Objective To build the early predictive model for chronic kidney disease(CKD)in hypertension and diabetes patients in the community.Methods The CKD patients were recruited from 4 health care centers in 4 urban areas in Kunming.The control group was residents without hypertension and diabetes(n = 1267).The disease group was residents with hypertension and/or diabetes(n = 566).The questionnaire survey,physical examination,laboratory testing,and 5 SNPs gene types in the PVT1 gene.The risk factors,which were filtered with logistics regression,were used to build predictive models.Four machine learning algorithms were built:support vector machine(SVM),random forest(RF),Na?ve Bayes(NB),and artificial neural network(ANN)models.Results Thirteen indicators included in the final diagnostic model:age,disease type,ethnicity,blood urea nitrogen,creatinine,eGFR from MDRD,ACR,eGFR from EPI2009,PAM13 score,sleep quality survey,staying-up late,PVT1 SNP rs11993333 and rs2720659.The accuracy,specificity,Kappa value,AUC of ROC,and PRC of ANN are greater than those of the other 3 models.The sensitivity of RF is the highest among 4 types of machine learning.Conclusions The ANN predictive model has a good ability of efficiency and classification to predict CKD with hypertension and/or diabetes patients in the community.

Objective To analyze the current situation of unplanned reoperation in cardiac surgery and to discuss the management measures of unplanned reoperation.Methods The information of patients undergoing cardiac surgery in a class A tertiary comprehensive hospital during 2018-2022 was collected to analyze the incidence of unplanned reoperation,major ca uses,disease types,surgica l moda lities and Complications.Results A tota l of 3902 patients underwent surgery,of whom 73(1.87%)underwent unplanned reoperation.The main cause of unplanned reoperation was bleeding(50%).The disease types with the highest unplanned reoperation composition ratio were coronary heart disease(38.4%),and the disease types with the highest incidence were dilated cardiomyopathy(11.1%).The average hospitalization cost,the average length of hospitalization,mortality rate and medical dispute rate of patients who had unplanned reoperation were significantly higher than those who did not have unplanned reoperation,the difference was statistically significant(P=0.001).Conclusion The hospital should strengthen the perioperative management of cardiac surgery,focus on supervising disease types and surgical modalities with high incidence of unplanned reoperation,and strictly implement the system of operation classification and the system of reporting unplanned reoperation to ensure the quality of patient surgery.

Objective:To investigate the correlation between triglyceride-glucose (TyG) index and high on-treatment platelet reactivity (HTPR) during clopidogrel treatment in patients with ischemic stroke.Methods:Patients with ischemic stroke who received maintenance dose of clopidogrel (75 mg/d) in the Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine from January 2017 to March 2021 were retrospectively included. The highest quartile (Q4) of the TyG index was defined as insulin resistance. Platelet reactivity was assessed by thromboelastogram and clopidogrel HTPR was defined as the clot strength induced by adenosine diphosphate (MA ADP) >47 mm. Multivariate regression model was used to analyze the independent correlation between TyG index and platelet reactivity. Results:A total of 83 patients were included. The TyG index showed a linear correlation with MA ADP. The patients were divided into 4 groups according to the quartile of TyG index. The incidence of clopidogrel HTPR increased significantly with the increase of the quartile of the TyG index ( Ptrend=0.017). Multivariate analysis showed that there was a significant independent correlation between insulin resistance and clopidogrel HTPR (odds ratio 4.597, 95% confidence interval 1.285-16.446; P=0.019). Conclusions:In patients with ischemic stroke treated with clopidogrel, the incidence of clopidogrel HTPR gradually increases with the increase of the quartile of the TyG index. The insulin resistance assessed by the TyG index is independently associated with clopidogrel HTPR.

Objective: To investigate the value of stool-based methylated SDC2 test in physical examination population for the screening of colorectal neoplasms. Methods: Using the prospective cohort study method, from December 2020 to November 2021, 2 107 participants from the First People's Hospital of Xiushui County, Jiangxi Province were enrolled, consisted of 1 012 males and 1 094 females, aged 20-90 years with the median age of 49 years old. Fresh stool samples were collected and SDC2 DNA methylation tests were carried out as the primary screening method. The participants with positive results were recommended to undergo colonoscopy, and those who were negative were followed up by telephone. The positive rate of screening, the compliance of colonoscopy, and the detection of colorectal lesions were analyzed by chi-square test. Combined the follow-up results of negative subjects, the value of SDC2 DNA methylation test for the screening of colorectal neoplasms was evaluated. Results: Among the 2 107 participants, 2 106 completed the SDC2 methylation test. 113 participants (5.4%) were positive. The positive rate of primary screening increased with age significantly (χ²=32.135, P<0.001). Out of 113 cases, 72 (63.7%) underwent colonoscopy examinations. Finally, 3 (4.2%) cases of colorectal cancer, 12 (16.7%) cases of advanced adenoma, 31 (43.1%) cases of non-advanced adenoma, and 16 (22.2%) cases of non-adenomatous polyp were detected. The positive predictive value (PPV) of stool-based SDC2 DNA methylation test for intestinal lesions and colorectal neoplasms were 86.1% and 63.9%, respectively. Among the 1 374 follow-up participants, the negative predictive value (NPV) of this test for intestinal lesions and colorectal neoplasms were 97.7% and 99.4%, respectively. Conclusion: Primary stool-based SDC2 DNA methylation test and subsequent colonoscopy examination can effectively find colorectal neoplasms. This strategy may be a potential tool for the screening of colorectal neoplasms in general risk population.
Male ; Female ; Humans ; Middle Aged ; Sensitivity and Specificity ; Prospective Studies ; Early Detection of Cancer/methods* ; Colorectal Neoplasms/diagnosis* ; Mass Screening/methods* ; Feces ; DNA Methylation ; Colonoscopy ; Physical Examination ; Syndecan-2/genetics*

BACKGROUND: The onset and clinical presentation of systemic lupus erythematosus (SLE) are sex-related. Few studies have investigated the distinctions in clinical characteristics and treatment preferences in male and female SLE patients in the initial cohort. This study aimed to improve the understanding of Chinese SLE patients by characterizing the different sexes of SLE patients in the inception cohort. METHODS: Based on the initial patient cohort established by the Chinese SLE Treatment and Research Group, a total of 8713 patients (795 men and 7918 women) with newly diagnosed SLE were enrolled between April 2009 and March 2021. Of these, 2900 patients (347 men and 2553 women) were eligible for lupus nephritis (LN). A cross-sectional analysis of the baseline demographic characteristics, clinical manifestations, laboratory parameters, organ damage, initial treatment regimens, and renal pathology classification was performed according to sex. RESULTS: In the SLE group, as compared to female patients, male patients had a later age of onset (male vs. female: 37.0 ± 15.8 years vs. 35.1 ± 13.7 years, P  = 0.006) and a higher SLE International Collaborative Clinic/American College of Rheumatology damage index score (male vs. female: 0.47 ± 1.13 vs. 0.34 ± 0.81, P  = 0.015), LN (male vs. female: 43.6% vs. 32.2%, P < 0.001), fever (male vs. female: 18.0% vs. 14.6%, P  = 0.010), thrombocytopenia (male vs. female: 21.4% vs. 18.5%, P  = 0.050), serositis (male vs. female: 14.7% vs. 11.7%, P  = 0.013), renal damage (male vs. female: 11.1% vs. 7.4%, P < 0.001), and treatment with cyclophosphamide (CYC) (P < 0.001). The frequency of leukopenia (male vs. female: 20.5% vs. 25.4%, P  = 0.002) and arthritis (male vs. female: 22.0% vs. 29.9%, P < 0.001) was less in male patients with SLE. In LN, no differences were observed in disease duration, SLE Disease Activity Index score, renal biopsy pathological typing, or 24-h urine protein quantification among the sexes. In comparisons with female patients with LN, male patients had later onset ages (P  = 0.026), high serum creatinine (P < 0.001), higher end-stage renal failure rates (P  = 0.002), musculoskeletal damage (P  = 0.023), cardiovascular impairment (P  = 0.009), and CYC use (P  = 0.001); while leukopenia (P  = 0.017), arthritis (P  = 0.014), and mycophenolate usage (P  = 0.013) rates were lower. CONCLUSIONS Male SLE patients had more severe organ damage and a higher LN incidence compared with female SLE patients; therefore, they may require more aggressive initial treatment compared to female patients.
Humans ; Female ; Male ; Cross-Sectional Studies ; Sex Characteristics ; East Asian People ; Severity of Illness Index ; Lupus Erythematosus, Systemic/diagnosis* ; Lupus Nephritis/pathology* ; Registries ; Cyclophosphamide/therapeutic use* ; Thrombocytopenia ; Leukopenia/drug therapy* ; Arthritis

OBJECTIVE: To explore the technique of autogenous bone graft combined with plate fixation in total knee arthroplasty(TKA) with severe proximal medial tibial bone defect. METHODS: From March 2012 to October 2018, 21 patients (9 males and 12 females) with severe bone defects in the proximal medial tibia during primary total knee arthroplasty were treated with autogenous structural bone grafting and steel plate fixation, with an age of 61 to 77 years old with an average of (69.6±9.1) years and a course of 64 to 257 months with an average of (73.6±170.7) months. According to Rand classification, there were 13 cases of type Ⅲb and 8 cases of type Ⅳb. Postoperative complications were observed, and knee joint function was evaluated by the Hospital for Special Surgery (HSS) score and SF-36 quality of life score. RESULTS: All 21 patients were followed up for 37 to 64 months with an average of (49.5±13.7) months. The incisions of all patients healed smoothly, and 2 patients developed lower limb intermuscular venous plexus thrombosis after operation. There were no periprosthetic infection, loosening of prosthesis and other complications. The autogenous bone grafts of all patients achieved bony healing during postoperative X-ray follow-up, and the healing time was 8 to 13 months with an average of (10.1±2.3) months. The HSS score of patients increased significantly from 30 to 48 with an average of (53.4±4.2) before operation to 75 to 92 with an average of (81.2±8.4) at the final follow-up (P<0.05). The SF-36 quality of life score of patients after operation was significantly different from that before operation (P<0.05). CONCLUSION The technique of autogenous bone graft combined with steel plate fixation can achieve satisfactory osseointegration effect in the treatment of severe proximal tibial bone defects in primary knee arthroplasty, with less complications and obvious improvement in knee function.
Male ; Female ; Humans ; Middle Aged ; Aged ; Arthroplasty, Replacement, Knee/methods* ; Tibia/transplantation* ; Bone Transplantation/methods* ; Quality of Life ; Transplantation, Autologous ; Steel

Objective:To analyze the independent risk factors of ulcerative colitis (UC) with thromboembolism (TE), in order to diagnose UC with TE as early as possible and take corresponding preventive measures, so as to improve the prognosis and reduce the mortality of UC with TE.Methods:From January 1, 2011 to December 31, 2020, at the First Affiliated Hospital of Xinjiang Medical University, from January 1, 2015 to December 31, 2020, at the Second Affiliated Hospital of Xinjiang Medical University, from January 1, 2015 to December 31, 2020, at the Fifth Affiliated Hospital of Xinjiang Medical University, during hospitalization 46 patients diagnosed with UC with TE were enrolled. According to the ratio of 1∶2, at same period 92 simple UC patients were selected as control. The condition of embolization of UC patients with TE was analyzed. The clinical data(hypertension history, length of hospital stay, etc.), the degree of disease activity, laboratory test indicators (prothrombin time (PT), D-dimer, fibrin degradation product(FDP), hemoglobin(Hb), mean platelet volume(MPV), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), etc.)of the patients of UC with TE and UC without comorbidities were compared. Multivariate logistic regression was used to analyze the independent risk factors of UC with TE. Independent sample t test, Mann-Whitney U test, Chi-square test or Fisher′s exact probability method were used for statistical analysis. Results:Among the 46 cases of UC with TE, 14 cases (30.4%) had single site venous TE, mainly venous thrombosis of lower limbs; 20 cases (43.5%) had single site arterial TE, mainly myocardial infarction and cerebral infarction; 12 cases (26.1%) had multi-site TE. The proportion of patients with hypertension history and with severe active period of UC, and the levels of D-dimer, FDP, ESR and CRP in patients with UC with TE were all higher than those in patients without comorbidities(52.2%, 24/46 vs.33.7%, 31/92, 45.7%, 21/46 vs.19.6%, 18/92, (822.03±654.33) μg/L vs.(230.28±225.62) μg/L, 5.77 mg/L(6.87 mg/L) vs. 2.10 mg/L(1.55 mg/L), (46.32±28.27) mm/1 h vs.(33.08±24.30) mm/1 h, 22.05 mg/L(46.42 mg/L) vs. 5.58 mg/L(11.58 mg/L)); the hospital stay and PT were longer than those in patients without comorbidities ((12.76±10.18) d vs.(8.66±4.89) d, (14.13±6.06) s vs.(11.86±1.42) s); the Hb and MPV were lower than those in patients without comorbidities ((110.91±31.38) g/L vs.(123.83±27.67) g/L, (9.60±0.94) fL vs.(10.04±1.16) fL; and the differences were statistically significant( χ2=4.37 and 10.29, t=-5.96, Z=-5.78, t=-2.85, Z=-3.87, t=-2.58, -2.50, 2.47 and 2.47; all P<0.05). The results of multivariate logistic regression analysis showed that severe activity period of UC ( OR=3.079, 95% confidence interval (95% CI) 1.100 to 8.615), hypertension history ( OR=4.454, 95% CI 1.467 to 13.519), and D-dimer level( OR=1.003, 95% CI 1.001 to 1.005) were all independent risk factors of UC with TE(all P<0.05). Conclusions:Lower extremity venous, myocardial infarction and cerebral infarction are common in UC with TE. Severe activity period of UC, history of hypertension and D-dimer level are independent risk factors of UC with TE. These above factors should be paid attention to and corresponding prevention should be taken.

To explore the pharmacogenomic markers that affect the platinum-based chemotherapy response in non-small-cell lung carcinoma (NSCLC), we performed a two-cohort of genome-wide association studies (GWAS), including 34 for WES-based and 433 for microarray-based analyses, as well as two independent validation cohorts. After integrating the results of two studies, the genetic variations related to the platinum-based chemotherapy response were further determined by fine-mapping in 838 samples, and their potential functional impact were investigated by eQTL analysis and in vitro cell experiments. We found that a total of 68 variations were significant at P < 1 × 10^-3 in cohort 1 discovery stage, of which 3 SNPs were verified in 262 independent samples. A total of 541 SNPs were significant at P < 1 × 10^-4 in cohort 2 discovery stage, of which 8 SNPs were verified in 347 independent samples. Comparing the validated SNPs in two GWAS, ADCY1 gene was verified in both independent studies. The results of fine-mapping showed that the G allele carriers of ADCY1 rs2280496 and C allele carriers of rs189178649 were more likely to be resistant to platinum-based chemotherapy. In conclusion, our study found that rs2280496 and rs189178649 in ADCY1 gene were associated the sensitivity of platinum-based chemotherapy in NSCLC patients.

Objective:To investigate the expression of low density lipoprotein receptor associated protein 8 (LRP8) in colorectal cancer and its correlation with clinicopathological features.Methods:The surgical specimens of colorectal cancer patients hospitalized in Hunan Provincial People's Hospital from January 1, 2020 to September 1, 2020 (without adjuvant treatment measures such as radiotherapy, chemotherapy and immunotherapy) and 45 corresponding adjacent normal tissues were collected. Immunohistochemistry was used to detect the expression of LRP8 in colorectal cancer and paracancer normal tissues. The relationship between LRP8 and clinical characteristics of colorectal cancer patients was determined by univariate logistic regression analysis and Spearman correlation analysis.Results:Immunohistochemical results showed that LRP8 protein was highly expressed in 37 cases (82.22%) and low expressed in 8 cases (17.78%) of 45 colorectal cancer tissues. LRP8 protein was highly expressed in 17 cases (37.78%) and low expressed in 28 cases (62.22%). The expression of LRP8 protein in colorectal cancer tissues and adjacent normal tissues was significantly different ( P<0.05). Chi-square test showed that LRP8 protein expression was correlated with colorectal cancer stage, perineural invasion, vascular invasion, carcinoembryonic antigen (CEA) and low density lipoprotein (LDL) (all P<0.05), but not correlated with gender, age, tumor differentiation, Ki67, CA199, lymph node metastasis, triglyceride, total cholesterol and high density lipoprotein (all P>0.05). Logistic regression analysis showed that tumor node metastasis (TNM) stage, vascular invasion, nerve invasion, serum CEA and LDL levels were the influencing factors of LRP8 overexpression in patients with colorectal cancer (all P<0.05). There was a weak negative correlation between ApoB and tumor stage ( rs=-0.382), lymph node metastasis ( rs=-0.316) and vascular invasion ( rs=-0.311) (all P<0.05). Conclusions:Our results indicate that there is a higher expression of LRP8 in colorectal cancer tissues. The expression of LRP8 correlates with the staging of the colorectal cancer, neurovascular invasion, CEA, and low density lipoprotein. Patients with high expression of LRP8 have worse tumor stage and are more likely to have concurrent neurologic and vascular invasion.

In this paper， the name， origin， producing area and other aspects of Menthae Haplocalycis Herba in the famous classical formulas were carried out by consulting herbal literature， medical books， prescription books in the past dynasties and related modern documents. Through the textual research， it can be seen that the name of Bohe was used as the correct name in the mainstream of the past dynasties， and there were still multiple synonyms， most of which originated from the false transmission of dialectal accent， producing area and efficacy. There are many varieties recorded in the literature of the past dynasties such as Bohe， Longnao Bohe， Hubohe and Shibohe. According to the textual research， Bohe， Longnao Bohe and Yebohe are consistent with Mentha haplocalyx， whcih is the mainstream variety. Longnao Bohe is named for its form of producing area， Shibohe is Mosla chinensis， Daye Bohe is Agastache rugosa， and Nanbohe is M. crispata. Menthae Haplocalycis Herba has been widely planted since Tang dynasty. It was mainly grown in Jiangsu， Zhejiang， Jiangxi and Sichuan in Ming and Qing dynasties， and Jiangsu is the genuine production area. Its quality is best if it has dry body， no roots， many leaves， green color and strong smell. In ancient times， the stems and leaves of Menthae Haplocalycis Herba were often picked and dried in summer and autumn， which is basically the same as the records of modern times when the stems and leaves are luxuriant in summer and autumn， or when the flowers bloom to three rounds， they are picked in sunny days and cut in different times， and then dried in the sun or in the shade， and the raw products was often used as medicine in ancient and modern times. Before the Song dynasty， Menthae Haplocalycis Herba was recorded as pungent and warm. Until the Song dynasty， it was written as “extremely cool” in Lyuchanyan Bencao. It may have been thought in the early stage that it was similar to several warm herbs， such as Perilla frutescens， Stachys japonica， Elsholtzia ciliata and M. chinensis in appearance， all of which have the function of Xinsan， so it was recorded as warm. Since the Qing dynasty， Menthae Haplocalycis Herba has been recorded as cool property in the mainstream materia medica， Menthae Haplocalycis Herba recorded as pungent and cool in the 2020 edition of Chinese Pharmacopoeia， and its effect is to dissipate wind heat， clear the head， relieve the pharynx and so on， the records of efficacy in ancient and modern times are basically the same. Based on the research results， it is suggested that raw products of M. haplocalyx should be selected when developing the famous classical formulas containing Menthae Haplocalycis Herba.