Comparison of effectiveness of group interventions for depression in women

The purpose of this study was to evaluate the effectiveness of a structured cognitive-behavioral group intervention designed by Verona Gordon to reduce depression in women. An experimental three group pretest and posttest design was used. Women were randomly assigned to the structured and support groups. The structured group was found to be significantly more effective in reducing depression, hopelessness, anxiety, and improving self-esteem than either the support or untreated control groups.     

表没食子儿茶素没食子酸酯对缺血再灌注损伤诱导的大鼠神经细胞凋亡的影响

目的探讨表没食子儿茶素没食子酸酯(EGCG)对缺血再灌注损伤诱导的大鼠神经细胞凋亡、氧化应激的影响及其对长链非编码RNA MALAT1(lncRNA MALAT1)/微小RNA-2115-3p(miR-2115-3p)分子轴的调控作用。方法体外培养大鼠神经元细胞HT22,建立氧糖剥夺/复氧损伤(OGD/R)神经细胞模型,随机分为Con组、OGD/R组、EGCG-L组、EGCG-M组、EGCG-H组、EGCG-H+pcDNA组、EGCG-H+pcDNA-MALAT1组。检测氧化应激指标超氧化物歧化酶(SOD)、丙二醛(MDA)的含量;流式细胞术检测细胞凋亡率;实时荧光定量聚合酶链反应(qRT-PCR)检测MALAT1、miR-2115-3p的表达量;双荧光素酶报告实验验证MALAT1、miR-2115-3p的靶向关系;蛋白免疫印迹法(Western blot)检测B淋巴细胞瘤-2相关蛋白(Bax)、B淋巴细胞瘤-2(Bcl-2)的表达量。结果与Con组比较,OGD/R组SOD含量降低(P<0.05),MDA含量升高(P<0.05),细胞凋亡率升高(P<0.05),Bax蛋白水平升高(P<0.05),Bcl-2蛋白水平降低(P<0.05),MALAT1表达水平升高(P<0.05),miR-2115-3p表达水平降低(P<0.05);与OGD/R组比较,EGCG-L组、EGCG-M组、EGCG-H组SOD含量升高(P<0.05),MDA含量降低(P<0.05),细胞凋亡率降低(P<0.05),Bax蛋白水平降低(P<0.05),Bcl-2蛋白水平升高(P<0.05),MALAT1表达水平降低(P<0.05),miR-2115-3p表达水平升高(P<0.05),且EGCG-L组、EGCG-M组、EGCG-H组各指标比较差异有统计学意义(P<0.05)。双荧光素酶报告实验证实MALAT1可靶向结合miR-2115-3p;MALAT1过表达可减弱EGCG对OGD/R诱导的神经细胞氧化应激及凋亡的作用。结论EGCG可通过调控MALAT1/miR-2115-3p分子轴,从而抑制缺血再灌注损伤诱导的大鼠神经细胞凋亡及减轻其氧化损伤。     

Proteinuria,Body Mass Index,and the Risk of New-Onset Heart Failure: A Prospective Cohort Study in Northern China

Some studies have reported that body-mass index (BMI) and proteinuria are risk factors for heart failure (HF). However, the combined effect of BMI and proteinuria on HF is still unclear. We aimed to investigate the association of BMI and proteinuria levels with the risk of HF in a large community-based population. A total of 61, 113 individuals aged ≥18 years from the prospective Kailuan cohort (recruited during 2006-2007) without preexisting heart failure were included. Each participant was categorized into 4 groups according to BMI (< 25 kg/m² or ≥ 25 kg/m²) and the urine dipstick test results (negative or positive). The primary outcome was HF. We performed multivariable Cox regression analyses to identify the association between BMI and proteinuria category and incident HF. Over a mean follow-up of 9.97±0.75 years, a total of 987 individuals developed incident HF, 1.62 per 1000 person-years. Compared to BMI < 25 kg/m² and absence of proteinuria, the risk of HF was higher for BMI ≥ 25 kg/m² and positive proteinuria (HR 2.630, 95% CI 1.982-3.490, P < 0.0001) (P for trend < 0.0001). Degree of proteinuria in participants was associated with a significantly higher rate of incident HF in dose dependent manner. Compared to consistently negative proteinuria, the risk of HF increased by 75.0% (HR 1.750, 95% CI 1.368-2.239, P < 0.0001) and 127.0% (HR 2.270, 95% CI 1.540-3.347, P < 0.0001) in the proteinuria aggravated group and persistent positive group, respectively. Proteinuria combined with a high BMI level is associated with an increased risk for HF in the Chinese population. However, the mechanism is unknown and awaits further study.     

Outpatient Myocardial Perfusion Imaging Scan for a Low-Risk Chest Pain Cohort From the Emergency Department: A Retrospective Analysis

Chest pain accounts for a significant attendances at emergency departments (ED). We examined the utility of early stress myocardial perfusion imaging (SMPI) for stratification of low-risk patients post-ED discharge. A retrospective audit was conducted of patients with chest pain and normal troponin-T (<30Ng/L), who were discharged with outpatient SMPI (median = 3 days post-ED discharge) between January 2018 to January 2020. 880 patients were included and followed up for 12 months. Outcomes measured were: 1) Cardiac events (CE) within 1 year of visit or 2) Significant coronary artery disease (CAD) - coronary angiography demonstrating ≥70% stenosis of epicardial vessels or coronary revascularization procedures performed. In the SMPI negative group, 2 of 802 patients (0.25%) had significant CEs and 11 patients (1.37%) were diagnosed with significant CAD. Of the 78 SMPI positive patients, 1 (1.28%) had a significant CE, while 24 had significant CAD. SMPI had a sensitivity of 65.8%, specificity of 93.7%, positive predictive value of 32.1% and a negative predictive value of 98.4% for predicting adverse CE. Early SMPI post-ED discharge demonstrated high negative predictive value in predicting CEs or significant CAD diagnosis at up to 1 year, suggesting that low-risk patients discharge from ED with early outpatient SMPI is a safe management option.     

益肠汤对腹腔镜胆囊切除术后胃肠功能的作用

目的：观察益肠汤对腹腔镜胆囊切除术后胃肠道功能恢复的疗效。方法：将168例患者随机分为两组,对照组术后行常规治疗,研究组术后在常规治疗的基础上,术后6h起服用益肠汤煎剂。观察两组患者排气、排便时间、肠鸣音恢复时间及术后血浆胃动素水平的变化情况。结果：研究组在肠鸣音恢复时间,首次排气、排便时间均显著优于对照组,血浆胃动素水平在术后24h、48h比较有明显统计学差异（P〈0.01）,术后0h、72h比较,无明显统计学意义。结论：益肠汤可增强胃排空和小肠推进作用,使血浆胃动素含量在术后早期明显提高,并持续在较高水平,有利于胃肠功能的尽早恢复,降低了术后并发症的发生。     

Association of Combined Healthy Lifestyles With Cardiovascular Disease and Mortality of Patients With Diabetes: An International Multicohort Study

ObjectiveTo prospectively examine the associations of combined lifestyle factors with incident cardiovascular disease (CVD) and mortality in patients with diabetes.Patients and MethodsPatients with prevalent diabetes were included from 5 prospective, population-based cohorts in China (Dongfeng-Tongji cohort and Kailuan study), the United Kingdom (UK Biobank study), and the United States (National Health and Nutrition Examination Survey and National Institutes of Health–AARP Diet and Health Study). Healthy lifestyle scores were constructed according to non–current smoking, low to moderate alcohol drinking, regular physical activity, healthy diet, and optimal body weight; the healthy level of each lifestyle factor was assigned 1 point, or 0 for otherwise, and the range of the score was 0 to 5. Cox proportional hazards models were used to estimate hazard ratios for incident CVD, CVD mortality, and all-cause mortality adjusting for sociodemographic, medical, and diabetes-related factors, and outcomes were obtained by linkage to medical records and death registries. Data were collected from October 18, 1988, to September 30, 2020.ResultsA total of 6945 incident CVD cases were documented in 41,350 participants without CVD at baseline from the 2 Chinese cohorts and the UK Biobank during 389,330 person-years of follow-up, and 40,353 deaths were documented in 101,219 participants from all 5 cohorts during 1,238,391 person-years of follow-up. Adjusted hazard ratios (95% CIs) comparing patients with 4 or 5 vs 0 or 1 healthy lifestyle factors were 0.67 (0.60 to 0.74) for incident CVD, 0.58 (0.50 to 0.68) for CVD mortality, and 0.60 (0.53 to 0.68) for all-cause mortality. Findings remained consistent across different cohorts, subgroups, and sensitivity analyses.ConclusionThe international analyses document that adherence to multicomponent healthy lifestyles is associated with lower risk of CVD and premature death of patients with diabetes.     

Spiked Helmet Electrocardiographic Sign-A Systematic Review of Case Reports

First reported in 2011, the spiked helmet sign (SHS) is an electrocardiographic pattern of ST-segment elevation anecdotally associated with poor prognosis. This study aims to systematically evaluate the electrocardiographic characteristics, clinical presentations, and outcomes of all cases of SHS reported in the literature. PubMed, Scopus, Web of Science, and EMBASE were searched electronically from their inception until November 2022. The Joanna Briggs Institute Critical Appraisal Checklist for Case Reports was used to critically appraise included studies. Studies written in English describing at least one patient with SHS were included. Altogether, 26 case reports or series describing 39 patients with SHS were included. All included studies were rated of acceptable quality. Associated conditions were heterogeneous, with intracranial hemorrhagic complications being the most common (9 patients), followed by pneumothorax (6 patients) or severe pneumonia (4 patients), bowel ischemia or obstruction (6 patients), and autonomic dysfunction (3 patients with Takotsubo cardiomyopathy and 3 patients with spinal injury, cocaine overuse, and stellate gangliectomy). Two patients had multiple complications and 12 other patients suffered from sepsis, myocardial infarction, etc. Clinical outcomes were reported for 32 patients, of whom 19 (59%) died during hospitalization (6 patients with pneumothorax or pneumonia, 4 patients with intracranial hemorrhagic complications, 2 patients with bowel ischemia or obstruction, and 7 patients due to other reasons). SHS may be associated with poor prognosis, necessitating its prompt recognition by clinicians and swift evaluation for underlying causes. Larger studies are needed to elucidate its prevalence, clinical implications, and precipitating mechanisms.     

Effect of body mass index trajectory on lifetime risk of cardiovascular disease in a Chinese population: A cohort study

Background and aimsThe longitudinal trajectories of body mass index (BMI) can reflect the pattern of BMI changes. Lifetime risk quantifies the cumulative risk of developing a disease over the remaining life of a person. We aimed to identify the trajectory of BMI and explore its association with cardiovascular disease (CVD) in the Chinese population.Methods and resultsA total of 68,603 participants with a mean age of 55.46 years were included from the Kailuan cohort in Tangshan, China, who were free of CVD and cancer and with repeated measurements of BMI from 2006 to 2010. A latent mixture model was used to identify BMI trajectories. An improved Kaplan-Meier estimator was used to predict the lifetime risk of CVD according to BMI trajectories. During a median follow-up of 7.0 years, 3325 participants developed CVD. Five BMI trajectories were identified at three index ages (35, 45, and 55) respectively. For index age 35 years, compared with the stable low-normal weight group (22.7% [95% CI, 20.0%–25.4%]), the stable high-normal weight (27.6% [25.6%–29.5%]), stable overweight (29.4% [27.4%–31.4%]), stable-low obesity (32.8% [30.0%–35.5%]), and stable-high obesity (38.9% [33.3%–44.5%]) groups had a higher lifetime risk of CVD (P < 0.05). We observed similar patterns for stroke and myocardial infarction. Similarly, the lifetime risk of CVD was higher in the long-term overweight and obese groups at 45 and 55 index ages.ConclusionsLong-term overweight and obesity were associated with an increased lifetime risk of CVD. Our findings could assist in predicting the population burden of CVD.