Background::Few evidence is available in the early prediction models of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer’s disease (AD). This study aimed to develop and validate a novel genetic-clinical-radiological nomogram for evaluating BPSD in patients with AD and explore its underlying nutritional mechanism.Methods::This retrospective study included 165 patients with AD from the Chinese Imaging, Biomarkers, and Lifestyle (CIBL) cohort between June 1, 2021, and March 31, 2022. Data on demographics, neuropsychological assessments, single-nucleotide polymorphisms of AD risk genes, and regional brain volumes were collected. A multivariate logistic regression model identified BPSD-associated factors, for subsequently constructing a diagnostic nomogram. This nomogram was internally validated through 1000-bootstrap resampling and externally validated using a time-series split based on the CIBL cohort data between June 1, 2022, and February 1, 2023. Area under receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were used to assess the discrimination, calibration, and clinical applicability of the nomogram.Results::Factors independently associated with BPSD were: CETP rs1800775 (odds ratio [OR] = 4.137, 95% confidence interval [CI]: 1.276-13.415, P = 0.018), decreased Mini Nutritional Assessment score (OR = 0.187, 95% CI: 0.086-0.405, P <0.001), increased caregiver burden inventory score (OR = 8.993, 95% CI: 3.830-21.119, P <0.001), and decreased brain stem volume (OR = 0.006, 95% CI: 0.001-0.191, P = 0.004). These variables were incorporated into the nomogram. The area under the ROC curve was 0.925 (95% CI: 0.884-0.967, P <0.001) in the internal validation and 0.791 (95% CI: 0.686-0.895, P <0.001) in the external validation. The calibration plots showed favorable consistency between the prediction of nomogram and actual observations, and the DCA showed that the model was clinically useful in both validations. Conclusion::A novel nomogram was established and validated based on lipid metabolism-related genes, nutritional status, and brain stem volumes, which may allow patients with AD to benefit from early triage and more intensive monitoring of BPSD.Registration::Chictr.org.cn, ChiCTR2100049131.

BACKGROUND: China bears the biggest atrial fibrillation (AF) burden in the world. However, little is known about the incidence and predictors of AF. This study aimed to investigate the current incidence of AF and its electrocardiographic (ECG) predictors in general community individuals aged over 60 years in China. METHODS: This was a prospective cohort study, recruiting subjects who were aged over 60 years and underwent annual health checkups from April to July 2015 in four community health centers in Songjiang District, Shanghai, China. The subjects were then followed up from 2015 to 2019 annually. Data on sociodemographic characteristics, medical history, and the resting 12-lead ECG were collected. Kaplan-Meier curve was used for showing the trends in AF incidence and calculating the predictors of AF. Associations of ECG abnormalities and AF incidence were examined using Cox proportional hazard models. RESULTS: This study recruited 18,738 subjects, and 351 (1.87%) developed AF. The overall incidence rate of AF was 5.2/1000 person-years during an observation period of 67,704 person-years. Multivariable Cox regression analysis indicated age (hazard ratio [HR], 1.07; 95% confidence interval [CI]: 1.06-1.09; P < 0.001), male (HR, 1.30; 95% CI: 1.05-1.62; P = 0.018), a history of hypertension (HR, 1.55; 95% CI: 1.23-1.95; P < 0.001), a history of cardiac diseases (HR, 3.23; 95% CI: 2.34-4.45; P < 0.001), atrial premature complex (APC) (HR, 2.82; 95% CI: 2.17-3.68; P < 0.001), atrial flutter (HR, 18.68; 95% CI: 7.37-47.31; P < 0.001), junctional premature complex (JPC) (HR, 3.57; 95% CI: 1.59-8.02; P = 0.002), junctional rhythm (HR, 18.24; 95% CI: 5.83-57.07; P < 0.001), ventricular premature complex (VPC) (HR, 1.76; 95% CI: 1.13-2.75, P = 0.012), short PR interval (HR, 5.49; 95% CI: 1.36-22.19; P = 0.017), right atrial enlargement (HR, 6.22; 95% CI: 1.54-25.14; P = 0.010), and pacing rhythm (HR, 3.99; 95% CI: 1.57-10.14; P = 0.004) were independently associated with the incidence of AF. CONCLUSIONS The present incidence of AF was 5.2/1000 person-years in the studied population aged over 60 years in China. Among various ECG abnormalities, only APC, atrial flutter, JPC, junctional rhythm, short PR interval, VPC, right atrial enlargement, and pacing rhythm were independently associated with AF incidence.
Humans ; Male ; Middle Aged ; Aged ; Atrial Fibrillation/epidemiology* ; Prospective Studies ; Incidence ; Atrial Flutter/complications* ; Risk Factors ; China/epidemiology* ; Electrocardiography

Objective:To evaluate the relationship between regional coronary flow reserve (CFR) obtained from cadmium-zinc-telluride SPECT(CZT SPECT) myocardial functional perfusion imaging (MFPI) and invasive fractional flow reserve (FFR) measured during coronary angiography (CAG) and its clinical value in guiding coronary interventions.Methods:Forty-two patients (30 males, 12 females, age (63.3±9.8) years) who completed CZT SPECT MFPI in the First Affiliated Hospital of Nanjing Medical University from June 2022 to September 2022 and underwent CAG within 3 months were included retrospectively. The concordance of CFR and FFR for diagnosing myocardial ischemia (CFR<2.0 and FFR<0.8) was calculated at the vascular level. The diagnostic efficacy of coronary stenosis≥70% for decreased myocardial blood flow (CFR<2.0) was calculated. Kappa test was used to analyze the data. Results:A total of 126 major coronary arteries were identified in 42 patients, of which 30(23.8%) had a CFR<2.0 by CZT SPECT and 33(26.2%) had stenosis≥70% in CAG. A total of 32 coronary vessels were performed with MFPI CFR and FFR measurements, of which 6 were both decreased and 21 were both normal, so the concordance rate was 84.4%(27/32)( Kappa=0.612, P<0.001). Among 33 coronary vessels with stenosis≥70%, 13 were with CFR≥2.0. Among 30 coronary vessels with CFR<2.0, 10 were with stenosis<70%. When using stenosis≥70% to diagnose CFR decreasing, the sensitivity was 66.7%(20/30), specificity was 86.5%(83/96), positive predictive value was 60.6%(20/33), negative predictive value was 89.2%(83/93), and accuracy was 81.7%(103/126). Conclusions:The concordance between CFR and FFR for the diagnosis of myocardial ischemia is good. Nearly 1/3 of the coronary arteries with decreased CFR have stenosis<70%, whereas nearly 40% of the coronary arteries with stenosis≥70% are not result in myocardial ischemia. Regional CFR determined by CZT SPECT may have potentially significant clinical value in the diagnosis of coronary artery disease and decision-making of coronary intervention.

Objective:To analyze the distribution of different SF3B1 genotypes in patients with myelodysplastic syndromes (MDS) and its prognostic value.Methods:Totally, 377MDS patients who were initially diagnosed in the First Affiliated Hospital of Nanjing Medical University from January 2014 to January 2022 were included in the retrospective analysis.The patients were divided into three different groups according to mutation stcote of SF3B1, including 317 patients with SF3B1 wild type (SF3B1 WT) (214 males and 103 females, 63(49, 71) years old),39 patients with SF3B1 K700E mutation(SF3B1 K700E(17 males and 22 females, 65(52, 73)years old)) and 21 patients with SF3B1 non-K700E mutation(SF3B1 non-K700E)(13 males and 8 females, 67(63, 73) years old). MDS-related 20 gene mutations were detected using targeted sequencing technology; Survival curves were constructed by the Kaplan-Meier method; Cox proportional hazards model was established to evaluate different factors at diagnosis on survival by univariate and multivariate analyses.. Results:Compared with SF3B1 non-K700E patients, SF3B1 K700E patients had a higher median absolute neutrophil count ( P=0.002) and were likely to be in the low/int-1 International Prognostic Scoring System (IPSS) categories ( P=0.023). A 20-gene targeted sequencing analysis showed that, compared with SF3B1 WT patients, SF3B1 K700E patients were associated with lower frequency of ASXL1 and U2AF1 mutations ( P=0.018 and P=0.003); while compared with SF3B1 non-K700E patients, the frequency of ASXL1 mutation was significantly lower in SF3B1 K700E cases ( P=0.029). Patients with SF3B1 K700E had better overall survival (OS) in comparison with SF3B1 WT and SF3B1 non-K700E in MDS patients ( P<0.001 and P=0.045, respectively). In comparison with SF3B1 WT patients, SF3B1 MUT patients had more favorable OS and progression-free survival (PFS) in MDS without excess blasts ( P<0.001 and P<0.001, respectively), but no significant difference was found in MDS with excess blasts ( P>0.05). Compared with SF3B1 WT patients, SF3B1 K700E patients had superior OS and PFS in the int-1 IPSS category ( P=0.010 and P=0.013, respectively). By multivariable analysis, the presence of SF3B1 K700Ewas an independent predictor of superior OS ( HR=0.461,95% CI 0.262-0.811, P=0.007). Conclusion:SF3B1 K700E and SF3B1 non-K700E patients had significantly improved OS in comparison with SF3B1 WT MDS patients. Furthermore, SF3B1 K700E patients were associated with a better OS compared with SF3B1 non-K700E MDS patients. SF3B1 mutation could not overcome the poor prognostic effect of excess blasts, which highlights the importance of the SF3B1 mutation subtype in risk assessment of MDS without excess blasts.

India is a parliamentary republic country located in South Asian. Its medical and healthcare insurance is paid by the state government and it has the world’s largest "free medical" service system. India has a long history of traditional medicine (TM) represented mainly by Ayurveda, Naturopathy, Yoga etc. As early as the 2nd century BC, Traditional Chinese Medicine (TCM) was introduced to India along with religious exchanges and trade activities. At present, acupuncture has achieved independent legal status in India and there are many acupuncture clinics and associations. However, non-acupuncture TCM treatments lack development in India, but the application of acupuncture lacks of systematic standards.

To achieve better results of the goal of training students' abilities in medical education,formative assessment has been implemented in medical immunology teaching for grade 2014 clinical medicine students.The evaluation indexes of medical immunology teaching have been constructed.Formative assessment has been implemented in classroom teaching,self-learning and group discussion,experimental teaching and network exams by following the principles of feedback,guidance and encouragement.Compared with summative assessment,formative assessment can dynamically reflect the learning progress of immunology and improve the learning effect.The deficiencies andpuzzlesin implementing the formative assessment have also been rethought and discussed deeply.

To determine there characteristic components content of Tibetan Medicine Triphala through establishing a HPLC method and its total tannin content through spectrophotometry. The chromatographic column of Agilent ZORBAX SB-Aq (250 × 4.6 mm, 5 μm) with methanol-0.1％ formic acid/water as the mobile phase, the flow rate 1 mL/min, and the detection wavelength 270 nm was applied to determine the Gallic acid, colijing and ellagic acid content in medicinal materials and the tannin parts of Tibetan Medicine Triphala. With the gallic acid as control group, total tannin content of Triphala and its tannin parts was determined through spectrophotometry. It revealed in the HPLC test that the linear range of gallic acid, coracine and ellagic acid was 0.91-4.55 μg, 0.274-1.368 μg and 0.329-2.634 μg respectively. It also showed that the average recovery rates of the three components in the medicinal materials were 101.06％, 101.72％and 100.27％ respectively. And the average recovery rates of the three components in the tannins were 100.4％, 100.85％and 101.70％ respectively. The result of spectrophotometry showed that gallic acid was linear in1.008-10.08 μg·mL-1, and that the recovery rate of medicinal materials and tannin parts were 100.25％ and 100.52％ respectively. The method is rapid, accurate and repeatable, and it can provide basis for the quality control of Tribescens and its tannins.

This paper aimed at investigating the water-soluble constituents of Terminalia billirica (Gaert.) Roxb.Compounds were isolated and purified by Diaion HP-20, Sephadex LH-20, Toyopearl HW-40, MCI gel CHP 20 P and ODS column chromatographies. The chemical structures were elucidated according to spectral data and physicochemical properties. The results showed that ten compounds were isolated and identified as corilagin, salicoside, methyl-α-Darabinofuranoside, 1, 4-dimethyl-β-d-fructopyranose, β-fructopyranose, β-fructofuranose gallic acid, ellagic acid, 1, 2, 3, 4, 6-penta-O-galloyl-β-D-glucopyranonside, Chebulagic acid. Except compound 7 and 8, others compounds are separated from Terminalia billirica (Gaert.) Roxb for the first time, and except corilgin, the other compounds are separated from Terminalia for the first time.

This paper was aimed to establish the HPLC fingerprint of T.Billerica (Gaertn.) Roxb.tannin fraction.The analysis was performed on Atlantic T3 (250 mm × 4.6 mm,5 μm) C18 column.The mobile phase was acetonitrile-0.2％ glacial acetic acid aqueous solution with gradient elution.The flow rate was 1.0 mL·min-1.The injection size was 20 μL.The temperature was maintained at 30℃.Eleven batches of T.Billerica (Gaertn.) Roxb.tannin fraction of chromatographic data was analyzed by similarity of chromatographic data,SPSS software and SIMCA software.There were 20 common peaks in the diagram.The similarity analysis of 11 samples revealed that the similarities were between 0.832 and 0.973.Only the similarity of tannin parts from Xinjiang was below 0.9.The cluster analysis classified the tannin parts into 3 types,which shared the similar results as the principal components analysis (PCA).PLS-DA found that peak 1,13 and 14 may be the main chromatographic peaks to identify tannins fraction.The HPLC-MSn information of 14 compounds in T.billerica (Gaertn.) Roxb.was summarized.It was concluded that chemometrics analysis method can be used to analyze the HPLC fingerprint of T.billerica (Gaertn.) Roxb.tannin fraction.This method was rapid,simple,and reproducible.It can be used as one of the effective methods for the quality control of T.billerica (Gaertn.) Roxb.tannin fraction.

This article was aimed to study the stability of tannin parts in Phyllanthus emblica L.in artificial gastric and intestinal juice,in order to provide a foundation for in vivo studies of Phyllanthus emblica L.HPLC-UV was used to determine the contents of main ingredients.The results showed that stability of main ingredients of tannin parts in Phyllanthus emblica L.,including gallic acid (GA),corilagin and ellagic acid (EA),in the artificial gastric juice.The content change was not obvious.The residual content was within 100％.The half-life was above 90 h.They were unstable in the artificial intestinal juice.The content was first increased and then decreased.The residual content was 100-300％.The half-life was above 10 h.It was concluded that the tannin parts in Phyllanthus emblica L.was stable in artificial gastric juice.And content changes of main components were not obvious.The tannin parts in Phyllanthus emblica L.were unstable in artificial intestinal juice.The main ingredients were first increased and then decreased.It was speculated that macromolecule can hydrolyze tannin part into small molecules.Hnwever,as time increases,all components may be decomposed.