Objective To systematically analyze the changes in clinical indicators including blood leukocytes and neutrophils,liver and kidney functions,coagulation function,lipids,and levels of thyroid hormones and antibodies in Graves'ophthalmopathy(GO)patients who had undergone effective treatment with tocilizumab(TCZ)and to explore their clinical significance.Methods Eighty-five patients with moderately or severely active GO who were effectively treated with TCZ were enrolled.Early morning fasting blood was collected and tested for routine blood,biochemical routine,coagulation function,thyroid hormone and antibodies,and basic information such as gender,age,duration of the disease,history of smoking,comorbidities,and medications were also collected from all patients,so changes in the clinical indicators before and after the treatment could be analyzed and correlation analyses could be carried out.Results Patients with moderately to severely active GO treated with TCZ showed a significant decrease in absolute blood leukocyte and neutrophil values compared with before,and a significant decrease in liver function(alanine transaminase,aspartate aminotransferase,creatinine),cholesterol(total cholesterol,high-density lipoprotein and low-density lipoprotein)levels were significantly higher than before,and concentrations of coagulation parameters[prothrombin time,activated partial thromboplastin time,fibrinogen(FIB)and D-dimer]were significantly decreased.The concentrations of thyroid hormone and thyroid-stimulating hormone levels increased significantly,and the antibody titer of thyrotropin receptor antibody(TRAB)was significantly down-regulated after treatment.TRAB levels were significantly correlated with FIB before treatment.Conclusion Thyroid function and antibody levels improved after TCZ treatment in patients with moderately to severely active GO,but blood leukocytes,liver function and coagulation function changed significantly compared with before.The results of this study confirm the therapeutic effect of TCZ on immune disorders in GO ophthalmopathy,while underscoring the importance of monitoring potential adverse effects in clinical treatment.

Objective:To compare the diagnostic efficacy of the added 99Tc m-methoxyisobutylisonitrile (MIBI) SPECT/CT imaging (tomography imaging) after early or delayed planar imaging in different types of hyperparathyroidism, and to seek for the optimal timing of preoperative imaging. Methods:A total of 339 patients (148 males, 191 females, age (52±13) years) with primary or secondary hyperparathyroidism and pathological results from January 2016 to June 2024 in the Second Affiliated Hospital of Soochow University were retrospectively analyzed. The patients were divided into primary early tomography imaging group ( n=63) and delayed tomography imaging group ( n=47), secondary early tomography imaging group ( n=89) and delayed tomography imaging group ( n=140). χ2 test was used to compare the diagnostic efficacies of early and delayed tomography imaging. Results:The difference of accuracy between primary delayed (98.40%(185/188)) and early tomography imaging (94.84%(239/252)) was statistically significant ( χ2=3.90, P=0.048). There were significant differences in sensitivity (77.29%(405/524) and 85.40%(275/322)), accuracy (75.89%(425/560) and 83.99%(299/356)) and negative predictive value (14.39%(20/139) and 33.80%(24/71)) between secondary delayed and early tomography imaging ( χ2 values: 8.33, 8.61, 10.70, all P<0.01). Conclusion:The optimal timing of preoperative 99Tc m-MIBI SPECT/CT imaging for primary and secondary hyperparathyroidism is after delayed planar imaging and after early planar imaging respectively.

Aim To explore the predictive value of serum free triiodothyronine(FT3)on the long-term prognosis of patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods All the subjects were from a prospective cohort study(PRACTICE study).In this study,15 250 patients with coronary heart disease after PCI in the First Affiliated Hospital of Xinjiang Medical University were selected,and the clinical data,FT3 and creatinine were collected.All the subjects were followed up regularly,and the primary follow-up endpoints were all-cause mortality and cardiogenic mortality,the secondary endpoints were major adverse cardiovascular events(MACE)and major adverse cardiovascular and cerebrovascular events(MACCE).According to the admission criteria,3 109 patients were finally in-cluded in this study.According to the baseline value of FT3,patients were divided into normal FT3 group(FT3:3.65～6.8 pmol/L,1 446 cases)and low FT3 group(FT3＜3.65 pmol/L,1 663 cases).Kaplan-Meier analysis was used for survival analysis,and Log-rank test was used for survival comparison.Multivariate Cox regression analysis was used to e-valuate the risk factors of the follow-up results of the two groups.Results Compared with the normal FT3 group,all-cause mortality and cardiogenic mortality in the low FT3 group increased significantly(P＜0.05).Kaplan-Meier analysis showed that the cumulative risk of all-cause mortality and cardiogenic mortality increased in the low FT3 group(P＜0.05).Multivariate Cox regression analysis indicated that the risk of all-cause mortality increased by 1.639 folds in the low FT3 group(HR=2.639,95％CI:1.385～5.348,P=0.007),while no statistical difference was found in cardiogenic mortality after adjusting for multiple factors(P=0.125).Conclusion The decrease in serum FT3 levels has important predictive value for all-cause mortality after PCI in patients with coronary heart disease.

Aim To investigate the role and mechanism of KLHL21 gene in myocardial infarction(MI)of mice.Methods KLHL21 gene knockout(KO)mice were generated using CRISPR/Cas9 technology,and C57BL/6 wild-type mice were used as controls.Sixty KLHL21 KO mice and 60 wild-type mice were randomly divided into four groups:WT+Sham group(n=30),WT+MI group(n=30),KO+Sham group(n=30)and KO+MI group(n=30).Postoperative is-chemic and infarct areas were assessed using TTC and Evans Blue staining,myocardial injury markers were measured by ELISA,cardiac function was evaluated by ultrasound,and histological changes were examined using HE and Masson stai-ning.Western blot was used to detect proteins related to the nuclear factor-κB(NF-κB)signaling pathway.Results KLHL21 protein expression in the myocardial tissue of KO mice was significantly lower than that in WT mice.The infarct area in KO+MI mice was significantly larger than that in WT+MI group.KO+MI mice showed reduced cardiac function compared with WT+MI mice.HE staining revealed myocardial cell loss,liquefactive necrosis,nuclear fragmentation,and significant neutrophil infiltration,while Masson staining showed aggravated fibrosis in KO+MI group.Serum tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6),creatine kinase-MB(CK-MB),and cardiac troponin Ⅰ(cTnⅠ)lev-els were significantly increased in KO+MI mice compared with WT+MI mice.Western blot analysis showed increased lev-els of phosphorylated inhibitor of nuclear factor-κB alpha(p-IKBα),P65,and P50,and decreased nuclear factor-κB al-pha(IKBα)in KO+MI mice.Conclusion KLHL21 gene plays a preventive role in myocardial infarction in mice,possibly through inhibition of NF-κB signaling pathway activation.

BACKGROUND: Cardiovascular disease (CVD) is the predominant cause of mortality in China. However, the mechanisms linking sarcopenia to CVD remain poorly understood, particularly in normal-weight populations. Individuals with the absence of overweight or obesity may tend to experience missed opportunities for timely intervention. This study aimed to investigate the longitudinal association between sarcopenia and incidence of new-onset CVD in a normal-weight population, and to examine the mediating effect of functional limitation in this relationship. METHODS: We conducted a closed-cohort analysis using a nationwide sample of 4,147 middle-aged and older adults with normal weight in China. We performed Cox proportional hazards regression analysis to explore the associations of baseline sarcopenia with incident CVD. The difference method was applied to estimate the mediation proportion of functional limitation in this association. RESULTS: Over a mean follow-up period of 7.62 years, CVD occurred in 835 participants. In the multivariable-adjusted Cox model, individuals with sarcopenia exhibited a significantly higher likelihood of developing incident CVD compared to those without sarcopenia (adjusted hazard ratio [aHR] = 1.45, 95% confidence interval [CI]: 1.21-1.73, P < 0.001). Similar associations were observed for the incidence of heart disease and stroke. Functional limitation accounted for approximately 15.0% of the total effect of sarcopenia on incident CVD (P < 0.001). CONCLUSIONS Sarcopenia exerts both direct and indirect effects on incident CVD among middle-aged and older adults who are normal weight, with functional limitation serving as a significant mediator. Interventions targeting both sarcopenia and functional limitation may offer a promising strategy for enhancing cardiovascular health in this population.
Humans ; Sarcopenia/complications* ; China/epidemiology* ; Male ; Female ; Middle Aged ; Cardiovascular Diseases/etiology* ; Aged ; Incidence ; Cohort Studies ; Proportional Hazards Models ; Risk Factors ; Aged, 80 and over ; Longitudinal Studies

Objective:To explore the correlation of bone metabolism with vitamin D and vitamin K levels in children with glucocorticoid-induced osteoporosis (GIOP) .Methods:A total of 120 GIOP children admitted to Neonatal Department of the First People’s Hospital of Chenzhou City, Hunan Province from Oct. 2022 to Dec. 2024 (GIOP group) and children without osteoporosis who received glucocorticoid therapy during the same period (the control group) were studied. Bone mineral density (BMD), biochemical indexes of bone metabolism and serum 25-hydroxyvitamin D (25 (OH) D), vitamin K1 (VitK1) and VitK2 were determined. BMD and bone metabolism indexes of GIOP children with different levels of 25 (OH) D, VitK1 and VitK2 were compared and their correlation was analyzed. Multiple linear regression analysis was conducted to analyze the independent factors affecting low BMD in GIOP children.Results:GIOP group had lower BMD, serum 25 (OH) D, VitK1 and VitK2 levels ( t=33.03, 42.22, 65.30, 86.16, P<0.05), while higher PINP, β-CTX and N-MID levels ( t=17.98, 34.78, 2.58, P<0.05); The levels of VitK1, VitK2, BMD, PINP, β-CTX and N-MID in GIOP children with different vitamin D and K levels were statistically significant ( F =54.31, 36.77, 82.32, 32.40, 22.80, 5.23), among which BMD was the lowest and PINP, β-CTX and N-MID levels were the highest ( P<0.05); The levels of 25 (OH) D, VitK1 and VitK2 were positively correlated with BMD ( r=0.54, 0.39, 0.47, P<0.05), but negatively correlated with PINP, β-CTX and N-MID ( r = -0.43, -0.34, -0.38, -0.39, -0.45, -0.44, -0.29, -0.32, -0.51, P<0.05); 25 (OH) D, VitK1 and VitK2 were protective factors for low BMD ( t=-2.76, -2.55, -3.51, P<0.05), while PINP, β-CTX, N-MID and hormone use time were risk factors ( t=2.48, 2.19, 2.22, 2.06, P<0.05) . Conclusions:The level of bone metabolism in children with GIOP is closely related to the levels of vitamin D and vitamin K. With the decrease of vitamin D and vitamin K levels, the decrease of BMD is more obvious. Therefore, vitamin D and vitamin K should be supplemented in a timely and reasonable manner for such children.

Objective This study aims to investigate the epidemiological characteristics of mental disorders in a rural town of Huazhou City,Guangdong Province,and explore their association with the rural revitalization strategy,so as to provide evidence for policy formulation.Methods A combination of questionnaire surveys and in-depth interviews was used to collect in-formation on the demographic characteristics,disease status,economic conditions,and policy awareness of registered mental dis-order patients in the town.Semi-structured interviews were also conducted with local doctors and village committee members.Da-ta were analyzed using descriptive statistics and logistic regression models to assess the impact of awareness of rural revitalization policies on patients'income.Results The average age of the study subjects was 47.71 years,with an average disease duration of 18.38 years.A total of 86.36％of patients had a family history of mental disorders.After onset,42.11％of patients had an annual income≥￥ 10 000,which was an increase compared to pre-illness levels,but 60.75％had completely lost their ability to work.Awareness of rural revitalization policies was low(only 18.29％were fully aware),but policy awareness was significant-ly associated with increased patient income(OR=18.03,P＜0.001).Additionally,medical expenditures were significantly higher among female patients than male patients(P＜0.001).Conclusion In a town in Huazhou City,Guangdong Province,60.75％of mental disorder patients have completely lost their ability to work,while 42.11％have an annual income exceeding ￥ 10,000.Income is positively correlated with policy awareness(OR=18.03).It is recommended to strengthen policy promo-tion,optimize the allocation of medical resources,and develop specialized assistance programs to promote the coordinated devel-opment of mental health and rural revitalization.

Objective:To explore the correlation of bone metabolism with vitamin D and vitamin K levels in children with glucocorticoid-induced osteoporosis (GIOP) .Methods:A total of 120 GIOP children admitted to Neonatal Department of the First People’s Hospital of Chenzhou City, Hunan Province from Oct. 2022 to Dec. 2024 (GIOP group) and children without osteoporosis who received glucocorticoid therapy during the same period (the control group) were studied. Bone mineral density (BMD), biochemical indexes of bone metabolism and serum 25-hydroxyvitamin D (25 (OH) D), vitamin K1 (VitK1) and VitK2 were determined. BMD and bone metabolism indexes of GIOP children with different levels of 25 (OH) D, VitK1 and VitK2 were compared and their correlation was analyzed. Multiple linear regression analysis was conducted to analyze the independent factors affecting low BMD in GIOP children.Results:GIOP group had lower BMD, serum 25 (OH) D, VitK1 and VitK2 levels ( t=33.03, 42.22, 65.30, 86.16, P<0.05), while higher PINP, β-CTX and N-MID levels ( t=17.98, 34.78, 2.58, P<0.05); The levels of VitK1, VitK2, BMD, PINP, β-CTX and N-MID in GIOP children with different vitamin D and K levels were statistically significant ( F =54.31, 36.77, 82.32, 32.40, 22.80, 5.23), among which BMD was the lowest and PINP, β-CTX and N-MID levels were the highest ( P<0.05); The levels of 25 (OH) D, VitK1 and VitK2 were positively correlated with BMD ( r=0.54, 0.39, 0.47, P<0.05), but negatively correlated with PINP, β-CTX and N-MID ( r = -0.43, -0.34, -0.38, -0.39, -0.45, -0.44, -0.29, -0.32, -0.51, P<0.05); 25 (OH) D, VitK1 and VitK2 were protective factors for low BMD ( t=-2.76, -2.55, -3.51, P<0.05), while PINP, β-CTX, N-MID and hormone use time were risk factors ( t=2.48, 2.19, 2.22, 2.06, P<0.05) . Conclusions:The level of bone metabolism in children with GIOP is closely related to the levels of vitamin D and vitamin K. With the decrease of vitamin D and vitamin K levels, the decrease of BMD is more obvious. Therefore, vitamin D and vitamin K should be supplemented in a timely and reasonable manner for such children.

Objective To systematically analyze the changes in clinical indicators including blood leukocytes and neutrophils,liver and kidney functions,coagulation function,lipids,and levels of thyroid hormones and antibodies in Graves'ophthalmopathy(GO)patients who had undergone effective treatment with tocilizumab(TCZ)and to explore their clinical significance.Methods Eighty-five patients with moderately or severely active GO who were effectively treated with TCZ were enrolled.Early morning fasting blood was collected and tested for routine blood,biochemical routine,coagulation function,thyroid hormone and antibodies,and basic information such as gender,age,duration of the disease,history of smoking,comorbidities,and medications were also collected from all patients,so changes in the clinical indicators before and after the treatment could be analyzed and correlation analyses could be carried out.Results Patients with moderately to severely active GO treated with TCZ showed a significant decrease in absolute blood leukocyte and neutrophil values compared with before,and a significant decrease in liver function(alanine transaminase,aspartate aminotransferase,creatinine),cholesterol(total cholesterol,high-density lipoprotein and low-density lipoprotein)levels were significantly higher than before,and concentrations of coagulation parameters[prothrombin time,activated partial thromboplastin time,fibrinogen(FIB)and D-dimer]were significantly decreased.The concentrations of thyroid hormone and thyroid-stimulating hormone levels increased significantly,and the antibody titer of thyrotropin receptor antibody(TRAB)was significantly down-regulated after treatment.TRAB levels were significantly correlated with FIB before treatment.Conclusion Thyroid function and antibody levels improved after TCZ treatment in patients with moderately to severely active GO,but blood leukocytes,liver function and coagulation function changed significantly compared with before.The results of this study confirm the therapeutic effect of TCZ on immune disorders in GO ophthalmopathy,while underscoring the importance of monitoring potential adverse effects in clinical treatment.

Objective:To analyze the characteristics of adverse reactions of sodium-glucose cotransporter 2 inhibitors (SGLT2i), and provide a basis for the rational clinical application.Methods:The adverse drug reaction (ADR) cases of SGLT2i reported by Beijing from January 1, 2019 to June 30, 2024 were collected through searching the National Adverse Drug Reaction Monitoring System of China. The Medical Dictionary for Regulatory Activities (MedDRA) terminology set was used to standardize the description of ADR, and the involving system organ class (SOC) and preferred term (PT) was extracted. Data of ADR were analyzed descriptively and statistically. Results:A total of 409 SGLT2i-related adverse reaction reports involving 409 patients were included. Among these patients, there were 232 females and 177 males; the median age was 62(52, 70) years, and 231 cases (56.48%) were under the age of 65 years; 5 types of SGLT2i (dapagliflozin, empagliflozin, canagliflozin, ertugliflozin, and henagliflozin proline) were involved, and reports of dapagliflozin was the most (279 cases, 68.22%). The primary indication for medication was diabetes (404 cases, 98.78%). The majority of ADRs did not reach the severe level (395 cases, 96.58%). The 14 cases (3.42%) of severe ADR were primarily about diabetic ketoacidosis (11 cases, 11/14), of which 7 cases presented with normal blood glucose levels and 5 cases occurred after medical stress events. The outcomes of patients were improvement in 241 cases (58.92%) and recovery in 127 cases (31.05%). In total, 476 ADR occurrences were recorded among the 409 patients, involving 82 PTs, 24 of which were not listed in the drug labels. The top 2 SOCs were the infections and infestations [26.26% (125/476)] and renal and urinary disorders [13.87% (66/476)]; the top 3 PTs were urinary tract infection [23.32% (111/476)], urinary ketone detection [6.51% (31/476)], and vulvovaginal pruritus [5.88% (28/476)]; the top 3 newly identified possible ADRs (PTs) were dizziness [2.31% (11/476)], palpitations [1.89% (9/476)], and decreased appetite [1.05% (5/476)].Conclusions:Based on the ADR monitoring data in Beijing in the past 5 and a half years, SGLT2i-associated adverse reactions primarily involved the infections and infestations, and renal and urinary disorders. ADRs identified in the study such as dizziness and palpitations are not documented in the drug labels, euglycaemic ketoacidosis accounts for a high proportion of severe reactions, and most of them occur after acute stress events.