Objective:To investigate the association between fibroblast growth factor 21(FGF21)and chronic kidney disease(CKD)in a prediabetic population by conducting a 4-year prospective cohort study among community-dwelling residents aged≥40 years in Guangzhou,China.Methods:A total of 1505 subjects who met the criteria for prediabetes and had complete baseline data were col-lected from the 2012 REACTION cohort,and they were followed up for 4 years to observe newly-onset CKD and the changes in urinary albumin-to-creatinine ratio(UACR)and estimated glomerular filtration rate(eGFR).Results:Among the 1 505 subjects with predia-betes,142 reached the diagnostic criteria for CKD during follow-up,yielding an overall incidence rate of 9.43%(95%CI=7.895%-10.902%).According to baseline serum FGF21 level,the subjects were divided into Q1-Q4 groups,with the lowest level of FGF21 in the Q1 group,and the Q4 group had a significantly higher eGFR than the other groups(P<0.05).After a mean follow-up time of 4 years,UACR was increased by 0.87 mg/g(P<0.001)and eGFR was reduced by 4.8 mL/(min·1.73 m2)(P<0.001).After stratification by FGF21 quartiles,there were differences in the declines of eGFR across groups,with the lowest degree of reduction in the Q2 group.In the multivariate regression model,the serum level of FGF21 was significantly negatively associated with the onset of CKD.When FGF21 was analyzed as a continuous variable in the multivariate lo-gistic regression analysis,FGF21 was still significantly negatively associated with the risk of CKD,which was consistent with the re-sults of the quartile-based analysis.However,restricted cubic spline curves showed an L-shaped non-linear relationship between FGF21 level and the risk of CKD,i.e.,the incidence rate of CKD de-creased with the increase in FGF21 level,but when FGF21 level reached a certain threshold,the risk of CKD no longer changed with FGF21.The linear regression analysis showed that FGF21 was positively associated with UACR and eGFR.Conclusion:In this pro-spective cohort study,FGF21 level might be potentially associated with the future risk of CKD among adults with prediabetes,while fur-ther studies are needed to clarify related mechanisms and clinical value.

Objective:To investigate the prevalence and influencing factors of frailty among older adults diagnosed with non-ST-segment elevation acute coronary syndrome(NSTE-ACS).Methods:We conducted a cross-sectional study involving patients aged 65 years and older with NSTE-ACS, who were admitted to the Cardiology Center and the Department of Geriatrics at Beijing Friendship Hospital, Capital Medical University, between January 2020 and November 2021.Patients were categorized into non-frail, pre-frail, and frail groups based on the FRAIL scale.We collected clinical data, including general health conditions, comorbidities, laboratory results, treatments, and comprehensive geriatric assessments.Logistic regression analysis was employed to identify the influencing factors associated with frailty and pre-frailty in older adults with NSTE-ACS.Results:A total of 528 patients with NSTE-ACS were included in the study, comprising 308 males(58.3%)and 220 females(41.7%). The age range of participants was from 65 to 90 years, with a median age of 72(68, 76)years.The prevalence of frailty among older adults with NSTE-ACS was 11.4%(60/528), while pre-frailty was observed in 51.9%(274/528), and non-frailty in 36.7%(194/528). Compared to the non-frail and pre-frail groups, patients in the frail group were older, had a higher proportion of females, exhibited a greater prevalence of chronic diseases, and presented with elevated inflammatory markers.Additionally, frail patients demonstrated poorer nutritional status and reduced functional ability(all P<0.005). Risk factors for frailty in older adults with NSTE-ACS included older age( OR=1.110, 95% CI: 1.032-1.194, P=0.005), diabetes( OR=2.489, 95% CI: 1.091-5.679, P=0.030), cerebrovascular disease ( OR=4.151, 95% CI: 1.660-10.384, P=0.002), chronic kidney disease ( OR=42.874, 95% CI: 3.957-464.513, P=0.002), and elevated white blood cell levels( OR=1.424, 95% CI: 1.125-1.802, P=0.003). Conversely, being male( OR=0.252, 95% CI: 0.105-0.604, P=0.002)was identified as a protective factor against frailty in this patient population.For pre-frail older adults with NSTE-ACS, identified risk factors included diabetes( OR=1.882, 95% CI: 1.199-2.955, P=0.006), cerebrovascular disease( OR=1.938, 95% CI: 1.176-3.195, P=0.009), and chronic kidney disease ( OR=12.137, 95% CI: 1.536-95.934, P=0.018). Similarly, being male( OR=0.601, 95% CI: 0.376-0.961, P=0.033)was also a protective factor for pre-frailty in older adults with NSTE-ACS. Conclusions:The prevalence of frailty and pre-frailty among older adults with NSTE-ACS is notably high.Common risk factors for frailty and pre-frailty in this population include female gender, diabetes, cerebrovascular disease, and chronic kidney disease.

BACKGROUND:Prosthesis misalignment and patient bone condition are important factors affecting the prognosis of unicompartmental knee arthroplasty,and postoperative osteoarthritic progression of the lateral compartment is a major complication leading to its high revision rate.Therefore,this will become a hot research topic in the future.OBJECTIVE:To analyze the effect of different femoral prosthesis tilt angles on the stress on the structure of the lateral compartment after unicompartmental knee arthroplasty in patients with normal bone and osteoporosis,and to investigate the correlation between osteoporosis and osteoarthritis of the lateral compartment in the postoperative period.METHODS:Using a validated finite element model of the knee,normal bone(M1)and osteoporotic(M2)unicompartmental knee arthroplasty were modeled.The femoral prosthesis tilt models(normal bone group:varus angles of 3°,6°,9°,12°,and 0°,valgus angles of 3°,6°,9°,12°;osteoporosis group:varus angles of 3°,6°,9°,12°,0°,valgus angles of 3°,6°,9°,12°)were established respectively,totaling 18 working conditions.The effects of different femoral prosthesis tilt angles on stress magnitude and distribution in the meniscus,tibial cartilage,and femoral cartilage of interstitial compartment were evaluated.RESULTS AND CONCLUSION:(1)The high stress values on the meniscus surface and tibial cartilage surface of the healthy lateral compartment of the two models increased with the increase of the prosthesis varus angle,and decreased with the increase of the prosthesis valgus angle.Under the same working conditions,the peak stress on the meniscus surface of the osteoporotic group was greater than that of the normal bone group,but that of the tibial cartilage surface of the osteoporotic group was less than that of the normal bone group.(2)The high stress values on the femoral cartilage of the lateral compartment of the two models increased with the increase of the prosthesis varus and valgus angles.Under the same working conditions,the peak stress on the femoral cartilage of the osteoporotic group was greater than that of the normal bone group.(3)It is indicated that when the fixed-bearing femoral prosthesis is varus,the stresses on the lateral compartment structures after medial unicompartmental knee arthroplasty in normal bone and osteoporotic knees will increase,and the increase in the stresses on the lateral intercondylar structures in osteoporotic knees will be more pronounced.Therefore,special attention should be paid to the placement of the prosthesis during unicompartmental knee arthroplasty to avoid varus and valgus of the prosthesis as much as possible.At the same time,the findings confirm that osteoporosis may exacerbate the progression of lateral compartment osteoarthritis after medial unicompartmental knee arthroplasty.

Objective:To investigate the predictive value of color Doppler ultrasound combined with electrocardio-gram for right heart dys function in patients with pulmonary heart disease(PHD).Methods:A total of 100 PHD patients admitted in Dongcheng Branch of First Affiliated Hospital of Anhui Medical University between January 2020 and December 2023 were retrospectively analyzed.According to results of 6min walking test(6MWT),pa-tients were divided into good right heart function group(n=64,≥350m)and right heart dysfunction group(n=36,＜350m).The indexes of cardiac color ultrasound[isovolumic relaxation time(IVRT),isovolumetric contraction time(IVCT)and right ventricular Tei index],ECG[24h mean R-R interval standard deviation(SDNN),normal R-R interval standard deviation per 5min(SDANN)and the ratio of low frequency components to high frequency components(LF/HF)]were compared between two groups.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of color Doppler ultrasound,ECG and their combination for right heart dys-function in PHD patients.Spearman correlation coefficient was used to analyze the association of color Doppler ul-trasound,ECG and their combination with right heart dysfunction in PHD patients.Results:Compared with those in good right heart function group,patients in right heart dysfunction group had significant higher IVRT[(120.64±14.08)ms vs.(97.87±10.93)ms],IVCT[(84.28±12.33)ms vs.(71.92±10.61)ms]and Tei index[(0.85±0.11)vs.(0.63±0.07)](P＜0.001 all),and significant lower SDNN[(75.52±12.58)ms vs.(85.58±11.75)ms],SDANN[(63.86±10.92)ms vs.(76.75±11.71)ms]and LF/HF[(1.33±0.19)vs.(1.84±0.27)](P＜0.001 all).ROC curve indicated that the AUC of color Doppler ultrasound combined ECG in diagnosing right heart dysfunction in PHD patients was 0.911(95％CI 0.838～0.959),which was significantly higher than those of color Doppler ultrasound[0.775(95％CI 0.681～0.853),Z=2.404,P=0.016]and ECG[0.688(95％CI 0.588～0.777),Z=3.968,P=0.001]alone.Spearman correlation analysis indicated that there was a significant positive correlation of color Doppler ultrasound(r=0.547),ECG(r=0.375)and their combination(r=0.810)with right heart dysfunction in PHD patients(P＜0.001 all),and the correlation between combined detection and right heart dysfunction in PHD patients was significantly higher.Conclusion:Color Doppler ultrasound combined with ECG possesses high diagnostic performance for right heart dysfunction in PHD patients.

Objective To investigate the expression levels and diagnostic value of long noncoding RNA(LncRNA)GUSBP3 and LncRNA SAM4 in peripheral blood of Kazakh type 2 diabetes mellitus(T2DM)patients in Xinjiang.Methods From January to September 2019,Kazakh T2DM patients in The First Affiliated Hospital of Shihezi University were recruited through outpatient or inpatient department(T2DM group,n=30).And 30 healthy people were selected as normal control(NC)group during the same period.The general data,biochemical indicators and differentially expressed LncRNA levels were compared between the two groups.Spearman correlation analysis was used to analyze the correlation between the target genes and each index.Logistic regression was used to analyze the influencing factors for T2DM.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of target genes.Results The differentially expressed LncRNA were LncRNA GUSBP3 and LncRNA SAM4 in the two groups.DBP,FPG,HbA1c,fructosamine,FIns,islet β cell function index,serum creatinine(Scr),LncRNA GUSBP3 and LncRNA SAM4 were higher in the T2DM group than in the NC group(P<0.05).Spearman correlation analysis showed that the expression of LncRNA GUSBP3 was positively correlated with Scr and serum uric acid(SUA)(r=0.328,0.322,P<0.05),and negatively correlated with FIns(r=-0.295,P<0.05).The expression of LncRNA SAM4 was positively correlated with SUA(r=0.275,P<0.05)and negatively correlated with LDL-C(r=-0.212,P<0.05).Logistic regression analysis showed that DBP(OR 1.175,95%CI 1.011～1.367),FIns(OR 0.852,95%CI 0.739～0.982),LncRNA GUSBP3(OR 0.378,95%CI 0.149～0.958)was influencing factors for T2DM in Kazakh population.The area under the ROC curve of LncRNA GUSBP3 was 0.789 for T2DM diagnosis.Conclusions The expression levels of LncRNA GUSBP3 and LncRNA SAM4 were higher in Kazakh patients with T2DM than in healthy people,and their expression levels are related to some biochemical indicators.DBP,FIns and LncRNA GUSBP3 are the influencing factors for T2DM in Kazakh population.LncRNA GUSBP3 may be a biomarker for the diagnosis of T2DM in Kazakh in Xinjiang.

Azvudine and nirmatrelvir/ritonavir (Paxlovid) are recommended for COVID-19 treatment in China, but their safety and efficacy in the elderly population are not fully known. In this multicenter, retrospective, cohort study, we identified 5131 elderly hospitalized COVID-19 patients from 32,864 COVID-19 patients admitted to nine hospitals in Henan Province, China, from December 5, 2022, to January 31, 2023. The primary outcome was all-cause death, and the secondary outcome was composite disease progression. Propensity score matching (PSM) was performed to control for confounding factors, including demographics, vaccination status, comorbidities, and laboratory tests. After 2:1 PSM, 1786 elderly patients receiving azvudine and 893 elderly patients receiving Paxlovid were included. Kaplan-Meier and Cox regression analyses revealed that compared with Paxlovid group, azvudine could significantly reduce the risk of all-cause death (log-rank P = 0.002; HR: 0.71, 95% CI: 0.573-0.883, P = 0.002), but there was no difference in composite disease progression (log-rank P = 0.52; HR: 1.05, 95% CI: 0.877-1.260, P = 0.588). Four sensitivity analyses verified the robustness of above results. Subgroup analysis suggested that a greater benefit of azvudine over Paxlovid was observed in elderly patients with primary malignant tumors (P for interaction = 0.005, HR: 0.32, 95% CI: 0.18-0.57) compared to patients without primary malignant tumors. Safety analysis revealed that azvudine treatment had a lower incidence of adverse events and higher lymphocyte levels than Paxlovid treatment. In conclusion, azvudine treatment is not inferior to Paxlovid treatment in terms of all-cause death, composite disease progression and adverse events in elderly hospitalized COVID-19 patients.

Prostate cancer is the second most common malignancy and the sixth leading cause of cancer-related death in men worldwide. Radical prostatectomy (RP) is the standard treatment for localized prostate cancer, but the procedure often results in postoperative erectile dysfunction (ED). The poor efficacy of phosphodiesterase 5 inhibitors after surgery highlights the need to develop new therapies to enhance cavernous nerve regeneration and improve the erectile function of these patients. In the present study, we aimed to examine the potential of heparin-binding epidermal growth factor-like growth factor (HB-EGF) in preserving erectile function in cavernous nerve injury (CNI) mice. We found that HB-EGF expression was reduced significantly on the 1 st day after CNI in penile tissue. Ex vivo and in vitro studies showed that HB-EGF promotes major pelvic ganglion neurite sprouting and neuro-2a (N2a) cell migration. In vivo studies showed that exogenous HB-EGF treatment significantly restored the erectile function of CNI mice to 86.9% of sham levels. Immunofluorescence staining showed that mural and neuronal cells were preserved by inducing cell proliferation and reducing apoptosis and reactive oxygen species production. Western blot analysis showed that HB-EGF upregulated protein kinase B and extracellular signal-regulated kinase activation and neurotrophic factor expression. Overall, HB-EGF is a major promising therapeutic agent for treating ED in postoperative RP.
Animals ; Male ; Heparin-binding EGF-like Growth Factor/therapeutic use* ; Erectile Dysfunction/etiology* ; Mice ; Penis/drug effects* ; Nerve Regeneration/drug effects* ; Penile Erection/drug effects* ; Peripheral Nerve Injuries/drug therapy* ; Cell Proliferation/drug effects* ; Apoptosis/drug effects* ; Cell Movement/drug effects* ; Prostatectomy/adverse effects* ; Mice, Inbred C57BL ; Reactive Oxygen Species/metabolism*

[Objective]To clarify the associations between plasma fibrinogen(Fbg)and volumetric bone mineral density(vBMD)as well as osteoporosis measured by quantitative computed tomography(QCT),and to explore the role of plasma Fbg in early screening and diagnosis of osteoporosis.[Methods]Patients with hypertension who were hospitalized in the Department of Endocrinology of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2018 to June 2022 and underwent QCT examinations were included for cross-sectional analysis.The study analyzed the correlation between plasma Fbg and osteoporosis in patients.The diagnostic efficacy of plasma Fbg for osteoporosis was evaluated by the area under the receiver operating characteristic(ROC)curve(AUC).[Results]Totally 441 subjects were included in the analysis,with an average age of 46.0±14.5 years and a prevalence of osteoporosis of 6.4%(28/441).As the level of plasma fibrinogen increased,the incidence of osteoporosis significantly increased(P<0.000 1)while the average bone mineral density of L1 and L2 were significantly decreased(P<0.05).Compared with the first quartile of plasma Fbg(1.99g/L-2.37g/L),the risk of osteoporosis in the fourth quartile of plasma Fbg(3.67g/L-4.46g/L)increased by 8.85 times after adjusting for related confounding factors.[Conclusion]This study found a negative correlation between plasma fibrinogen levels and bone density in patients with hypertension.Plasma fibrinogen levels may serve as a potential screening indicator for osteoporosis,aiding in early diagnosis and therapeutic monitoring.This discovery offers a new perspective for the study of bone metabolic diseases and warrants further investigation.

Objective:To investigate the prevalence and influencing factors of frailty among older adults diagnosed with non-ST-segment elevation acute coronary syndrome(NSTE-ACS).Methods:We conducted a cross-sectional study involving patients aged 65 years and older with NSTE-ACS, who were admitted to the Cardiology Center and the Department of Geriatrics at Beijing Friendship Hospital, Capital Medical University, between January 2020 and November 2021.Patients were categorized into non-frail, pre-frail, and frail groups based on the FRAIL scale.We collected clinical data, including general health conditions, comorbidities, laboratory results, treatments, and comprehensive geriatric assessments.Logistic regression analysis was employed to identify the influencing factors associated with frailty and pre-frailty in older adults with NSTE-ACS.Results:A total of 528 patients with NSTE-ACS were included in the study, comprising 308 males(58.3%)and 220 females(41.7%). The age range of participants was from 65 to 90 years, with a median age of 72(68, 76)years.The prevalence of frailty among older adults with NSTE-ACS was 11.4%(60/528), while pre-frailty was observed in 51.9%(274/528), and non-frailty in 36.7%(194/528). Compared to the non-frail and pre-frail groups, patients in the frail group were older, had a higher proportion of females, exhibited a greater prevalence of chronic diseases, and presented with elevated inflammatory markers.Additionally, frail patients demonstrated poorer nutritional status and reduced functional ability(all P<0.005). Risk factors for frailty in older adults with NSTE-ACS included older age( OR=1.110, 95% CI: 1.032-1.194, P=0.005), diabetes( OR=2.489, 95% CI: 1.091-5.679, P=0.030), cerebrovascular disease ( OR=4.151, 95% CI: 1.660-10.384, P=0.002), chronic kidney disease ( OR=42.874, 95% CI: 3.957-464.513, P=0.002), and elevated white blood cell levels( OR=1.424, 95% CI: 1.125-1.802, P=0.003). Conversely, being male( OR=0.252, 95% CI: 0.105-0.604, P=0.002)was identified as a protective factor against frailty in this patient population.For pre-frail older adults with NSTE-ACS, identified risk factors included diabetes( OR=1.882, 95% CI: 1.199-2.955, P=0.006), cerebrovascular disease( OR=1.938, 95% CI: 1.176-3.195, P=0.009), and chronic kidney disease ( OR=12.137, 95% CI: 1.536-95.934, P=0.018). Similarly, being male( OR=0.601, 95% CI: 0.376-0.961, P=0.033)was also a protective factor for pre-frailty in older adults with NSTE-ACS. Conclusions:The prevalence of frailty and pre-frailty among older adults with NSTE-ACS is notably high.Common risk factors for frailty and pre-frailty in this population include female gender, diabetes, cerebrovascular disease, and chronic kidney disease.

BACKGROUND:Prosthesis misalignment and patient bone condition are important factors affecting the prognosis of unicompartmental knee arthroplasty,and postoperative osteoarthritic progression of the lateral compartment is a major complication leading to its high revision rate.Therefore,this will become a hot research topic in the future.OBJECTIVE:To analyze the effect of different femoral prosthesis tilt angles on the stress on the structure of the lateral compartment after unicompartmental knee arthroplasty in patients with normal bone and osteoporosis,and to investigate the correlation between osteoporosis and osteoarthritis of the lateral compartment in the postoperative period.METHODS:Using a validated finite element model of the knee,normal bone(M1)and osteoporotic(M2)unicompartmental knee arthroplasty were modeled.The femoral prosthesis tilt models(normal bone group:varus angles of 3°,6°,9°,12°,and 0°,valgus angles of 3°,6°,9°,12°;osteoporosis group:varus angles of 3°,6°,9°,12°,0°,valgus angles of 3°,6°,9°,12°)were established respectively,totaling 18 working conditions.The effects of different femoral prosthesis tilt angles on stress magnitude and distribution in the meniscus,tibial cartilage,and femoral cartilage of interstitial compartment were evaluated.RESULTS AND CONCLUSION:(1)The high stress values on the meniscus surface and tibial cartilage surface of the healthy lateral compartment of the two models increased with the increase of the prosthesis varus angle,and decreased with the increase of the prosthesis valgus angle.Under the same working conditions,the peak stress on the meniscus surface of the osteoporotic group was greater than that of the normal bone group,but that of the tibial cartilage surface of the osteoporotic group was less than that of the normal bone group.(2)The high stress values on the femoral cartilage of the lateral compartment of the two models increased with the increase of the prosthesis varus and valgus angles.Under the same working conditions,the peak stress on the femoral cartilage of the osteoporotic group was greater than that of the normal bone group.(3)It is indicated that when the fixed-bearing femoral prosthesis is varus,the stresses on the lateral compartment structures after medial unicompartmental knee arthroplasty in normal bone and osteoporotic knees will increase,and the increase in the stresses on the lateral intercondylar structures in osteoporotic knees will be more pronounced.Therefore,special attention should be paid to the placement of the prosthesis during unicompartmental knee arthroplasty to avoid varus and valgus of the prosthesis as much as possible.At the same time,the findings confirm that osteoporosis may exacerbate the progression of lateral compartment osteoarthritis after medial unicompartmental knee arthroplasty.