values: 0.007, 0.011). TPV was smaller in the shBRCA1+ radiotherapy group compared with that in the NC+ radiotherapy group (0.48±0.03 vs 0.61±0.07; F=25.36, t=3.82, P=0.003). Immunohistochemical assays showed that Ki-67 was less expressed in the shBRCA1+ radiotherapy group than that in the NC+ radiotherapy group (0.286±0.072 vs 0.476±0.093; F=15.73, t=3.61, P=0.007). Correlation analysis showed a positive correlation between Ki-67 expression and SUV max ( r=0.83, P<0.001). Conclusion:18F-FLT microPET/CT imaging can evaluate the radiosensitizing effect of shBRCA1 expression on MDA-MB-231 breast cancer bearing nude mice.