Objective:To analyze the co-morbidity patterns of chronic diseases among the elderly in China and provide suggestions for health management strategies.Methods:It was a cross-sectional study. A total of 9 383 respondents aged ≥60 years with complete data of key variables (chronic disease status, age, gender, marital status, etc.) in the 2020 China Health and Aged Care Tracking Survey (CHARLS) dataset were selected as study subjects. Systematic clustering was used to analyze the pattern of multimorbidity among urban and rural elderly, and probit model was used to analyze the relevant factors associated with the risk of multimorbidity in order to provide suggestions for health management strategies.Results:There were similarities in the multimorbidity patterns of chronic diseases among the elderly in both urban and rural areas in China, including emotional and mental problems, Parkinson′s disease and malignant tumors such as cancer as a group of psychosomatic and neurodegenerative disease pattern, and stroke, asthma and liver disease as a group of inflammatory response disease pattern. However, there were differences, with dyslipidemia clustered as a separate group among the urban elderly, and memory-related diseases with diabetes or elevated blood glucose, chronic lung disease and kidney disease clustered as another group; and in rural elderly, gastric or digestive disorders were clustered with memory-related disorders, diabetes or elevated blood glucose, chronic lung disease, and kidney disease. Registered residence in rural areas ( Z=-0.530), and heavy physical activity (Z=-0.024) were negatively with the risk of multimorbidity. Age ( Z=0.037), alcohol consumption ( Z=0.037), smoking ( Z=0.042), depression score ( Z=0.130), and length of sleep ( Z=0.027) were positively correlated with the risk of multimorbidity (all P<0.05), with domicile location being the most strongly associated factor, and depression score being the second one. Conclusion:The pattern of chronic disease co-morbidity among the elderly in China differs between urban and rural areas. It is recommended that targeted chronic disease management strategies should be developed based on the characteristics of chronic disease co-morbidity among the elderly in urban and rural areas in China to improve the effectiveness of chronic disease co-morbidity prevention and management.

Objective:To investigate the influence of serum C-X-C motif chemokine ligand 9 (CXCL9) and C-X3-C motif chemokine ligand 1 (CX3CL1) on the development of preeclampsia in patients with gestational diabetes mellitus (GDM).Methods:A retrospective analysis was conducted on the clinical data of 398 GDM patients admitted to Huangshi Aikang Hospital from January 2021 to August 2024. Based on the occurrence of preeclampsia, patients were divided into the GDM-preeclampsia group (51 cases) and the simple GDM group (347 cases). The baseline data, blood glucose indicators, four lipid items, platelet count (PLT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen, serum creatinine, and 24-hour urinary protein quantification were compared between the two groups. The influencing factors for GDM complicated by preeclampsia were analyzed, and the predictive value of serum CXCL9 and CX3CL1 for the onset of preeclampsia in GDM patients was assessed. Measurement data with a normal distribution were expressed as Mean ± SD, and the t'-test was used for intergroup comparisons when variances were unequal; measurement data with a skewed distribution were expressed as M ( Q1, Q3), and the Wilcoxon rank-sum test was used for intergroup comparisons; counting data were expressed as case (%), and the χ2 test was used for intergroup comparisons. Unconditional logistic regression models were used to analyze the risk factors for preeclampsia in GDM patients. The predictive value of serum CXCL9 and CX3CL1 levels for preeclampsia in GDM patients was analyzed using the receiver operator characteristic (ROC) curve. Results:Pre-pregnancy body mass index, glycated hemoglobin, and 24-hour urinary protein quantification in the GDM-preeclampsia group [(24.50±3.74) kg/m 2, (5.68±0.52)%, 0.42 (0.17, 0.69) g] were all higher than those in the simple GDM group [(22.70±2.97) kg/m 2, (5.42±0.44)%, 0.30 (0.10, 0.44) g], with statistically significant differences between groups (statistic values: t'=3.90, t'=3.85, U=2.70; P values: <0.001, <0.001, 0.007, respectively). Serum CXCL9 levels in the GDM-preeclampsia group [(111.69±36.65) ng/L] were lower than those in the simple GDM group [(200.16±85.57) ng/L], while CX3CL1 levels [(2.22±0.29) μg/L] were higher than those in the simple GDM group [(1.83±0.35) μg/L], with statistically significant differences ( t' values: 7.28 and 7.58, respectively; both P<0.001). Multivariate logistic regression analysis showed that increased CX3CL1 ( OR=1.562, 95% CI: 1.237-1.972), decreased CXCL9 ( OR=0.979, 95% CI: 0.970-0.989), increased pre-pregnancy body mass index ( OR=1.226, 95% CI: 1.060-1.417), and increased glycated hemoglobin ( OR=3.474, 95% CI: 1.192-10.122) were associated with an increased risk of developing preeclampsia in GDM patients ( P values: <0.001, <0.001, 0.006, 0.023, respectively). The ROC curve showed that the area under the curve for serum CXCL9 (sensitivity: 88.24%, specificity: 70.89%) and CX3CL1 (sensitivity: 78.43%, specificity: 69.16%) in predicting preeclampsia in GDM patients were both >0.50 ( P values: 0.015, 0.034, respectively), indicating that both have high predictive efficacy, with CXCL9 being slightly superior to CX3CL1. Conclusion:Decreased serum CXCL9 and increased CX3CL1 are associated with an increased risk of preeclampsia in GDM patients. Both can serve as auxiliary predictive indicators for preeclampsia in GDM patients.

Objective:To investigate the influence of serum C-X-C motif chemokine ligand 9 (CXCL9) and C-X3-C motif chemokine ligand 1 (CX3CL1) on the development of preeclampsia in patients with gestational diabetes mellitus (GDM).Methods:A retrospective analysis was conducted on the clinical data of 398 GDM patients admitted to Huangshi Aikang Hospital from January 2021 to August 2024. Based on the occurrence of preeclampsia, patients were divided into the GDM-preeclampsia group (51 cases) and the simple GDM group (347 cases). The baseline data, blood glucose indicators, four lipid items, platelet count (PLT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen, serum creatinine, and 24-hour urinary protein quantification were compared between the two groups. The influencing factors for GDM complicated by preeclampsia were analyzed, and the predictive value of serum CXCL9 and CX3CL1 for the onset of preeclampsia in GDM patients was assessed. Measurement data with a normal distribution were expressed as Mean ± SD, and the t'-test was used for intergroup comparisons when variances were unequal; measurement data with a skewed distribution were expressed as M ( Q1, Q3), and the Wilcoxon rank-sum test was used for intergroup comparisons; counting data were expressed as case (%), and the χ2 test was used for intergroup comparisons. Unconditional logistic regression models were used to analyze the risk factors for preeclampsia in GDM patients. The predictive value of serum CXCL9 and CX3CL1 levels for preeclampsia in GDM patients was analyzed using the receiver operator characteristic (ROC) curve. Results:Pre-pregnancy body mass index, glycated hemoglobin, and 24-hour urinary protein quantification in the GDM-preeclampsia group [(24.50±3.74) kg/m 2, (5.68±0.52)%, 0.42 (0.17, 0.69) g] were all higher than those in the simple GDM group [(22.70±2.97) kg/m 2, (5.42±0.44)%, 0.30 (0.10, 0.44) g], with statistically significant differences between groups (statistic values: t'=3.90, t'=3.85, U=2.70; P values: <0.001, <0.001, 0.007, respectively). Serum CXCL9 levels in the GDM-preeclampsia group [(111.69±36.65) ng/L] were lower than those in the simple GDM group [(200.16±85.57) ng/L], while CX3CL1 levels [(2.22±0.29) μg/L] were higher than those in the simple GDM group [(1.83±0.35) μg/L], with statistically significant differences ( t' values: 7.28 and 7.58, respectively; both P<0.001). Multivariate logistic regression analysis showed that increased CX3CL1 ( OR=1.562, 95% CI: 1.237-1.972), decreased CXCL9 ( OR=0.979, 95% CI: 0.970-0.989), increased pre-pregnancy body mass index ( OR=1.226, 95% CI: 1.060-1.417), and increased glycated hemoglobin ( OR=3.474, 95% CI: 1.192-10.122) were associated with an increased risk of developing preeclampsia in GDM patients ( P values: <0.001, <0.001, 0.006, 0.023, respectively). The ROC curve showed that the area under the curve for serum CXCL9 (sensitivity: 88.24%, specificity: 70.89%) and CX3CL1 (sensitivity: 78.43%, specificity: 69.16%) in predicting preeclampsia in GDM patients were both >0.50 ( P values: 0.015, 0.034, respectively), indicating that both have high predictive efficacy, with CXCL9 being slightly superior to CX3CL1. Conclusion:Decreased serum CXCL9 and increased CX3CL1 are associated with an increased risk of preeclampsia in GDM patients. Both can serve as auxiliary predictive indicators for preeclampsia in GDM patients.

Objective:To analyze the co-morbidity patterns of chronic diseases among the elderly in China and provide suggestions for health management strategies.Methods:It was a cross-sectional study. A total of 9 383 respondents aged ≥60 years with complete data of key variables (chronic disease status, age, gender, marital status, etc.) in the 2020 China Health and Aged Care Tracking Survey (CHARLS) dataset were selected as study subjects. Systematic clustering was used to analyze the pattern of multimorbidity among urban and rural elderly, and probit model was used to analyze the relevant factors associated with the risk of multimorbidity in order to provide suggestions for health management strategies.Results:There were similarities in the multimorbidity patterns of chronic diseases among the elderly in both urban and rural areas in China, including emotional and mental problems, Parkinson′s disease and malignant tumors such as cancer as a group of psychosomatic and neurodegenerative disease pattern, and stroke, asthma and liver disease as a group of inflammatory response disease pattern. However, there were differences, with dyslipidemia clustered as a separate group among the urban elderly, and memory-related diseases with diabetes or elevated blood glucose, chronic lung disease and kidney disease clustered as another group; and in rural elderly, gastric or digestive disorders were clustered with memory-related disorders, diabetes or elevated blood glucose, chronic lung disease, and kidney disease. Registered residence in rural areas ( Z=-0.530), and heavy physical activity (Z=-0.024) were negatively with the risk of multimorbidity. Age ( Z=0.037), alcohol consumption ( Z=0.037), smoking ( Z=0.042), depression score ( Z=0.130), and length of sleep ( Z=0.027) were positively correlated with the risk of multimorbidity (all P<0.05), with domicile location being the most strongly associated factor, and depression score being the second one. Conclusion:The pattern of chronic disease co-morbidity among the elderly in China differs between urban and rural areas. It is recommended that targeted chronic disease management strategies should be developed based on the characteristics of chronic disease co-morbidity among the elderly in urban and rural areas in China to improve the effectiveness of chronic disease co-morbidity prevention and management.

OBJECTIVES: Currently, it is difficult to assess the expression status of hormone receptor (HR) in breast malignant tumors with human epidermal growth factor receptor 2 (HER-2)-positive in the early preoperative stage, and it is difficult to predict whether it is non-invasively. This study aims to explore the value of MRI on the different HR expression status (HR⁺/HR^-) in HER-2 positive breast cancer. METHODS: Thirty patients with HR+ HER-2-positive breast cancer (HR+ group) and 23 patients with HR-HER-2-positive breast cancer (HR- group) from the First Hospital of Hunan University of Traditional Chinese Medicine between January 7, 2015 and November 26, 2021 were selected as subjects, and all the patients were examined by MRI and all were confirmed by surgery or pathological biopsy puncture. The immunohistochemical staining results were used as the gold standard to analyze the basic clinical conditions, peri-lesion conditions and MRI sign characteristics in the 2 groups. RESULTS: There were all significant differences in terms of mass margins, internal reinforcement features, and apparent diffusion coefficient (ADC) values between the HR+ group and the HR- group (all P<0.05). The logistic multivariate regression model showed that: when the lesion presented as a mass-type breast cancer on MRI, the internal enhancement features of the lesion were an independent predictor for differentiation in the 2 types of breast cancer [odds ratio (OR)=5.95, 95% CI: 1.223 to 28.951, P<0.05], and the mass margin (OR=0.386, 95% CI: 0.137 to 1.082, P>0.05) and ADC value (OR=0.234, 95% CI: 0.001 to 105.293, P>0.05) were not the independent predictors in distinguishing the 2 types of breast cancer. CONCLUSIONS Multiparametric MRI has good diagnostic value for HR expression status in HER-2-positive breast cancer. Combined logistic regression analysis to construct a predictive model may be helpful to the identical diagnosis.
Humans ; Female ; Breast Neoplasms/surgery* ; Magnetic Resonance Imaging/methods* ; Diffusion Magnetic Resonance Imaging/methods* ; Breast ; Magnetic Resonance Spectroscopy ; Retrospective Studies

BACKGROUND: SMARCA4-deficient non-small cell lung cancer (SMARCA4-dNSCLC) is a rare primary lung malignancy. These diseases are not listed separately in the 2021 World Health Organization (WHO) classification of lung neoplasms, but they have special morphological, immunophenotypic and molecular genetic characteristics. This study aims to improve understanding of SMARCA4-dNSCLC by discussing the clinicopathological features, diagonosis and differential diagnosis of the disease. METHODS: The clinical and imaging data of 9 cases of SMARCA4-dNSCLC diagnosed in Shanghai Changhai Hospital from January 2020 to March 2022 were collected. The clinicopathological features were analyzed by histological and immunohistochemical staining, and the literature was reviewed. RESULTS: The median age of 9 patients was 65 years old. Six men were smokers. The average maximum diameter of tumor was 3.3 cm. Six cases had been metastasized. The imaging showed that it was an infiltrating mass with unclear boundary and 3 cases invaded the pleura. Nine cases were diagnosed as SMARCA4-dNSCLC, which mainly showed three pathological forms including classic lung adenocarcinoma, mucinous adenocarcinoma and poorly differentiated carcinoma. Poorly differentiated tumor cells are epithelioid, syncytial or rhabdomyoid, the cytoplasm was rich, the cytoplasm could be completely transparent to eosinophilic, eosinophilic globules or small abscesses could be seen, showing solid flakes, with more inflammatory cells and flake necrosis in the stroma. Immunohistochemistry showed that SMARCA4 was negative in all cases and eight cases demonstrated cytokeratin 5.2 (CAM5.2) and cytokeratin 7 (CK7) was diffusely strongly positive, p40 was negative, thyroid transcription factor-1 (TTF-1) was negative in 6 cases, partially positive in 2 cases and diffusely positive in 1 case. CONCLUSIONS SMARCA4-dNSCLC is a rare subtype of lung cancer with complex and diverse pathological morphology. The characteristic of immunohistochemical phenotype can assist in the diagnosis.
Biomarkers, Tumor/genetics* ; Carcinoma, Non-Small-Cell Lung/genetics* ; China ; DNA Helicases/genetics* ; Humans ; Lung Neoplasms/pathology* ; Nuclear Proteins/genetics* ; Transcription Factors/genetics*

Objective: To determine the changes in peripheral plasma concentrations of interleukin-10 (IL-10), interleukin -12 (IL-12) and interfoeron-γ(IFN-γ) in the patients with chronic hepatitis B virus (HBV) infection and their correlations with HBV infection stage or HBV DNA load of HBV carriers. Methods: Data of 135 patients with chronic HBV infection from March 2016 to March 2017 were collected, the patients included 32 chronic HBV carriers, 61 with chronic hepatitis and 42 with cirrhosis. Forty healthy subjects served as controls. The concentrations of IL-10, IL-12 and IFN-γ were determined using enzyme-linked immunosorbent assay (ELISA). Correlation analysis was performed using the Pearson correlation test, which was performed to analyze the correlation between IL-10, IL-12, IFN-γ and HBV infection stage, HBV DNA load of HBV carriers. Results: Compared with those in healthy controls, plasma IL-10 and IL-12 levels in patients with chronic hepatitis and cirrhosis increased significantly (F=22.06, 15.67, P=0.013, 0.021), plasma IL-10 and IL-12 levels in cirrhosis cases were higher than those in chronic hepatitis (all P<0.001), plasma IL-10 and IL-12 levels in chronic hepatitis were higher than those in chronic HBV carriers (all P<0.001). Plasma IFN-γ level in chronic HBV carriers, chronic hepatitis and cirrhosis were significantly higher than those in healthy controls (F=18.36, P=0.017). There were statistically significant differences in IFN-γ levels among the three groups in the chronic HBV carriers, chronic hepatitis and cirrhosis. IL-10, IL-12 and IFN-γ levels of the low, medium and high HBV DNA load groups were statistically significant (all P<0.05). There was no correlation between IL-10 and HBV DNA. IFN-γ, IL-12 and HBV DNA load were negatively correlated. There was no correlation between IL-10 and IFN-γ (r=0.103, P>0.05), IL-12 and IFN-γ were significantly positively correlated (r=0.687, P<0.05). Conclusions IL-10, IL-12 and IFN-γ may play an important role in the chronic HBV infection.

Objective To investigate the effect of complement C3a on mouse podocytes phenotype transformation.Methods Purified C3a recombinant protein was used to stimulate mature mouse podocytes.The expression of the mature podocyte markers synaptopodin,podocin,nephrin,CD2-associated protein (CD2AP) and the mesenchymal cell markers fibroblast specific protein 1 (FSP-1),α-smooth muscle actin (α-SMA) were detected by RT-PCR,Western blotting,immunochemistry and immunofluorescence,respectively.Some podocytes were transfected with integrin-linked kinase (ILK) siRNA before the administration of C3a,the expression of nephrin and α-SMA were accessed by Western blotting,and the expression of Snail and α-actinin 4 were accessed by Western blotting and immunochemical method.The migration ability of podocytes was observed by scratch test.Results Immunocytochemistry and immunofluorescence analysis showed that synaptopodin,podocin,nephrin,CD2AP were highly expressed by mature mouse podocytes.The expression of these podocyte markers could be markedly inhibited after 24 h of C3a (0.1 μmol/L) treatment,and accompanied by the induction of mesenchymal markers FSP-1 and α-SMA.Compared with control group,the mRNA levels of synaptopodin,podocin,CD2AP and nephrin were significantly repressed by the administration of C3a in a dose-dependent manner,whereas the transcription of FSP-1 and α-SMA were remarkably up-regulated by C3a treatment (P ＜ 0.05,respectively).Western blotting analysis also confirmed the decrease of synaptopodin,podocin,nephrin and CD2AP protein and the increase of FSP-1 and α-SMA protein were closely depend on the C3a concentration (P ＜ 0.05,respectively).To further assess the downstream of C3a,some podocytes were transfected with ILK siRNA before the administration of C3a.Compared with C3a group,the protein levels of nephrin and α-SMA were significantly changed by the administration of ILK siRNA (P ＜ 0.05,respectively).The expression of α-actinin 4 and Snail induced by C3a were inhibited by ILK knockdown (P ＜ 0.05,respectively),accompanied by a decline of cell migration potency.Conclusion Complement fragment C3a can induce transformation of mouse podocytes to mesenehymal cells,and ILK signaling pathway is involved in this cell type transformation.

Objective To compare the effect of cisplatin or nedaplatin combined with paclitaxel as an adjuvant chemotherapy for cervical cancer.Methods Total 160 patients with cervical cancer in Ningqiang County Tianjin Hospital from February 2011 to December 2015 were divided into two groups according to different treatments.Cisplatin group was treated with TP chemotherapy,nedaplatin group was treated with TN chemotherapy,the curative effect,adverse reaction of chemotherapy,hospitalization time and treatment costs were compared between the two groups.Results The effective rate of cisplatin group was 79.26％ and nedaplatin group's was 82.05％,the two groups had no significant difference;The incidence of Ⅰ-Ⅳ grade hemoglobin,leukocyte of nedaplatin group were significantly higher than those in the cisplatin group (P ＜ 0.05),but between the two groups Ⅲ and Ⅳ grade had no significant difference,the incidence of Ⅰ-Ⅳ grade and Ⅲ-Ⅳ grade nausea,vomiting of nedaplatin group were significantly lower than cisplatin group (P ＜ 0.05);The hospitalization time of nedaplatin group was significantly shorter than cisplatin group (P ＜ 0.05),The cost of treatment between nedaplatin group and cisplatin group had no significant difference.Conclusion Cisplatin or nedaplatin combined with paclitaxel has similar efficacy in the neoadjuvant chemotherapy for cervical cancer,gastrointestinal adverse reactions of nedaplatin are lower than cisptatin,bone marrow suppression increase but still can be controlled,nedaplatin chemotherapy can shorten the duration of hospitalization,and hospitalization expenses were not significantly increased,which makes it more easily accepted by patients.

Objective To investigate the correlation between the characteristics of intracranial lesions and the level of cognitive function in patients with an initial diagnosis of brain metastases.Methods A retrospective analysis was performed in 51 patients with an initial diagnosis of brain metastases who were admitted to The Second Hospital Affiliated to Suzhou University from January 2015 to April 2016.CT and (or) MRI were used to determine the characteristics of intracranial lesions and the Montreal Cognitive Assessment was used to evaluate the cognitive function of patients.Comparison between groups was made by Mann-Whitney U test.The correlation between ranked data was analyzed by Spearman rank correlation test.Results Of the 51 patients with an initial diagnosis of brain metastases,47(92%) had cognitive impairment,including mild cognitive impairment in 31(61%) and dementia in 16(31%).There was no significant difference in level of cognitive function between the patients with involvement of the left hemisphere alone and those with involvement of the right hemisphere alone (P=0.425).The patients with involvement of both hemispheres had a significantly lower level of cognitive function than those with involvement of the left hemisphere alone (P=0.042).The patients with involvement of three or more brain lobes had a significantly lower level of cognitive function than those with involvement of one or two brain lobes (P=0.015,0.024).The intracranial lesion volume and edema volume had no significant effect on the overall cognitive function of patients (P=0.077,0.178).The patients with>3 intracranial lesions had a significantly lower level of cognitive function than those with 1-3 intracranial lesions (P=0.010).Conclusions More than 90% of patients with an initial diagnosis of brain metastases have cognitive impairment.Cognitive impairment is mainly associated with lesion site,involvement of brain lobes,and number of lesions,but not with lesion volume and edema volume.