Objective:To evaluate the health benefits and intervention efficiency of different strategies of initiating antihypertensive therapy for the primary prevention of cardiovascular diseases in a community-based Chinese population from the Chinese electronic health records research in Yinzhou(CHERRY)study.Methods:A decision-analytic Markov model was used to simulate and compare different antihy-pertensive initiation strategies,including:Strategy 1,initiation of antihypertensive therapy for Chinese adults with systolic blood pressure(SBP)≥140 mmHg(2020 Chinese guideline on the primary preven-tion of cardiovascular diseases);Strategy 2,initiation of antihypertensive therapy for Chinese adults with SBP≥130 mmHg;Strategy 3,initiation of antihypertensive therapy for Chinese adults with SBP ≥140 mmHg,or with SBP between 130 and 140 mmHg and at high risk of cardiovascular diseases(2017 American College of Cardiology/American Heart Association guideline for the prevention,detection,evaluation,and management of high blood pressure in adults);Strategy 4,initiation of antihypertensive therapy for Chinese adults with SBP≥ 160 mmHg,or with SBP between 140 and 160 mmHg and at high risk of car-diovascular diseases(2019 United Kingdom National Institute for Health and Care Excellence guideline for the hypertension in adults:Diagnosis and management).The high 10-year cardiovascular risk was de-fined as the predicted risk over 10％based on the 2019 World Health Organization cardiovascular disease risk charts.Different strategies were simulated by the Markov model for ten years(cycles),with parame-ters mainly from the CHERRY study or published literature.After ten cycles of simulation,the numbers of quality-adjusted life years(QALY),cardiovascular events and all-cause deaths were calculated to evaluate the health benefits of each strategy,and the numbers needed to treat(NNT)for each cardiovas-cular event or all-cause death could be prevented were calculated to assess the intervention efficiency.One-way sensitivity analysis on the uncertainty of incidence rates of cardiovascular disease and probabilis-tic sensitivity analysis on the uncertainty of hazard ratios of interventions were conducted.Results:A to-tal of 213 987 Chinese adults aged 35-79 years without cardiovascular diseases were included.Com-pared with strategy 1,the number of cardiovascular events that could be prevented in strategy 2 increased by 666(95％UI:334-975),while the NNT per cardiovascular event prevented increased by 10(95％UI:7-20).In contrast to strategy 1,the number of cardiovascular events that could be prevented in strategy 3 increased by 388(95％UI:194-569),and the NNT per cardiovascular event prevented decreased by 6(95％UI:4-12),suggesting that strategy 3 had better health benefits and intervention efficiency.Compared to strategy 1,although the number of cardiovascular events that could be prevented decreased by 193(95％UI:98-281)in strategy 4,the NNT per cardiovascular event prevented decreased by 18(95％UI:13-37)with better efficiency.The results were consistent in the sensitivity analyses.Conclusion:When initiating antihypertensive therapy in an economically developed area of China,the strategy combined with cardiovascular risk assessment is more efficient than those purely based on the SBP threshold.The cardiovascular risk assessment strategy with different SBP thresholds is suggested to balance health benefits and intervention efficiency in diverse populations.

Objective:To systematically evaluate the prevalence of malnutrition in elderly patients with diabetes.Methods:A total of eight databases, namely PubMed, Embase, Web of Science, The Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), and VIP Database, were systematically searched for cross-sectional studies on malnutrition in elderly diabetic patients published from the inception of the databases to September 13, 2023. Two researchers independently conducted literature screening, data extraction, and quality assessment. Data analysis was performed using Stata 16.0 software.Results:A total of 22 studies were included, involving 6 349 elderly diabetic patients. Results of the meta-analysis showed that the overall prevalence of malnutrition in elderly patients with diabetes was 32.3% (95% CI: 0.21 to 0.43), and the prevalence of at-risk of malnutrition was 49.0% (95% CI: 0.31 to 0.67). Subgroup analysis showed that the prevalence of malnutrition in elderly diabetic patients with chronic complications (56.8%) was significantly higher than those without chronic complications (21.9%). Inpatients also showed a higher prevalence compared with outpatients and community (44.4%, 29.0%, and 18.5%, respectively). The prevalence of malnutrition as per mini-nutritional assessment scale was higher than that as per mini-nutritional assessment short-form scale (35.8% vs. 23.3%, P<0.05). There was no significant difference in the prevalence of malnutrition in elderly diabetic patients of different genders ( P>0.05). Conclusions:The prevalence of malnutrition and at-risk of malnutrition in elderly diabetic patients is high. In clinical practice, we should not only strengthen the early diagnosis of malnutrition in patients, but also emphasize the screening of malnutrition risk, implement timely corresponding interventions, and promote patient education on nutrition and health, to improve the prognosis and quality of life in elderly diabetes patients.

The aim of this study is to evaluate the in vitro and in vivo antibacterial potential of Ly-sZHSHW,a phage lysin against Acinetobacter baumannii infections,and to study its characteris-tics.The pET28a-Lys recombinant plasmid containing LysZHSHW coding gene was constructed by PCR,enzyme digestion and ligation using the expression plasmid pET28a as the backbone and ex-pressed in E.coli BL21(DE3).After confirming the expression of the LysZHSHW through West-ern blot analysis,its characterization and potential applications were assessed both in vitro and in vivo.The results showed that the pET28a-Lys recombinant plasmid was successfully constructed and the LysZHSHW protein was expressed correctly.The mass concentration of the purified en-zyme was 4 086 mg/L,which could be used for subsequent experiments.The enzymatic activity of LysZHSHW was determined to be 630 U/μg,with maximum activity observed at 25 ℃ and pH9.0.In vitro experiments demonstrated that 1 000 or 750 mg/L of LysZHSHW,in the presence of EDTA,resulted in a four-log reduction in bacterial counts without any cytotoxicity.In vivo,2.5 μg of LysZHSHW combined with EDTA could increase the survival rate of Galleria mellonel-la larvae infection model to 92.86％after 24 hours,and 0.15 mg of LysZHSHW reduced the bacte-rial load in the thighs of mice by 2.8 logs and alleviated the inflammatory response in muscle fi-bers.In conclusion,LysZHSHW derived from Acinetobacter baumannii bacteriophage exhibited characteristics such as stability at room temperature,alkaline pH,and safety,making it a promis-ing candidate as a novel antimicrobial agent.

Objective To analyze the correlation between sleep disorder and bone mineral density(BMD)and fracture risk in middle-aged and elderly patients with type 2 diabetes mellitus(T2DM).Methods 150 T2DM patients over 50 years old who were hospitalized in the Endocrine Metabolism Department of Changsha First Hospital from September 2022 to April 2023 were selected.According to the Pittsburgh Sleep Quality Index(PSQI),they were divided into a non-sleep disorder group(66 cases)and a sleep disorder group(84 cases).The general data and biochemical indicators of the two groups were compared.The relationship between sleep disorder and BMD,fracture risk was analyzed.Results Compared with the non-sleep disorder group,HbA1c,FPG,female proportion,the proportion of hypnotics and risk scores of vertebral fracture in the sleep disorder group were higher,and BMI,BMD of femoral neck and hip were lower(P<0.05).Pearson correlation analysis showed a negative correlation between PSQI score and BMD of femoral neck and hip(P<0.05).Pearson or Spearman correlation analysis showed that the risk scores of vertebral fracture was positively correlated with age,duration of DM,use of hypnotics and sleep disorder(P<0.05 or P<0.01),and negatively correlated with BMD of femoral neck and hip(P<0.01).Binary logistic regression analysis showed that FPG,use of hypnotics and hip BMD were influencing factors of sleep disorders,while sleep disorders and PSQI scores were influencing factors of osteoporosis.Conclusions For middle-aged and elderly T2DM patients,improving sleep may help reduce the occurrence of osteoporosis and reduce the risk of fractures.

Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Objective To form the expert consensus on the limb management of patients with transvenous temporary cardiac pacing,standardize the limb management of patients with transvenous temporary cardiac pacing,and reduce complications related to the limb.Methods Using evidence-based methods,the evidence in this field was searched,evaluated and summarized,and relevant recommendations and research conclusions were extracted and classified by the level of evidence quality,and then the first draft of the consensus was formed.From December 2023 to January 2024,through 2 rounds of expert consultation and 4 rounds of expert meetings,the content was adjusted and the consensus was reached.Results Totally 16 experts participated in the consultation.The positive coefficient is 100%;the authoritative coefficient is 0.847 and 0.836;the average value of each index is more than＞3.8;the coefficient of variation is less than 0.21.The Kendall's harmony coefficient of the 2 rounds of expert consultation is 0.372 and 0.314,respectively,which were statistically significant.The consensus covers the preoperative,intraoperative and postoperative on limb management of patients with transvenous temporary cardiac pacing.Totally 11 themes were involved,including the preoperative preparation,position and catheter fixation in operation,position and catheter fixation in postoperative,activity,turn and transfer,duty shift on limb,nursing care after withdrawal of the catheter,prevention of deep vein thrombosis of the operative limb and prevent infection.Conclusion The consensus is highly scientific,and it is helpful to standardize the limb management of patients with transvenous temporary cardiac pacing.

Objective To develop"a guideline for pressure injury risk assessment and prevention of neonates in NICU",and to provide guidance and references for clinical staff in the implementation of pressure injury assessment and prevention for neonates in NICU.Methods Based on the World Health 0rganization Guideline Development Manual and the results of systematic search for identified clinical problems,the GRADE method was used to evaluate the evidence and grade the recommendations,and the RIGHT report specifications were referred to for writing,and the guideline was developed and revised according to the results and recommendations of the expert review,so as to form the official guideline.Results The guideline included 2 aspects of pressure injury risk assessment and prevention,resulting in 12 clinical questions and 19 recommendations.Conclusion The guideline for risk assessment and prevention of pressure injury of neonates in NICU is an evidence-based guideline based on the best available evidence,clinical practice,and professional judgment,and it can provide a practical basis for scientific decision-making by clinical staff and managers.

Objective:To evaluate the effect of controlled low central venous pressure (CLCVP) induced by milrinone on intraoperative cerebral blood flow in the patients undergoing laparoscopic hepatectomy.Methods:Eighty American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients, regardless of gender, scheduled for elective laparoscopic hepatectomy, with body mass index of 18-30 kg/m 2, aged 18-64 yr, were divided into 2 groups ( n=40 each) by a random number table method: nitroglycerin group (X group) and milrinone group (M group). After the start of surgery, milrinone 0.5 μg·kg -1·min -1 was continuously infused in group M and nitroglycerin 0.5-1.5 μg·kg -1·min -1 was continuously infused in group X to maintain central venous pressure (CVP)<5 cmH 2O. Norepinephrine 0.01-0.10 μg·kg -1·min -1 was intravenously injected during operation to maintain mean arterial pressure at 60-90 mmHg. Norepinephrine 8-16 μg was intravenously injected when necessary. At 10 min after tracheal intubation (T 1), after establishment of pneumoperitoneum (T 2), at 5 and 30 min after CVP reached the target value (T 3, T 4), at 5 min after CVP returned to normal value (T 5) and at the end of surgery (T 6), the internal carotid artery mean blood flow velocity, internal carotid artery blood flow, cardiac output, and cardiac index were recorded. The surgical field score, consumption of intraoperative norepinephrine, fluid input and output, and occurrence of adverse reactions at 7 days after operation were recorded. Results:Compared with group X, the cardiac output, cardiac index, internal carotid artery mean blood flow velocity and internal carotid artery blood flow were significantly increased, the consumption of intraoperative norepinephrine was decreased, and the surgical field score was increased at T 3-5 in group M ( P<0.05). There was no significant difference in the intraoperative fluid intake and output and incidence of postoperative adverse reactions at each time point between the 2 groups ( P>0.05). Conclusions:Compared with nitroglycerin-induced CLCVP, milrinone-induced CLCVP can improve the reduction in intraoperative cerebral blood flow in the patients undergoing laparoscopic hepatectomy to some extent.

Objective:To establish a risk prediction model of liver failure after liver resection for hepatocellular carcinoma.Method:A retrospective case-control study was designed. Clinical data and laboratory results, including gender, age, and preoperative 18 laboratory indicators, were collected from 320 patients with hepatocellular carcinoma undergoing liver resection in Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Medical University from January 1, 2013 to December 31, 2023. According to the surgical time, 252 cases in the training cohort were divided into 62 and 190 cases with and without postoperative liver failure, respectively. Of the 68 cases in validation cohort, 34 developed postoperative liver failure and 34 did not. Binary Logistic regression analysis was used to conduct univariate analysis of gender, age, and 18 preoperative laboratory indicators, and multivariate analysis was carried out for significant results to determine the influencing factors of liver failure after liver resection for hepatocellular carcinoma, and Logistic regression model was established.Result:In the training cohort, indicators significantly associated with liver failure after liver resection for hepatocellular carcinoma included age ( P=0.016), platelets ( P=0.005), prealbumin ( P<0.001), and alkaline phosphatase ( P<0.001). Logistic regression was used to construct a nomogram model and draw a calibration curve by combining these four indicators. In the training cohort, the nomogram model showed good discriminability in predicting the risk of liver failure after hepatectomy for hepatocellular carcinoma. The area under the curve of was 0.82 (95% CI 0.76-0.88), and the sensitivity was 73% and specificity was 80% when the optimal cut-off value was 0.2646. In the validation cohort, the predictive performance of the nomogram model was comparable to that of the training cohort, with an area under the curve of 0.81 (95% CI 0.71-0.92), sensitivity of 82%, and specificity of 77%. Conclusion:Preoperative platelet and prealbumin decreases, alkaline phosphatase increases, and elderly patients are prone to liver failure after liver resection. The nomogram model constructed with preoperative test data has shows good discriminatory ability and accuracy in predicting liver failure after liver resection for hepatocellular carcinoma.

Cryptogenic organic pneumonia (COP) refers to organic pneumonia that has not been identified a clear cause by current medical methods. A small proportion of COP can exhibit severe and progressive characteristics, while severe COP can cause systemic inflammatory storms and can be secondary to hemophilia. This article reported a case of acute severe COP secondary to hemophilia. A 67-year-old male patient was admitted to the hospital due to cough, shortness of breath, and fever. At first, he was misdiagnosed as severe pneumonia, but failed to receive anti infection treatments. Sputum pathogenetic examination and Macrogene testing of alveolar lavage fluid were performed, and no etiology was found to explain the patient's condition. The condition was gradually worsened and hemophilia occurred to explain, suggesting that acute severe COP was relevant. After receiving hormone treatment, the condition gradually relieved and the absorption of lung lesions improved. Hemophilia secondary to COP is rare, and the specific mechanism needs further study.
Male ; Humans ; Aged ; Hemophilia A/complications* ; Pneumonia/diagnosis* ; Bronchoalveolar Lavage Fluid ; Cough ; Dyspnea/etiology*