Objective To explore the causal relationships between 13 micronutrients (copper, selenium, zinc, calcium, folate, iron, magnesium, vitamin A, vitamin B6, vitamin B12, vitamin C, vitamin D, and vitamin E) and risk of tuberculosis (TB) through a two-sample Mendelian randomization (MR) study. Methods The Genome-Wide Association Study (GWAS) data about micronutrients and TB were obtained from the IEU Open GWAS and FinnGen Biobank, and Bayesian Weighted Mendelian Randomization (BWMR) and Inverse Variance Weighted (IVW) methods were employed to explore the causal relationship between micronutrients and risk of TB. The robustness and reliability of the results were assessed through horizontal pleiotropy tests, heterogeneity tests, and leave-one-out sensitivity analyses. Results The BWMR results indicated that iron (OR = 0.40, 95% CI : 0.20- 0.79, P = 0.008) and vitamin C (OR = 0.42, 95% CI : 0.20 - 0.87, P = 0.019) were protective factors against TB infection, while no causal relationships were found between other micronutrients with TB infection. The IVW method produced consistent results with BWMR. The results for other micronutrients were robust and reliable (P > 0.05), except for calcium-related Instrumental Variables (IVs), which exhibited heterogeneity (P < 0.05). Conclusion Iron and vitamin C may play a protective role in reducing the risk of TB, whereas the remaining micronutrients show no significant causal relationship with TB.

Objective:To conduct a cost-utility analysis of Tuberculosis Preventive Treatment(TPT)strategies for Latent Tuberculosis Infection(LTBI)individuals,providing a scientific basis for the implementation of TPT strategies and fund allocation.Methods:Based on a simulated population of 100 000 LTBI individuals,a decision tree-Markov Model was constructed to compare the cost-utility of six TPT strategies over 20 years.Results:Compared with no treatment,3HP-SAT,3HP-DOT,3HR-SAT,3HR-DOT and Vaccae could prevent 91.08％,94.15％,83.49％,87.18％and 53.13％of ATB cases,respectively,and avoid 3.55％,3.70％,3.30％,3.43％,and 2.06％of LTBI individuals from dying of ATB.Except for Vaccae,other schemes could reduce costs and improve QALYs,being absolutely dominant strategies,while Vaccae was a relatively dominant strategy.3HP under DOT was more cost-utility than that under SAT.Sensitivity analysis showed that the utility value of curing ATB was the only parameter affecting the ICUR result,and the model result was stable and reliable.When the WTP threshold was greater than 41 608.54 yuan/QALY,3HP-DOT was better than 3HP-SAT;otherwise,3HP-SAT was the optimal strategy.Conclusion:TPT for LTBI individuals has high cost-utility value.Clarifying the advantages of short-course therapy helps promote the implementation of TPT strategies and contributes to achieving the goal of"ending tuberculosis".

Objective:To conduct a cost-utility analysis of Tuberculosis Preventive Treatment(TPT)strategies for Latent Tuberculosis Infection(LTBI)individuals,providing a scientific basis for the implementation of TPT strategies and fund allocation.Methods:Based on a simulated population of 100 000 LTBI individuals,a decision tree-Markov Model was constructed to compare the cost-utility of six TPT strategies over 20 years.Results:Compared with no treatment,3HP-SAT,3HP-DOT,3HR-SAT,3HR-DOT and Vaccae could prevent 91.08％,94.15％,83.49％,87.18％and 53.13％of ATB cases,respectively,and avoid 3.55％,3.70％,3.30％,3.43％,and 2.06％of LTBI individuals from dying of ATB.Except for Vaccae,other schemes could reduce costs and improve QALYs,being absolutely dominant strategies,while Vaccae was a relatively dominant strategy.3HP under DOT was more cost-utility than that under SAT.Sensitivity analysis showed that the utility value of curing ATB was the only parameter affecting the ICUR result,and the model result was stable and reliable.When the WTP threshold was greater than 41 608.54 yuan/QALY,3HP-DOT was better than 3HP-SAT;otherwise,3HP-SAT was the optimal strategy.Conclusion:TPT for LTBI individuals has high cost-utility value.Clarifying the advantages of short-course therapy helps promote the implementation of TPT strategies and contributes to achieving the goal of"ending tuberculosis".

Objective: To investigate the delay in identification, healthcare-seeking, and definitive diagnosis of tuberculosis among students in Urumqi City from 2010 to 2019, and to identify the influencing factors, so as to provide insights into tuberculosis control among students. Methods: The demographic and diagnosis data of tuberculosis patients in Urumqi City from 2010 to 2019 were captured from the Tuberculosis Information Management System of Chinese Disease Control and Prevention Information System. The delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis was analyzed among students, and the factors affecting the delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis were identified using a multivariable logistic regression model. Results: A total of 996 tuberculosis cases were identified among students in Urumqi City from 2010 to 2019. There were 702 students with delay in identification of tuberculosis (70.48%), 500 students with delay in healthcare-seeking (55.22%) and 534 students with delay in definitive diagnosis (53.61%). Multivariable logistic regression analysis identified active identification (OR=0.116, 95%CI: 0.032-0.420) as a factor affecting delay in identification of tuberculosis, women (OR=1.424, 95%CI: 1.104-1.836), non-local household registration (OR=1.311, 95%CI: 1.016-1.694) and active identification (OR=0.232, 95%CI: 0.064-0.848) as factors affecting delay in healthcare-seeking, and active identification (OR=0.143, 95%CI: 0.032-0.644) as a factor affecting delay in definitive diagnosis of tuberculosis among students. Conclusions There is a high proportion of delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis among students in Urumqi City from 2010 to 2019, and female and non-locally household-registered students were at a high risk of delay in healthcare-seeking for tuberculosis. Active detection and screening of tuberculosis should be reinforced.

Objective: To analyze the association between recombinant solute carrier family 11, member 1 ( SLC11A1 ) rs17235409 polymorphism and treatment failure of pulmonary tuberculosis, so as to provide the basis for the prevention and treatment of pulmonary tuberculosis. Methods: The patients with pulmonary tuberculosis registered for treatment at the Urumqi Center for Disease Control and Prevention in 2019 was recruited and collected demographic, clinical and treatment information from National Infectious Diseases Reporting System. The polymorphism of SLC11A1 rs17235409 was detected by multiple ligase chain reaction and Hardy-Weinberg balance test was performed. The multivariate logistic regression analysis was conducted for the association between rs17235409 and the treatment outcome of tuberculosis. Results: A total of 731 cases of pulmonary tuberculosis patients were enrolled, and 37 cases failed, with a failure rate of 5.06%. The failure rate of the patients with G/A was 8.55%, with G/G was 4.23%. The results of multivariate logistic regression analysis showed that the patients with G/A were more likely to fail in the treatment than those with G/G ( OR=2.213, 95%CI: 1.041-4.702 ). The males with G/A were more likely to fail in the treatment than those with G/G ( OR=2.547, 95%CI: 1.021-6.356 ). Conclusion The rs17235409 polymorphism of SLC11A1 is associated with the failure of tuberculosis treatment, and the patients with G/A are more likely to fail.

Objective:To evaluate the efficacy and safety of conventional diuretic therapy versus Tolvaptan in elderly chronic heart failure patients combined with mild to moderate renal insufficiency with hyponatremia, in order to provide clinical evidence for the treatment of heart failure in the elderly.Methods:This was a randomized control trial.A total of 88 elderly chronic heart failure patients combined with mild to moderate renal insufficiency with hyponatremia were randomly divided into the control group(n=46)and the experimental group(n=42). Once enrolled both groups stopped taking oral loop diuretics.In addition to routine treatment, the control group was treated with furosemide 40 mg once a day, while the experimental group was treated with Tolvaptan 15 mg once a day.The rate of effectiveness in relieving heart failure, the diuretic effects and improvement in heart and kidney function were monitored, and changes in serum potassium and sodium levels and the incidences of thirst and other adverse events were compared between the two groups.Results:The effectiveness rate on heart failure was higher in the experimental group than in the control group(85.7% or 36/42 vs.65.2% or 30/46, χ2=17.855, P<0.001). After treatment, greater changes in average 24-hour urine volume from baseline(787.4±219.6 ml vs.388.6±179.6 ml, t=322.588, P<0.001), more weight loss(-2.4±2.1 kg vs.-1.7±1.6 kg, t=6.942, P=0.009), smaller changes in N-terminal pro-B-type natriuretic peptide(NT-proBNP)from baseline(-897.6±432.1 ng/L vs.-578.4±476.9 ng/L, t=539.400, P<0.001), greater changes in left ventricular ejection fraction(LVEF)from baseline(6.5±5.6 % vs.1.5±5.7 %, t=3.966, P=0.048), smaller changes in serum creatinine from baseline(-8.6±12.4 μmol/L vs.9.6±11.3 μmol/L, t=87.161, P<0.001), and greater changes in estimated glomerular filtration rate(eGFR)from baseline(1.4±1.8 ml·min -1·1.73m -2vs.-4.1±5.6 ml·min -1·1.73m -2, t=63.856, P<0.001)and in serum sodium from baseline(6.2±2.1 mmol/L vs.1.4±1.9 mmol/L, t=234.065, P<0.001)were observed in the experimental group than in the control group.There was no significant difference in the incidences of thirst, dry mouth and other adverse events between the two groups(16.7% or 7/42 vs.10.9% or 5/46, χ2=0.626, P=0.429). Conclusions:Tolvaptan can effectively improve the clinical symptoms and cardiac function and correct hyponatremia in elderly chronic heart failure patients combined with mild to moderate renal insufficiency, with a good safety profile.

Objective: To investigate the impact of comprehensive geriatric assessment(CGA)on treatment outcomes of chronic heart failure(CHF)complicated with emotional disorders in the elderly. Methods: A total of 216 CHF patients with emotional disorders at Henan Provincial People’s Hospital were recruited from September 2017 to March 2019 and were randomly divided into a CGA group and a control group with 108 cases in each group.The control group was given standard drug treatment and psychological counseling, whereas individualized treatment was given to participants in the CGA group in compliance with CGA guidelines.The clinical effects after intervention for 8 weeks in the two groups were examined, using measures such as Hamilton Depression Rating Scale for Depression(HAMD)-24, Hamilton Anxiety Scale(HAMA)-14, amino-terminal pro-brain natriuretic peptide(NT-proBNP), the 6 minute walk test(6MWT)and left ventricular ejection fraction(LVEF). The changes of cognitive status, nutritional status, fall risk and other indicators in patients were comprehensively assessed and statistically analyzed. Results: Compared with pre-treatment data, 8 weeks of treatment for both the control group and the CGA group resulted in decreased HAMD-24 scores(Control group: 31.78±9.08, 23.69±10.16; CGA group: 32.09±8.98, 15.35±7.91; P<0.05), HAMA-14 scores(Control group: 22.38±7.09, 15.28±6.54; CGA group: 21.99±8.12, 10.48±6.82; P<0.05)and NT-proBNP levels[Control group: (4672±392)ng/L, (3279±282)ng/L; CGA group: (4861±378)ng/L, (2387±215)ng/L; P<0.05], and increased LVEF(%)[Control group(34.5±6.2)%, (39.8±7.5)%; CGA group(35.1±3.9)%, (42.5±6.1)%; P<0.05]and 6MWT scores[Control group(298±79±7.5)m, (358±102)m; CGA group(305±98)m, (402±178)m; P<0.05], with more marked changes in all the measures in the CGA group than in the control group(P<0.05). Conclusions The early application of CGA can improve the condition and prognosis in elderly heart failure patients complicated with emotional disorders.

Objective To evaluate the efficacy and safety of double-dosage Clopidogrel in elderly patients with Clopidogrel resistance after percutaneous coronary intervention(PCI).Methods The randomized control trials design was used in this study.108 senile ACS patients with Clopidogrel resistance(platelet inhibition rate＜ 30 ％) were randomized into control group(Clopidogrel 75 mg/d,n =54)and experimental group(Clopidogrel 150 mg/d,n=54).Blood platelet inhibition rate of ADP,major adverse cardiovascular events and main side effects were observed before and 7 d,30 d,90 d and 180 d after intervention.Results Compared with control group,the experimental group was associated with significantly increased platelet inhibition rate on 7 d (22.4 ± 4.5) ％ vs.(37.6 ± 4.5)％,30 d(22.6±4.3)％ vs.(38.8±4.7)％,90 d(22.7±4.6)％ vs.(38.5±4.5)％,and 180 d (23.7±4.3)％ vs.(38.9±4.6)％ after treatment(all P＜0.05).Furthermore,the incidence of main adverse cardiovascular events was also significantly lower in the experimental group(3.7％ vs.35.1％,x2 =15.133,P＜0.001).Meanwhile,the incidence of bleeding and dyspnea were higher in experimental group,but there was no significant difference between the two groups.Conclusions Compared with general dosage,double-dosage of Clopidogrel offers better curative effect and good safety in elderly ACS patients with Clopidogrel resistance after PCI.

Objective To investigate the predictive value of clinical and radiographic features in fungal pathogen identification in immunocompromised patients with pulmonary invasive fungal infection (IFI).Methods All consecutive immunocompromised adult patients with pulmonary IFI in respiratory intensive care unit (ICU)in the First Affiliated Hospital of Xinjiang Medical University were recruited during a 2 year period.All patients met the 2008 European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC /MSG) criteria were studied for proved or probable IFI responding to antifungal agents.The data of demographic,clinical and radiographic features,as well as serological test results of the patients were collected.Differences in the clinical and radiographic features of pulmonary IFIs caused by yeasts and molds were compared by χ2 test.A logistic regression model was used to perform discriminant analysis,and the effect of discrimination was assessed for accuracy.Results The study included 143 patients with a probable diagnosis of IFI who had the following risk factors:diabetes mellitus (43.4%),chronic lung disease (32.2%),broad-spectrum antibiotics administration (≥14 days;35.7%),malignancy (23.1%),corticosteroid therapy (≥14 days;23.1%),chronic renal failure and renal replacement therapy (16.1%),and immunological disease (10.5%).Frequent broad-spectrum antibiotics administration was associated with yeast infection (P <0.05 ),while mold infection was associated with chronic lung disease (P <0.05 ) .Yeast was more often isolated from patients with concurrent bacterial infection and on mechanical ventilation (P <0.05 ) . Thoracic high-resolution computed tomography (HRCT)showed the following images:bronchial pneumonia/pulmonary consolidation (53.1%),massive shadowing (29.4%),small nodules (24.5%),large nodules (18.9%),pleural effusion (18.9%),halo sign (14%),and cavity (9.8%).Imaging showed that mold was more common than yeast in patients with pleural and pericardial effusions (P <0.05).Logistic regression modeling showed that broad-spectrum antibiotics administration,prolonged mechanical ventilation,and pleural and pericardial effusions were statistically significant in fungal identification (P <0.05 ),with a predictive accuracy of 77.6%.Conclusions For immunocompromised patients with pulmonary IFI,most of the risk factors ,the main clinical and chest HRCT features did not help to predict the type of fungal pathogen,and yeast but not cryptococcus may be accompanied or colonized.

Objective The main purpose is to investigate the status of brucellosis infection in high-risk areas of Urumqi and population characteristics,and to provide a basis for prevention of brucellosis.Methods In Urumqi City,Dabancheng District,Gaoxin District,Midong,Zone and Urumqi County were selected as survey sites;according to pastoral,agro-pastoral and agricultural,all towns in each survey site were classified into three categories;150 to 200 residents in each township were selected as subjects.Basic demographic information was collected,and blood samples were collected for serological detection.rose bengal plate agglutination test (RBPT) was used for preliminary screening,RBPT positive persons were further confirmed by standard tube agglutination test (SAT).Different regions,gender,age,occupation,exposure difference and brucellosis infection rates were studied.x2 test was used to compare rates.Results The infection rate was 5.42％ (29/535).Furthermore,the infection rate ofthe Dabancheng District [10.34％ (12/116)] was higher than those of Gaoxin District [2.94％ (3/102)] and Urumqi County [2.58％ (4/155),x2 =4.643,7.199,all P ＜ 0.05],the differences were statistically significant (x2 =9.327,P ＜0.05).Besides,infection rate of the average exposure occupation [8.33％ (24/288)] was higher than those of low exposure occupation [0(0/61)] and high exposure occupation [2.72％ (5/184),x2 =5.459,6.140,all P ＜ 0.05].The differences were statistically significant (x2 =10.846,P ＜ 0.05).The differences of infection rates in ages and nations showed no statistical significance (x2 =2.396,4.639,all P ＞ 0.05).Conclusions High risk areas of brucellosis are still exist in Urumqi.Health education should be strengthened in the future,in order to enhance residents' seff-protection awareness in exposed population.