Objective To investigate the predictive value of uric acid for cardiovascular events in the elderly patients with ACS.Methods An observational follow-up study was conducted on 3440 ACS inpatients and outpatients admitted in the Heart Center of Beijing Chaoyang Hospital and the First Medical Center of Chinese PLA General Hospital from June 2017 to October 2022.According to the occurrence of cardiovascular events,they were divided into a cardiovascular event group(529 patients)and a non-cardiovascular event group(2911 patients).Their clinical data were collected for Cox risk proportional regression analysis.Results The cardiovascular event group had significantly uric acid when compared with the non-cardiovascular event group(P＜0.01).Af-ter adjusting the traditional risk factors and plasma biomarkers,uric acid was still a significant predictor for clinical endpoints(HR=2.634,95％CI:1.870-3.744,P＜0.01)and for cardiovascu-lar events(HR=1.508,95％CI:1.357-1.660,P＜0.01).Furthermore,uric acid was significantly correlated with acute heart failure,cardiovascular death and all-cause death(P＜0.01).Conclusion Uric acid is a risk predictor for cardiovascular events in elderly ACS patients,and can provide ear-ly warning information and diagnostic value for acute cardiovascular events.

Objective To investigate the predictive value of uric acid for cardiovascular events in the elderly patients with ACS.Methods An observational follow-up study was conducted on 3440 ACS inpatients and outpatients admitted in the Heart Center of Beijing Chaoyang Hospital and the First Medical Center of Chinese PLA General Hospital from June 2017 to October 2022.According to the occurrence of cardiovascular events,they were divided into a cardiovascular event group(529 patients)and a non-cardiovascular event group(2911 patients).Their clinical data were collected for Cox risk proportional regression analysis.Results The cardiovascular event group had significantly uric acid when compared with the non-cardiovascular event group(P＜0.01).Af-ter adjusting the traditional risk factors and plasma biomarkers,uric acid was still a significant predictor for clinical endpoints(HR=2.634,95％CI:1.870-3.744,P＜0.01)and for cardiovascu-lar events(HR=1.508,95％CI:1.357-1.660,P＜0.01).Furthermore,uric acid was significantly correlated with acute heart failure,cardiovascular death and all-cause death(P＜0.01).Conclusion Uric acid is a risk predictor for cardiovascular events in elderly ACS patients,and can provide ear-ly warning information and diagnostic value for acute cardiovascular events.

BACKGROUND:It is known that N6-methyladenosine(m6A)plays a role in the pathogenesis of various diseases and studies have suggested its involvement in the pathologic changes of steroid-induced femoral head necrosis(SNFH).However,research on m6A methylation modifications in steroid-induced femoral head necrosis is limited. OBJECTIVE:Using bioinformatics methods to identify the differential expression of m6A-related genes in steroid-induced femoral head necrosis and to predict miRNAs associated with these genes to further elucidate the role and mechanism of m6A methylation in steroid-induced femoral head necrosis. METHODS:Differential gene expression between steroid-induced femoral head necrosis and control groups was analyzed using GSE123568 gene expression data and identified using the"limma"package in R.Functional enrichment analysis was performed on the differentially expressed genes.Differential analysis of the related genes was carried out using the"ggstatsplot"package in R.The differential genes were cross-validated using the GSE74089 dataset.An mRNA-miRNA regulatory network was constructed,and co-expression analysis was performed on the module genes followed by enrichment analysis.Differences in immune cell infiltration between steroid-induced femoral head necrosis and control groups were quantified using the ssGSEA method. RESULTS AND CONCLUSION:Correlation analysis revealed 13 m6A-related genes,and further analysis through the protein-protein interaction network identification and receiver operating characteristic curve analysis showed that YTHDF2 was expected to be a core differential gene as a potential early biomarker.Enrichment analysis indicated that differentially expressed genes were mainly involved in inflammation and immune response and were closely related to osteoclasts.Cross-validation analysis showed that differential gene expression results between the two datasets were consistent.mRNA-miRNA regulatory network analysis revealed that YTHDF2 was negatively correlated with miRNA-27a.Immune infiltration analysis revealed an increase in immune cell infiltration in steroid-induced femoral head necrosis,and YTHDF2 was positively correlated with the infiltration of CD4+T cells.To conclude,m6A-related gene YTHDF2 can serve as a potential biomarker of steroid-induced femoral head necrosis and is valuable for the early clinical diagnosis and treatment of steroid-induced femoral head necrosis.The negative correlation between YTHDF2 and mir-27a and the positive correlation between YTHDF2 and CD4+T cell infiltration provide new insights into the early diagnosis and treatment of steroid-induced femoral head necrosis and shed light on the mechanism of m6A in steroid-induced femoral head necrosis.

BACKGROUND:Osteoporotic vertebral compression fracture is a common fracture secondary to osteoporosis.At present,there is no effective prediction index and method for osteoporotic vertebral compression fracture. OBJECTIVE:To investigate the predictive effect of the comprehensive index of lumbar vertebral body bone strength on osteoporotic vertebral compression fracture. METHODS:233 patients with osteoporosis were divided into a fracture group and a non-fracture group according to whether a vertebral fracture occurred.The demography,body mass index,vertebral bone mineral density and other details were collected.Lateral X-ray films of the lumbar spine were photographed.The vertebral body width,vertebral body length,sacral slope,pelvic tilt,pelvic incidence,lumbar compressive strength index and the lumbar impact strength index were measured,calculated,and analyzed by univariate and multivariate,and the receiver operating characteristic curve was analyzed.The survival analysis was conducted according to the cut-off value. RESULTS AND CONCLUSION:(1)All patients were followed up for 2-4 years,with an average of 3.1 years.During the follow-up period,99 cases(38 cases of L1 vertebral body,61 cases of L2 vertebral body)had fractures(fracture group),and 134 cases(52 cases of L1 vertebral body,82 cases of L2 vertebral body)had no fractures(non-fracture group).Univariate analysis showed that there was no significant difference in age,sex,height,body mass,body mass index and fracture segment between the two groups(P>0.05).(2)Lumbar compressive strength index and lumbar impact strength index in the fracture group were lower than those in the non-fracture group(P<0.05).Pelvic incidence and pelvic tilt in the fracture group were higher than those in the non-fracture group(P<0.05).(3)Multivariate analysis showed that lumbar compressive strength index,lumbar impact strength index and pelvic tilt were risk factors for osteoporotic vertebral compression fractures(P<0.05).(4)Receiver operating characteristic curve analysis showed that the cutoff values of vertebral bone mineral density,lumbar compressive strength index,lumbar impact strength index,pelvic tilt and pelvic incidence were 0.913 5 g/cm2,1.932,0.903,21.5° and 55°,respectively;areas under the curve were 0.630,0.800,0.911,0.633 and 0.568,respectively.(5)According to the survival analysis(with osteoporotic vertebral compression fracture as the end point),the average survival time of the patients with lumbar impact strength index≥0.903 was significantly longer than that of the patients with lumbar impact strength index<0.903(P<0.05).(6)These findings conclude that the comprehensive index of lumbar vertebral body bone strength is more accurate than the bone mineral density of the vertebral body and spine-pelvis sagittal parameters in predicting osteoporotic vertebral compression fractures,which is helpful for early prevention and treatment of osteoporotic vertebral compression fractures.

BACKGROUND:Osteoporosis vertebral compression fracture is a common fracture secondary to osteoporosis,and there is currently a lack of effective predictive indicators and methods for osteoporosis vertebral compression fracture. OBJECTIVE:To investigate the predictive effects of paravertebral muscle degeneration,functional cross-sectional area,and percentage of fat infiltration on osteoporotic vertebral compression fractures. METHODS:The 224 patients with osteoporosis diagnosed from January 2018 to June 2022 were included.They were followed up for more than 2 years.They were divided into fracture group and non-fracture group according to the presence and absence of vertebral fracture.The detailed information of demographics,body mass index,bone mineral density and so on were collected.The functional cross-sectional area and percentage of fat infiltration of bilateral Psoas major muscle and extensor dorsi(Erector spinae muscles muscle and multifidus muscle)at the level of lower endplate of L2 vertebral body were measured and calculated. RESULTS AND CONCLUSION:(1)224 patients were ultimately included,of which 126 had fractures as the fracture group and 98 had no fractures as the non-fracture group.There was no statistically significant difference in age,gender,height,body mass,body mass index,and fracture segment between the two groups(P>0.05).(2)The bone mineral density of the fracture group was significantly lower than that of the non-fracture group(P<0.05).Functional cross-sectional areas of Psoas major muscle and extensor dorsi in the fracture group were significantly lower than those in the non-fracture group(P<0.05).The percentage of fat infiltration of the extensor dorsi in the fracture group was significantly higher than that in the non-fracture group(P<0.05).There was no significant difference in percentage of fat infiltration of Psoas major muscle between the two groups(P>0.05).(3)Receiver operating characteristic analysis showed that the vertebral bone mineral density,percentage of fat infiltration of extensor dorsi,functional cross-sectional area of extensor dorsi and percentage of fat infiltration of Psoas major muscle were 0.903 g/cm2,35.426%,418.875 mm2,and 6.375%,respectively.The areas under curve were 0.634,0.755,0.876,and 0.585,respectively.(4)These findings indicate that paravertebral muscle degeneration is strongly associated with the occurrence of osteoporotic vertebral compression fractures.The functional cross-sectional area of extensor dorsi muscle can effectively predict the occurrence of osteoporotic vertebral compression fractures,which is helpful for early prevention and treatment of osteoporotic vertebral compression fractures.

On August 2-4,2023,the"Third Summit Forum on'Building a Community of Shared Future for Doctors and Patients'"was jointly organized by institutions such as the Chinese Medical Ethics,the Hospital Humanities Management and Talent Training Special Committee of the China Population and Culture Promotion Association,Center for Ethical Studies of Renmin University of China,the Newspaper for China's Physicians,the China Health Law Society,the China Anti-Cancer Association,and the China Association For Ethical Studies in Harbin.The conference arranged a sub-forum for the"Seminar on the Construction of Chinese Medical Humanities",with domestic medical humanities scholars attending the conference.After heated discussions at the seminar,the Scholars'Consensus on the Construction and Development of Chinese Medical Humanities was formed.It was proposed that in the new era,it is urgent to build the medical humanities discipline,as well as lead the academic integration and development of medical humanities under the core socialist values.At the same time,for the construction of the medical humanities discipline,it is necessary to optimize the organizational mechanism,prosper and develop the overall framework of the medical humanities discipline,accelerate the construction of a professional teaching team for the medical humanities discipline,promote the establishment of a new carrier medical humanities education and teaching in cultivating morality and nurturing talents,as well as focus on solving problems related to the cultivation of medical humanities graduate students.

Objective:To provide references for finding an objective, accurate, highly repeatable and operable measurement method of the resting energy expenditure (REE) for flying personnel by taking the indirect calorimetry measured REE as the gold standard and establishing the formula for predicting REE combined with body composition indexes.Methods:Fourteen normal-size male volunteers were chosen as the subjects. The hypobaric hypoxia environment was constructed in the hypobaric chamber. The subjects were asked to complete single task (flight control) and dual task (flight control and calculation). The body weight, fat free mass (FFM), muscle mass (MM), fat mass (FM), waist-to-hip ratio (WHR), visceral fat mass (VFM) and body fat percentage (BF%) were directly measured by body composition analyzer. The respiratory frequency (RF), volume of CO 2 (VCO 2), maximal volume of O 2 (VO 2max), volume of tidal (VT), minute ventilation volume (VE), metablic equivalent (MET), REE and REE/kg/d were measured by gas metabolizer. The correlation between REE and body composition indexes was analyzed and a linear regression equation was obtained. Results:In the simulated hypobaric hypoxia environment, the RF, VCO 2, VO 2max, VE, VT, REE, REE/kg/d, MET and heart rate of the subjects increased slightly in the dual task, but there were no significant differences between the dual task and the single task (all P>0.05). REE was positively correlated with FFM and MM ( r=0.566, 0.570, P=0.035, 0.033), but not with height, FM and heart rate (all P>0.05). The prediction formula of REE in hypobaric hypoxia environment was Model A: REE=60.34×MM-1 121 ( r=0.570, P=0.033), or Model B: REE=55.34×FFM-1 073 ( r=0.566, P=0.035). There was a positive correlation between the predicted REE and the measured REE ( r=0.570, P=0.033) for Model A, and the error value was (0.032±358.170) kcal/d, P=1.00>0.05. Conclusions:FFM and MM are the main determinants of REE in normal-size subjects under hypobaric hypoxia environment. Either MM or FFM shows a good prediction effect to REE.

Objective:To provide references for finding an objective, accurate, highly repeatable and operable measurement method of the resting energy expenditure (REE) for flying personnel by taking the indirect calorimetry measured REE as the gold standard and establishing the formula for predicting REE combined with body composition indexes.Methods:Fourteen normal-size male volunteers were chosen as the subjects. The hypobaric hypoxia environment was constructed in the hypobaric chamber. The subjects were asked to complete single task (flight control) and dual task (flight control and calculation). The body weight, fat free mass (FFM), muscle mass (MM), fat mass (FM), waist-to-hip ratio (WHR), visceral fat mass (VFM) and body fat percentage (BF%) were directly measured by body composition analyzer. The respiratory frequency (RF), volume of CO 2 (VCO 2), maximal volume of O 2 (VO 2max), volume of tidal (VT), minute ventilation volume (VE), metablic equivalent (MET), REE and REE/kg/d were measured by gas metabolizer. The correlation between REE and body composition indexes was analyzed and a linear regression equation was obtained. Results:In the simulated hypobaric hypoxia environment, the RF, VCO 2, VO 2max, VE, VT, REE, REE/kg/d, MET and heart rate of the subjects increased slightly in the dual task, but there were no significant differences between the dual task and the single task (all P>0.05). REE was positively correlated with FFM and MM ( r=0.566, 0.570, P=0.035, 0.033), but not with height, FM and heart rate (all P>0.05). The prediction formula of REE in hypobaric hypoxia environment was Model A: REE=60.34×MM-1 121 ( r=0.570, P=0.033), or Model B: REE=55.34×FFM-1 073 ( r=0.566, P=0.035). There was a positive correlation between the predicted REE and the measured REE ( r=0.570, P=0.033) for Model A, and the error value was (0.032±358.170) kcal/d, P=1.00>0.05. Conclusions:FFM and MM are the main determinants of REE in normal-size subjects under hypobaric hypoxia environment. Either MM or FFM shows a good prediction effect to REE.

Objective To explore the feasibility of differential diagnosis of Gleason score (GS)(3+4)and (4+3)in prostate cancer (PCa) based on texture parameters of T2 WI and ADC maps.Methods A total of 77 patients with GS 7 points in PCa confirmed by pathology were enrolled in this retrospective study,including 45 GS(3+4)cases and 32 GS(4+3)cases.ROI was manually drew on the largest section of tumor on the axial T2 WI and ADC maps,and five texture parameters were extracted,namely,angular second moment (ASM),contrast, correlation,inverse difference moment and entropy,and the texture parameters between groups were analyzed statistically,then ROC curve was used to evaluate the diagnostic efficiency of texture parameters with statistical differences.Results There was no significant difference in age and prostate specific antigen (PSA)between GS (3 + 4)and GS (4 + 3)groups (P＞0.05).There were significant differences in ASM and entropy between T2 WI and ADC (P＜0.05),but there was no statistical difference in contrast,correlation and inverse difference moment (P＞0.05).Except for the AUC of T2 WIASM,there were statistical differences among T2 WIentropy ,ADCASM and ADCentropy.The AUC of ADCASM and ADCentropy were larger than that of T2 WIASM and T2 WIentropy.The AUC of ADCentropy had the largest AUC (0.732),the cut off value was 5.71 ,with the sensitivity was 97.6% and specificity was 5 9.5%.Conclusion MRI texture analysis can be used to differentiate GS (3 + 4)from GS (4 + 3)in PCa,and the ADCentropy have the best diagnostic efficacy.

Objective To analyze the clinical features of systemic lupus erythematosus (SLE) com-plicated by noncirrhotic portal hypertention (NCPH),and improve the recognition of NCPH.Methods Clinical data from SLE complicated by NCPH in our hospital were retrospectively analyzed and summarized,while the related literatures were reviewed.Results Four patients diagnosed as SLE complicated by NCPH were all women.NCPH presented with the clinical features of portal hypertension with normal or slightly elevated transaminase.Anticardiolipin (ACL) antibodies were positive in 2 patients.Two patients underwent liver needle biopsy,showing nodular regenerative hyperplasia,of which,one with liver portal fibrosis.The treatment strategy was managing the primary disorder and controling of portal hypertention in four patients.Twenty-two cases of SLE complicated by NCPH were reviewed and analyzed,including 18 cases from related literatures and our 4 cases.Among the 22 cases,the mean time between the diagnosis of SLE and NCPH was eight years,of which one patient with NCPH before SLE,one diagnosed at the same time and the rest with NCPH after SLE.19％ (4/21) of patients presented with Raynaud's phenomenon and 18％ (4/22) complicated by pulmonary hypertension.In serological tests,patients presented with positive ACL anti-bodies [33％(7/21)] and anti-dsDNA [48％(10/21)],as well as increased IgG and γ-Globulin [38％(8/21)].Liver needle biopsy showed nodular regenerative hyperplasia or liver portal fibrosis with the prevalence of 80％ (16/20) and 25％ (5/20),respectively.Conclusion SLE complicated by NCPH is very rare clinically and is easily being misdiagnosed without obvious symptoms and signs in the early stage.Positive ACL antibodies and Raynaud's phenomenon maybe be closely related to SLE complicated by NCPH.