BACKGROUND: The benefits of ideal cardiovascular-health metrics (ICVHMs) in patients with renal insufficiency remain unclear. This study aimed to investigate the associations between ICVHM and prognosis in a renal insufficiency population. METHODS: The trial enrolled 29,682 participants from the US National Health and Nutrition Examination Survey (NHANES), 2007-2018, with mortality follow-up through December 31, 2019. Participants were divided into three groups based on estimated glomerular filtration rates. Cardiovascular health was assessed using new "Life's Essential 8" metrics. Cox regression analyses based on NHANES data were used to determine the associations between ICVHMs and cardiovascular mortality in patients with renal insufficiency. RESULTS: During a mean follow-up of 6.58 years, ideal cardiovascular health (hazard ratio [HR] = 0.42; 95% confidence interval [CI]; 0.25-0.70) and ideal health behavior (HR = 0.53; 95% CI; 0.39-0.73) reduced cardiovascular mortality in participants with renal insufficiency. For each one ICVHM increment, a 25% reduction in cardiovascular mortality was recorded (95% CI; 0.69-0.82). When compared with participants with normal renal function, for those with mild renal insufficiency, the HR for cardiovascular mortality gradually decreased from 1.47 (95% CI; 0.85-2.52) in those who had ≤1 ICVHMs to 0.30 (95% CI; 0.12-0.77) in participants who had >6 ICVHMs. CONCLUSIONS From an ICVHM perspective, enhanced cardiovascular benefits were observed in individuals with renal insufficiency, coupled with a reduced risk of all-cause mortality. Furthermore, when compared with individuals with normal renal function, increased ICVHMs can mitigate adverse risks associated with renal impairment.
Humans ; Male ; Female ; Nutrition Surveys ; Middle Aged ; Renal Insufficiency/physiopathology* ; Aged ; Prognosis ; Adult ; Cardiovascular Diseases/mortality* ; Glomerular Filtration Rate/physiology* ; Proportional Hazards Models

Objective:To analyze the early and middle term clinical effects of mitral valve repair in children with mitral insufficiency.Methods:From January 2012 to January 2019, a total of 202 cases of children with mitral insufficiency treated by mitral valve repair were selected from the department of cardiothoracic surgery of Nanjing Children's Hospital, patients with atrioventricular septal defect, single ventricle and ischemic mitral regurgitation were excluded. Echocardiography was used to compare the preoperative and postoperative left ventricular function and degree of regurgitation in children to evaluate the early and middle term efficacy of mitral valvuloplasty.Results:There were 5 cases of early death(5/202, 2.5%) and 3 cases of late death(3/202, 1.5%). The mean follow-up time was(19.49±17.48) months(1-68 months). Postoperative echocardiography showed that the left heart function and mitral regurgitation were significantly improved.Conclusion:Mitral valvuloplasty can significantly correct mitral insufficiency in children, and it has satisfactory mid-term efficacy and good clinical value.

Objective: To investigate the feasibility of one-step coronary and carotid-cerebrovascular computed tomography angiography (CTA) using high-pitch Double Turbo Flash mode and to analyze the image quality and radiation dose in patients with heart rate variability using multi-slice detector dual-source CT. Methods: A total of 79 patients with heart rate variability higher than 3 beat/min (bpm) were retrospectively analyzed. They were grouped by the scanning methods. Group A (n=40) were performed double turbo flash mode for one-step coronary and carotid-cerebrovascular arteriesinjected with one injection of contrast agent.further divided into Single A (only the phase 1 image)and Double A(combined images of phases 1 and 2). Group B (n=39) were performed separately with twice injection of contrast agent. Subjective scoring was performed on the image quality of the group Single A, Double A and B using a 4-point. Then the objective parameters of image quality, CT attenuations, image noise, signal-to-noise (SNR), and contrast-to-noise (CNR), were evaluated. Then subjective scores, objective evaluation indicators, and radiation dose were compared with one-way ANOVA analysis among the three groups.Contrast agent were compared by using t test in group A and B. Results: No significant difference was found (F=2.093, P=0.128) for the subjective scores of the head and neck CTA among the three groups with (3.47±0.51), (3.53±0.51), (3.69±0.47). Significant difference was found (F=50.955, P<0.01) for the subjective scores of coronary CTA among the three groups with (2.70±0.76), (3.35±0.66), (3.58±0.50), and there was no statistically significant difference between Double A and B groups (P=0.104), met the requirements for diagnosis. The objective evaluation of the three groups compared the head and neck CTA images were statistically significant (P<0.05), of which the difference between the Single A and the Double A was not statistically significant (P>0.05), met the requirements for diagnosis; the differences in SNR and CNR of coronary CTA images are statistically significant (F=12.991, 12.236, P<0.01), and there was no statistically significant difference between Double A and B (P>0.05), met the requirements for diagnosis. Radiation dose in the group Double A was lower than group B (decreased by 46.15%,P<0.01).The amount of the contrast agent in the group Double A was lower than group B (decreased by 44.13%, t=-45.455;P<0.01). Conclusion The double turbo flash mode is feasibility for one-step coronary and carotid-cerebrovascular CTA in patients with the heart rate variability using multi-slice dual-source CT.This scan mode can maintain the diagnostic image quality with low contrast agent and radiation dose.

Objective To investigate the related factors for the survival of the patients with pancreatic cancer.Methods A total of 1 620 patients confirmed as pancreatic cancer admitted in Sun Yat-sen Memorial Hospital affiliated with Sun Yat-sen University,Tumor prevention and treatment center affiliated with Sun Yat-sen University and People's Hospital of Guangdong Province from 2004 to 2016 were retrospectively analyzed,and the effects of TNM staging,surgical treatment,palliative chemotherapy and postoperative assisted chemotherapy on the survival of the patients with pancreatic cancer were examined by life table and Log-rank test.Results The median survival time of all 1 620 cases was 7.15 months.The median survival time of TNM stage Ⅰ,Ⅱ,Ⅲ and Ⅳ was 12.50 months,10.12 months,9.56 months and 5.43 months,and there was statistically significant difference (P =0.001).The median survival time of cases who did not undergo surgery was 6.10 months,which of patients who underwent radical surgery was 13.67 months,and the difference was statistically significant (P =0.001).The median survival time of cases without chemotherapy was 5.55 months,which of patients who underwent palliative chemotherapy was 7.58 months,and the difference was statistically significant (P =0.001).The median survival time of cases with pure radical surgery without chemotherapy was 12.38 months,which of patients who underwent adjuvant chemotherapy was 14.50 months,and the difference was no statistically significant (P =0.561).Conclusions Early diagnosis followed closely by radical surgery is the key to prolong the survival of pancreatic cancer patients.And adjuvant chemotherapy for patients who lose surgery opportunity may improve clinical prognosis to a certain extent.

Objective To evaluate the efficacy of early controlled cold atomization inhalation of budesonide in the treatment of post-operative sore throat (POST) after double-lumen endotracheal intubation. Methods A total of 105 ASAⅠ~Ⅲpatients having POST after thoracic surgery with double-lumen endotracheal intubation were randomly divided into three groups(n = 35 each). The patients in the control group were treated with atomization inhalation of 12 mL 20℃saline(Group C)and those in the observation groups were treated with 10 mL 20℃saline plus 2 mL(1 mg)budesonide(Group R)or 10 mL 0℃saline plus 2 mL(1 mg)budesonide (Group L)for 15 minutes immediately after extubation. The 4-score scale was used to evaluate sore throat,dry throat,hoarseness and swallowing difficulty 1,2,6 and 24 h after the extubation and QoR-40 scale to assess post-operative recovery at 24 h. Results The scores of sore throat and dry throat were significant lower in group L than those in group C(P < 0.05)at 1,2 and 24 h and the score of swallowing difficulty(dysphagia)was also signifi-cant relieved at 1,6 and 24 h after the extubation in group L. Furthermore,the score of sore throat was significant lower in group L than that in group R(P<0.05)at 1 h. There were no significant differences of hoarseness in three groups(P > 0.05). The total score of QoR-40 scale was the significantly highest in group L than that in group C and group R(P<0.05)24 h postoperatively. Conclusion Cold atomization inhalation of budesonide immediately after the extubation of double-lumen endotracheal can alleviate POST and bring more benefits to patients which help to enhance the recovery after throracic surgery.

Objective To analyze the operation of long-term effect of edge to edge mitral repair for mitral vavle moderateto-severe insufficiency in children retrospectively.Methods Clinical dates of 102 patients who underwent edge to edge mitrel valve repair in Nanjing Children's Hospital from March 2003 to March 2015 were collected.Postoperative thoracic echocardiography was adopted to observe the effect of mitral valve forming and evaluate the follow-up results.Results The whole group of 2 patients died in hospital,Followed up for 1 months to 12 years,during the follow-up of 10 patients were lost.The early fol low-up,medium-term follow-up and long-term follow-up were completed 93,55 and 26 cases,respectively.In the early followup,6 patients had recurrent moderate mitral regurgitation(MR),and 5 patients had recurrent moderate-to-severe MR and reoperated during the follow-up period,a total of 2 cases died.In the medium-term follow up,moderate and severe MR were found in 6 and 4 cases,respectively.Three patients accepted reoperation,two patients died.In the long-term follow-up,1 case had recurrent severe MR,2 cases had re-operation and had no death.Early survival rate was 97.8 ％ (91/93),avoid reoperation rate was 94.6％ (88/93).The incidence of moderate or severe mitral regurgitation was 11.8％ (11/93).Midtcrm survival rate was 96.4％ (53/55),avoid reoperation rate was 94.6％ (52/55),moderate or severe mitral regurgitation rate was 18.2％ (10/55).Long-term follow-up have no death,avoid reoperation rate was 92.3 ％ (24/26),mitral valve moderate and above reflux rate was 7.7 ％ (2/26).The actuarial survival and freedom from MV reoperation rate was (92.4 ± 2.4) ％ and (77.7 ± 6.4) ％ at 10 years,respectively.Conclusion Edge to edge mitral repair in the treatment of children with moderate to severe mitral insufficiency had relatively stable curative effect,relatively fewer complications,and high long-term clinical effect.

Objective: To investigate the influence of aluminum chloride (AlCl₃) solution on the embryon-ic development of zebrafish and neurobehavior of juvenile fish. Methods: The embryos of zebrafishat 6 hours after fertilization were exposed to AlCl₃ solution at a concentration of 0, 55.0, 60.5, 66.6, 73.5, 80.5, or 100.0 mg/L, and embryonic hatching rates at 48 and 72 hours after fertilization were calculated. The embryos of zebrafishat 6 hours after fertilization were exposed to AlCl₃ solution at a concentration of 0, 60.0, 72.0, 86.4, 103.7, or 124.4 mg/L, and the embryonic mortality rates at 12, 24, 48, 72, and 96 hours after fertilization were calculat-ed. The embryos of zebrafish at 6 hours after fertilization were exposed to AlCl₃ solution at a concentration of 0, 50, 100, 200, 400, or 800 μg/L, and the changes in the neurobehavior of juvenile fish were observed after hatching, including touch-escape reaction at 72 hours after fertilization and autonomic movement and panic es-cape reflex at 7 days after fertilization. Results: Compared with the 0 mg/L group, the≥66.6 mg/L group had a sig-nificant reduction in embryonic hatching rate at 48 and 72 hours after fertilization, and the ≥72.0 mg/L group had a significant increase in embryonic mortality rate at 96 hours after fertilization (P<0.05) . Compared with the 0 μg/L group, the≥100 μg/L group had a significant reduction in the number of times of touch-escape reaction (P<0.05) .Compared with the 0 and 50 μg/L groups, the 100-800 μg/L groups had significant reductions in total movement distance and average speed (P<0.05) . Compared with the dark period before illumination, all groups had a significant increase in movement speed during the light period of the panic escape reflex test (i.e., the third minute) (P<0.05) ; within 2 minutes after the light was turned off, there was no significant change in movement speed in the 0-200 μg/L groups (P>0.05) ; the 400 and 800 μg/L groups had a significant increase in movement speed (P<0.05) . Conclusion AlCl₃ exposure may cause embryonic developmental disorder in zebrafish and ab-normal neurobehavior in juvenile fish.

Objective To investigate thecorrelation between nonmusle myosin heavy chain 9 gene (MYH9) rs12107,signal transducer and activator of transcription (STAT4) rs3024912, Urokinase plasminogen activator (uPA) rs4065 single nucleotide polymorphism and idiopathic Uighur membranous nephropathy (IMN). Methods Patients admittedby People′s Hospital of Xinjiang Uyghur Autonomous Region from June 2011 to May 2015 were selected in the research,of which 45 with IMN (group A),45 patients with IgA nephropathy (group B) and 45 healthy controls(group C). The polymorphisms of rs12107,rs3024912 and rs4065 were measured with direct sequencing, in order to analyzing the correlation between genotype and allele with IMN. Results Group Ars12107 (MYH9) locus genotype CC, C allele (48.9%, 65.6%) frequency were higher than those in group B (13.3%, 33.3%) and group C (20.0%, 46.7%), and the difference was statistically significance (P < 0.05). C allele carriers of the risk of IMN is 2.18 times that of the T allele (95% CI: 1.19-3.97). Univariate Logistic regression analysis of rs12107 CC genotype showed patients with CC genotype faced with high risk of renal failure (OR = 5.56,95% CI:1.27-24.29, P = 0.023) compared with non-CC genotype patients. rs3024912 genotype and allele frequencies showed no significant difference among the three groups (P > 0.05). rs3024912 GG genotype patients showed higher risk of renal failure compared with non-GG genotype patients (95% CI:1.48-26.83, P = 0.013). Only TT genotype was detected on rs4065 locus. TC and CC genotype were not detected. Conclusions MYH9 gene rs12107 locus CC genotype and C allele are associated with susceptibility to IMN in Xinjiang Uygur, and CC genotypes associated with renal function. rs3024912 (STAT4)GG genotype are not susceptibility gene,but associated with renal function in patients with IMN.

Objective To explore the effect of inhibiting placental growth factor ( PIGF ) by small interfering RNA ( siRNA) on migration, invasion and chemoresistance of human pancreatic cancer cell line PANC1.Methods Three specific siRNAs targeting PIGF (siRNA-PIGF) were designed.PANC1 cells were transfected with siRNA-PIGF by liposome transfection using untransfected cells as blank controls and nonspecific siRNA ( siRNA-NC) transfected cells as negative controls .The PIGF mRNA and protein expression was examined by real-time RT-PCR and ELISA.MTT method was used to assess the inhibition rate of chemotherapeutic reagents on cell proliferation .The abilities of migration and invasion were evaluated by Transwell assay.Results The inhibition rate of PIGF mRNA in PANC1 cells transfected by 3 siRNA-PIGF were (64.38 ±8.92)%, (70.48 ±7.72)% and (81.25 ±6.02)%, which was lowest in siRNA-PIGF-3 transfected cells.The expression of PIGF mRNA in PANC1 cells were decreased by (63.72 ±8.20)%at 24 h after siRNA-PIGF transfection compared with siRNA-NC transfected cells;and the level of PIGF protein in the supernatant of cultured PANC1 cells was lowered by (42.92 ±1.34)% compared with siRNA-NC transfected cells and by (46.25 ±3.64)% compared with untransfected cells at 48h after transfection, which all had significant difference .There was no statistical difference between untransfected and siRNA-NC transfected cells.After 3 ng/L gemicitabine treatment , the inhibition rate of cell proliferation in siRNA-PIGF group was even higher than that in siRNA-NC and untransfected group [(44.35 ±5.05)% vs(34.29 ±3.60)% and (31.01 ±1.08)%;both P<0.05], and no significant difference was not observed after 5-FU and adriamycin treatment.In migration and invasion assay , the number of transmembrane cells from siRNA-PIGF group was 38.1%and 28.2%of that from siRNA-NC group and 40.8% and 36.2% of that from untransfected group , which had statistical difference (all P<0.05).Conclusions PIGF silencing could significantly suppress the migration and invasion of PANC 1 cells and improve the sensitivity to gemicitabine .

OBJECTIVETo investigate the risk factors on initial surgery in Crohn's disease.

METHODSThe clinical data of 173 patients with Crohn's disease who were treated during 2010 and 2014 years in the Second Affiliated Hospital of Sun Yat-Sen University, were analyzed retrospectively. The patients who had received intestinal resection or whose initial symptoms occurred at least 5 years at the end of the follow-up were recruited. Montreal classification was used to evaluate lesion location and disease behavior. The risk factors of the initial surgery were analyzed by using Logistic regression model.

RESULTSEighty-five patients (49.1%) received intestinal resection in 5 years after the onset of symptoms. The result of univariate analysis showed that the probability of surgical treatment is high in patients who were male and those older than 40 years at diagnosis (P<0.05). Lesions involving upper digestive tract, stenosis and penetrating lesions were also the risk factors on initial surgery in Crohn's disease (P<0.05). The result of multivariate analysis showed the relative risk of initial surgery was increased in male gender (OR=2.02, 95%CI:1.04-3.92) and in those who were older than 40 years at diagnosis (OR=2.34,95%CI:1.05-5.22). However, in patients with Crohn's disease involving colon alone, the relative risk of initial surgery was decreased (OR=0.35, 95%CI:0.13-0.97).

CONCLUSIONAbdominal pain is the most common clinical presentation in Crohn's disease. Disease behavior and operation is closely related. Older than 40 years at diagnosis and male gender is high risk factor for surgery while colonic lesion alone is protective factor.

Abdominal Pain ; Colon ; Constriction, Pathologic ; Crohn Disease ; Follow-Up Studies ; Humans ; Logistic Models ; Male ; Protective Factors ; Retrospective Studies ; Risk Factors