Objective:To explore whether transjugular intrahepatic portosystemic shunt (TIPS) can improve the prognosis of esophagogastric variceal bleeding (EGVB) combined with sarcopenia in cirrhotic patients.Methods:A retrospective cohort study was performed. A total of 464 cases with cirrhotic EGVB who received standard or TIPS treatment between January 2017 and December 2019 were selected. Regular follow-up was performed for the long-term after treatment. The primary outcome was transplantation-free survival. The secondary endpoints were rebleeding and overt hepatic encephalopathy (OHE). The obtained data were statistically analyzed. The t-test and Wilcoxon rank-sum test were used to compare continuous variables between groups. The χ2 test, or Fisher's exact probability test, was used to compare categorical variables between groups. Results:The age of the included patients was 55.27±13.86 years, and 286 cases were male. There were 203 cases of combined sarcopenia and 261 cases of non-combined sarcopenia. The median follow-up period was 43 months. The two groups had no statistically significant difference in follow-up time. There was no statistically significant difference in transplant-free survival between the TIPS group and the standard treatment group in the overall cohort ( HR=1.31, 95% CI: 0.97-1.78, P=0.08). The TIPS patient group with cirrhosis combined with sarcopenia had longer transplant-free survival (median survival: 47.76 vs. 52.45, χ2=4.09; HR=1.55, 95 CI: 1.01~2.38, P=0.04). There was no statistically significant difference in transplant-free survival between the two kinds of treatments for patients without sarcopenia ( HR=1.22, 95% CI: 0.78~1.88, P=0.39). Rebleeding time was prolonged in TIPS patients with or without sarcopenia combination (patients without combined sarcopenia: median rebleeding time: 39.48 vs. 53.61, χ2=18.68; R=2.47, 95 CI: 1.67~3.65, P<0.01; patients with sarcopenia: median rebleeding time: 39.91 vs. 50.68, χ2=12.36; HR=2.20, 95 CI: 1.42~3.40, P<0.01). TIPS patients had an increased 1-year OHE incidence rate compared to the standard treatment group (sarcopenia patients: 6.93% vs. 16.67%, χ2=3.87, P=0.049; patients without sarcopenia combination: 2.19% vs. 9.68%, χ2=8.85, P=0.01). There was no statistically significant difference in the long-term OHE incidence rate between the two kinds of treatment groups ( P>0.05). Conclusion:TIPS can significantly prolong transplant-free survival compared to standard treatment as a secondary prevention of EGVB concomitant with sarcopenia in patients with cirrhosis. However, its advantage is not prominent for patients with cirrhosis in EGVB without sarcopenia.

Objective:The purpose of this study is to explore in depth the mechanism of the impact of brain drain on organizational cohesion,with a view to cracking the vicious circle problem caused by brain drain in the northeast region and eliminating the unfavorable factors affecting the core cohesion of public health institutions.Methods:A combination of convenience sampling and snowball sampling was used to survey11 912 valid questionnaires,and the data were systematically analyzed using descriptive statistics,regression analysis,and moderated mediated effects analysis.Results:Brain drain has a significant negative effect on organizational cohesion(β=-1.29,P<0.001);and role overload partially mediates between the two,with a significant mediating effect(effect value=-0.56,95%CI=-0.67～-0.46),and the indirect effect accounts for 43.4%of the total effect;and monthly income significantly moderates the effect of brain drain on organizational cohesion through role overload(β=1.00,P<0.001).Conclusion:It is recommended to alleviate the sense of role overload among public health personnel by adjusting the level of salary and benefits,and to reduce the negative impact of brain drain by adopting long-term incentive mechanisms and other strategies,thus enhancing organizational cohesion and providing theoretical and practical guidance for relevant institutions.

Objective:To investigate the influencing factors for major adverse cardiovascular events(MACE)in older patients with preserved ejection fraction(HFpEF)or with mid-range ejection fraction(HFmrEF)heart failure in the vulnerable phase.Methods:Data for 312 patients with preserved or mid-range ejection fraction heart failure hospitalized at the Department of Geriatrics, General Hospital of Tianjin Medical University from January 2017 to October 2019 were retrospectively collected, and 17 patients were lost to follow-up.A total of 295 elderly patients with preserved or mid-range ejection fraction heart failure were included in this study.According to whether major cardiovascular events occurred in the vulnerable phase(90 d after discharge), patients were divided into a MACE group(n=87)and anon-MACE group(n=208). Baseline data between the two groups were compared.Univariate logistic regression analysis wasused to determine risk factors for patients in the vulnerable phase, and COX regression analysis and Kaplan-Meier survival analysis were conducted to evaluate the influence of resting heart rate and hematocrit on MACE in the vulnerable phase.The predictive value of resting heart rate and hematocrit in MACE was analyzed by the ROC curve.Results:The resting heart rate at discharge in the MACE group was(78.6±6.9)bpm, higher than(71.1±8.4)bpm in the non-MACE group( t=7.30, P<0.01), whereas hematocrit was(32.3±3.6)%in the MACE group, lower than(36.6±4.9)% in the non-MACE group( t=-8.22, P<0.01). Resting heart rate and hematocrit were risk factors for MACE in elderly patients with HFpEF or HFmrEF in the vulnerable phase.Multivariate Cox regression analysis showed that HR was 1.11 for resting heart rate(95% CI: 1.07-1.14, P<0.001)and 0.91 for hematocrit(95% CI: 0.83-0.99, P=0.034). The survival times of patients with low and high resting heart rate were(86.5±1.2)d and(57.9±3.2)d, respectively.The survival rate of the high resting heart rate group(87.3%, 89/102)was lower than that of the low resting heart rate group(98.4%, 190/193)( χ2=116.30, P<0.01). The survival times of patients with high and low hematocrit values were(84.6±1.7)d and(67.0±2.4)d, respectively.The survival rate of the low hematocrit group(91.9%, 148/161)was lower than that of the high hematocrit group(97.8%, 131/134)( χ2=40.32, P<0.01). ROC curve analysis revealed that the cut-off values for resting heart rate and hematocrit were 73.5 bpm and 35.4%, respectively.The area under the ROC curve(0.919, 95% CI: 0.882-0.947, P<0.05)for the diagnosis of MACE using the combination of both parameters was significantly larger than that using resting heart rate(0.885, 95% CI: 0.843-0.919, P<0.05)or hematocrit(0.747, 95% CI: 0.694-0.796, P<0.05)alone. Conclusions:Resting heart rate and hematocrit are the main influencing factors for MACE in elderly patients with HFpEF or HFmrEF in the vulnerable phase.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Objective To understand the correlation and clinical significance between cystatin C and atherogenic index of plasma change in hypertensive patients. Methods At the Quzhou City central hospital between 2014 and 2015, 526 cases of hypertensive patients as hypertensive group and 546 cases of people with normal blood pressure in the healthy check-up as normal blood pressure group were investigated with physical examination, blood biochemical index detection and the serum cystatin C level detection. The analysis of the relationship between the serum cystatin C level and atherogenic index of plasma among two groups was done. Results The evidence that the serum cystatin C level between hypertensive group and normal blood pressure group shows respectively as: 1.12±0.44 (mg/L) and 0.81±0.22 (mg/L), atherogenic index of plasma shows respectively as:0.68±0.03 and -0.22±0.02, both differences were statistically significant (P<0.01) . As the serum cystatin C level increased, the risk of hypertension increased (OR=20.06, 95％CI: 12.67-31.76) . Plasma arteriosclerosis index in hypertensive group was correlated with systolic blood pressure, body mass index, total cholesterol, triglyceride, high-density lipoprotein, LDL cholesterol, and uric acid level respectively, all differences were statistically significant. In addition to the above indicators, the serum cystatin C level in hypertensive group was correlated with serum creatinine level (all P<0.05) . Conclusion The serum cystatin C level and plasma arteriosclerosis index in patients with hypertension both were higher than those with normal blood pressure. These two indicators were correlated with systolic blood pressure and multiple blood lipid indicators. They could be used to monitor arteriosclerosis and target organ damage in patients with hypertension.

Objective: To summarize the clinical features and treatment status for elderly in-hospital patients with mitral regurgitation (MR). Methods: A single center retrospective study was conducted in 1 741 patients admitted in our hospital from 2014-05-01 to 2015-04-30 with echocardiography confirmed moderate to severe MR. The patients were divided into 2 groups: Elderly group, n=680(39.06%)patients≥60 years of age and Non-elderly group,n=1 061(60.94%)patients<60 years.Clinical features and treatment status were studied and compared between 2 groups. Results: The mean age in Elderly group was (66.98±5.94) years and the most common type was degenerative MR (41.18%). Compared with Non-elderly group, Elderly group had more patients combining coronary artery disease (37.79% vs 17.43% ), more risk factors of atherosclerosis such as hypertension (45.44% vs 25.17%), diabetes (19.56% vs 8.48%) and hyperglycemia (35.29% vs 19.51%) all P<0.05; Elderly group had the higher EuroSCORE Ⅱ score (5.54±2.42) vs (3.15±1.66), greater left ventricular end diastolic diameter (57.72±12.37) mm vs (57.33±10.19) mm and less patients combining multiple valve disease (35.59% vs 40.81%), less patients received surgical treatment (54.71% vs 63.9%), all P<0.05. The surgery procedures (mitral valve replacement or mitral-plasty) were similar between 2 groups; compared with Non-elderly group, Elderly group had the higher application rate of bio-prosthetic valve (53.88% vs 18.67%), P<0.001. Conclusion: About 40% in-hospital moderate to severe MR patients were the elderly crowd, the most common pathogenesis was degenerative changes which leaded the higher incidences of cardiac complications, worse cardiac function and the higher risk scores for surgical treatment, there were less patients received surgery.

Objective To study the effects of health management on blood pressure and lifestyle of hypertensive outpatients.Methods A total of 319 hypertensive outpatients were randomly assigned to the control group (n =160) or the health management group (n =159).Pharmacologic therapy was given to the control group,while in the health management group,intensive health management combined with pharmacologic therapy was conducted.Blood pressure,height,body weight (BW),total cholesterol (TC),and fasting blood glucose (FBG) of the participants were measured and compared at baseline and 12 months.Results There were no significant differences of clinical characteristics between two groups at baseline.After 12 months' intervention,more significant decrease of systolic blood pressure and diastolic blood pressure was found in the health management group (t values were 2.701 and 2.306,respectively;both P ＜ 0.05).There were statistically significant differences of body mass index (BMI) and serum TC levels between the control and the health management group (t values were 2.111 and 2.227,respectively ;P ＜ 0.05).After the intervention,two groups showed no significant difference in current cigarette smoking (x2=2.787,P ＞ 0.05).The participants in the health management group showed improved physical exercises,diet,and adherence to treatment at the end of the observation (x2 values were 59.459,52.018,6.321 and 5.392,respectively; all P ＜ 0.05).Conclusion Compared with pharmacologic therapy,health management combined with pharmacologic therapy could significantly improve clinical parameters and life style of hypertensive patients.

Serum levels of human CXC-chemokine ligand 16,basic fibroblast growth factor,plateletderived endothelial cell growth factor,and number of endothelial progenitor cells were determined in 80 patients with type 2 diabetes mellitus and 40 normal control subjects.It was found that there were some disturbances of angiogenesis in diabetic patients.These abnormalities were more pronounced in these patients with old age,hyperglycemia,raised HbA1c,and presence of vascular diseases.

ObjectiveTo study the effects of health management on elderly patients with metabolic syndrome and lower extremity arterial disease.Methods A total of 118 metabolic syndrome( MS ) patients with ankle-brachial index (ABI) ＜ 0.9 and no intermittent claudication were randomly assigned to the control group( n =60,receiving pharmacologic therapy ) or health management group ( n =58,receiving intensive health management + pharmacologic therapy).Blood pressure,ABI,total cholesterol (TC),and fasting blood glucose(FBS) were tested before and 12 after the intervention.Results Clinical data were comparable between the two groups at baseline.After 12-months' intervention,systolic blood pressure(SBP) and FBS in both groups were significantly decreased,especially in the health management group[SBP:(141 ± 10)mm Hg(1 mm Hg=0.133 kPa) vs(146±11) mm Hg,t =2.581,P=0.011; FBS:(5.32 ±1.33) mmol/L vs ( 5.92 ± 1.61 ) mmol/L,t =2.231,P =0.028].TC ( 5.51 ± 0.51 ) mmol/L vs ( 5.11 ± 0.49 ) mmol/L,(t=4.307,P=0.000) and ABI(0.77 ±0.17 vs 0.84 ±0.19,t=2.091,P=0.039) of the health management group were significantly improved at 12 months.Patients in the health management group also showed higher SF-36 scores than those in the control group( physical functioning:72.2 ± 12.4 vs 65.2 ±20.1,t =2.268,P =0.025 ; emotion:73.9 ± 18.0 vs 65.6 ± 21.1,t =2.295,P =0.023 ; mental health:63.9 ± 13.3vs 58.3 ± 12.5,t =2.358,P =0.020 ).Conclusion Compared with medication,health management and pharmacologic therapy could significantly improve clinical parameters and quality of life of elderly MS patients combined with peripheral arterial disease.

Aged, 80 and over ; Echinocandins ; adverse effects ; therapeutic use ; Humans ; Lipopeptides ; Liver ; drug effects ; Liver Function Tests ; Mycoses ; drug therapy ; Retrospective Studies