Objective:To construct and validate a three-level early warning model of moderate to severe ovarian hyperstimulation syndrome (OHSS) in assisted reproductive technology.Methods:A case-control study was conducted. Totally 10 181 infertility patients who underwent in vitro fertilization treatment in Reproductive Medicine Center, Women and Children's Medical Center Affiliated to Guangzhou Medical University from April 2013 to April 2023 were retrospectively analyzed and divided into modeling group (8 145 cases) and validation group (2 036 cases) by random number table method. The clinical data of the two groups were analyzed, and the risk factors affecting the occurrence of moderate and severe OHSS after oocytes retrieval were screened by multi-factor logistic regression analysis. The early warning model was established and the column diagram was drawn at three nodes which were before ovarian stimulation, before trigger and 3 d after oocyte retrieval. The receiver operating characteristic (ROC) curve and calibration curve were used to verify the models. Results:The antral follicle count (AFC, OR=1.045, 95% CI: 1.020-1.071, P<0.001), anti-Müllerian hormone (AMH)>3.36 μg/L ( OR=7.135, 95% CI: 2.084-24.432, P=0.002) and number of cycles ( OR=0.149, 95% CI: 0.022-1.026, P=0.049) were included in the pre-stimulation prediction model. AFC ( OR=1.046, 95% CI: 1.018-1.074, P=0.001), AMH>3.36 μg/L ( OR=5.780, 95% CI: 1.661-20.116, P=0.006), gonadotropin releasing hormone-agonist protocols ( OR=3.895, 95% CI=1.913-7.931, P<0.001), estrogen peak≥18 350 pmol/L ( OR=2.258, 95% CI: 1.092-4.666, P=0.028), the number of follicles with a diameter of ≥10 mm>20 ( OR=2.377, 95% CI: 1.092-5.172, P=0.029) were included in the pre-trigger prediction model. AMH>3.36 μg/L ( OR=8.374, 95% CI: 2.417-29.019, P=0.001), estrogen peak≥18 350 pmol/L ( OR=3.947, 95% CI: 1.533-10.167, P=0.004), total number of oocytes retrived ( OR=1.042, 95% CI: 0.996-1.090, P=0.025), abdominal distension ( OR=60.181, 95% CI: 22.515-160.854, P<0.001), fresh transplantation ( OR=21.766, 95% CI: 7.119-66.544, P<0.001), human chorionic gonadotropin trigger ( OR=17.752, 95% CI: 3.993-78.924, P<0.001) were included in the prediction model of 3 d after oocyte retrieval. The areas under ROC curves of the three models were 0.830 (95% CI: 0.782-0.878), 0.859 (95% CI: 0.812-0.906) and 0.948 (95% CI: 0.919-0.977), respectively. The areas under ROC curves of the validation groups of the three models were 0.922 (95% CI: 0.880-0.965), 0.936 (95% CI: 0.886-0.986), and 0.971 (95% CI: 0.938-0.999), respectively. The calibration curve indicated that the early-warning evaluation model has good stability. Conclusion:The three-level early warning model of moderate and severe OHSS has good differentiation, reliable predictability and clinical practicability, which is conducive to the dynamic and continuous assessment of the risk of moderate and severe OHSS, adjustment of treatment plan at any time, and timely adoption of effective preventive measures.

OBJECTIVE: To reveal the gap between the evidence of systematic reviews (SRs) and clinical concerns by systematically summarizing the evidence on acupuncture and moxibustion for frozen shoulder and investigating the concerns and needs of clinicians in treatment with acupuncture and moxibustion for this disease. METHODS: The articles of SR and Meta-analysis on acupuncture and moxibustion for frozen shoulder were searched from CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase and Cochrane Library, starting from the inception of each database up to December 31st, 2022. Two researchers screened the articles and extracted data independently. Using AMSTAR-2, the methodological quality of the included studies was evaluated. Based on systematic reviews and expert discussion, a questionnaire on clinical concerns of acupuncture and moxibustion for frozen shoulder was developed and distributed to clinicians. The discrepancies between the evidence and clinical concerns were compared from 5 dimensions, including population, interventions, control measures, outcome indicators and review time points. RESULTS: The evidence gaps existed between SRs and clinical concerns. In the existing studies, the needs of personalized treatment were not fully considered in terms of different syndromes/patterns of frozen shoulder and stages of illness, the outcome indicators were not employed properly, the time for outcome measurement was vague, the control groups were set up outside of standardization, and the methodological quality was lower. CONCLUSION It is suggested that future studies should improve the quality of methodology, lay more consideration to different patient groups, optimize outcome indicators and standardize the setting of control groups, so as to better meet the needs of patients and achieve the best match between evidence and clinicians' needs.
Humans ; Acupuncture Therapy ; Bursitis/therapy* ; Evidence Gaps ; Moxibustion ; Systematic Reviews as Topic ; Meta-Analysis as Topic

OBJECTIVE: To investigate possible associations between physical function assessment scales, such as Short Physical Performance Battery (SPPB) and Berg Balance Scale (BBS), with all-cause mortality in acute decompensated heart failure (ADHF) patients. METHODS: A total of 108 ADHF patients were analyzed from October 2020 to October 2022, and followed up to May 2023. The association between baseline clinical characteristics and all-cause mortality was analyzed by univariate Cox regression analysis, while for SPPB and BBS, univariate Cox regression analysis was followed by receiver operating characteristic curves, in which the area under the curve represented their predictive accuracy for all-cause mortality. Incremental predictive values for both physical function assessments were measured by calculating net reclassification index and integrated discrimination improvement scores. Optimal cut-off value for BBS was then identified using restricted cubic spline plots, and survival differences below and above that cut-off were compared using Kaplan-Meier survival curves and the log-rank test. The clinical utility of BBS was measured using decision curve analysis. RESULTS: For baseline characteristics, age, female, blood urea nitrogen, as well as statins, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, or angiotensin receptor-neprilysin inhibitors, were predictive for all-cause mortality for ADHF patients. With respect to SPPB and BBS, higher scores were associated with lower all-cause mortality rates for both assessments; similar area under the curves were measured for both (0.774 for SPPB and 0.776 for BBS). Furthermore, BBS ≤ 36.5 was associated with significantly higher mortality, which was still applicable even adjusting for confounding factors; BBS was also found to have great clinical utility under decision curve analysis. CONCLUSIONS BBS or SPPB could be used as tools to assess physical function in ageing ADHF patients, as well as prognosticate on all-cause mortality. Moreover, prioritizing the improvement of balance capabilities of ADHF patients in cardiac rehabilitation regimens could aid in lowering mortality risk.

Objective To evaluate the efficacy and safety of rivaroxaban in elderly patients with atrial fibrillation.Methods The cases datas of 236 elderly patients with atrial fibrillation hospitalized in Minzu Hospital of Guangxi Zhuang Autonomous Region from July 2022 to September 2023 were retrospectively analyzed.According to the use of anticoagulant drugs,they were divided into rivaroxaban group(148 cases)and warfarin group(88 cases).New thrombosis,bleeding events and all-cause death during hospitalization were compared between two groups.Logistic regression and multi-factor Cox regression analysis were used to investigate the influencing factors of new thrombus,hemorrhage and all-cause death.Results The proportion of antiplatelet drugs and platelet count in rivaroxaban group were significantly higher than those in warfarin group,and thrombin time,prothrombin time and international standardized ratio were significantly lower than those in warfarin group(P＜0.05).Before and after adjusting for confounders,there were no significant differences in the risk of new thrombosis,bleeding events and all-cause death between two groups(P＞0.05).Multivariate Cox regression analysis showed that combined use of non steroidal antiinflammatory drug and low-dose rivaroxaban were risk factors for death in elderly patients with atrial fibrillation(P＜0.05).Conclusion The efficacy and safety of rivaroxaban in elderly patients with atrial fibrillation are not inferior to warfarin.

Objective:To construct and validate a three-level early warning model of moderate to severe ovarian hyperstimulation syndrome (OHSS) in assisted reproductive technology.Methods:A case-control study was conducted. Totally 10 181 infertility patients who underwent in vitro fertilization treatment in Reproductive Medicine Center, Women and Children's Medical Center Affiliated to Guangzhou Medical University from April 2013 to April 2023 were retrospectively analyzed and divided into modeling group (8 145 cases) and validation group (2 036 cases) by random number table method. The clinical data of the two groups were analyzed, and the risk factors affecting the occurrence of moderate and severe OHSS after oocytes retrieval were screened by multi-factor logistic regression analysis. The early warning model was established and the column diagram was drawn at three nodes which were before ovarian stimulation, before trigger and 3 d after oocyte retrieval. The receiver operating characteristic (ROC) curve and calibration curve were used to verify the models. Results:The antral follicle count (AFC, OR=1.045, 95% CI: 1.020-1.071, P<0.001), anti-Müllerian hormone (AMH)>3.36 μg/L ( OR=7.135, 95% CI: 2.084-24.432, P=0.002) and number of cycles ( OR=0.149, 95% CI: 0.022-1.026, P=0.049) were included in the pre-stimulation prediction model. AFC ( OR=1.046, 95% CI: 1.018-1.074, P=0.001), AMH>3.36 μg/L ( OR=5.780, 95% CI: 1.661-20.116, P=0.006), gonadotropin releasing hormone-agonist protocols ( OR=3.895, 95% CI=1.913-7.931, P<0.001), estrogen peak≥18 350 pmol/L ( OR=2.258, 95% CI: 1.092-4.666, P=0.028), the number of follicles with a diameter of ≥10 mm>20 ( OR=2.377, 95% CI: 1.092-5.172, P=0.029) were included in the pre-trigger prediction model. AMH>3.36 μg/L ( OR=8.374, 95% CI: 2.417-29.019, P=0.001), estrogen peak≥18 350 pmol/L ( OR=3.947, 95% CI: 1.533-10.167, P=0.004), total number of oocytes retrived ( OR=1.042, 95% CI: 0.996-1.090, P=0.025), abdominal distension ( OR=60.181, 95% CI: 22.515-160.854, P<0.001), fresh transplantation ( OR=21.766, 95% CI: 7.119-66.544, P<0.001), human chorionic gonadotropin trigger ( OR=17.752, 95% CI: 3.993-78.924, P<0.001) were included in the prediction model of 3 d after oocyte retrieval. The areas under ROC curves of the three models were 0.830 (95% CI: 0.782-0.878), 0.859 (95% CI: 0.812-0.906) and 0.948 (95% CI: 0.919-0.977), respectively. The areas under ROC curves of the validation groups of the three models were 0.922 (95% CI: 0.880-0.965), 0.936 (95% CI: 0.886-0.986), and 0.971 (95% CI: 0.938-0.999), respectively. The calibration curve indicated that the early-warning evaluation model has good stability. Conclusion:The three-level early warning model of moderate and severe OHSS has good differentiation, reliable predictability and clinical practicability, which is conducive to the dynamic and continuous assessment of the risk of moderate and severe OHSS, adjustment of treatment plan at any time, and timely adoption of effective preventive measures.

Objective:To evaluate the levels and source of cadmium exposure by dietary pathway among middle-aged and elderly people ≥40 in cadmium-contaminated areas of China.Methods:A total of 7 193 people aged 40-89 years from four typical cadmium-contaminated areas in China were selected as the study subjects. Food Frequency Questionnaire (FFQ), Total Diet Study (TDS) and a 3-day-24-hour dietary recall survey were conducted. Dietary cadmium intake and food sources through dietary pathways were assessed based on cadmium content in foods, consumption amounts and intake frequencies.Results:The mean age of the participants was 63.39±12.21 years, with 50.05% being males. The average monthly dietary cadmium intake was 7.39 μg/(kg·BW). Staple foods and vegetables were the primary sources of dietary cadmium intake, accounting for 57.51% and 32.48%, respectively. The monthly dietary cadmium intake in all surveyed regions did not exceed the Provisional Tolerable Monthly Intake (PTMI) recommended by the Joint FAO/WHO Expert Committee on Food Additives (JECFA).Conclusion:The monthly dietary cadmium intake among middle-aged and elderly people in cadmium-contaminated areas of China is relatively low, with the risk remaining at an acceptable level. Staple foods and vegetables are the most significant contributors to dietary cadmium intake.

AIM To establish a rapid quantitative analysis model for saponins in Paris polyphylla var.yunnanensis(PPY)by near infrared spectroscopy.METHODS The contents of polyphyllins Ⅰ,Ⅱ,Ⅶ and there total content in PPY were determined by HPLC,while spectral data within the range of 10 000 to 4 000 cm-1 were collected.A quantitative analysis model was established by combining these data with partial least squares regression(PLSR).Multivariate scatter correction(MSC)and vector normalization(SNV)were applied prior to further preprocessing the spectra with original,first-order derivative(1stD),or second-order derivative(2ndD)treatments.Lastly,the model was optimized through non-smoothing(NS),Norris Derivative filtering(Nd),and Savitzky-Golay filtering(S-G)method.Model stability was evaluated based on correlation coefficients and variance.The predicted contents of each saponin component in the validation set samples were calculated.RESULTS The contents of polyphyllins Ⅰ,Ⅱ,Ⅶ were 0.42-17.98,0.46-10.44,0.23-3.86 mg/g,respectively.The total content ranged from 2.91 to 22.1 mg/g.The optimal parameters of three saponins were achieved when selecting the MSC+2ndD+S-G pretreatment method.The corresponding ratio of line segment length to segment gap was 13∶5,15∶5,11∶5,with correlation coefficients of 0.982,0.930,0.958,respectively.The root mean square errors of calibration(RMSEC)were 0.702,0.797,0.238,and the root mean square errors of prediction(RMSEP)were 1.120,0.835,0.304,respectively.The optimal parameters for the total content were obtained when selecting the MSC+2ndD+NS pretreatment method,with a correlation coefficient of 0.970,a RMSEC of 1.090,and a RMSEP of 1.740.CONCLUSION This accurate and rapid method can be used for detection of saponin contents in P.Polyphylla.

Caspase-8 is a cysteine-aspartate protease widely dis-tributed in cells.As a molecular"switch",caspase-8 is involved in the regulation of various modes of cell death,including apopto-sis,necroptosis and pyroptosis.During cerebral ischemia/reper-fusion,caspase-8 activation is one of the key factors inducing neuronal cell death.Currently there are both specific inhibitors of caspase-8,such as Z-IETD-FMK and Ac-IETD-CHO,as well as a variety of pan-caspase inhibitors,such as z-VAD,Q-VD-OPH,and enricosan.Both animal and cellular experiments have demonstrated that all of these inhibitors attenuate cerebral ische-mia/reperfusion injury,an effect that involves inhibition of caspase-8 activity and reduction of neuronal apoptosis.Clinical-ly,certain drugs for ischemic stroke reduce plasma caspase-8 ac-tivity,suggesting that caspase-8 may be a biomarker for the diag-nosis and prognosis of ischemic stroke.Finding and developing clinically valuable inhibitors around caspase-8 is expected to provide new ideas for new drug development in ischemic stroke.