Objective To systematically evaluate the risk prediction model of anastomotic fistula after radical resection of esophageal cancer, and to provide objective basis for selecting a suitable model. Methods A comprehensive search was conducted on Chinese and English databases including CNKI, Wanfang, VIP, CBM, PubMed, EMbase, Web of Science, The Cochrane Library for relevant studies on the risk prediction model of anastomotic fistula after radical resection of esophageal cancer from inception to April 30, 2023. Two researchers independently screened literatures and extracted data information. PROBAST tool was used to assess the risk of bias and applicability of included literatures. Meta-analysis was performed on the predictive value of common predictors in the model with RevMan 5.3 software. Results A total of 18 studies were included, including 11 Chinese literatures and 7 English literatures. The area under the curve (AUC) of the prediction models ranged from 0.68 to 0.954, and the AUC of 10 models was >0.8, indicating that the prediction performance was good, but the risk of bias in the included studies was high, mainly in the field of research design and data analysis. The results of the meta-analysis on common predictors showed that age, history of hypertension, history of diabetes, C-reactive protein, history of preoperative chemotherapy, hypoproteinemia, peripheral vascular disease, pulmonary infection, and calcification of gastric omental vascular branches are effective predictors for the occurrence of anastomotic leakage after radical surgery for esophageal cancer (P<0.05). Conclusion The study on the risk prediction model of anastomotic fistula after radical resection of esophageal cancer is still in the development stage. Future studies can refer to the common predictors summarized by this study, and select appropriate methods to develop and verify the anastomotic fistula prediction model in combination with clinical practice, so as to provide targeted preventive measures for patients with high-risk anastomotic fistula as soon as possible.

Objective : To illuminate the distribution of brucellosis patients and the epidemic typologies as well as the genetic attributes of brucellosis in Bozhou City,Anhui Province,thereby furnishing a substantive foundation for formulating efficacious prevention and control strategies for this disease within the region. Methods : The rose bengal plate agglutination test(RBPT) and the tube agglutination test(TAT) were conducted on a total of 698 blood samples that had been collected.Epidemiological data of the tested subjects were meticulously collected,followed by statistical analyses of the obtained results.The genomic DNA of positive bacterial strains was cultured and extracted.Molecular identification and typing of the isolated strains were executed through 16 S rRNA sequencing.Sequence alignment was conducted employing Clustal W and MEGA 7,with comparisons made against the outcomes of AMOS-PCR and BCSP31-PCR. Results : A total of 66 positive samples were detected through serological assays,with a positive rate of 9.46%.The demographic cohort demonstrating the highest detection rate primarily comprised individuals engaged in live sheep slaughtering.The 1 6 S rRNA gene sequencing on ten positive strains disclosed close phylogenetic affinities with Brucella melitensis.Moreover,the phylogenetic tree analysis indicated that these strains coalesced within the same branch,the findings were in alignment with the results obtained from BCSP31-PCR and AMOS-PCR assays. Conclusion Brucella melitensis assumes a predominant position in the transmission dynamics within this area,identifying individuals involved in sheep breeding,slaughtering,vending,and related occupations as high-risk groups.The outcomes of this study offer molecular biological substantiation for the distribution of brucellosis patients in this region,contribute to genotyping endeavors and tracing studies associated with the pathogen,and concurrently verify the efficacy of 16S rRNA molecular tracing.

Objective To investigate the efficacy of sevelamer(SL)and calcium acetate(CA)in treating hyperphosphatemia in patients with end-stage renal disease(ESRD)undergoing maintenance hemodialysis(MHD)and their effects on calcium-phosphorus metabolism and levels of peripheral blood fetuin-A and fibroblast growth factor-23(FGF-23).Methods A total of 92 ESRD patients attending the First Hospital of Zibo between January 2022 and December 2023 were enrolled.They were randomly assigned to either the CA group(46 cases)or the SL group(46 cases)using a random number table method.Patients in both groups received MHD and conventional treatment.Additionally,patients in the CA group were given CA,while those in the SL group were given SL,with the treatment continuing for 3 months.The outcome indicators were assessed and compared between the two groups.The primary outcome indicator was clinical efficacy.The secondary outcome indicators included calcium-phosphorus metabolism indicators(blood calcium,blood phosphorus,calcium-phosphorus product,and intact parathyroid hormone[iPTH]),coronary artery calcification score(CACs),serum biochemical indicators(including fetuin-A,FGF-23,and C-reactive protein[CRP]),and adverse reactions and cardiovascular events during the course of treatment.Results There were no statistically significant differences in baseline data between the two groups(P>0.05).There was a significant difference in clinical efficacy between the SL group and the CA group(P<0.05).The differences in blood calcium,blood phosphorus,calcium-phosphorus product,iPTH,and CACs before and after treatment were statistically significant between the two groups(P<0.05).The differences in fetuin-A,FGF-23,and CRP before and after treatment were also statistically significant between the two groups(P<0.05).During treatment,there was no significant difference in the incidences of adverse reactions and cardiovascular events between the two groups(P>0.05).Conclusion SL demonstrates superior efficacy compared to CA in treating hyperphosphatemia in MHD patients.SL effectively regulates calcium-phosphorus metabolism,reduces CACs,regulates peripheral blood fetuin-A and FGF-23 levels,and leads to fewer adverse reactions.SL may be a preferred option for clinical management.

BACKGROUND: The hemoglobin glycation index (HGI) was developed to quantify glucose metabolism and individual differences and proved to be a robust measure of individual glycosylated hemoglobin (HbA1c) bias. Here, we aimed to explore the relationship between different HGIs and the risk of 5-year major adverse cardiovascular events (MACEs) by performing a large multicenter cohort study in China. METHODS: A total of 9791 subjects from the Risk Evaluation of Cancers in Chinese Diabetic Individuals: a Longitudinal Study (the REACTION study) were divided into five subgroups (Q1-Q5) with the HGI quantiles (≤5th, >5th and ≤33.3th, >33.3th and ≤66.7th, >66.7th and ≤95th, and >95th percentile). A multivariate logistic regression model constructed by the restricted cubic spline method was used to evaluate the relationship between the HGI and the 5-year MACE risk. Subgroup analysis between the HGI and covariates were explored to detect differences among the five subgroups. RESULTS: The total 5-year MACE rate in the nationwide cohort was 6.87% (673/9791). Restricted cubic spline analysis suggested a U-shaped correlation between the HGI values and MACE risk after adjustment for cardiovascular risk factors ( χ2 = 29.5, P <0.001). After adjustment for potential confounders, subjects with HGIs ≤-0.75 or >0.82 showed odds ratios (ORs) for MACE of 1.471 (95% confidence interval [CI], 1.027-2.069) and 2.222 (95% CI, 1.641-3.026) compared to subjects with HGIs of >-0.75 and ≤-0.20. In the subgroup with non-coronary heart disease, the risk of MACE was significantly higher in subjects with HGIs ≤-0.75 (OR, 1.540 [1.039-2.234]; P = 0.027) and >0.82 (OR, 2.022 [1.392-2.890]; P <0.001) compared to those with HGIs of ≤-0.75 or >0.82 after adjustment for potential confounders. CONCLUSIONS We found a U-shaped correlation between the HGI values and the risk of 5-year MACE. Both low and high HGIs were associated with an increased risk of MACE. Therefore, the HGI may predict the 5-year MACE risk.
Humans ; Cohort Studies ; Longitudinal Studies ; Diabetes Mellitus, Type 2/diagnosis* ; Maillard Reaction ; Glycated Hemoglobin ; Cardiovascular Diseases

Objective:To explore the genetic etiology of fetuses with high suspicion of congenital skeletal malformation detected by prenatal ultrasound.Methods:This retrospective study collected 21 pregnant women with highly suspected fetal skeletal malformation indicated by ultrasound (the couples had no skeletal malformation) at Institute of Medical Genetics, Henan Provincial People's Hospital from January 2019 to August 2020. Amniotic fluid/umbilical cord blood of the fetus and peripheral blood of the couples were obtained for karyotype analysis, chromosomal microarray analysis, and whole-exome sequencing. Sanger sequencing was performed for the "pathogenic" "suspected pathogenic" "variants of uncertain significance" variants detected by whole exome sequencing. Genetic etiology of the 21 fetuses was described.Results:A total of five chromosomal abnormalities were detected, including four cases of trisomy 21 and one trisomy 18. Chromosome microarray analysis detected one case of abnormal copy number variation, 16 p11.2 microdeletion syndrome. Ten cases of monogenic diseases were found by whole exome sequencing and eight genes were involved ( SGMS2, FGFR3, DYNC2H1, WDR35, TBX5, COL2A1, FGFR2, and ALPL). Totally, 14 variations were detected, among which seven were novel variations (c.8129T>A, c.7126G>A, c.10307_10320del, and c.2641G>T in DYNC2H1 gene; c.3085G>A and c.491G>A in WDR35 gene; c.1070G>T in COL2A1 gene). Conclusions:For fetus, whose parents have no skeletal malformation, highly suspected of congenital malformation of skeletal system by prenatal ultrasound, genetic factor is the primary reason, including chromosomal abnormalities, copy number variations, and monogenic mutations.

Objective : To explore the main points of clinical treatment of fourth branchial cleft deformity in special positions and to provide a reference for clinical practice. Methods: The clinical data of one case of a fourth branchial cleft deformity that occurred in the left anterior chest wall with a fistula below the clavicle are summarized and combined with a literature review. Results: The patient complained of repeated swelling and pain under the left anterior chest wall for 2 months. A 10 mm×10 mm fistula with yellow clear liquid exudate from the fistula was observed on the left side below the clavicle. A 20 mm×20 mm×10 mm swelling was immediately adjacent at the superficial cervicothoracic junction of the upper sternoclavicular joint, with no fluctuation and poor activity; this swelling produced slight pain upon pressing. Imaging examinations pointed to cystic lesions. The primary diagnosis was a fourth branchial deformity. A small amount of methylene blue was injected into the patient's subclavian fistula, and a supraclavicular T-shaped incision was made where the cyst contacted the fistula. By turning the flap, all the methylene blue-stained areas and adjacent submucosal tissues were exposed. During the operation, a mass was found on the sternum. The platysma was found deep in the notch, which was incised before excising the surrounding area. The pathological result is the fourth branchial cleft deformity. After 1 week and 3 months of follow-up, the patients had no discomfort and no recurrence. A review of the relevant literature shows that the fourth branchial cleft deformity is a congenital developmental abnormality that occurs in 1% of all branchial cleft deformity. It often presents as a fistula, cyst, or sinus tract and is anatomically located at the neck root and supravicular region. The fistula is close to the medial lower boundary of the sternocleidomastoid muscle. The diagnosis is often made based on its anatomical location, imaging examinations and, ultimately, pathology. The differential diagnoses include other cervical swellings, such as hemangioma and a thyroglossal duct cyst. Surgical resection is a commonly used treatment method. In recent years, endoscopic positioning and internal fistula burning have had good curative effects for recurrent fourth branchial cleft deformity, with a small chance of recurrence or cancer. Conclusion Given its unique position, clinicians should make full use of imaging methods to determine the size, anatomical location and course of the lesion when treating the fourth branchial cleft deformity to ensure the complete and safe surgical resection of the lesion and prevent recurrence.

Objective:To explore the effect of the nutritional status on the clinical outcome and adverse effects of patients with concurrent radiochemotherapy for cervical cancer and analyze the cost-effectiveness of this treatment.Method:This study is a prospective, observational cohort study continuously enrolling patients with cervical cancer who received concurrent radiochemotherapy from 2018-05-01 to 2018-09-01 in Peking Union Medical College Hospital. According to the criteria, patients were divided into two groups: nutritional disorders and normal nutrition groups. There were 81 and 94 cases of abnormal and normal nutrition, respectively. Blood tests, liver function tests, treatment costs for adverse effects, and nutritional support were employed. We observed the incidence of vomiting, diarrhea, bone marrow suppression, infection, and other responses in the two groups, followed by clinical outcomes and the cost-effectiveness analysis.Results:Compared with the normal nutrition group, the infection rate (27.2% vs 14.9%, χ 2=4.007, P=0.045), the incidence of bone marrow suppression (86.4% vs 69.1%, χ 2=7.36, P= 0.007), the cost of bone marrow suppression treatment [324.0 (164.2-648.0) vs 587.8 (243.6-1 728.0), z=2.698, P=0.007), and the treatment cost [71.4 (45.2-123.7) vs 85.1 (57.0-198.9), z=1.994, P=0.030) significantly increased in the nutritional disorder group. There were more patients with poor clinical outcomes in the nutritional disorder group than in the normal group (29.6% vs 8.5%, χ 2= 12.987, P<0.001). Only 7.2% of the patients had visited a nutrition clinic, and the rate of nutrition intervention was extremely low. Conclusion:In patients with cervical cancer undergoing concurrent radiochemotherapy, there is a higher incidence of adverse effects, such as infection and bone marrow suppression, as well as higher treatment costs and worse clinical outcomes.

Objective:To the effects of testosterone replacement therapy on muscle strength and function among the elderly (≥65 years old).Methods:We searched English and Chinese databases of PubMed, SinoMed, etc, upto July 4, 2020. All retrieved literatures were reviewed according to inclusion and exclusion criteria in accordance with PICOS principles. The Cochrane risk bias assessment tool was used for quality evaluation. Two researchers extracted data and evaluated literature quality independently. The outcomes included muscle strength (assessed by handgrip strength, leg extension strength, etc) and function (assessed by walking speed according to 6-minute walking test, 6MWT). Review Manager 5.3 software was used for statistical analysis. The fixed or random effects model was used to merge data of upper-and lower-extremity strength or 6MWT to produce forest plot and funnel plot. The subgroup analyses were conducted based on the characteristics of included studies. The sensitivity analyses were conducted for excluding literatures with small sample size, etc.Results:A total of 15 relatively high quality researches (14 English literatures and 1 Chinese literature) were included. The results of this meta analyses showed TRT could improve upper-extremity (0.21[0.11, 0.32]) and lower-extremity (0.34[0.12, 0.55]) muscle strength while not physical function (17.62[-13.06, 48.31]) among the elderly men. Subgroup analyses showed that region, source of participants, administration route and intervention period, while not the baseline testosterone level had effect on the pooled effect size. Funnel plot suggested a certain degree of publication bias. Sensitivity analyses revealed that the meta analyses were robust.Conclusion:TRT can improve muscle strength while not physical function among elderly men.

Objective    To analyze the Ebstein anomaly's reoperative strategy and mid- to long-term results. Methods    We retrospectively reviewed the clinical data of 23 patients who diagnosed with Ebstein anomaly and underwent reoperation for tricuspid valve insufficiency between July 2002 and July 2017 in Fuwai Hospital. There were 9 (39.1%) males and 14 (60.9%) females, with a median age of 28.0 (19.0, 45.0) years. Results    Among the 23 patients, 8 (34.8%) underwent tricuspid valvuloplasty and 15 (65.2%) underwent tricuspid valve replacement. The rate of valvuloplasty was 16.7% before 2012, and 54.5% after 2012 (P=0.089) as Cone reconstruction procedure was used. In the valvuloplasty cohort, 3 (37.5%) patients were treated with Danielson or Carpentier technique, and 5 (62.5%) patients were treated with Cone reconstruction procedure. There was no operation-related death. Early complications occurred in 3 (37.5%) patients. The median follow-up was 6.9 years (range, 3.0-15.1 years), and no adverse cardiac events occurred. In the patients with valve replacement, 7 (46.7%) received mechanical prosthesis and 8 (53.3%) received bio-prosthesis. There was no operation-related death. And early complications were observed in 3 (20.0%) patients. The median follow-up was 6.5 years (range, 2.5-15.3 years). One (6.3%) patient died and 4 (26.7%) had long-term complications during the follow-up period. Conclusion    The mid- to long-term outcomes are convincing in patients who undergo the second operation due to recurrent tricuspid regurgitation of Ebstein anomaly. A low incidence of reoperation is observed. Cone reconstruction procedure provides possibilities of second tricuspid valvuloplasty, and this technique can reduce the rate of tricuspid valve replacement in the second operation. Tricuspid valve replacement is still an alternative method for the treatment of recurrent tricuspid regurgitation in patients with Ebstein anomaly. The bioprosthetic prosthesis may be a better choice than mechanical prosthesis.