Objective:To investigate the factors influencing left atrial fibrosis in patients with atrial fibrillation(AF)and the association of Periostin protein,serum transforming growth factor-β2(TGF-β2)with left atrial fibrosis.Methods:We enrolled 100 AF patients admitted to Gansu Provincial People's Hospital between March 2021 and March 2023.They were divided into control group(＜10％,n=53)and fibrosis group(≥10％,n=47)according to their left atrial low voltage region.Univariate and multivariate Logistic regression were used to analyze the influ-encing factors of left atrial fibrosis in AF patients and construct a nomogram model.The diagnostic value of related factors and their combined detection for left atrial fibrosis in AF patients were analyzed by receiver operating char-acteristic curve(ROC).Spearman correlation analysis was used to analyze the association of Periostin protein,TGF-β2 with left atrial fibrosis in AF patients.Results:Compared to patients in the control group,those in the fibrosis group had significant higher left atrial diameter(LAD)[(37.08±3.19)mm vs.(33.45±2.45)mm],levels of ser-um uric acid(SUA)[(313.75±49.06)μmol/L vs.(279.88±38.15)μmol/L],Periostin protein[(83.27±3.98)ng/L vs.(75.21±3.04)ng/L],TGF-β2[(4346.84±321.34)ng/L vs.(4186.02±306.91)ng/L],and signifi-cant lower left atrial ejection fraction(LVEF)[(62.28±5.00)％vs.(67.24±3.07)％](P＜0.05 or＜0.01).Multivariate Logistic regression analysis showed that LAD(OR=1.663,95％CI 1.238～3.887,P=0.001),SUA(OR=1.586,95％CI 1.164～2.892,P＜0.001),Periostin protein(OR=1.997,95％CI 1.513～4.585,P=0.001),TGF-β2(OR=2.013,95％CI 1.543～5.864,P＜0.001)were independent risk factors for left atrial fi-brosis in AF patients,while LVEF was an independent protective factor(OR=0.524,95％CI 0.141～0.920,P=0.002).The nomogram model for left atrial fibrosis in AF patients:logit(P)=4.631+0.445 × LVEF+0.546 × LAD+0.575 × SUA+0.530 × Periostin protein+0.347 × TGF-β2.ROC curve showed that the area under the curve(AUC)of combined detection(0.893,95％CI 0.842～0.932)was significantly higher than SUA(AUC=0.637,95％CI 0.566～0.704),LVEF(AUC=0.701,95％CI 0.632～0.763),LAD(AUC=0.649,95％CI 0.579～0.715),Periostin protein(AUC=0.676,95％CI 0.606～0.740),TGF-β2(AUC=0.641,95％CI 0.570～0.707)alone(Z=5.265,6.399,6.379,6.040,6.483,P＜0.001 all).Spearman correlation analysis showed that Perios-tin protein and TGF-β2 were significantly positive correlated with left atrial fibrosis in AF patients(r=0.536,0.578,P＜0.001 all).Conclusion:Periostin protein and TGF-β2 were independent risk factors for left atrial fi-brosis in AF patients and were significantly positive correlated with it,a combination of above-mentioned indexes,cardiac function indexes and uric acid had good diagnostic value for left atrial fibrosis.

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

Objective:To observe and preliminarily analyze the risk factors related to silicone oil dependence after pars plana vitrectomy (PPV) in open globe injuries (OGI) .Methods:A retrospective clinical study. This study included 211 patients with OGI who received PPV treatment from January 1, 2005 to December 31, 2016 in Eye Injury Vitrectomy Study database. Silicone oil dependence was defined as the intraocular pressure <10 mm Hg (1 mm Hg= 0.133 kPa) in silicone oil tamponade eye 6 months after PPV. The patient's age, intraocular pressure, type of injury, length of eyeball wound, as well as the presence of ciliary body injury, choroidal injury, and retinal resection and/or defect area were recorded in detail. Logistic multifactorial regression analyzed the correlation between age, eye wound length and ciliary body iinjury, choroidal injury and retinal resection and/or defect severity and silicone oil dependence.Results:211 OGI eyes underwent vitrectomy were included, the mean age of the study population was 32.93 years (range 1-73 years), and the median follow-up period was 20.06 months (range 5.85-90.58 months). Among the 211 eyes, 121 (57.3%, 121/211), 52 (24.6%, 52/211), 23 (10.9%, 23/211) and 15 (7.1%, 15/211) were rupture, perforation, intraocular foreign bodies and penetrating injury, respectively. 98 eyes (46.4%, 98/211) of silicone oil dependence in total, among them, 64 (65.3%, 64/98), 19 (19.4%, 19/98), 9 (9.2%, 9/98) and 6 (6.1%, 6/98) eyes were rupture, perforation, intraocular foreign body and penetrating injury, respectively. Correlation analysis revealed that silicone oil dependence was significantly associated with ciliary body injury [odds ratio ( OR) = 2.150, 95% confidence interval ( CI) 1.052-4.393], choroidal injury ( OR=3.233, 95% CI 1.454-7.191), and retinal injury ( OR=2.731, 95% CI 1.393-5.353). No correlation was found with age ( OR= 0.981, 95% CI 0.960-1.002) or ocular wound length ( OR=1.716, 95% CI 0.987-2.984) ( P> 0.05). Conclusion:Silicone oil dependency following PPV in OGIs are associated with ciliary body, choroidal, and retinal injuries, but no association with age or length of the ocular wound.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To investigate the effect of phosphorus-containing replacement solution for the prevention and treatment of hypophosphatemia during continuous renal replacement therapy (CRRT) in critically ill patients with blood phosphorus level ≤1.45 mmol/L, and to provide clinical reference.Methods:It was a historical prospective cohort study. The critically ill patients receiving CRRT with blood phosphorus ≤ 1.45 mmol/L in the intensive care unit of Henan Provincial People's Hospital from October 2021 to January 2023 and from April 2023 to January 2024 was selected as the study subjects. The patients were divided into test group (from April 2023 to January 2024) and control group (from October 2021 to January 2023) according to whether phosphate (1.0 mmol/L) was added to the replacement solution during CRRT, and the differences of clinical data before and after CRRT between the two groups were compared. The patients were divided into hypophosphatemia group and non-hypophosphatemia group according to whether blood phosphorus < 0.81 mmol/L within 24 h after the end of CRRT, and the differences of clinical data between the two groups were compared. Logistic regression analysis was used to analyze the related factors of hypophosphatemia.Results:A total of 149 critically ill patients with blood phosphorus level ≤1.45 mmol/L undergoing CRRT were enrolled in the study, with age of 64(47, 75) years and 87 males (58.4%). Among 149 patients, 84(56.4%) had hypophosphatemia after CRRT, and no hyperphosphatemia occurred. The incidence of hypophosphatemia in test group and control group was 40.0% (30/75) and 73.0% (54/74), respectively. There was no statistically significant difference in baseline clinical data before CRRT between test group and control group (all P>0.05). C-reactive protein ( Z=-3.356, P=0.001), blood calcium ( Z=-3.835, P<0.001) and proportion of hypophosphatemia ( χ2=16.467, P<0.001) in the test group were lower than those in the control group, and blood phosphorus ( Z=3.886, P<0.001) in the test group was higher than that in the control group within 24 h after CRRT. Compared with non-hypophosphatemia group, the proportion of parenteral nutrition ( χ2=6.802, P=0.009) and blood calcium within 24 h after CRRT ( Z=-2.515, P=0.012) in the hypophosphatemia group were higher, and blood phosphorus within 24 h after CRRT ( Z=-10.451, P<0.001), blood phosphorus after 24 h after CRRT treatment ( Z=-5.331, P<0.001) and the proportion of applied replacement solution containing phosphorus ( χ2=16.467, P<0.001) in the hypophosphatemia group were lower. The results of multivariate logistic regression analysis showed that parenteral nutrition ( OR=2.521, 95% CI 1.228-5.175, P=0.012) and application of phosphorus- containing replacement solution ( OR=0.241, 95% CI 0.119-0.491, P<0.001) were independent relevant factors of hypophosphatemia after CRRT in the whole cohort of patients. Conclusions:The application of phosphorus-containing replacement solution in critically ill patients with blood phosphorus level ≤1.45 mmol/L undergoing CRRT is safe and effective, and the incidence of hypophosphatemia is low. Application of phosphorus-containing replacement solution in critically ill patients with blood phosphorus level ≤1.45 mmol/L undergoing CRRT can reduce the incidence risk of hypophosphatemia after CRRT.

Objective:To investigate the factors influencing left atrial fibrosis in patients with atrial fibrillation(AF)and the association of Periostin protein,serum transforming growth factor-β2(TGF-β2)with left atrial fibrosis.Methods:We enrolled 100 AF patients admitted to Gansu Provincial People's Hospital between March 2021 and March 2023.They were divided into control group(＜10％,n=53)and fibrosis group(≥10％,n=47)according to their left atrial low voltage region.Univariate and multivariate Logistic regression were used to analyze the influ-encing factors of left atrial fibrosis in AF patients and construct a nomogram model.The diagnostic value of related factors and their combined detection for left atrial fibrosis in AF patients were analyzed by receiver operating char-acteristic curve(ROC).Spearman correlation analysis was used to analyze the association of Periostin protein,TGF-β2 with left atrial fibrosis in AF patients.Results:Compared to patients in the control group,those in the fibrosis group had significant higher left atrial diameter(LAD)[(37.08±3.19)mm vs.(33.45±2.45)mm],levels of ser-um uric acid(SUA)[(313.75±49.06)μmol/L vs.(279.88±38.15)μmol/L],Periostin protein[(83.27±3.98)ng/L vs.(75.21±3.04)ng/L],TGF-β2[(4346.84±321.34)ng/L vs.(4186.02±306.91)ng/L],and signifi-cant lower left atrial ejection fraction(LVEF)[(62.28±5.00)％vs.(67.24±3.07)％](P＜0.05 or＜0.01).Multivariate Logistic regression analysis showed that LAD(OR=1.663,95％CI 1.238～3.887,P=0.001),SUA(OR=1.586,95％CI 1.164～2.892,P＜0.001),Periostin protein(OR=1.997,95％CI 1.513～4.585,P=0.001),TGF-β2(OR=2.013,95％CI 1.543～5.864,P＜0.001)were independent risk factors for left atrial fi-brosis in AF patients,while LVEF was an independent protective factor(OR=0.524,95％CI 0.141～0.920,P=0.002).The nomogram model for left atrial fibrosis in AF patients:logit(P)=4.631+0.445 × LVEF+0.546 × LAD+0.575 × SUA+0.530 × Periostin protein+0.347 × TGF-β2.ROC curve showed that the area under the curve(AUC)of combined detection(0.893,95％CI 0.842～0.932)was significantly higher than SUA(AUC=0.637,95％CI 0.566～0.704),LVEF(AUC=0.701,95％CI 0.632～0.763),LAD(AUC=0.649,95％CI 0.579～0.715),Periostin protein(AUC=0.676,95％CI 0.606～0.740),TGF-β2(AUC=0.641,95％CI 0.570～0.707)alone(Z=5.265,6.399,6.379,6.040,6.483,P＜0.001 all).Spearman correlation analysis showed that Perios-tin protein and TGF-β2 were significantly positive correlated with left atrial fibrosis in AF patients(r=0.536,0.578,P＜0.001 all).Conclusion:Periostin protein and TGF-β2 were independent risk factors for left atrial fi-brosis in AF patients and were significantly positive correlated with it,a combination of above-mentioned indexes,cardiac function indexes and uric acid had good diagnostic value for left atrial fibrosis.

Objective:To investigate whether changes in CT pulmonary angiography (CTPA) parameters before and after balloon pulmonary angioplasty (BPA) are correlated with treatment effects in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods:A retrospective study was conducted, including patients with CTEPH who underwent BPA treatment at Beijing Anzhen Hospital from November 2021 to Febbruary 2024. Clinical data and CTPA parameters were analyzed before the initial BPA session and at least 6 months after the final BPA session. Clinical data included WHO functional class, 6-minute walk distance (6MWD), and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. The CTPA parameters included the widest diameter of the pulmonary artery diameter (dPA), ascending aorta diameter (dAA), the widest transverse diameter of the right atrium (dRA), the widest short-axis diameter of the right ventricle (dRV), the widest short-axis diameter of the left ventricle (dLV), and the diameter of right ventricular free wall thickness(dRVW). Multiple linear regression was applied to identify variables associated with the decrease in mean pulmonary artery pressure (mPAP) among the CTPA parameters.Results:All CTEPH patients underwent a total of 115 BPA treatments. Postoperatively, the WHO functional class of the patients improved compared to preoperative levels ( χ2=5.01, P<0.001), 6MWD improved ( t=4.50, P<0.001), and NT-proBNP levels decreased ( Z=4.47, P<0.001). Hemodynamic parameters, including mPAP, pulmonary vascular resistance, cardiac output, and cardiac index, were significantly improved postoperatively (all P<0.001). CTPA-related parameters, including dPA, dRA, dRV, dRVW, dPA/dAA, dRV/dLV, and dRA/dPA, significantly decreased compared to preoperative values (all P<0.001). Multiple linear regression analysis showed that the decrease in dPA ( β=0.314, P=0.037) and dRA ( β=0.334, P=0.046) were significantly correlated with the improvement in mPAP. Conclusions:Exercise tolerance, hemodynamics, and CTPA parameters in patients with CTEPH significantly improved after BPA treatment. The decrease in dPA and dRA were significantly correlated with the improvement in mPAP, suggesting that CTPA is a potentially novel, objective, effective, and noninvasive method for evaluating the therapeutic efficacy of BPA.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To investigate the effect of phosphorus-containing replacement solution for the prevention and treatment of hypophosphatemia during continuous renal replacement therapy (CRRT) in critically ill patients with blood phosphorus level ≤1.45 mmol/L, and to provide clinical reference.Methods:It was a historical prospective cohort study. The critically ill patients receiving CRRT with blood phosphorus ≤ 1.45 mmol/L in the intensive care unit of Henan Provincial People's Hospital from October 2021 to January 2023 and from April 2023 to January 2024 was selected as the study subjects. The patients were divided into test group (from April 2023 to January 2024) and control group (from October 2021 to January 2023) according to whether phosphate (1.0 mmol/L) was added to the replacement solution during CRRT, and the differences of clinical data before and after CRRT between the two groups were compared. The patients were divided into hypophosphatemia group and non-hypophosphatemia group according to whether blood phosphorus < 0.81 mmol/L within 24 h after the end of CRRT, and the differences of clinical data between the two groups were compared. Logistic regression analysis was used to analyze the related factors of hypophosphatemia.Results:A total of 149 critically ill patients with blood phosphorus level ≤1.45 mmol/L undergoing CRRT were enrolled in the study, with age of 64(47, 75) years and 87 males (58.4%). Among 149 patients, 84(56.4%) had hypophosphatemia after CRRT, and no hyperphosphatemia occurred. The incidence of hypophosphatemia in test group and control group was 40.0% (30/75) and 73.0% (54/74), respectively. There was no statistically significant difference in baseline clinical data before CRRT between test group and control group (all P>0.05). C-reactive protein ( Z=-3.356, P=0.001), blood calcium ( Z=-3.835, P<0.001) and proportion of hypophosphatemia ( χ2=16.467, P<0.001) in the test group were lower than those in the control group, and blood phosphorus ( Z=3.886, P<0.001) in the test group was higher than that in the control group within 24 h after CRRT. Compared with non-hypophosphatemia group, the proportion of parenteral nutrition ( χ2=6.802, P=0.009) and blood calcium within 24 h after CRRT ( Z=-2.515, P=0.012) in the hypophosphatemia group were higher, and blood phosphorus within 24 h after CRRT ( Z=-10.451, P<0.001), blood phosphorus after 24 h after CRRT treatment ( Z=-5.331, P<0.001) and the proportion of applied replacement solution containing phosphorus ( χ2=16.467, P<0.001) in the hypophosphatemia group were lower. The results of multivariate logistic regression analysis showed that parenteral nutrition ( OR=2.521, 95% CI 1.228-5.175, P=0.012) and application of phosphorus- containing replacement solution ( OR=0.241, 95% CI 0.119-0.491, P<0.001) were independent relevant factors of hypophosphatemia after CRRT in the whole cohort of patients. Conclusions:The application of phosphorus-containing replacement solution in critically ill patients with blood phosphorus level ≤1.45 mmol/L undergoing CRRT is safe and effective, and the incidence of hypophosphatemia is low. Application of phosphorus-containing replacement solution in critically ill patients with blood phosphorus level ≤1.45 mmol/L undergoing CRRT can reduce the incidence risk of hypophosphatemia after CRRT.