Negative association of time in range and urinary albumin excretion rate in patients with type 2 diabetes mellitus: a retrospective study of inpatients

Background: Time in range (TIR) refers to the time an individual spends within their target glucose range, which now has been popularized as an important metric to classify glycemic management and also recognized as an important outcome of current diabetes therapies. This study aimed to investigate the association between TIR and the severity of the urinary albumin excretion rate (UAER) in patients with type 2 diabetes mellitus (T2DM).Methods: We retrospectively analyzed the data of 1014 inpatie...     

Diagnostic value of aldosterone to renin ratio calculated by plasma renin activity or plasma renin concentration in primary aldosteronism: a meta-analysis

Background: Since the diagnostic value of aldosterone to renin ratio (ARR) calculated by plasma renin concentration (PRC) or plasma renin activity (PRA) is still inconclusive, we conducted a meta-analysis by systematically reviewing relevant literature to explore the difference in the diagnostic efficacy of ARR calculated by PRC or PRA, so as to provide guidance for clinical diagnosis.Methods: We searched PubMed, Embase, and Cochrane Library from the establishment of the database to March 2021. ...     

Comparison of the effectiveness and pregnancy outcomes of labor induction with dinoprostone or single-balloon catheter in term nulliparous women with borderline oligohydramnios

Backgrounds: At present, there is no consensus on the induction methods in term pregnancy with borderline oligohydramnios. This study aimed to compare the effectiveness and pregnancy outcomes of labor induction with dinoprostone or single-balloon catheter (SBC) in term nulliparous women with borderline oligohydramnios.Methods: We conducted a retrospective cohort study from January 2016 to November 2018. During the study period, a total of 244 cases were enrolled. Of these, 103 cases were selecte...     

Risk of infections of biological and targeted drugs in patients with spondyloarthritis: meta-analysis of randomized clinical trials

Background: Concerns exist regarding the risk of infections in patients with spondyloarthritis (SpA) treated with biologics. We assessed the risk of infections of biological and targeted drugs in patients with SpA by performing a meta-analysis based on randomized controlled trials (RCTs).Methods: A systematic literature search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, and China Biology Medicine Disc for RCTs evaluating the risk of infections of biological therapy in ...     

Discharge heart rate and 1-year clinical outcomes in heart failure patients with atrial fibrillation

Background: The association between heart rate and 1-year clinical outcomes in heart failure (HF) patients with atrial fibrillation (AF), and whether this association depends on left ventricular ejection fraction (LVEF), are unclear. We investigated the relationship between discharge heart rate and 1-year clinical outcomes after discharge among hospitalized HF patients with AF, and further explored this association that differ by LVEF level.Methods: In this analysis, we enrolled 1760 hospitalize...     

Predictive value of hypothermic machine perfusion parameters combined perfusate biomarkers in deceased donor kidney transplantation

Background: Delayed graft function (DGF) is the main cause of renal function failure after kidney transplantation. This study aims at investigating the value of hypothermic machine perfusion (HMP) parameters combined with perfusate biomarkers on predicting DGF and the time of renal function recovery after deceased donor (DD) kidney transplantation.Methods: HMP parameters, perfusate biomarkers and baseline characteristics of 113 DD kidney transplantations from January 1, 2019 to August 31, 2019 i...     

Associations between cancer family history and esophageal cancer and precancerous lesions in high-risk areas of China

Background: Family clustering of esophageal cancer (EC) has been found in high-risk areas of China. However, the relationships between cancer family history and esophageal cancer and precancerous lesions (ECPL) have not been comprehensively reported in recent years. This study aimed to provide evidence for identification of high-risk populations.Methods: This study was conducted in five high-risk areas in China from 2017 to 2019, based on the National Cohort of Esophageal Cancer. The permanent r...     

胎儿侧脑室和（或）后颅窝池增宽影像学评价与致病性拷贝数变异的差异

目的：探讨胎儿侧脑室增大（VM）和（或）后颅窝池增宽（PCFCE）影像学评价与致病性拷贝数变异（CNVs）的差异。方法：收集2015 年1月至2020 年10月温州医科大学附属第二医院育英儿童医院及玉环市人民医院经产前超声诊断为胎儿VM和（或）PCFCE共1 114例,其中468例胎儿行MRI及染色体核型分析（16～24 周羊水检测317 例,24～38 周脐血检测151例）,染色体核型正常胎儿440 例行全基因组高分辨染色体微阵列分析（CMA）检测,分析胎儿VM和（或）PCFCE程度与各系统畸形及CNVs的差异,评估妊娠结局。结果：①468例胎儿中,染色体核型异常发生率为5.98%（28/468）,其中数目异常11例,结构异常10,数目+结构异常7例,28例均引产;440例染色体核型正常胎儿中,致病性CNVs发生率为8.41%（37/440）。②440例染色体核型正常胎儿中,重度VM和（或）PCFCE组致病性CNVs发生率高于轻中度组（13.71% vs. 6.33%,P =0.012）;三组间致病性CNVs发生率比较为VM+PCFCE＞单纯PCFCE＞单纯VM（12.14% vs. 11.69% vs. 4.93%,P =0.029）。③37例致病性CNVs胎儿中,并发中枢神经系统畸形5例,泌尿生殖系统4例,心脏大血管畸形5例,消化系统畸形2例。④重度VM和（或）PCFCE组胎儿畸形发生率高于轻中度组（7.26% vs. 2.22%,P =0.020）;37例致病性CNVs胎儿中,引产23例,分娩14例。结论：重度VM和（或）PCFCE组发生致病性CNVs及胎儿畸形率较高, VM+PCFCE组致病性CNVs高于单纯VM或PCFCE组;精准的影像学评估有助于VM和（或）PCFCE胎儿的宫内转归、临床评估和遗传咨询。     

Risk factors for intracranial hemorrhage and mortality in adult patients with severe respiratory failure managed using veno-venous extracorporeal membrane oxygenation

Background: Intracerebral hemorrhage (ICH) is one of the most severe complications during veno-venous extracorporeal membrane oxygenation (VV-ECMO). This study aimed to determine the risk factors for ICH and mortality in such patients.Methods: We analyzed the clinical data of 77 patients who received VV-ECMO due to severe respiratory failure from July 2013 to May 2019 at China-Japan Friendship Hospital. Demographical data, laboratory indices, imaging characteristics, and other clinical informati...     

Independent and joint association of physical activity and sedentary behavior on all-cause mortality

Backgrounds:Physical activity (PA) and sedentary behavior (SB) have been associated with mortality, while the joint association with mortality is rarely reported among Chinese population. We aimed to examine the independent and joint association of PA and SB with all-cause mortality in southern China.Methods:A cohort of 12,608 China Hypertension Survey participants aged ≥35 years were enrolled in 2013 to 2014, with a follow-up period of 5.4 years. Baseline self-reported PA and SB were collected via the questionnaire. Kaplan–Meier curves (log-rank test) and Cox proportional hazards regression were performed to evaluate the associations of PA and SB on all-cause mortality.Results:A total of 11,744 eligible participants were included in the analysis. Over an average of 5.4 years of follow-up, 796 deaths occurred. The risk of all-cause mortality was lower among participants with high PA than those with low to moderate level (5.2% vs. 8.9%; hazards ratio [HR]: 0.75, 95% confidence interval [CI]: 0.61–0.87). Participants with SB ≥ 6 h had a higher risk of all-cause mortality than those with SB <6 h (7.8% vs. 6.0%; HR: 1.37, 95% CI: 1.17–1.61). Participants with prolonged SB (≥6 h) and inadequate PA (low to moderate) had a higher risk of all-cause mortality compared to those with SB < 6 h and high PA (11.2% vs. 4.9%; HR: 1.67, 95% CI: 1.35–2.06). Even in the participants with high PA, prolonged SB (≥6 h) was still associated with the higher risk of all-cause mortality compared with SB < 6 h (7.0% vs. 4.9%; HR: 1.33, 95% CI: 1.12–1.56).Conclusions:Among Chinese population, PA and SB have a joint association with the risk of all-cause mortality. Participants with inadequate PA and prolonged SB had the highest risk of all-cause mortality compared with others.     

妊娠中期鼻骨发育异常胎儿的染色体检测结果及相关因素分析

背景　胎儿鼻骨发育情况评估作为常规产前超声检查项目，是胎儿染色体检查的重要指标，近几年染色体微阵列分析技术（CMA）的应用使得产前胎儿染色体疾病的检查范围更广、准确度更高，在此基础上有必要对鼻骨发育异常和染色体异常之间的相关性重新进行总结，为临床提供参考。目的　探讨胎儿鼻骨发育异常或与其他产前筛查高危因素结合在预测胎儿染色体异常中的价值，以及CMA在胎儿鼻骨发育异常遗传学检测中的应用价值。方法　选取2016年12月-2020年1月于内蒙古自治区妇幼保健院进行产前超声检查并提示胎儿鼻骨缺失或发育不良的92例孕妇及胎儿为研究对象。收集其产检信息、遗传学检测结果及妊娠结局。遗传学检测方法包括染色体核型分析和CMA。结果　染色体核型分析检出染色体异常19例（20.7%），均为21-三体；CMA检出染色体异常25例（27.2%），包括21-三体19例，染色体微缺失微重复6例。孤立性与非孤立性鼻骨发育异常胎儿染色体异常发生率比较，差异无统计学意义（P>0.05）。与单纯孤立性鼻骨发育异常胎儿相比，孤立性鼻骨发育异常+颈项透明层（NT）增厚、孤立性鼻骨发育异常+血清学筛查（MSS）高风险、孤立性鼻骨发育异常+无创产前筛查（NIPT）高风险、孤立性鼻骨发育异常+2种及以上产前筛查高危因素胎儿染色体异常发生率均升高（P<0.05）。结论　鼻骨缺失或发育不良的胎儿染色体异常发生率较高，且与基因组变异有关；染色体核型分析、CMA结合其他产前筛查高危因素将有效提高染色体异常的检出率。CMA的应用为产前诊断提供了更多的染色体变异信息，建议所有类型的胎儿鼻骨缺失或发育不良进行染色体核型分析与CMA结合的遗传学检测。     

Delivery room resuscitation and short-term outcomes of extremely preterm and extremely low birth weight infants: a multicenter survey in North China

Background:Delivery room resuscitation assists preterm infants, especially extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI), in breathing support, while it potentially exerts a negative impact on the lungs and outcomes of preterm infants. This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China.Methods:The clinical data of EPI (gestational age [GA] <28 weeks) and ELBWI (birth weight [BW] <1000 g), admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018, were analyzed. The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation (DRI). The secondary outcomes were survival rates, incidence of bronchopulmonary dysplasia (BPD), and risk factors for BPD.Results:A cohort of 952 preterm infants were enrolled. The incidence of DRI, chest compressions, and administration of epinephrine was 55.9% (532/952), 12.5% (119/952), and 7.0% (67/952), respectively. Multivariate analysis revealed that the risk factors for DRI were GA <28 weeks (odds ratio [OR], 3.147; 95% confidence interval [CI], 2.082–4.755), BW <1000 g (OR, 2.240; 95% CI, 1.606–3.125), and antepartum infection (OR, 1.429; 95% CI, 1.044–1.956). The survival rate was 65.9% (627/952) and was dependent on GA. The rate of BPD was 29.3% (181/627). Multivariate analysis showed that the risk factors for BPD were male (OR, 1.603; 95% CI, 1.061–2.424), DRI (OR, 2.094; 95% CI, 1.328–3.303), respiratory distress syndrome exposed to ≥2 doses of pulmonary surfactants (PS; OR, 2.700; 95% CI, 1.679–4.343), and mechanical ventilation ≥7 days (OR, 4.358; 95% CI, 2.777–6.837). However, a larger BW (OR, 0.998; 95% CI, 0.996–0.999), antenatal steroid (OR, 0.577; 95% CI, 0.379–0.880), and PS use in the delivery room (OR, 0.273; 95% CI, 0.160–0.467) were preventive factors for BPD (all P < 0.05).Conclusion:Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.     

Physical activity and sedentary behaviour of ambulatory older adults in a developed Asian community: a cross-sectional study

INTRODUCTION:Physical activity (PA) and sedentary behaviour (SB) independently influence the health outcomes of older adults. Both provide interventional opportunities for successful ageing. We aimed to determine levels of PA and SB in ambulatory older adults and their associated factors in a developed Asian population known for its longevity.METHODS:We conducted a cross-sectional observational study in a Singapore public primary healthcare centre. Multi-ethnic Asian adults aged ≥ 60 years took an interviewer-administered questionnaire survey. PA and SB were assessed using the Physical Activity Scale for the Elderly (PASE; score range 0 to > 400) and the Sedentary Behaviour Questionnaire for the Elderly, respectively.RESULTS:Among 397 participants (50.9% female; 73.2% Chinese; 47.9% aged ≥ 70 years; 33.5% employed, including voluntary work), 58.7% had ≥ 3 chronic illnesses and 11.1% required walking aids. The median PASE score was 110.8 (interquartile range 73.8–171.6) and decreased significantly with increasing age. Higher PASE score was associated with higher educational level, employment, independent ambulation without aid, and fewer chronic illnesses (p < 0.01). Employment status significantly influenced PASE score (β = 84.9, 95% confidence interval [CI] 66.5–103.4; p < 0.01). 37.0% spent ≥ 8 hours daily on sedentary activity and were twice as likely to do so if they were employed (odds ratio 2.19, 95% CI 1.34–3.59; p < 0.01).CONCLUSION:The PA of the older adults decreased with increasing age and increased with employment. One-third of them were sedentary for ≥ 8 hours daily. Those who were employed were twice as likely to have SB.     

Effect of Glutamine Enriched Nutrition Support on Surgical Patients with Gastrointestinal Tumor: A Meta-Analysis of Randomized Controlled Trials

Background:Associations between glutamine (Gln) enriched nutrition support and surgical patients with gastrointestinal (GI) tumor remain controversy.The purpose of this meta-analysis was to assess the ...     

Hemodynamic effects of different fluid volumes for a fluid challenge in septic shock patients

Background: It is still unclear what the minimal infusion volume is to effectively predict fluid responsiveness. This study was designed to explore the minimal infusion volume to effectively predict fluid responsiveness in septic shock patients. Hemodynamic effects of fluid administration on arterial load were observed and added values of effective arterial elastance (Ea) in fluid resuscitation were assessed.Methods: Intensive care unit septic shock patients with indwelling pulmonary artery cath...     

Long-term outcomes and independent predictors of mortality in patients presenting to emergency departments with acute heart failure in Beijing: a multicenter cohort study with a 5-year follow-up

Background:Acute heart failure (AHF) is the most common disease in emergency departments (EDs). However, clinical data exploring the outcomes of patients presenting AHF in EDs are limited, especially the long-term outcomes. The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors.Methods:This prospective, multicenter, cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1, 2011 and September 23, 2012. Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors.Results:The 5-year mortality and cardiovascular death rates were 55.4% and 49.6%, respectively. The median overall survival was 34 months. Independent predictors of 5-year mortality were patient age (hazard ratio [HR]: 1.027, 95 confidence interval [CI]: 1.023–1.030), body mass index (BMI) (HR: 0.971, 95% CI: 0.958–0.983), fatigue (HR: 1.127, 95% CI: 1.009–1.258), ascites (HR: 1.190, 95% CI: 1.057–1.340), hepatic jugular reflux (HR: 1.339, 95% CI: 1.140–1.572), New York Heart Association (NYHA) class III to IV (HR: 1.511, 95% CI: 1.291–1.769), heart rate (HR: 1.003, 95% CI: 1.001–1.005), diastolic blood pressure (DBP) (HR: 0.996, 95% CI: 0.993–0.999), blood urea nitrogen (BUN) (HR: 1.014, 95% CI: 1.008–1.020), B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in the third (HR: 1.426, 95% CI: 1.220–1.668) or fourth quartile (HR: 1.437, 95% CI: 1.223–1.690), serum sodium (HR: 0.980, 95% CI: 0.972–0.988), serum albumin (HR: 0.981, 95% CI: 0.971–0.992), ischemic heart diseases (HR: 1.195, 95% CI: 1.073–1.331), primary cardiomyopathy (HR: 1.382, 95% CI: 1.183–1.614), diabetes (HR: 1.118, 95% CI: 1.010–1.237), stroke (HR: 1.252, 95% CI: 1.121–1.397), and the use of diuretics (HR: 0.714, 95% CI: 0.626–0.814), β-blockers (HR: 0.673, 95% CI: 0.588–0.769), angiotensin-converting enzyme inhibitors (ACEIs) (HR: 0.714, 95% CI: 0.604–0.845), angiotensin-II receptor blockers (ARBs) (HR: 0.790, 95% CI: 0.646–0.965), spironolactone (HR: 0.814, 95% CI: 0.663–0.999), calcium antagonists (HR: 0.624, 95% CI: 0.531–0.733), nitrates (HR: 0.715, 95% CI: 0.631–0.811), and digoxin (HR: 0.579, 95% CI: 0.465–0.721).Conclusions:The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF. Age, BMI, fatigue, ascites, hepatic jugular reflux, NYHA class III to IV, heart rate, DBP, BUN, BNP/NT-proBNP level in the third or fourth quartile, serum sodium, serum albumin, ischemic heart diseases, primary cardiomyopathy, diabetes, stroke, and the use of diuretics, β-blockers, ACEIs, ARBs, spironolactone, calcium antagonists, nitrates, and digoxin were independently associated with 5-year all-cause mortality.     

膝骨关节炎MSCT、MRI的影像学特征及联合应用的诊断价值

目的 探讨膝骨关节炎多层螺旋计算机断层扫描（MSCT）、磁共振成像（MRI）的影像学特征，分析两者联合诊断的效能。方法 回顾性分析2017年1月—2018年3月北京市和平里医院接收的疑似膝骨关节炎受检者78例的临床资料，分别实施MSCT、MRI检查。所有受试者行关节镜检查明确膝骨关节炎的发生情况，将其作为“金标准”。总结MSCT、MRI的影像学表现，绘制受试者工作特征（ROC）曲线，分析不同方法的诊断效能。结果 全组受试者中共有102膝确诊为膝骨关节炎，MSCT、MRI诊断该病均有典型的特征；MSCT、MRI、两者联合诊断膝骨关节炎的敏感性分别为86.27%（95% CI：0.786，0.897）、95.10%（95% CI：0.824，0.959）、98.04%（95% CI：0.855，0.987）；特异性分别为77.78%（95% CI：0.712，0.798）、90.74%（95% CI：0.866，0.913）、98.15%（95% CI：0.890，0.985）；准确性分别为83.33%、93.89%、98.08%；AUC分别为0.712（95% CI：0.502，0.851）、0.806（95% CI：0.671，0.855）、0.913（95% CI：0.782，0.974）（P <0.05）。联合诊断的敏感性、特异性、准确性和AUC均高于单独诊断。结论 MSCT、MRI诊断膝骨关节炎有典型的影像学特征，且两者联合诊断的效能更佳。     

染色体微阵列分析方法诊断侧脑室增宽胎儿的临床价值

目的探讨染色体微阵列分析（CMA）在侧脑室增宽胎儿中遗传病因诊断的临床应用价值。方法回顾性分析2014年1月 ~2016年12月因超声提示“胎儿侧脑室增宽”于南方医科大学南方医院产前诊断中心同时行常规核型分析和CMA芯片检测109 例单胎妊娠孕妇。比较侧脑室增宽胎儿核型分析和CMA芯片的染色体异常检出率。结果（1）核型分析的异常检出率为 12.84%;CMA芯片的异常检出率为26.60%;两种检测的异常检出率比较,差异有统计学意义（P=0.011）,核型分析结合CMA芯 片的异常检出率为28.44%,核型分析结合CMA芯片能有效提高异常检出率。（2）17例侧脑室增宽胎儿中,核型分析显示正常而 CMA芯片显示异常,额外异常检出率为15.60%。其中微缺失6例、微重复9例、微缺失合并微重复1例,单亲二倍体杂合缺失1 例。结论CMA技术可敏感检出侧脑室增宽胎儿的染色体拷贝数异常,提高异常检出率,有利于侧脑室增宽胎儿的产前咨询和 预后评估。     

胎儿侧脑室增宽的妊娠结局和预后的回顾性队列研究

  目的  评价胎儿侧脑室增宽（ventriculomegaly, VM）的妊娠结局和胎儿神经发育等预后。  方法  采用回顾性队列研究纳入2011年3月–2020年9月四川大学华西第二医院住院收治的所有超声诊断的VM胎儿,采用随机数字表选取同时期的非VM胎儿作为对照组,比较两组间的妊娠结局及胎儿出生后的神经发育等预后情况。  结果  VM组的活产率77.63%（229/295）,对照组活产率94.31%（265/281）,VM组胎儿的活产率低于对照组（P<0.001）,且VM组胎儿出生后转新生儿科监护观察的比例高于对照组〔 20.96%（48/229） vs. 4.53% （12/265）,P<0.001〕。随访中VM组胎儿出现神经发育异常率高于对照组〔 11.79%（27/229） vs. 1.90% （5/265）,P<0.001〕,且VM胎儿出生后的神经发育异常与侧脑室增宽的分度（P=0.010）、VM宫内进展（P=0.024）、出生后头颅超声是否提示VM（P=0.001）有关,且出生后头颅超声提示VM是神经发育异常的独立危险因素（OR=9.434, 95% CI: 1.791～49.688, P=0.008）。  结论  VM降低了胎儿活产率,且可能增加胎儿出生后发生神经发育异常的风险。所有VM出生后均应严密随访神经发育等情况,尤其是重度VM、出现宫内进展、出生后头颅超声结果仍提示VM者。