Objective To investigate the effect of secondary preventive scheme on recurrence rate of ce-rebrovascular event based on China ischemic stroke subclassification(CISS)of intracranial arterial stenosis is-chemic stroke(IS).Methods A total of 192 patients with intracranial arterial stenosis IS were prospectively included and the secondary preventive scheme was formulated according to whether or not based on the patho-genesis.Then the patients were divided into the personalized treatment group and conventional treatment group.The personalized group conducted the classification and was given different the secondary preventive schemes the artery-artery embolism group was given the active lipid-lowering scheme to make the low density lipoprotein(LDL)reaching the standard;the low hypoperfusion group was given the smooth pressure reduc-tion program;the carrier artery occlusion perforating artery group was given the routine secondary prevention program;the mixture mechanism group was given the corresponding schemes superposition according to dif-ferent mechanisms].The conventional treatment group was given the conventional secondary preventive scheme.The difference in the recurrence rate of cerebrovascular events on 90 d was compared between the two groups.Meanwhile the univariate and multivariate logistic regression were used to analyze the influencing fac-tors of recurrence of cerebrovascular events on 90 d in intracranial arterial stenosis IS.Results Among 192 study subjects,there were 90 cases in the personalized treatment group(20 cases of vector artery occlusion and perforator artery,44 cases of arterial-arterial embolization,6 cases of hypoperfusion and 20 cases of mixed mechanism).There were 102 cases in the conventional treatment group(16 cases of perforator artery occlu-sion of the vector artery,52 cases of arterial-arterial embolism,8 cases of hypoperfusion and 26 cases of mixed mechanism).The occurrence rate of cerebrovascular events on 90 d in the personalized treatment group was significantly decreased compared to the conventional treatment group(7.8%vs.17.6%,χ2=4.112,P=0.043).The Logistic regression analysis revealed that the active lipid-lowering scheme for LDL reaching the standard was the independent protective factor of the cerebrovascular event recurrence on 90 d(OR=0.128,95%CI:1.150-71.170).Conclusion The personalized secondary prevention scheme based on pathogenesis reduces the recurrence rate of cerebrovascular event in intracranial arterial stenosis IS,in which making the LDL reaching the standard by the active lipid-lowering scheme is the independent protective factor for cerebro-vascular event recurrence in intracranial arterial stenosis IS.

Objective:To compare the characteristics of background mucosa, lesion features, and the efficiency of endoscopic submucosal dissection(ESD)between elderly and non-elderly patients with early gastric cancer(EGC).Methods:This study retrospectively collected data on patients with EGC who underwent ESD treatment at Beijing Hospital from April 2020 to December 2022.The clinical characteristics, background mucosa, lesion features, ESD outcomes, and pathological results of the patients were analyzed to compare the differences between elderly and non-elderly patients.Results:A total of 100 patients with EGC were selected, comprising 57 patients in the elderly group and 43 patients in the non-elderly group, with a total of 111 lesions identified(64 lesions in the elderly group and 47 lesions in the non-elderly group).The proportion of patients with a history of chronic atrophic gastritis was significantly higher in the elderly group(89.5%、51/57)compared to the non-elderly group(74.4%、32/43), with a statistically significant difference( P=0.047).Additionally, the difference in the extent of atrophy between elderly patients with EGC and their non-elderly counterparts was statistically significant( P=0.022).Among these patients, the proportion of those classified as Kimura-Takemoto C0 to C1 in the elderly group(15.6%、10/64)was lower than that in the non-elderly group(40.4%、19/47).In contrast, the proportion of patients classified as C2 to C3 in the elderly group(65.6%、42/64)was higher than that in the non-elderly group(51.1%、24/47), and the proportion of those classified as O1 to O3 in elderly patients(12.5%、8/64)was also higher than in the non-elderly group(4.3%、2/47).Furthermore, the difference in the extent of intestinal metaplasia between elderly and non-elderly patients with early gastric cancer was statistically significant( P=0.007).The overall proportion of total intestinal metaplasia in elderly patients(85.9%、55/64)was significantly higher than that in non-elderly patients(61.7%、29/47).Notably, the proportion of patients exhibiting extensive intestinal metaplasia(intestinal metaplasia present in both the gastric antrum and gastric body)was greater in the elderly group(43.8%、28/64)compared to the non-elderly group(23.4%、11/47).The Kyoto gastric cancer risk endoscopic score for elderly patients with EGC was(2.43±1.28)points, significantly higher than that of the non-elderly group(1.72±1.41)points, with a statistically significant difference observed( t=2.778, P=0.006).No statistically significant differences were observed in the proportions of total resection rates, R0 resections, curative resections, or postoperative complications following ESD when comparing elderly patients with EGC to their non-elderly counterparts. Conclusions:The proportion of extensive atrophy and intestinal metaplasia was higher in the background mucosa of elderly patients with EGC, and correspondingly, the Kyoto endoscopic gastric cancer risk score was elevated.Therefore, endoscopic examinations for elderly patients with chronic atrophic gastritis should be conducted with greater care and comprehensiveness.

Objective:To explore the effects of body mass index (BMI) on the incidence of nocturnal hypertension in patients with hypertension.Methods:Totally 341 hospitalized hypertensive patients treated at the Affiliated Hospital of Jining Medical University from February to May 2023 were selected by convenience sampling. Patients' general information, clinical data, and 24-hour ambulatory blood pressure results were collected. A binomial Logistic regression analysis was conducted to investigate the factors affecting the occurrence of nocturnal hypertension in these patients. The relationship between BMI and the incidence of nocturnal hypertension was examined using threshold effect tests and smooth curve fitting.Results:The binomial Logistic regression analysis indicated that blood phosphate level was a factor influencing the occurrence of nocturnal hypertension in hypertensive patients ( P<0.05). Smooth curve fitting and threshold effect test results showed that the relationship between BMI and the incidence of nocturnal hypertension was curve-correlated, with a turning point at 24.61 kg/m 2. To the left of the turning point, there was no correlation ( P=0.130) ; to the right, there was a correlation ( P=0.016) . Conclusions:When the BMI of hypertensive patients exceeds 24.61 kg/m 2, the likelihood of nocturnal hypertension increases with rising BMI, providing a precise intervention target for weight management-based patient care in hypertension.

Objective To investigate the current status and awareness of pharmaceutical services in hospitals in Guizhou province and to provide a reference for exploring and carrying out pharmaceutical service fees.Methods The questionnaire was designed by the"wjx.cn"website.Three kinds of questionnaires were designed for pharmacists,doctors,nurses,and patients as the research objects,with corresponding differences in some questions,and promoted on WeChat,Dingxiangyuan,and other network platforms.Results A total of 655 questionnaires were collected,and 639 valid questionnaires were recovered,with an effective recovery rate of 97.56%.324 pharmacists(50.70%),82 doctors and nurses(12.83%),233 patients(36.46%)were surveyed.The average approval score of these three groups of respondents on pharmaceutical service fees was 4.67,4.23,and 4.22,respectively(full score:5).Conclusions Overall,pharmacists'professional services have received support from medical staff and patients.However,patients'pharmaceutical service projects currently focus on dispensing services.The recognition of pharmacists'work and the public's awareness of pharmaceutical services can be improved by enhancing the professional ability of pharmacists,strengthening publicity and guidance,and exploring"Internet+pharmaceutical services",etc.,to promote the sustainable development of pharmaceutical services.

Background: Long coronavirus disease 2019 (COVID-19) in recovered patients (RPs) is gradually recognized by more people. However, how long it will last and the underlining mechanism remains unclear. Methods: We conducted a prospective follow-up study to evaluate the long-term symptoms and clinical indices of RPs at one-year after discharge from Union Hospital, Wuhan, China between December 2020 to May 2021. We also performed the 16S rRNA sequencing of stool samples from RPs and healthy controls (HCs) and analyzed the correlation between the gut microbiota and long COVID-19. Results: In total, 187 RPs were enrolled, among them, 84 (44.9%) RPs reported long COVID-19 symptoms at one-year after discharge. The most common long-term symptoms were cardiopulmonary symptoms, including chest tightness after activity (39/187, 20.9%), palpitations on exercise (27/187, 14.4%), sputum (21/187, 11.2%), cough (15/187, 8.0%) and chest pain (13/187, 7.0%), followed by systemic symptoms including fatigue (34/187, 18.2%) and myalgia (20/187, 10.7%), and digestive symptoms including constipation (14/187, 7.5%), anorexia (13/187, 7.0%), and diarrhea (8/187, 4.3%). Sixty-six (35.9%) RPs presented either anxiety or depression (42/187 [22.8%] and 53/187 [28.8%] respectively), and the proportion of anxiety or depression in the long symptomatic group was significantly higher than that in the asymptomatic group (41/187 [50.6%] vs. 25/187 [24.3%]). Compared with the asymptomatic group, scores of all nine 36-Item Short Form General Health Survey domains were lower in the symptomatic group (all P < 0.05). One hundred thirty RPs and 32 HCs (non-severe acute respiratory syndrome coronavirus 2 infected subjects) performed fecal sample sequencing.Compared with HCs, symptomatic RPs had obvious gut microbiota dysbiosis including significantly reduced bacterial diversities and lower relative abundance of short-chain fatty acids (SCFAs)-producing salutary symbionts such as Eubacterium_hallii_group, Subdoligranulum, Ruminococcus, Dorea, Coprococcus, and Eubacterium_ventriosum_group. Meanwhile, the relative abundance of Eubacterium_hallii_group, Subdoligranulum, and Ruminococcus showed decreasing tendencies between HCs, the asymptomatic group, and the symptomatic group. Conclusion This study demonstrated the presence of long COVID-19 which correlates with gut microbiota dysbiosis in RPs at one-year after discharge, indicating gut microbiota may play an important role in long COVID-19.

Objective:To investigate the effects of breast milk to total milk intake ratio during hospitalization on the duration of antibiotic therapy in preterm infants less than 34 weeks of gestation.Methods:Clinical data of preterm infants ( n=1 792) less than 34 gestational weeks were retrospectively collected in 16 hospitals of Jiangsu Province Neonatal-Perinatal Cooperation Network from January 1, 2019, to December 31, 2021. The days of therapy (DOT) were used to evaluate the duration of antibiotic administration. The median DOT was 15.0 d (7.0-27.0 d). The patients were divided into four groups based on the quartiles of DOT: Q 1 (DOT≤7.0 d), Q 2 (7.0 d27.0 d) groups. According to the breast milk intake ratio (breast milk intake to total milk intake during hospitalization×100%), they were also divided into four groups: very-low-ratio breastfeeding group (breast milk intake ratio≤25%), low-ratio breastfeeding group (25%75%). Univariate analysis ( Chi-square test and Kruskal-Wallis rank-sum test) was used to analyze the factors influencing DOT. Spearman correlation analysis and trend Chi-square test were used to explore the relationship between breast milk intake ratio and DOT. After using multiple imputations to address missing data, two models were constructed after adjusting for different factors, and multinomial logistic regression model was applied to evaluate the effects of the breast milk intake ratio on DOT. Finally, sensitivity analysis was conducted to assess the stability of the models. Results:(1) Of the 1 792 preterm infants, there were 507 (28.3%) in the Q 1 group, 422 (23.5%) in the Q 2 group, 438 (24.4%) in the Q 3 group and 425 (23.7%) in the Q 4 group. (2) The median values of DOT in the very-low-ratio, low-ratio, medium-ratio and high-ratio breastfeeding groups were 20.0 d (11.0-31.0 d), 20.0 d (11.0-32.0 d), 13.0 d (6.0-25.8 d) and 10.0 d (4.0-21.0 d), respectively. Compared with the very-low-ratio and low-ratio breastfeeding groups, the medium-ratio and high-ratio breastfeeding groups had shorter DOT (all P<0.05). (3) After adjusting for factors with P<0.1 (prenatal glucocorticoid exposure, antimicrobial use within 24 h before delivery, gestational age at delivery, birth weight, Apgar score≤7 at 1 min, neonatal respiratory distress syndrome, infectious pneumonia and early-onset neonatal sepsis) between the DOT quartile groups, it showed that medium-ratio and high-ratio breastfeeding were protective factors in contrast to very-low-ratio breastfeeding in the Q 2, Q 3 and Q 4 groups as compared with the Q 1 group [Q 2 group: OR=0.50 (95% CI: 0.30-0.85) and OR=0.36 (95% CI: 0.26-0.51); Q 3 group: OR=0.31 (95% CI: 0.18-0.55) and OR=0.20 (95% CI: 0.14-0.29); Q 4 group: OR=0.22 (95% CI: 0.12-0.42) and OR=0.17 (95% CI: 0.12-0.26)]. Conclusion:Breast milk intake accounting for over 50% of total milk intake has a positive impact on reducing DOT in premature infants requiring antibiotics, which suggests that breastfeeding should be actively encouraged.

Objective:To retrieve and analyze the evidence related to perioperative blood glucose management in patients with coronary heart disease (CHD) complicated by diabetes undergoing percutaneous coronary intervention (PCI) , and provide clinical guidance for glucose management.Methods:Systematic searches were conducted on domestic and international guideline websites, evidence-based databases, primary research databases, and related association websites for evidence concerning perioperative blood glucose management for this patient group. The search included clinical decisions, guidelines, expert consensus, evidence summaries, and systematic reviews, covering the time span from database inception to February 2022. Two evidence-trained researchers independently conducted literature quality assessments and evidence extraction, with disputes resolved by a third party.Results:Eighteen articles were included: one clinical decision, nine guidelines, and eight expert consensuses. The findings were summarized into eight aspects: team formation and training, admission assessment and treatment, blood glucose control targets, preoperative glucose management, intraoperative glucose management, postoperative glucose management, perioperative abnormal glucose management, and discharge management, totaling 35 evidence points.Conclusions:This study consolidates evidence related to perioperative blood glucose management for patients with CHD complicated by diabetes undergoing PCI. However, during the evidence translation and application process, conditions of the application site, medical resources, and patient preferences should be fully considered. After assessing the feasibility and applicability of the evidence, a personalized blood glucose management plan should be developed for the patient, aiming to improve blood glucose levels and prognosis.

  Objective  To study the demographic and clinical characteristics, correlation of genotype and phenotype and treatment of Blau syndrome to facilitate early diagnosis and timely treatment of Blau syndrome.  Methods  Seventy-two patients with Blau syndrome from 11 centers from May 2006 to April 2022 were retrospectively analyzed, and their general information, clinical data, laboratory examination and treatment medication were collected.  Results  The distribution of patients with Blau syndrome was uniform in geographical north and south of China, and there was no obvious gender bias. The mean age of onset was (14.30±12.81) months, and the age of diagnosis was (55.18±36.22) months. 35% of patients with Blau syndrome happened before 1 year old, and all patients developed before 5 years old. 87.50% (63/72) had granulomatous arthritis, 65.28% (47/72) had rash, 36.11% (26/72) had ocular involvement, 27.78% (20/72) had fever, and 15.28% (11/72) had pulmonary involvement. Arthritic manifestations of Blau syndrome were most at risk, followed by rash, ocular involvement, and fever.The first 25 months of the disease, the risk of developing a rash was the greatest. The risk of developing arthritis was the greatest between 25 months and 84 months. The main mutations were p.R334Q and p.R334W, and patients with p.R334Q mutation had relatively high incidence of fever (35.71%[5/14] vs. 14.29%[1/7], P=0.43) and ocular involvement (42.86%[6/14]vs. 28.57%[2/7], P=0.51). There was a relatively high incidence of rash (85.71%[6/7] vs. 64.29%[9/14], P=0.59) in patients with the p.R334W mutation. Forty-five patients(62.50%)were treated with a combina-tion of glucocorticoid and methotrexate. Twenty-two patients were treated with tumor necrosis factor antagonist in addition to glucocorticoid and methotrexate.  Conclusions  The risk of different clinical manifestations of Blau syndrome from high to low was arthritis, followed by rash, ocular involvement and fever. The main treatment was glucocorticoid combined with methotrexate, to which biological agents could be added.

Objective:To investigate the incidence and influential factors of hyperuricemia in older adult patients who live in the sanatorium and to improve the prevention and treatment of hyperuricemia people.Methods:A total of 800 older adult patients living in Wuyunshan Sanatorium between June 2017 and December 2019 were recruited for this study. The prevalence of hyperuricemia was determined as per the diagnostic criteria of hyperuricemia. These patients were divided into control and hyperuricemia groups according to whether they had hyperuricemia. General data, health status, physical examination, and laboratory indices were compared between the two groups. The influential factors of hyperuricemia were analyzed using the logistic regression analysis method.Results:The incidence of hyperuricemia in older adult patients living in the sanatorium was 18% (144/800). There was significant difference in the prevalence of hyperuricemia between male and female older adults [22.17% (104/469) vs. (12.08%) (40/331), χ2 = 13.38, P < 0.001]. The incidence of hyperuricemia was significantly higher in male older adults aged 60-90 years than in female older adults at the same age brackets [18.50% (59/319) vs. 5.48% (12/219), χ2 = 19.20, P < 0.001]. The overall prevalence of hyperuricemia and the prevalences of hyperuricemia in male and female older adults significantly increased with aging ( Z = 30.47, 11.92, 24.81, P < 0.001). There were significant differences in age, sex, alcohol consumption, urinary protein-positive, exercise, the prevalences of hypertriglyceridemia, hypercholesterolemia, and renal insufficiency between the control and hyperuricemia groups ( χ2/ t = 2.36, 19.41, 41.18, 10.11, 50.42, 8.24, 6.43, 8.59, all P < 0.05). Age, alcohol consumption, hypercholesterolemia and renal insufficiency were independent risk factors of hyperuricemia in older adults living in sanatorium ( OR = 2.07, 2.54, 2.31, 2.76, 95% CI = 1.218-3.541, 1.740-3.729, 1.538-3.468, 1.920-3.974). Exercise was a protective factor of hyperuricemia ( OR = 0.49, 95% CI = 0.356-0.694). Conclusion:Older adults living in sanatorium have a high incidence of hyperuricemia. Prevention and treatment of hyperuricemia should be strengthened in older adults who have a high risk for hyperuricemia to reduce the incidence of hyperuricemia.

Antifungal agents have shown good efficacy and tolerability in the general population. However, the antifungal treatment remains a great challenge in some special populations due to their special conditions, such as children, the elderly, pregnant women and patients with hepatic insufficiency. This review summarizes recommendations for the use of common antifungal agents in the above special populations.