OBJECTIVE: To investigate the relationship between the weight-adjusted waist index (WWI) and acute, subacute pain or chronic pain among American adults. METHODS: There was a cross-sectional study. Data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) concerning waist circumference, weight, pain status and covariates (age, gender, race, marital status, education level and income, physical activity, alcohol consumption, smoking status, and diabetes) were extracted for analysis. Multinomial Logistic regression was conducted across the three models to investigate the associations between WWI and acute, subacute and chronic pain. Model 1 did not involve any adjustments. Model 2 involved adjustments for age, gender, race, marital status, education level, and income. Model 3 was further adjusted for physical activity, alcohol consumption, smoking, and diabetes status. RESULTS: This study involved 12 694 participants with an average age of (50.6±18.7) years. Among all the participants, 9 614 people (75.74%) had no pain, 870 people (6.85%) experienced acute pain, 354 people (2.79%) suffered from subacute pain, and 1 856 people (14.62%) experienced chronic pain. The WWI of all the participants was (10.95±0.85) cm/$\sqrt{\mathrm{kg}}$, divided into four groups based on quartiles: Group Q1 (7.90-10.36) cm/$\sqrt{\mathrm{kg}}$, group Q2 (10.37-10.94) cm/$\sqrt{\mathrm{kg}}$, group Q3 (10.95-11.53) cm/$\sqrt{\mathrm{kg}}$ and group Q4 (11.54-15.20) cm/$\sqrt{\mathrm{kg}}$. With the increase of WWI, the analysis revealed a significant statistical difference in the participants' acute and chronic pain status (all P < 0.001). In Model 1, the prevalence of acute pain was lower in group Q2 and group Q4 compared with group Q1 (group Q2: OR=0.765, 95%CI: 0.615-0.953, P=0.017; group Q4: OR= 0.648, 95%CI: 0.503-0.835, P < 0.001). Compared with group Q1, the prevalence of chronic pain increased in group Q2, group Q3, and group Q4 (group Q2: OR =1.365, 95%CI: 1.149-1.622, P < 0.001; group Q3: OR=1.291, 95%CI: 1.082-1.541, P=0.005; group Q4: OR=1.874, 95%CI: 1.579-2.224, P < 0.001). In Model 2, compared with group Q1, an increase in chronic pain prevalence was still associated with an increase in WWI in other three groups (group Q2: OR=1.359, 95%CI: 1.137-1.624, P=0.001; group Q3: OR=1.260, 95%CI: 1.039-1.528, P=0.019; group Q4: OR=1.735, 95%CI: 1.413-2.132, P < 0.001). In Model 3, group Q4 had a 49.2% increased prevalence of chronic pain compared to group Q1 (OR = 1.492, 95%CI: 1.208-1.842, P < 0.001). However, in Models 2 and 3, no significant relationship was observed between acute pain and WWI (all P>0.05). And none of the three models identified a significant association between subacute pain and WWI (all P>0.05). CONCLUSION For American adults, there was no significant correlation between WWI and acute pain or subacute pain. However, as WWI increases, so does the prevalence of chronic pain. Further validation of this conclusion through large-scale prospective studies is warranted.
Humans ; Cross-Sectional Studies ; Middle Aged ; Male ; Female ; Adult ; Waist Circumference ; Chronic Pain/epidemiology* ; Aged ; Nutrition Surveys ; Pain/epidemiology* ; Body Weight ; Logistic Models ; Body Mass Index

Objective To develop and validate risk prediction models utilizing five machine learning algorithms for assessing postoperative pulmonary infection(PPI)risk in lung cancer patients undergoing grade Ⅳ thoracoscopic surgery.Methods A retrospective cohort study included 2,380 lung cancer patients who underwent grade Ⅳ thoracoscopic surgery at a tertiary hospital in Shanghai(January 2022 to June 2024).Patients were stratified into training(n=1,665)and validation(n=715)cohorts.Five machine learning algorithms—Logistic regression(LR),artificial neural network(ANN),support vector machine(S VM),random forest(RF),and extreme gradient boosting(XGB)—were employed to construct predictive models.A nomogram was developed for clinical utility.Results Among 2,380 patients,226(9.5％)developed PPI.The Least Absolute Shrinkage and Se-lection Operator(LASSO)regression identified eight predictive variables:daily cigarette consumption,diabetes history,preoperative diffusing capacity,maximal tumor diameter,24-hour postoperative chest drainage volume,perioperative oral nutritional supplementation(ONS),postoperative urinary cathe-terization,and intraoperative pleural adhesion severity.All models demonstrated robust discrimina-tion,with area under the curve(AUC)values ranging from 0.862 to 0.947.The XGB model a-chieved superior performance(AUC=0.947,95％CI,0.937 to 0.962),followed closely by the LR model(AUC=0.926,95％CI,0.918 to 0.933).Conclusion Machine learning-based algo-rithms models effectively stratify PPI risk in lung cancer patients following grade Ⅳ thoracoscopic surgery.The derived nomogram provides a practical tool for perioperative risk management by healthcare providers.

Objective To investigate the effect of nursing intervention based on Kano model on surgical outcomes and negative emotions in patients with diabetic retinopathy(DR).Methods A to-tal of 262 DR patients who underwent vitrectomy were randomly divided into control group(n=131)and observation group(n=131)using the random number table method.The control group received routine nursing intervention,while the observation group received nursing intervention based on the Kano model.The surgical outcomes[visual acuity level and improvement in visual function],nursing needs[Perioperative Nursing Needs Questionnaire for DR Surgical Patients],negative emotions[Self-Rat-ing Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)],and quality of life[Chinese Version of Low Vision Quality of Life Scale(CLVQOL)]were compared between the two groups.The incidence of complications during the intervention period was also recorded in both groups.Results After interven-tion,the visual acuity levels in both groups increased compared to those before intervention,and the rates of low vision decreased(P＜0.001).The visual acuity level in the observation group was high-er,and the rate of low vision was lower than that in the control group,with statistically significant differences(P＜0.001).After intervention,the scores for peripheral visual field,sensory adaptation,and limitations in daily activities decreased in both groups compared to those before intervention,and the scores in the observation group were lower than those in the control group(P＜0.05).After intervention,the SAS and SDS scores in both groups decreased compared to those before interven-tion,and the scores in the observation group were lower than those in the control group(P＜0.001).After intervention,the CLVQOL scores in both groups increased compared to those before the intervention,and the score in the observation group was higher than that in the control group(P＜0.001).The incidence of complications in the control group was higher than that in the obser-vation group(12.22％versus 4.58％,P＜0.05).Conclusion Nursing intervention based on the Kano model can improve visual acuity level,visual function,and negative emotions,enhance the quality of life,and further reduce the incidence of complications in DR patients undergoing vitrectomy.

From the perspective of state differentiation and treatment， it is believed that the pathogenesis of acute respiratory distress syndrome （ARDS） is that evil poisons injured the lungs， and the lung qi suddenly collapsed， then blocked and exhausted， and the qi failure to control blood and liquid， then the fluids overflow outside the vessels， and damp phlegm， stasis， and toxins became knotted up in the body， which ultimately leads to qi dysfunction， and a series of symptom arise， so qi impairment is the principal mechanism of ARDS. A combination of Chinese and Western medicine was proposed to treat ARDS by combining tangible qi and intangible qi， using Chinese herbal medicine to boost qi and relieve collapse， percolate and drain dampness with bland medicinals， resolve toxins and dissolve stasis， and regulate qi， and combining with Western medicine to assist qi circulation to improve qi's consolidation， propulsion， and transformation， so as to make the evil qi go away， the positive qi restored， the viscera qi circulated， qi， blood， yin， and yang connected， and the activities of life maintained， and thus to achieve the goal of treating ARDS by integrated Chinese medicine and Western medicine.

CD200 and its receptor CD200R constitute an endogenous inhibitory signal. The binding of CD200 and CD200R can regulate the immune response to pathogenic stimuli, which has received much attention in recent years. It has been found that CD200-CD200R is involved in the regulation of many kinds of pathological inflammation, including autoimmune diseases, cardiac cerebrovascular disease, infection and tumor. This paper reviews the protein structure, distribution, expression, biological function of CD200-CD200R and the correlation with diseases, and analyses the current status and development ideas of CD200-CD200R as drug targets. It aims to provide theoretical support for new drug research and development based on this target.

Objective To evaluate the efficacy,safety,and economy of 4 intravenous iron formulations in the treatment of iron deficiency anemia(IDA)by rapid health technology assessment,and to provide evidence for clinical decision-making.Methods PubMed,Embase,the Cochrane Library,CNKI,WanFang,SinoMed,and official websites of international health technology assessment agencies were electronically searched to collect health technology assessment reports,systematic reviews/Meta-analysis,and pharmacoeconomic studies concerning the treatment of IDA with iron sucrose(IS),iron dextran(ID),ferric carboxymaltose(FCM),and iron isomaltoside(IIM)from the inception to August 15,2024.Two researchers independently screened the studies,extracted data and assessed the quality of included studies.The results were then qualitatively described and analyzed.Results A total of 32 studies were included,including one health technology assessment report,16 systematic reviews/Meta-analysis,and 15 pharmacoeconomic evaluations.In terms of effectiveness,FCM had a higher response rate than that of IS(P＜0.05),FCM and IIM had no statistical difference(P＞0.05).Regarding hemoglobin level change,patients treated with FCM had higher hemoglobin levels than those treated with IS(P＜0.05);the improvement in hemoglobin levels between IIM and FCM was inconclusive.In terms of ferritin level change,FCM might be superior to the other three intravenous iron formulations.In terms of safety,the adverse event rates for FCM,IS,ID and IIM were 12.0％,15.3％,12.0％and 17.0％,respectively;IIM was significantly associated with a lower rate of cardiovascular adverse events compared to FCM and IS(P＜0.05);FCM had the highest rate of hypophosphatemia among the four formulations(P＜0.05),and there was no significant difference among IIM,IS and ID(P＞0.05);IIM had a lower risk of severe or serious hypersensitivity reactions compared to FCM and IS.In terms of economy,FCM and IIM had an economic advantage compared to IS.The economic efficiency ranking among IS,ID,and FCM was in the order of FCM,ID,and IS,the economic comparison between FCM and IIM remains inconclusive and needs to be further demonstrated.Conclusion FCM and IIM have good efficacy,safety and economy in the treatment of IDA,but most of the included economy studies based on foreign populations,and domestic economic studies need to be further demonstrated.

Objective To investigate the risk factors for the occurrence of bronchiolitis obliterans (BO) in children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and their predictive value of the factors. Methods A retrospective analysis was performed for the medical records of 156 children with RMPP who were admitted to the hospital from May 2020 to March 2024. According to the diagnostic criteria for BO,they were divided into a BO group (n=76) and a non-BO group (n=80). A logistic regression analysis was used to investigate risk factors for the occurrence of BO,and the receiver operating characteristic (ROC) curve was used to assess the value of the model established based on the risk factors in predicting BO. Results Compared with the non-BO group,the BO group had a significantly longer duration of fever,a significantly higher leukocyte count,and a significantly lower albumin level (P<0.05). Compared with the non-BO group,the BO group had a significantly lower proportion of children with initiation of macrolide antibiotic therapy within 5 days,initiation of glucocorticoid therapy within 2 weeks,or initiation of bronchoscopic therapy within<2 weeks (P<0.05). The ROC curve analysis showed that the logistic regression model established based on the above six indicators had an area under the curve of 0.901 (95％CI:0.849-0.953,P<0.001) in predicting the occurrence of BO,with a sensitivity of 0.893 and a specificity of 0.827 at the optimal cut-off value of 0.341. Conclusions The logistic regression model established based on duration of fever,leukocyte count,albumin,initiation of macrolide antibiotic therapy within 5 days,initiation of glucocorticoid therapy within 2 weeks,and initiation of bronchoscopic therapy within 2 weeks has relatively high sensitivity and specificity in predicting the occurrence of BO in children with RMPP.

Objective To analyze the antimicrobial susceptibility,molecular types,serotypes,virulence factors and resistance mechanisms of Streptococcus agalactiae(S.agalactiae)isolated from pregnant women with ad-vanced maternal age in Tangshan City,and provide basic data for the treatment,prevention and control of S.aga-lactiae infection.Methods 42 strains of S.agalactiae isolated from pregnant women with advanced maternal age in North China University of Science and Technology Affiliated Hospital as well as Tangshan Maternal and Child Health Hospital were collected.Detection of antimicrobial susceptibility and whole genome sequencing of 13 antimi-crobial agents were performed.Results The percentage of tetracycline,erythromycin,levofloxacin,and chloram-phenicol concurrently resistant strains was 7.1％,35.7％of the strains presented multidrug resistance to erythro-mycin,clindamycin,and levofloxacin.The carriage rates of resistance genes ermB and tetM were 66.7％and 47.6％,respectively.29 strains(69.0％)exhibited mutations in both gyrA and parC fluoroquinolone resistance determi-nants.42 strains of S.agalactiae belonged to 4 serotypes,namely ⅠB(35.7％),Ⅲ(33.3％),Ⅴ(26.2％),andⅠA(4.8％);and 11 sequence types(STs),with the highest proportion being ST10(35.7％)and ST19(31.0％);as well as 6 clonal complexes(CCs),among which CC19(42.9％)and CC12(35.7％)had the highest proportion.All S.agalactiae carried virulence factor-encoding genes of cfb,cylE,and pavA.Conclusion The molecular types and serotypes of S.agalactiae carried by pregnant women with advanced maternal age in Tangshan City pre-sent polymorphism,with obvious multidrug resistance,and carry multiple types of drug resistance genes and viru-lence genes.

Objective:To analyze the mutant spectrum of clonal hematopoiesis of indeterminate potential(CHIP)related mutations and clinical characteristics and to explore the correlation and the possible mechanism between CHIP-related mutations and cardio-cerebrovasculars events(CCEs)in patients with myeloproliferative neoplasms(MPNs).Methods:The clinical data and next-generation sequencing results of 73 MPN patients in Beijing Anzhen Hospital from August 2019 to July 2022 were retrospectively analyzed.Statistical analyses were conducted by multivariate logistic regression for the effects of CHIP-related mutations and inflammatory cytokines on CCEs for MPNs patients.Results:Fifty-five cases of MPN(75.3％)showed positive in CHIP-related genes.There was no significant difference in variant allele frequency of CHIP-related gene between essential thrombocythemia(ET)and polycythemia vera(PV).CHIP-related gene mutations were mainly single gene mutations,with mutation rate from high to low as JAK2V617F(63.0％,46/73),ASXL1(16.4％,12/73),TET2(11.0％,8/73),DNMT3A(9.6％,7/73),SRSF2(6.9％,5/73),SF3B1(4.1％,3/73),TP53(1.4％,1/73)and PPM1D(1.4％,1/73).The mutation rate of CHIP-related genes in MPN patients＞60 years old was significantly higher than that in the patients ≤ 60 years old[91.7％(33/36)vs 59.5％(22/37)].CCEs occurred in 27 MPNs patients(37.0％,MPNs/CCEs),and 5 had recurrent CCEs,all of which were arterial events.Age(62.8±12.8 years vs 53.9±15.8 years,P=0.015),IL-1β level(17.7±26.0 vs 4.3±8.6,P=0.012),IL-8 level(360.7±598.6 vs 108.3±317.0,P=0.045),the proportion of the patients with thrombosis history(29.6％vs 2.2％,P=0.020),and the detection rate of CHIP-related mutations(88.9％vs 67.4％,P=0.040)in the group with CCEs were higher than those in the group without CCEs.Multivariate Logistic regression analysis showed that age(OR=0.917,95％CI:0.843-0.999,P=0.047),thrombosis history(OR=34.148,95％CI·2.392-487.535,P=0.009),any CHIP-related mutations(OR=16.065,95％CI·1.217-212.024,P=0.035),and elevated levelofIL-1β(OR=0.929,95％CI:0.870-0.992,P=0.027)were independent risk factors for MPNs/CCEs.CHIP-related gene mutations were not associated with CCEs in MPN patients,but DNMT3A(OR=88.717,95％CI:2.690-292.482,P=0.012)and ASXL1(OR=7.941,95％CI:1.045-60.353,P=0.045)were independent risk factors for CCEs in PV.Conclusion:There is a higher mutation rate of CHIP-related genes in MPN patients,especially those over 60 years old.Older age,thrombosis history,CHIP-related mutations and IL-1βelevated levels are independent risk factors for CCEs in MPN.DNMT3A and ASXL1 mutations are independent risk factors for CCEs in PV patients.CHIP-related gene mutations and inflammatory cytokine IL-1 β elevated levels may be the novel risk factors for CCEs in MPN.