Lifetime risk of cardiovascular disease and life expectancy with and without cardiovascular disease according to changes in metabolic syndrome status

Background and aimsThe relationship between dynamic changes in metabolic syndrome (MetS) status and lifetime risk of cardiovascular disease (CVD) has not been reliably quantified. This study aimed to estimate lifetime risk of CVD and life expectancy with and without CVD according to dynamic MetS status.Methods and ResultsDynamic changes in MetS status were assessed: MetS-free, MetS-chronic, MetS-developed, and MetS-recovery groups. We used Modified Kaplan–Meier method to estimate lifetime risk and used multistate life table method to calculate life expectancy. Participants free of CVD at index ages 35 (n = 40 168), 45 (n = 33 569), and 55 (n = 18 546) years. At index age 35 years, we recorded 1341 CVD events during a median follow-up of 6.1 years. Lifetime risk of 33.9% (95% CI: 26.9%–41.0%) in MetS-recovery group was lower than that of 39.4% (95% CI: 36.1%–42.8%) in MetS-chronic group. Lifetime risk of 37.8% (95% CI: 30.6%–45.1%) in MetS-developed group was higher than that of 26.4% (95% CI: 22.7%–30.0%) in MetS-free group. At index age 35 years, life expectancy free of CVD for MetS-recovery group (44.1 years) was higher than that for MetS-chronic group (38.8 years). Life expectancy free of CVD for MetS-developed group (41.9 years) was lower than that for MetS-free group (46.7 years).ConclusionsRecovery from MetS was associated with decreased lifetime risk of CVD and a longer life expectancy free of CVD, whereas development of MetS was associated with increased lifetime risk of CVD and a shorter life expectancy free of CVD.     

Very low maternal lead level in pregnancy and birth outcomes in an eastern Massachusetts population

PurposeMaternal lead exposure is associated with poor birth outcomes in populations with moderate to high blood levels. However, no studies have looked at exposure levels commonly experienced by US women.MethodsWe evaluated the relationship between maternal red blood cell (RBC) lead levels in midpregnancy and birth outcomes in 949 mother–child pairs in a prebirth cohort. We used multiple linear regression and logistic regression, adjusted for potential confounders including maternal age, race, prepregnancy body mass index, and smoking to relate maternal lead to infant birth size and risk for preterm birth (<37 weeks).ResultsMean RBC lead level was 1.2 μg/dL (range, 0.0–5.0). Mean (standard deviation) birthweight was 3505 (520) g, birthweight for gestational age z-score 0.22 (0.93), and length of gestation 39.5 (1.7) weeks. Mothers in the highest versus lowest lead quartile did not have higher odds (OR, 1.85; 95% confidence interval [CI], 0.79–4.34) of preterm delivery; after stratifying by child sex, there was an association among males (OR, 5.51; 95% CI, 1.21–25.15) but not females (OR, 0.82; 95% CI, 0.24–2.85). Maternal RBC lead was not associated with any continuous outcomes in combined or sex-stratified analyses.ConclusionsMaternal lead exposure, even at very low levels, may adversely affect some childbirth outcomes, particularly preterm birth among males.     

SARS病毒感染相关免疫损伤分子机制和干预药物的生物信息学预测及其对COVID-19的意义

目的:通过对SARS病毒转录组数据进行临床生物信息学分析,探讨免疫损伤组学机制,预测针对性治疗药物,并为COVID-19的临床治疗提供参考。方法:收集公共基因表达数据库(Gene Expression Omnibus,GEO)中的SARS病毒转录组数据并筛选差异基因,应用富集分析、蛋白质相互作用分析探讨SARS病毒感染相关免疫损伤机制,并应用表观精准治疗平台预测潜在治疗药物。结果:SARS病毒感染相关免疫损伤机制复杂,包括通过Toll样受体等信号通路影响免疫细胞的功能、通过Th17信号通路诱导血浆细胞因子水平升高,以及通过IL-6、NF-κB、TNF等分子生成自身抗体介导自身免疫应答等。川穹、益赛普等药物可能对SARS病毒感染相关免疫损伤具有治疗作用。结论:SARS病毒能够引起大量免疫相关分子及信号通路的异常,川穹、益赛普等药物可能对SARS病毒感染相关免疫损伤具有治疗作用。本研究可为COVID-19的临床治疗提供参考。     

非常规前折叠素 RPB5相互作用蛋白的生物学功能及其在肝癌中的研究进展

非常规前折叠素 RPB5相互作用蛋白( URI)是不依赖腺苷三磷酸( ATP)的分子伴侣复合体,在细胞增殖、分化、细胞周期调控、肿瘤及恶质病等生理和病理过程发挥着重要的调控作用。越来越多的研究指出 URI在肿瘤疾病的发生发展、诊断、治疗和预后中发挥重要作用,可能是肿瘤疾病潜在的诊断、预后标志物和治疗靶标。该研究主要对 URI的结构特点、生理病理学功能和其对肝细胞癌发生发展调控机制方面的研究进展进行综述,探讨 URI在肝细胞癌中的研究价值。     

Dural plasmacytoma as the initial presentation of multiple myeloma: A case report and review of the literature

Dural plasmacytoma is a type of multiple myeloma of the central nervous system. Our patient presented with symptoms of headache. Imaging findings suspected glioblastoma, whereas pathological findings revealed mucosa-associated lymphoid tissue lymphoma associating with plasma cell differentiation. Further in-depth studies confirmed a diagnosis of dural plasmacytoma. This case indicates that morphological variations may occur in the extramedullary involvement of CD20-positive multiple myeloma. The multidisciplinary team contributes to the diagnosis of hematological diseases.     

Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer

Introduction: Esophageal cancer is the fourth most common cause of cancer death in China. Patients with esophageal cancer are more likely to suffer from malnutrition. The purpose of this study is to assess nutritional status of patients with esophageal cancer from multiple perspectives and analyze the risk factors. Methods: A total of 1482 esophageal cancer patients were enrolled in the study. We investigated the Scored Patient Generated Subjective Global Assessment (PG-SGA) scores, NRS-2002 scores, Karnofsky performance status scores, anthropometric, and laboratory indicators of patients. Unconditional logistic regression analysis was applied to identify the risk factors of nutritional status. Results: PG-SGA (≥4) and NRS-2002 (≥3) showed the incidence of malnutrition were 76% and 50%, respectively. In the patients with PG-SGA score ≥4, the proportion of patients who did not receive any nutritional support was 60%. The incidence of malnutrition in females was significantly higher than that in males. Besides, abnormality rates of Red blood cell (P < 0.001), MAC (P = 0.037), and MAMC (P < 0.001) in males was significantly higher than that in females, while abnormality rates of TSF (P < 0.001) was lower than that in females. After adjusted with the other potential risk factors listed, unconditional logistic regression analysis indicated smoking (odds ratio: 2.868, 95% confidence interval: 1.660-4.954), drinking (OR: 1.726, 95% CI: 1.099-2.712), family history (OR: 1.840, 95% CI: 1.132-2.992), radiotherapy or chemotherapy (OR: 1.594, 95% CI: 1.065-2.387), and pathological stage (OR: 2.263, 95% CI: 1.084-4.726) might be the risk factors of nutritional status, while nutritional support can reduce the risk of malnutrition. Conclusion: Effective nutritional risk assessment methods and nutritional intervention measures can be adopted according to the research data to improve quality of life of esophageal cancer patients.     

A fatal case of pneumonia and sepsis caused by sequence type 398 methicillin-susceptible Staphylococcus aureus carrying Pantone-Valentine leukocidin in China

Staphylococcus aureus (S. aureus) sequence type 398 (ST398) has aroused great concern for its spread throughout the world. ST398 community-acquired MRSA (CA-MRSA) has been given greater emphasis because of its high virulence and high probability of treatment failure. Herein, A 22-year-old male was admitted to our hospital with a history of fever, chest pain and dyspnea for 2 days. A chest CT scan showed infiltrative and nodular shadows. The sequence type of the isolates from blood culture was ST398, the virulence genes detected was PVL gene (lukS-PV and lukF-PV). Despite resuscitation efforts, he died of multiple organ failure on admission 3rd day. This is the first described case of severe pneumonia and sepsis due to hematogenous spread of scalp furuncles caused by Panton–Valentine leukocidin (PVL) positive community-acquired methicillin-susceptible S. aureus (CA-MSSA) ST398 strains in an immunocompentent adult in mainland China. This report highlight the emergence CA-PVL-MSSA ST398 infection and its association with life-threatening infections. Early decolonization and identification of ST398 is critical. Severe skin and soft tissue infections should be suspected for ST398 PVL-MSSA.     

Hemostasis: Old System,New Players,New Directions

Initiation of clotting cascade by tissue factor (TF): Factor VII (FVII) complex is essential for hemostasis however pathologic expression of TF leads to thrombosis. In contrast, the contact pathway factor XII, and to the smaller extent FXI are dispensable for normal hemostasis but still contribute to pathologic thrombosis. New data suggest that not only platelets but also leukocytes and red blood cells can actively participate to thrombosis. Growing evidence demonstrates that coagulation proteases not only regulate hemostasis and thrombosis but also contribute to the many cellular responses via activation of protease activated receptors (PARs). The reviews in this supplement summarize the latest findings related to TF and coagulation proteases, including novel models of hemostasis and thrombosis, new insights into mechanism of thrombosis and trauma induced coagulopathy, interplay between coagulation and innate immune system and pathophysiology of contact activation pathway.     

脾肾阳虚在过敏性紫癜病机中的意义

结合络病理论和《伤寒论》温阳法,从基础理论和临床2个方面的研究表明,脾肾阳虚是过敏性紫癜发病的核心病机。外在热象只是一种表面现象,素体脾肾阳虚和疾病迁延不愈均可造成脾肾阳虚,而这一核心病机贯穿于整个过敏性紫癜的病程。温阳固络是治疗过敏性紫癜的根本法则,一改目前以清热凉血为主流的治疗原则。在治疗本病的全程中均要以温阳固络为宗,审症辨证,结合不同的固络方法施治。     

De-escalating Locoregional Therapy for Axillary Micrometastases in Breast Cancer: How Much is Too Much?

BackgroundThe applicability of modern prospective data on adjuvant radiotherapy (RT) fields in patients with micrometastases is limited because many trials occurred prior to routine measurement of nodal metastasis size and modern sentinel lymph node evaluation techniques. We aimed to determine prognostic factors for patients with micrometastases and evaluate the impact of adjuvant RT on disease outcomes.Patients and MethodsPatients diagnosed with pathologic T1-T3 N1mi breast cancers between 2004-2015 were identified. Cox proportional hazards methods were used to determine characteristics predictive of locoregional recurrence (LRR). Tumor and treatment-specific factors were further evaluated using log-rank statistics to compare rates of LRR-free survival.ResultsThis analysis included 156 patients. On multivariable analysis, grade 3 histology (HR 10.84, 95% CI 2.72-43.21) and adjuvant RT (HR 0.22, 95% CI 0.06-0.81) were independent predictors of LRR. Among patients with grade 1-2 histology, 5-year LRR-free survival was 98.8% in patients who received adjuvant RT versus 100% in patients who did not receive adjuvant RT (P = .82). Among patients with grade 3 histology, 5-year LRR-free survival was 90.1% in patients who received adjuvant RT versus 53.0% in patients who did not receive adjuvant RT (P = .025), and 100% in patients receiving comprehensive nodal irradiation versus 76.7% in patients receiving whole breast irradiation or no RT (P = .045).ConclusionPatients with grade 3 micrometastases are at substantial risk for LRR. Adjuvant RT, including comprehensive nodal irradiation, should be strongly considered in these women.