Objective To explore characteristics of clinical parameters and cytokines in patients with drug-induced liver injury(DILI)caused by different drugs and their correlation with clinical indicators. Method The study was conducted on patients who were up to Review of Uncertainties in Confidence Assessment for Medical Tests(RUCAM)scoring criteria and clinically diagnosed with DILI.Based on Chinese herbal medicine,cardiovascular drugs,non-steroidal anti-inflammatory drugs(NSAIDs),anti-infective drugs,and other drugs,patients were divided into five groups.Cytokines were measured by Luminex technology.Baseline characteristics of clinical biochemical indicators and cytokines in DILI patients and their correlation were analyzed. Results 73 patients were enrolled.Age among five groups was statistically different(P=0.032).Alanine aminotransferase(ALT)(P=0.033)and aspartate aminotransferase(AST)(P=0.007)in NSAIDs group were higher than those in chinese herbal medicine group.Interleukin-6(IL-6)and tumor necrosis factor alpha(TNF-α)in patients with Chinese herbal medicine(IL-6:P<0.001;TNF-α:P<0.001)and cardiovascular medicine(IL-6:P=0.020;TNF-α:P=0.001)were lower than those in NSAIDs group.There was a positive correlation between ALT(r=0.697,P=0.025),AST(r=0.721,P=0.019),and IL-6 in NSAIDs group. Conclusion Older age may be more prone to DILI.Patients with NSAIDs have more severe liver damage in early stages of DILI,TNF-α and IL-6 may partake the inflammatory process of DILI.

Objective To develop an intelligent model for differential diagnosis of atrioventricular nodal re-entrant tachycardia(AVNRT)and atrioventricular re-entrant tachycardia(AVRT)using 12-lead wearable electrocardiogram devices.Methods A total of 356 samples of 12-lead supraventricular tachycardia(SVT)electrocardiograms recorded by wearable devices were randomly divided into training and validation sets using 5-fold cross validation to establish the intelligent classification model,and 101 patients with the diagnosis of SVT undergoing electrophysiological studies and radiofrequency ablation from October,2021 to March,2023 were selected as the testing set.The changes in electrocardiogram parameters before and during induced tachycardia were compared.Based on multiscale deep neural network,an intelligent diagnosis model for classifying SVT mechanisms was constructed and validated.The 3-lead electrocardiogram signals from Ⅱ,Ⅲ,and V1 were extracted to build new classification models,whose diagnostic efficacy was compared with that of the 12-lead model.Results Of the 101 patients with SVT in the testing set,68 were diagnosed with AVNRT and 33 were diagnosed with AVRT by electrophysiological study.The pre-trained model achieved a high area under the precision-recall curve(0.9492)and F1 score(0.8195)for identifying AVNRT in the validation set.The total F1 scores of the lead Ⅱ,Ⅲ,V1,3-lead and 12-lead intelligent diagnostic models in the testing set were 0.5597,0.6061,0.3419,0.6003 and 0.6136,respectively.Compared with the 12-lead classification model,the lead-Ⅲ model had a net reclassification index improvement of-0.029(P=0.878)and an integrated discrimination index improvement of-0.005(P=0.965).Conclusion The intelligent diagnostic model based on multiscale deep neural network using wearable electrocardiogram devices has an acceptable accuracy for classifying SVT mechanisms.

Objective:To investigate the factors influencing mortality within one year following hip fracture surgery in elderly patients.Methods:This study retrospectively analyzed clinical data from 1 263 elderly patients with hip fractures who underwent surgery at the First Affiliated Hospital of Air Force Medical University between January 2014 and December 2022.Based on their survival status one-year post-surgery, the patients were categorized into two groups: the death group(212 cases)and the survival group(1 051 cases).Univariate and multivariate logistic regression models were employed to identify factors associated with 1-year mortality.Results:The 1-year mortality rate was found to be 16.78%.Multivariate logistic regression analysis identified several significant predictors of 1-year mortality in elderly patients with hip fractures.These predictors include gender( OR=0.67, 95% CI: 0.48-0.95), age greater than 85 years( OR=2.23, 95% CI: 1.56-3.19), body mass index(BMI)less than 18.5( OR=1.74, 95% CI: 1.17-2.60), BMI between 30 and 40( OR=3.14, 95% CI: 1.20-8.21), history of stroke( OR=1.59, 95% CI: 1.06-2.38), presence of anemia( OR=1.75, 95% CI: 1.07-2.86), fibrinogen(FIB)levels either below 1.8 or above 3.5( OR=1.63, 95% CI: 1.12-2.37), deep vein thrombosis( OR=1.57, 95% CI: 1.13-2.18), and American Society of Anesthesiologists(ASA)grade Ⅲ/Ⅳ( OR=2.37, 95% CI: 1.56-3.59). Conclusions:In elderly patients with hip fractures, age over 85 years, a BMI less than 18.5 or between 30 and 40, the presence of stroke, anemia, FIB levels below 1.8 or above 3.5, deep vein thrombosis(DVT), and ASA classifications Ⅲ or Ⅳ are identified as independent risk factors for 1-year mortality.Conversely, being female serves as a protective factor.

Objective To investigate the effect of individual exercise training on the rehabilitation of patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods A total of 81 patients between January 2021 and December 2023 were randomly allocated into an observation group(n=41)and a control group(n=40)using a simple random number Tab.method.The control group received routine post-operative rehabilitation intervention,while the observation group received individualized exercise training as the core component of cardiac rehabilitation intervention.The study compared the effects of rehabilitation,cardiac function parameters[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)],exercise endurance measures[6-minute walking distance(6MWD)],and quality of life assessed by Seattle Angina Pecina Scale(SAQ)scores between the two groups before and after a three-month intervention period.Results The total recovery response rate in the observation group was higher than that in the control group(P＜0.05).LVEF,LVEDD,6 MWD,maximum exercise load and SAQ scales(P＞0.05),LVEF were higher than before intervention(t=3.345,2.480,3.165,5.016,2.059,4.582,4.443,3.353,P＜0.05),and LVEDD was lower than before intervention(t=3.335,P＜0.05).Conclusion The individualized exercise training-based cardiac rehabili-tation program demonstrates potential for enhancing cardiac function and exercise endurance in patients with CHD following PCI,thereby improving their overall quality of life.This finding holds significant clinical implications.

Objective To compare the application value of three image post-processing techniques volume rendering(VR),multiplanar reformation(MPR)and curved planar reformation(CPR)in the identifi-cation of rib fracture malunion.Methods The types and numbers of rib fracture malunion in 75 pa-tients were recorded,and the sensitivity,specificity,accuracy and Youden index of VR,MPR and CPR in the diagnosis of rib fracture malunion were compared.Receiver operator characteristic(ROC)curve was drawn and area under the curve(AUC)was calculated,and the detection rates of three image post-processing techniques for different types of rib fracture malunion were compared.Results A total of 243 rib fractures were malunion in 75 patients.The diagnostic sensitivity of VR,MPR and CPR for rib fracture malunion was 52.67%,79.84%and 91.36%,the specificity was 99.58%,97.89%and 99.15%,the accuracy was 83.66%,91.76%and 96.51%,the Youden index was 0.52,0.78 and 0.91,the AUC was 0.761,0.889 and 0.953,respectively.Compared with VR,there were statistically signifi-cant differences in the number of broken rib end misalignment over 1/3,broken rib end overlap,bro-ken rib end angulation and intercostal bridge detected in MPR(P<0.05).Compared with VR,there was a statistically significant difference in the number of different types of rib fracture malunion de-tected by CPR(P<0.05).Compared with MPR,there were statistically significant differences in the number of broken rib end misalignment over 1/3,broken rib end separation and intercostal bridge de-tected in CPR(P<0.05).Conclusion The three image post-processing techniques are of great signifi-cance for the identification of rib fracture malunion.Especially CPR is highly effective in the diagno-sis of rib fracture malunion,and can be used as the main post-processing technique for forensic clini-cal identification of rib fracture malunion.

Objective:To explore the effect of staged rehabilitation nursing in patients undergoing arthroscopic rotator cuff repair.Methods:From January 2021 to December 2022, convenience sampling was used to select 73 patients who underwent arthroscopic rotator cuff repair in the Department of Hand Surgery at Affiliated Hospital of Nantong University as participants. According to the random number table method, patients were divided into a control group ( n=36) and an observation group ( n=37). Control group received routine rehabilitation nursing, while observation group received staged rehabilitation nursing. The University of California, Los Angeles (UCLA) Shoulder Rating Scale score, American Shoulder and Elbow Surgeons (ASES) Rating Scale score, Constant-Murley Shoulder Scale score, and complications during rehabilitation were compared between two groups of patients before and six months after intervention. Results:Six months after surgery, both groups showed an increase in UCLA scores and ASES scores compared to before the intervention ( P<0.05), and the scores of observation group were higher than those of control group, with statistical differences ( P<0.05). Six months after surgery, the Constant-Murley Shoulder Scale scores for daily life and shoulder range of motion in observation group were higher than those in control group, and the differences were statistically significant ( P<0.05). During the rehabilitation period, the incidence of complications in observation group was lower than that in control group with a statistical difference ( P<0.05) . Conclusions:Staged rehabilitation nursing in patients undergoing arthroscopic rotator cuff repair shows significant effects and can effectively promote patient recovery.

Objective To develop an intelligent model for differential diagnosis of atrioventricular nodal re-entrant tachycardia(AVNRT)and atrioventricular re-entrant tachycardia(AVRT)using 12-lead wearable electrocardiogram devices.Methods A total of 356 samples of 12-lead supraventricular tachycardia(SVT)electrocardiograms recorded by wearable devices were randomly divided into training and validation sets using 5-fold cross validation to establish the intelligent classification model,and 101 patients with the diagnosis of SVT undergoing electrophysiological studies and radiofrequency ablation from October,2021 to March,2023 were selected as the testing set.The changes in electrocardiogram parameters before and during induced tachycardia were compared.Based on multiscale deep neural network,an intelligent diagnosis model for classifying SVT mechanisms was constructed and validated.The 3-lead electrocardiogram signals from Ⅱ,Ⅲ,and V1 were extracted to build new classification models,whose diagnostic efficacy was compared with that of the 12-lead model.Results Of the 101 patients with SVT in the testing set,68 were diagnosed with AVNRT and 33 were diagnosed with AVRT by electrophysiological study.The pre-trained model achieved a high area under the precision-recall curve(0.9492)and F1 score(0.8195)for identifying AVNRT in the validation set.The total F1 scores of the lead Ⅱ,Ⅲ,V1,3-lead and 12-lead intelligent diagnostic models in the testing set were 0.5597,0.6061,0.3419,0.6003 and 0.6136,respectively.Compared with the 12-lead classification model,the lead-Ⅲ model had a net reclassification index improvement of-0.029(P=0.878)and an integrated discrimination index improvement of-0.005(P=0.965).Conclusion The intelligent diagnostic model based on multiscale deep neural network using wearable electrocardiogram devices has an acceptable accuracy for classifying SVT mechanisms.

Objective To analyze the genetic subtypes of human immunodeficiency virus (HIV) and the prevalence of pretreatment drug resistance in the newly reported HIV-infected men in Guangxi. Methods The stratified random sampling method was employed to select the newly reported HIV-infected men aged≥50 years old in 14 cities of Guangxi from January to June in 2020.The pol gene of HIV-1 was amplified by nested reverse transcription polymerase chain reaction and then sequenced.The mutation sites associated with drug resistance and the degree of drug resistance were then analyzed. Results A total of 615 HIV-infected men were included in the study.The genetic subtypes of CRF01_AE,CRF07_BC,and CRF08_BC accounted for 57.4% (353/615),17.1% (105/615),and 22.4% (138/615),respectively.The mutations associated with the resistance to nucleoside reverse transcriptase inhibitors (NRTI),non-nucleoside reverse transcriptase inhibitors (NNRTI),and protease inhibitors occurred in 8 (1.3%),18 (2.9%),and 0 patients,respectively.M184V (0.7%) and K103N (1.8%) were the mutations with the highest occurrence rates for the resistance to NRTIs and NNRTIs,respectively.Twenty-two (3.6%) patients were resistant to at least one type of inhibitors.Specifically,4 (0.7%),14 (2.3%),4 (0.7%),and 0 patients were resistant to NRTIs,NNRTIs,both NRTIs and NNRTIs,and protease inhibitors,respectively.The pretreatment resistance to NNRTIs had much higher frequency than that to NRTIs (2.9% vs.1.3%;χ²=3.929,P=0.047).The prevalence of pretreatment resistance to lamivudine,zidovudine,tenofovir,abacavir,rilpivirine,efavirenz,nevirapine,and lopinavir/ritonavir was 0.8%, 0.3%, 0.7%, 1.0%, 1.3%, 2.8%, 2.9%, and 0, respectively. Conclusions CRF01_AE,CRF07_BC,and CRF08_BC are the three major strains of HIV-infected men≥50 years old newly reported in Guangxi,2020,and the pretreatment drug resistance demonstrates low prevalence.
Male ; Humans ; Middle Aged ; Reverse Transcriptase Inhibitors/therapeutic use* ; HIV Infections/drug therapy* ; Drug Resistance, Viral/genetics* ; China/epidemiology* ; Mutation ; HIV-1/genetics* ; Protease Inhibitors/therapeutic use* ; Genotype

Trimethylamine N-oxide(TMAO), a metabolite of gut microbiota, is closely associated with chronic kidney disease(CKD). It can aggravate the kidney injury and promote the occurrence of complications of CKD mainly by inducing renal fibroblast activation, vascular endothelial inflammation, macrophage foaming, platelet hyperreactivity, and inhibition of reverse cholesterol transport. Thus it is of great significance for clinical treatment of CKD to regulate circulating TMAO and alleviate its induced body damage. Currently, therapeutic strategies for TMAO regulation include dietary structure adjustment, lifestyle intervention, intestinal microflora regulation, and inhibition of intestinal trimethylamine synthesis and liver trimethylamine oxidation. Chinese medicinal herbs have the clinical advantage of multi-component and multi-target effects, and application of traditional Chinese medicine(TCM) to synergistically regulating TMAO and improving CKD via multiple pathways has broad prospects. This study systematically reviewed the clinical relevance and mechanism of TMAO in aggravating CKD renal function deterioration and complication progression. In addition, the effect and mechanism of TCM in improving TMAO-induced kidney injury, cardiovascular disease, hyperlipidemia, thrombosis and osteoporosis were summarized. The results provided a theoretical basis for TCM in attenuating gut microbiota-derived metabolite TMAO and improving CKD, as well as a basis and direction for in-depth clinical development and mechanism research in the future.
Humans ; Gastrointestinal Microbiome ; Medicine, Chinese Traditional ; Renal Insufficiency, Chronic/drug therapy*

Animals ; SARS-CoV-2 ; Antibodies, Neutralizing ; Macaca mulatta ; COVID-19/prevention & control* ; Antibodies, Viral ; Vaccines