BACKGROUND: The role of inflammation in the development of gestational diabetes mellitus (GDM) has recently become a focus of research. The systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), novel indices, reflect the body's chronic immune-inflammatory state. This study aimed to investigate the associations between the SII or SIRI and GDM. METHODS: A prospective birth cohort study was conducted at Beijing Obstetrics and Gynecology Hospital from February 2018 to December 2020, recruiting participants in their first trimester of pregnancy. Baseline SII and SIRI values were derived from routine clinical blood results, calculated as follows: SII = neutrophil (Neut) count × platelet (PLT) count/lymphocyte (Lymph) count, SIRI = Neut count × monocyte (Mono) count/Lymph count, with participants being grouped by quartiles of their SII or SIRI values. Participants were followed up for GDM with a 75-g, 2-h oral glucose tolerance test (OGTT) at 24-28 weeks of gestation using the glucose thresholds of the International Association of Diabetes and Pregnancy Study Groups (IADPSG). Logistic regression was used to analyze the odds ratios (ORs) (95% confidence intervals [CIs]) for the the associations between SII, SIRI, and the risk of GDM. RESULTS: Among the 28,124 women included in the study, the average age was 31.8 ± 3.8 years, and 15.76% (4432/28,124) developed GDM. Higher SII and SIRI quartiles were correlated with increased GDM rates, with rates ranging from 12.26% (862/7031) in the lowest quartile to 20.10% (1413/7031) in the highest quartile for the SII ( Ptrend <0.001) and 11.92-19.31% for the SIRI ( Ptrend <0.001). The ORs (95% CIs) of the second, third, and fourth SII quartiles were 1.09 (0.98-1.21), 1.21 (1.09-1.34), and 1.39 (1.26-1.54), respectively. The SIRI findings paralleled the SII outcomes. For the second through fourth quartiles, the ORs (95% CIs) were 1.24 (1.12-1.38), 1.41 (1.27-1.57), and 1.64 (1.48-1.82), respectively. These associations were maintained in subgroup and sensitivity analyses. CONCLUSION The SII and SIRI are potential independent risk factors contributing to the onset of GDM.
Humans ; Female ; Pregnancy ; Diabetes, Gestational/immunology* ; Prospective Studies ; Adult ; Inflammation/immunology* ; Glucose Tolerance Test ; Birth Cohort

Objective To summarize the experience of performing selective laparoscopic appendectomy in re-admission children who had been given conservative treatment for acute appendicitis complicated with peri-appendiceal abscess.Methods From September 2019 to July 2024,22 patients with acute appendicitis complicated with peri-appendiceal abscess underwent three port laparoscopic appendectomy after receiving conservative treatment for 6-14 weeks.Their age ranged 5-14 years old,with an average of 8.5 years old.A 5 mm trocar and a 30° laparoscope were inserted through a midline umbilical incision,and 5 mm trocars and forceps were placed at the suprapubic area,lateral to the left rectus abdominis,and 3-5 cm below the umbilicus.Adequate adhesiolysis was performed,including detaching the omentum from the pelvic sidewall,separating the ileocecal region from the omentum,and freeing the appendix from the lateral peritoneum and the mesenteric tissue of the terminal ileum to expose the affected appendix.The mesoappendix and the base of the appendix were then ligated and transected.Results The operations in all the 22 cases were successful.The surgical time ranged 50-150 min(mean,75.5±10.0 min).The patients were able to mobilize independently at 6-8 h postoperatively,resumed passing gas and consumed clear liquids within 1-1.5 d.The postoperative hospital stay was 3-6 d,with an average of 4 d.Pathological reports indicated chronic appendicitis with necrotizing perforation.Follow-ups lasted for 2-13 months(mean,6 months),with no reports of abdominal pain,fever,incision infection,adhesive intestinal obstruction,residual appendicitis,or pelvic abscess.Conclusions For children with acute appendicitis complicated with peri-appendiceal abscess who have received conservative treatment,effective adhesiolysis within the abdominal and pelvic cavities during selective laparoscopic appendectomy is crucial,which is also the primary reason for a relatively prolonged surgical time.Adhesions are primarily located between the omentum and pelvic sidewall,between the ileocecal region and omentum,and between the appendix and lateral peritoneum as well as the mesentery of the terminal ileum.Adequate adhesiolysis followed by appendectomy can effectively alleviate symptoms such as abdominal pain.

Objective:To investigate the correlation between frailty and immune markers in elderly patients diagnosed with heart failure with preserved ejection fraction(HFpEF).Methods:A total of 416 elderly patients with HFpEF, who were hospitalized in the Department of Geriatrics at Henan Provincial People's Hospital from March 2021 to December 2023, were selected as research subjects.The Fried frailty phenotype was employed to assess frailty.Fasting venous blood samples were collected to measure levels of CD4+ T lymphocytes, CD8+ T lymphocytes, the CD4+ /CD8+ ratio, and immunoglobulins A, M, and G. Spearman correlation analysis and multiple linear regression analysis were conducted to evaluate the relationship between frailty scores and immune markers.Results:Spearman correlation analysis revealed a significant association between frailty score and the CD4+ /CD8+ ratio( r=-0.659, P<0.001), immunoglobulin A( r=-0.454, P<0.001), immunoglobulin M( r=-0.522, P<0.001), and immunoglobulin G( r=-0.802, P<0.001).Furthermore, multiple linear regression analysis indicated that, after adjusting for confounding factors, frailty score served as a significant negative predictor of the CD4+ /CD8+ ratio( β=-0.562, P<0.001), immunoglobulin A( β=-0.366, P<0.001), immunoglobulin M( β=-0.445, P<0.001), and immunoglobulin G( β=-0.772, P<0.001).In comparison to the non-frail group, the frail group exhibited significantly lower values for the CD4+ /CD8+ ratio( β=-0.666, P<0.001)and levels of immunoglobulin A( β=-0.514, P<0.001), immunoglobulin M( β=-0.526, P<0.001), and immunoglobulin G( β=-0.814, P<0.001). Conclusions:In hospitalized elderly patients with heart failure with HFpEF, frailty serves as an independent risk factor for the reduction of the CD4+ /CD8+ ratio, as well as levels of immunoglobulin A, immunoglobulin M, and immunoglobulin G. Furthermore, the frailty score demonstrates a significant negative predictive value for these immunological markers.Therefore, it is essential to enhance our understanding of frailty and to prioritize its prevention and treatment, as this may help mitigate immune dysfunction and promote recovery in elderly patients.

Objective To summarize the experience of performing selective laparoscopic appendectomy in re-admission children who had been given conservative treatment for acute appendicitis complicated with peri-appendiceal abscess.Methods From September 2019 to July 2024,22 patients with acute appendicitis complicated with peri-appendiceal abscess underwent three port laparoscopic appendectomy after receiving conservative treatment for 6-14 weeks.Their age ranged 5-14 years old,with an average of 8.5 years old.A 5 mm trocar and a 30° laparoscope were inserted through a midline umbilical incision,and 5 mm trocars and forceps were placed at the suprapubic area,lateral to the left rectus abdominis,and 3-5 cm below the umbilicus.Adequate adhesiolysis was performed,including detaching the omentum from the pelvic sidewall,separating the ileocecal region from the omentum,and freeing the appendix from the lateral peritoneum and the mesenteric tissue of the terminal ileum to expose the affected appendix.The mesoappendix and the base of the appendix were then ligated and transected.Results The operations in all the 22 cases were successful.The surgical time ranged 50-150 min(mean,75.5±10.0 min).The patients were able to mobilize independently at 6-8 h postoperatively,resumed passing gas and consumed clear liquids within 1-1.5 d.The postoperative hospital stay was 3-6 d,with an average of 4 d.Pathological reports indicated chronic appendicitis with necrotizing perforation.Follow-ups lasted for 2-13 months(mean,6 months),with no reports of abdominal pain,fever,incision infection,adhesive intestinal obstruction,residual appendicitis,or pelvic abscess.Conclusions For children with acute appendicitis complicated with peri-appendiceal abscess who have received conservative treatment,effective adhesiolysis within the abdominal and pelvic cavities during selective laparoscopic appendectomy is crucial,which is also the primary reason for a relatively prolonged surgical time.Adhesions are primarily located between the omentum and pelvic sidewall,between the ileocecal region and omentum,and between the appendix and lateral peritoneum as well as the mesentery of the terminal ileum.Adequate adhesiolysis followed by appendectomy can effectively alleviate symptoms such as abdominal pain.

Objective:To investigate the correlation between frailty and immune markers in elderly patients diagnosed with heart failure with preserved ejection fraction(HFpEF).Methods:A total of 416 elderly patients with HFpEF, who were hospitalized in the Department of Geriatrics at Henan Provincial People's Hospital from March 2021 to December 2023, were selected as research subjects.The Fried frailty phenotype was employed to assess frailty.Fasting venous blood samples were collected to measure levels of CD4+ T lymphocytes, CD8+ T lymphocytes, the CD4+ /CD8+ ratio, and immunoglobulins A, M, and G. Spearman correlation analysis and multiple linear regression analysis were conducted to evaluate the relationship between frailty scores and immune markers.Results:Spearman correlation analysis revealed a significant association between frailty score and the CD4+ /CD8+ ratio( r=-0.659, P<0.001), immunoglobulin A( r=-0.454, P<0.001), immunoglobulin M( r=-0.522, P<0.001), and immunoglobulin G( r=-0.802, P<0.001).Furthermore, multiple linear regression analysis indicated that, after adjusting for confounding factors, frailty score served as a significant negative predictor of the CD4+ /CD8+ ratio( β=-0.562, P<0.001), immunoglobulin A( β=-0.366, P<0.001), immunoglobulin M( β=-0.445, P<0.001), and immunoglobulin G( β=-0.772, P<0.001).In comparison to the non-frail group, the frail group exhibited significantly lower values for the CD4+ /CD8+ ratio( β=-0.666, P<0.001)and levels of immunoglobulin A( β=-0.514, P<0.001), immunoglobulin M( β=-0.526, P<0.001), and immunoglobulin G( β=-0.814, P<0.001). Conclusions:In hospitalized elderly patients with heart failure with HFpEF, frailty serves as an independent risk factor for the reduction of the CD4+ /CD8+ ratio, as well as levels of immunoglobulin A, immunoglobulin M, and immunoglobulin G. Furthermore, the frailty score demonstrates a significant negative predictive value for these immunological markers.Therefore, it is essential to enhance our understanding of frailty and to prioritize its prevention and treatment, as this may help mitigate immune dysfunction and promote recovery in elderly patients.

Objective:To investigate the association of time in range with metabolic associated fatty liver disease(MAFLD) and advanced liver fibrosis in patients with type 2 diabetes.Methods:This study was a retrospective study. A total of 494 type 2 diabetic patients were recruited in the Department of Endocrinololgy of Henan Provincial People′s Hospital from November 2019 to April 2022. Time in range(TIR) was calculated with continuous glucose monitoring data. Abdominal ultrasound scan was used to diagnose fatty liver. Liver stiffness measurement(LSM) by transient elastography was used to evaluate liver fibrosis. Pearson and multivariate linear regression analysis was used to evaluate the association between TIR and LSM. Multivariate logistic regression analysis was used to analyze the association of TIR with risk of MAFLD and advanced liver fibrosis.Results:Pearson correlation analysis showed that LSM was negatively correlated with TIR( r=-0.86, P<0.001) and was positively correlated with homeostasis model assessment for insulin resistance(HOMA-IR; r=0.48, P<0.001). After adjusting for confounding factors, multivariate linear regression analysis showed that TIR significantly negatively predicted LSM( β=-0.75, P<0.001), and HOMA-IR significantly positively predicted LSM( β=0.21, P=0.025). After adjusting for confounding factors, logistic regression analysis showed that compared with TIR Q4 patients, TIR Q1 patients had an increased risk of MAFLD( OR=1.96, 95% CI 1.07-3.62, P=0.027), advanced liver fibrosis( OR=3.82, 95% CI 1.17-12.50, P=0.027), and HOMA-IR was an independent risk factor for MAFLD( OR=1.22, 95% CI 1.04-1.43, P=0.005) and advanced liver fibrosis( OR=1.26, 95% CI 1.03-1.54, P=0.025). Conclusions:TIR and insulin resistance are independent risk factors for MAFLD and advanced liver fibrosis in patients with type 2 diabetes. TIR has a significant predictive value for MAFLD and advanced liver fibrosis.

Objective:To investigate the association of time in range(TIR) with the severity of coronary artery disease and acute coronary syndrome in patients with type 2 diabetes mellitus.Methods:A total of 216 patients with type 2 diabetes mellitus and coronary heart disease were recruited and undergone anthropometric and biochemical measurements, continuous glucose monitoring, and calculation of SYNTAX score. TIR was defined as the percentage of time within the glucose range of 3.9-10.0 mmol/L during 24 h. Spearman correlation analysis and multivariate linear regression analysis were used to evaluate the correlation factors of SYNTAX score. Multivariate logistic regression analysis was used to analyze the association of TIR with the severity of coronary artery disease and acute coronary syndrome. Results:Compared with patients with mild coronary artery disease, TIR in patients with moderate to severe coronary artery disease was lower[(69.4±17.3)% vs (60.8±17.8)%, t=3.0, P=0.003], and HbA 1C of patients with moderate to severe coronary artery disease was higher [(9.6±1.7)% vs (8.8±1.6)%, t=3.3, P=0.001]. SYNTAX score was negatively correlated with TIR ( r=-0.251, P<0.01) and positively correlated with HbA 1C ( r=0.249, P<0.01). Moreover, compared with HbA 1C (standardized coefficients=0.181, P=0.007), TIR (standardized coefficients=-0.192, P=0.004) had a greater influence on SYNTAX score. Multivariate linear regression analysis showed that TIR, HbA 1C, duration of diabetes and smoking were independently correlated with SYNTAX score. Multivariate logistic regression analysis revealed that compared with TIR Q1, Q3 and Q4 were independent protective factors for moderate to severe coronary artery disease (respectively, OR=0.61 and 0.59, 95% CI 0.39-0.96 and 0.38-0.94, P=0.014 and 0.009) and acute coronary syndrome (respectively, OR=0.51 and 0.39, 95% CI 0.32-0.95 and 0.26-0.75, P=0.022 and 0.008). Conclusion:TIR was significantly and independently correlated with the severity of coronary artery disease and acute coronary syndrome in type 2 diabetes mellitus after controlling confounding factors. When TIR level was decreased, the severity of coronary artery disease was aggravated, and SYNTAX score and the risk of acute coronary syndrome was increased.

The recent advancement of single-cell RNA sequencing (scRNA-seq) technologies facilitates the study of cell lineages in developmental processes and cancer.In this study,we developed a computational method,called redPATH,to reconstruct the pseudo developmental time of cell lineages using a consensus asymmetric Hamiltonian path algorithm.Besides,we developed a novel approach to visualize the trajectory development and implemented visualization methods to provide biological insights.We validated the performance of redPATH by segmenting different stages of cell development on multiple neural stem cell and cancer datasets,as well as other single-cell transcriptome data.In particular,we identified a stem cell-like subpopulation in malig-nant glioma cells.These cells express known proliferative markers,such as GFAP,ATP1A2,IGFBPL1,and ALDOC,and remain silenced for quiescent markers such as ID3.Furthermore,we identified MCL1 as a significant gene that regulates cell apoptosis and CSF1R for reprogram-ming macrophages to control tumor growth.In conclusion,redPATH is a comprehensive tool for analyzing scRNA-seq datasets along the pseudo developmental time.redPATH is available at https://github.com/tinglabs/redPATH.

Objective:To investigate the influence of frailty on post-treatment outcomes in elderly heart failure patients with reduced ejection fraction treated with Sacubitril/Valsartan.Methods:The 231 heart failure patients aged 60 years or over with reduced ejection fraction were enrolled from October 2017 to October 2018 in Department of Geriatric Medicine, Henan Provincial People's Hospital.Patients were divided into the frailty group(n=116)and the control group(n=115). Frailty diagnosis was made by five indexes suggested by LP Fried.Both groups were treated with sacubitril/valsartan(49/51 mg)for 1 year.The left ventricular ejection(LVEF), estimated glomerular filtration rate(eGFR), N-terminal pro B-type natriuretic peptide(NT-proBNP)and other clinical and laboratory indexes were detected before and after treatment and compared between the frailty group and the control group.Results:16 subjects in the frailty group and 11 subjects in the control group dropped out of the study.The frailty group versus the control group showed a higher mortality rate of cardiovascular causes(13.0% or 13/100 vs.6.7% or 7/104, χ2=6.437, P=0.027), a higher first re-hospitalization rate(18.0% or 18/100 vs.11.5% or 12/104, χ2=4.458, P=0.043)and a higher all-cause mortality(16.0% or 16/100 vs.8.6% or 9/104, χ2=3.875, P=0.039). In the frailty group, levels of serum NT-proBNP and creatinine were higher and eGFR was lower after treatment than before treatment[(2 253±144) ng/L vs.(2 094±136) ng/L, (137±24) μmol/L vs.(125±23) μmol/L, (49.2±5.9) ml·min -1·1.73 m -2vs.(56.7±6.3) ml·min -1·1.73 m -2, t=3.674, 2.893 and 2.068, P=0.017, 0.026 and 0.029]. In the control group, serum NT-proBNP levels were lower after treatment than before treatment[(1 828±123) ng/L vs.(1 945±128) ng/L, t=1.896, P=0.043], while serum creatinine levels[(120±22) μmol/L vs.(117±19) μmol/L, t=2.099, P=0.650]and eGFR[(59.8±6.5) ml·min -1·1.73 m -2vs.(61.6±6.8) ml·min -1·1.73 m -2, t=2.444, P=0.173]had no significant difference between post-treatment and pre-treatment. Conclusions:Frailty has adverse affects on the mortality, re-hospitalization rate and renal function in elderly heart failure patients with reduced ejection fraction treated with Sacubitril/Valsartan.