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OBJECTIVE: The objective of this study was to investigate the potential association between the inflammatory burden index (IBI) and the prevalence of chronic inflammatory airway diseases (CIAD), as well as mortality rates among individuals diagnosed with CIAD. METHODS: Participants were sourced from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2010. The IBI was calculated using the formula: IBI = C-reactive protein * neutrophils / lymphocytes. CIAD comprised self-reported asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). Mortality outcomes, including all-cause and respiratory disease mortality, were determined through linked data from the National Death Index (NDI) up to December 2019. RESULTS: A total of 27,495 adults were included. IBI was divided into quartiles, with the lowest quartile as the reference group. After adjusting for confounding variables, a positive correlation was observed between higher IBI and increased prevalence of total CIAD (OR = 1.383 [1.215-1.575]), asthma (OR = 1.267 [1.096-1.465]), chronic bronchitis (OR = 1.568 [1.263-1.946]), and COPD (OR = 1.907 [1.311-2.774]). Over a median follow-up of 12.33 [9.92-16.00] years, there were 1221 deaths from all causes and 220 deaths from respiratory disease among 4499 patients with CIAD. Following multivariate adjustments, the fourth quartile was significantly associated with increased risk of all-cause mortality (HR = 2.227 [1.714-2.893]) and respiratory disease mortality (HR = 2.748 [1.383-5.459]) compared to the first quartile of IBI in CIAD participants. Moreover, variable importance analysis using a random survival forest model demonstrated the significance of IBI in predicting mortality from both all-cause and respiratory diseases. CONCLUSION: IBI exhibited an association with the prevalence of CIAD, with higher IBI levels correlating with elevated all-cause and respiratory disease mortality among individuals with CIAD.
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Asma , Bronquitis Crónica , Proteína C-Reactiva , Encuestas Nutricionales , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Bronquitis Crónica/mortalidad , Bronquitis Crónica/epidemiología , Asma/mortalidad , Asma/epidemiología , Proteína C-Reactiva/análisis , Anciano , Prevalencia , Estudios de Cohortes , Inflamación , NeutrófilosRESUMEN
OBJECTIVES: To report our initial experience of one-stage flexible ureteroscopic lithotripsy(FURL) with 11/13Fr suctioning ureteral access sheath(UAS) and 8.55Fr single-use digital flexible ureteroscope(SDFU) in upper ureteral or renal calculi. MATERIALS AND METHODS: We retrospectively collected the clinical data of 900 adult patients with upper ureteral or renal calculi treated by FURL with 11/13Fr suctioning UAS and 8.55Fr SDFU from January 2022 to April 2024. Demographics, peri- and postoperative outcomes were assessed. RESULTS: In all, 40 of 940 cases(4.26%) failed to introduce UAS and required second-stage FURL because of ureterostenosis and were excluded. Mean stones size of the remaining 900 eligible cases was 1.68 ± 0.58 cm in greatest diameter. There were 228 cases of upper ureteral stone, 456 cases of renal stone and 216 cases of concomitant ureteral and renal calculi. The mean operation time was 52.20 ± 20.21 min and the postoperative hospital stay was 2.87 ± 1.37 days. The stone-free rate of 1 month postoperatively was 89.56% and only 2.44% of patients with residue underwent additional reoperation. The rate of postoperative fever, postoperative pain needing analgesic and slight ureteral mucosal injury were 5.11%, 8.22% and 7.78%, respectively. None of patient suffered from severe complications, such as sepsis or ureteral perforation. CONCLUSION: It's practical and suitable for the vast majority of adult patients to undergo FURL in single session with 11/13Fr suctioning UAS without preoperative stenting. FURL with 11/13Fr suctioning UAS and 8.55Fr SDFU is feasible, reliable, safe, and efficient in the management of renal stone and upper ureteral stone.
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Cálculos Renales , Litotricia , Cálculos Ureterales , Ureteroscopios , Ureteroscopía , Humanos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Litotricia/métodos , Litotricia/instrumentación , Litotricia/efectos adversos , Adulto , Cálculos Renales/cirugía , Cálculos Renales/terapia , Succión/instrumentación , Succión/métodos , Ureteroscopía/instrumentación , Ureteroscopía/efectos adversos , Ureteroscopía/métodos , Cálculos Ureterales/cirugía , Cálculos Ureterales/terapia , Diseño de Equipo , Resultado del Tratamiento , Anciano , Uréter/cirugía , Tempo OperativoRESUMEN
Introduction: Previous observational studies have shown that polycystic ovary syndrome (PCOS) was associated with adverse pregnancy and perinatal outcomes. However, it remains controversial whether PCOS is an essential risk factor for these adverse pregnancy and perinatal outcomes. We aimed to use instrumental variables in a two-sample Mendelian randomization (MR) study to determine causality between PCOS and adverse pregnancy and perinatal outcomes. Materials and methods: Summary statistics were extracted from a recent genome-wide association study (GWAS) meta-analysis conducted in PCOS, which included 10,074 cases and 103,164 controls of European ancestry. Data on Adverse pregnancy and perinatal outcomes were summarized from the FinnGen database of European ancestry, which included more than 180,000 samples. The inverse variance weighted (IVW) method of MR was applied for the main outcome. To assess heterogeneity and pleiotropy, we conducted sensitivity analyses, including leave-one-out analysis, weighted median, MR-PRESSO (Mendelian Randomization Pleiotropy RESidual Sum and Outlier), and MR-Egger regression. Results: Two-sample MR analysis with the IVW method suggested that PCOS exerted causal effects on the risk of hypertensive disorders of pregnancy [odds ratio (OR) 1.170, 95% confidence interval (CI) 1.051-1.302, p = 0.004], in particular gestational hypertension (OR 1.083, 95% CI 1.007-1.164, p = 0.031), but not other pregnancy and perinatal diseases (all p > 0.05). Sensitivity analyses demonstrated pleiotropy only in pre-eclampsia or eclampsia (p = 0.0004), but not in other pregnancy and perinatal diseases (all p > 0.05). The results remained consistent after excluding two outliers (all p > 0.05). Conclusions: We confirmed a causal relationship between PCOS and hypertensive disorders of pregnancy, in particular gestational hypertension, but no association with any other adverse pregnancy or perinatal outcome. Therefore, we suggest that women with PCOS who are pregnant should have their blood pressure closely monitored.
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Estudio de Asociación del Genoma Completo , Análisis de la Aleatorización Mendeliana , Síndrome del Ovario Poliquístico , Resultado del Embarazo , Humanos , Síndrome del Ovario Poliquístico/genética , Síndrome del Ovario Poliquístico/epidemiología , Síndrome del Ovario Poliquístico/complicaciones , Femenino , Embarazo , Resultado del Embarazo/epidemiología , Hipertensión Inducida en el Embarazo/epidemiología , Hipertensión Inducida en el Embarazo/genética , Complicaciones del Embarazo/genética , Complicaciones del Embarazo/epidemiología , Factores de Riesgo , Recién Nacido , Polimorfismo de Nucleótido SimpleRESUMEN
OBJECTIVE: Early diagnosis and differential diagnosis of tuberculous pleural effusion (TPE) remains challenging and is critical to the patients' prognosis. The present study aimed to develop nine machine learning (ML) algorithms for early diagnosis of TPE and compare their performance. METHODS: A total of 1435 untreated patients with pleural effusions (PEs) were retrospectively included and divided into the training set (80%) and the test set (20%). The demographic and laboratory variables were collected, preprocessed, and analyzed to select features, which were fed into nine ML algorithms to develop an optimal diagnostic model for TPE. The proposed model was validated by an independently external data. The decision curve analysis (DCA) and the SHapley Additive exPlanations (SHAP) were also applied. RESULTS: Support vector machine (SVM) was the best model in discriminating TPE from non-TPE, with a balanced accuracy of 87.7%, precision of 85.3%, area under the curve (AUC) of 0.914, sensitivity of 94.7%, specificity of 80.7%, and F1-score of 86.0% among the nine ML algorithms. The excellent diagnostic performance was also validated by the external data (a balanced accuracy of 87.7%, precision of 85.2%, and AUC of 0.898). Neural network (NN) and K-nearest neighbor (KNN) had better net benefits in clinical usefulness. Besides, PE adenosine deaminase (ADA), PE carcinoembryonic antigen (CEA), and serum CYFRA21-1 were identified as the top three important features for diagnosing TPE. CONCLUSIONS: This study developed and validated a SVM model for the early diagnosis of TPE, which might help clinicians provide better diagnosis and treatment for TPE patients.
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Derrame Pleural , Tuberculosis Pleural , Humanos , Tuberculosis Pleural/diagnóstico , Estudios Retrospectivos , Derrame Pleural/diagnóstico , Algoritmos , Aprendizaje AutomáticoRESUMEN
Objective: This study was to evaluate the prognostic value of the Naples prognostic score (NPS) in adult patients with asthma. Methods: Data on 44 601 participants from the 1999-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed. The NPS was calculated based on serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR), and participants were divided into 3 groups. Self-administered questionnaires were used to collect information on asthma, and mortality was identified using the National Death Index through December 31, 2019. Multiple logistic regressions were used to analyze the relationship between NPS and its components and the prevalence of asthma. Kaplan-Meier survival analysis, Cox proportional regressions, and the random survival forest (RSF) were used to assess the significance of NPS and its components in predicting all-cause and cause-specific (cardiovascular, cancer, and respiratory diseases) mortality in asthma patients. Results: The mean age of the participants was 47.59 ± 0.18 years, and 48.47% were male. The prevalence of asthma was 13.11%. The participants were categorized into 3 groups: 8306 (18.6%) participants were in group 0 (NPS 0), 30 842 (69.2%) were in group 1 (NPS 1 or 2), and 5453 (11.2%) were in group 2 (NPS 3 or 4). Compared to the reference group, participants in group 2 had a higher prevalence of asthma (odds ratio [OR] = 1.40 [1.24-1.56]). Participants with asthma in group 2 had a significantly increased risk of all-cause mortality (hazard ratio [HR] = 2.42 [1.67-3.50]), cardiovascular mortality (HR = 2.68 [1.50-4.79]), cancer mortality (HR = 2.10 [1.00-4.45]), and respiratory disease mortality (HR = 3.00 [1.18-7.65]) compared to those with asthma in group 0. The RSF showed that NPS had the highest value in predicting all-cause mortality in adults with asthma, compared to its components. Conclusions: The results of this study indicate that the NPS is a powerful prognostic indicator for outcomes in asthma patients.
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BACKGROUND: Accurate prediction of acute exacerbation helps select patients with chronic obstructive pulmonary disease (COPD) for individualized therapy. The potential of lymphocyte subsets to function as clinical predictive factors for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) remains uncertain. METHODS: In this single-center prospective cohort study with a 2-year follow-up, 137 patients aged 51 to 79 with AECOPD were enrolled. We examined the prognostic indicators of AECOPD by analyzing lymphocyte subsets and baseline symptom score. Furthermore, a predictive model was constructed to anticipate the occurrence of respiratory failure in patients experiencing AECOPD. RESULTS: The COPD Assessment Test (CAT) score combined with home oxygen therapy and CD4+CD8+ T cells% to predict respiratory failure in AECOPD patients were the best (the area under the curves [AUC] = 0.77, 95% CI: 0.70-0.86, P < 0.0001, sensitivity: 60.4%, specificity: 86.8%). The nomogram model, the C index, calibration plot, decision curve analysis, and clinical impact curve all indicate the model's good predictive performance. The observed decrease in the proportions of CD4+CD8+ T cells appears to be correlated with more unfavorable outcomes. CONCLUSIONS: The nomogram model, developed to forecast respiratory failure in patients with AECOPD, utilizing variables such as home oxygen therapy, CAT score, and CD4+CD8+ T cells%, demonstrated a high level of practicality in clinical settings. CD4+CD8+ T cells serve as a reliable and readily accessible predictor of AECOPD, exhibiting greater stability compared to other indices. It is less susceptible to subjective influences from patients or physicians. This model facilitated personalized estimations, enabling healthcare professionals to make informed decisions regarding preventive interventions.
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Enfermedad Pulmonar Obstructiva Crónica , Insuficiencia Respiratoria , Humanos , Estudios Prospectivos , Linfocitos T CD8-positivos , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Oxígeno/uso terapéutico , Progresión de la EnfermedadRESUMEN
Cotinine, the primary metabolite of nicotine, can be utilized as a marker for active smoking and as an indicator of exposure to secondhand smoke. However, the direct relationship between dietary flavonoid intake and serum cotinine levels remains a subject of ongoing investigation. In this study, we utilized data from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 and 2017-2018 to assess the association between dietary flavonoid intake and serum cotinine levels in adults through multiple linear regression analysis. A weighted quantile sum (WQS) regression model was used to assess the association of the mixture of six dietary flavonoids with serum cotinine levels in adults, which could represent the overall effect of the mixture of six dietary flavonoids. We also conducted stratified analyses by smoke status to explore multiple linear regression associations between different flavonoid intake and serum cotinine levels. A total of 14,962 adults were included in the study. Compared to the group with the lowest dietary flavonoid intake, total flavonoid intake in the second (ß = -0.29 [-0.44, -0.14]), third (ß = -0.41 [-0.58, -0.24]), and highest groups (ß = -0.32 [-0.49, -0.16]) was inversely related to the levels of serum cotinine after adjusting the full model. An RCS model showed that when the total dietary flavonoid intake was less than 99.61 mg/day, there was a negative linear association between dietary flavonoid intake and the serum cotinine. The WQS regression model also showed that the intake of a mixture of six dietary flavonoids was significantly negatively correlated with serum cotinine levels (ß = -0.54 [-0.61, -0.46], p <0.01), with anthocyanins having the greatest effect (weights = 32.30%). Our findings imply a significant correlation between dietary flavonoid intake and serum cotinine levels among adults. The consumption of a combination of six dietary flavonoids was consistently linked to lower serum cotinine levels, with anthocyanins displaying the most pronounced impact.
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Cotinina , Flavonoides , Encuestas Nutricionales , Antocianinas , PolifenolesRESUMEN
Human health is adversely affected by exposure to organophosphate (OP) pesticides. This study aims to investigate the correlation between urinary OP metabolites and the prevalence of asthma. In cross-sectional studies, data from the National Health and Nutrition Examination Survey (NHANES) projects conducted between 2003-2008, 2011-2012, and 2015-2018 were analyzed. Multiple logistic regressions and restricted cubic spline (RCS) regressions were utilized to examine the relationship between four urinary OP metabolites, namely dimethyl phosphate (DMP), diethyl phosphate (DEP), dimethyl phosphorothioate (DMTP), and diethyl phosphorothioate (DETP), and the prevalence of asthma. Additionally, quantile g-computation (QG-C) regression was employed to evaluate the association between urinary OP metabolites (both individual and combined exposures) and asthma prevalence. The results showed that a total of 9316 adults, including 1298 participants with asthma, were included in the analysis. The median age of the participants was 47.37 years, and 50.27% were female. In the comprehensive model, the third tertile of DMP and DEP exhibited a positive association with asthma prevalence compared to the first tertile (odds ratio [95% confidence interval]: 1.26 [1.01-1.57], Ptrend = 0.036; and 1.25 [1.07-1.51], Ptrend = 0.008, respectively). Moreover, a linear relationship was observed between DMP, DEP, and asthma prevalence (P for nonlinearity = 0.320 and 0.553, respectively). The QG-C regression revealed a positive association between the mixture of urinary OP metabolites and asthma prevalence (OR = 1.04 [1.01-1.07], P = 0.025), with DEP contributing the most substantial effect (weight = 0.564). Our findings suggest that exposure to OP pesticides is associated with an increased prevalence of asthma, with DEP demonstrating the strongest impact.
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Insecticidas , Plaguicidas , Humanos , Adulto , Femenino , Persona de Mediana Edad , Masculino , Estudios Transversales , Encuestas Nutricionales , Plaguicidas/orina , Compuestos Organofosforados , Organofosfatos , Exposición a Riesgos AmbientalesRESUMEN
OBJECTIVE: Pleural effusion (PE) is a common clinical complication associated with various disorders. We aimed to utilize laboratory variables and their corresponding ratios in serum and PE for the differential diagnosis of multiple types of PE based on a decision tree (DT) algorithm. METHODS: A total of 1435 untreated patients with PE admitted to The First Affiliated Hospital of Ningbo University were enrolled. The demographic and laboratory variables were collected and compared. The receiver operating characteristic curve was used to select important variables for diagnosing malignant pleural effusion (MPE) or tuberculous pleural effusion (TPE) and included in the DT model. The data were divided into the training set and the test set at a ratio of 7:3. The training data was used to develop the DT model, and the test data was for evaluating the model. Independent data was collected as external validation. RESULTS: Three PE indicators (carcinoembryonic antigen, adenosine deaminase [ADA], and total protein), two serum indicators (neuron-specific enolase and cytokeratin 19 fragments), and two ratios [high-sensitivity C-reactive protein (hsCRP)/ PE lymphocyte and hsCRP/PE ADA] were used to construct the DT model. The area under the curve (AUC), sensitivity, and specificity for diagnosing MPE were 0.963, 84.0%, 91.6% in the training set, 0.976, 84.1%, 88.6% in the test set, and 0.955,83.3%, 86.7% in the external validation set. The AUC, sensitivity, and specificity of diagnosing TPE were 0.898, 86.8%, 92.3% in the training set, 0.888, 88.8%, 92.7% in the test set, and 0.778, 84.8%, 94.3% in the external validation set. CONCLUSION: The DT model showed good diagnostic efficacy and could be applied for the differential diagnosis of MPE and TPE in clinical settings.
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OBJECTIVE: To investigate the risk factors of pulmonary embolism in patients with lung cancer and develop and validate a novel nomogram scoring system-based prediction model. METHOD: We retrospectively analyzed the clinical data and laboratory characteristics of 900 patients with lung cancer who were treated, including patients with lung cancer without pulmonary embolism (LC) and patients with lung cancer with pulmonary embolism (LC + PE). The patients were randomly divided into derivation and internal validation groups in a 7:3 ratio. Using logistic regression analysis, a diagnostic model of the nomogram scoring system was developed by incorporating selected variables in the derivation group and validated in the internal and external validation groups (n = 108). RESULT: Seven variables (adenocarcinoma, stage III-IV LC, indwelling central venous catheter, chemotherapy, and the levels of serum albumin, hemoglobin, and D-dimer) were identified as valuable parameters for developing the novel nomogram diagnostic model for differentiating patients with LC and LC + PE. The scoring system demonstrated good diagnostic performance in the derivation (area under the curve [AUC]; 95% confidence interval [CI], 0.918; 0.893, 0.943; sensitivity, 88.5%; specificity, 80.5%), internal validation (AUC; 95% CI, 0.921; 0.884, 0.958; sensitivity, 90.5%; specificity, 80.4%), and external validation (AUC; 95% CI, 0.929; 0.875, 0.983; sensitivity; 85.0%; specificity; 87.5%) groups. CONCLUSION: In this study, we constructed and validated a nomogram scoring system based on 7 clinical parameters. The scoring system exhibits good accuracy and discrimination between patients with LC and LC + PE and can effectively predict the risk of PE in patients with LC.
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Neoplasias Pulmonares , Embolia Pulmonar , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/patología , Nomogramas , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Ureteroscopy is well-established as a primary treatment modality for urolithiasis. Ureteral avulsion, particularly complete or full-length avulsion with a resultant long segment of the ureter left attached to the ureteroscope, is a rare but devastating complication of the procedure. Management of this complication is challenging. Moreover, general consensus regarding the optimal management is undetermined. We report our experience of managing a complete ureteral avulsion case via an extended Boari flap technique with long-term results. CASE SUMMARY: A 41-year-old female patient subjected to complete ureteral avulsion caused by ureteroscopy was referred to our hospital. A modified, extended Boari flap technique was successfully performed to repair the full-length ureteral defect. Maximal mobilization of the bladder and affected kidney followed by psoas hitch and downward nephropexy maximized the probability of a tension-free anastomosis. Meticulous blood supply preservation to the flap also contributed to the success. During the 4-year study period, no complications except for a mild urinary frequency and a slightly lower maximum urinary flow rate were reported. The patient was satisfied with the surgical outcomes. CONCLUSION: The extended Boari flap procedure is a feasible and preferred technique to manage complete ureteral avulsion, particularly in emergencies.
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Perturbation of the microbiome has numerous associations with the phenotypes and progression in chronic airways disease. However, the differences in the nasal microbiome in asthma and allergic rhinitis (AR) have not been defined. We examined whether the nasal microbiome would vary among different comorbidities in asthma and AR and that those differences may be associated with the severity of asthma. Nasal lavage fluid was collected from 110 participants, including 20 healthy controls, 30 subjects with AR, 30 subjects with asthma and 30 subjects with combined asthma + AR. The Asthma Control Questionnaire (ACQ-7) was used to evaluate asthma control status. Using 16S rRNA bacterial gene sequencing, we analyzed nasal microbiome in patients with asthma, AR, combined asthma + AR, and healthy controls. Bacterial diversity was analyzed in corresponding with α diversity indices (Chao and Shannon index). Compared with healthy controls, the Chao index tended to be lower in subjects with AR (P = 0.001), asthma (P = 0.001), and combined asthma + AR (P = 0.001) when compared with healthy controls. Furthermore, the Shannon index was significantly lower in subjects with asthma (P = 0.013) and comorbid asthma with AR (P = 0.004) than the control subjects. Disparity in the structure and composition of nasal bacteria were also observed among the four groups. Furthermore, patients with combined asthma + AR and isolated asthma were divided into two groups according to the level of disease control: partially or well-controlled and uncontrolled asthma. The mean relative abundance observed in the groups mentioned the genera of Pseudoflavonifractor were dominated in patients with well and partially controlled disease, in both isolated asthma and combined asthma + AR. In subjects with uncontrolled asthma and combined asthma + AR, a lower evenness and richness (Shannon index, P = 0.040) was observed in nasal microbiome composition. Importantly, lower evenness and richness in the nasal microbiome may be associated with poor disease control in combined asthma + AR. This study showed the upper airway microbiome is associated with airway inflammation disorders and the level of asthma control.
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Asma , Microbiota , Rinitis Alérgica , Asma/complicaciones , Bacterias/genética , Humanos , Microbiota/genética , ARN Ribosómico 16S/genética , Rinitis Alérgica/complicaciones , Rinitis Alérgica/microbiologíaRESUMEN
INTRODUCTION: This study aimed to explore the efficacy of abrupt and gradual smoking cessation with pre-cessation varenicline therapy. METHODS: A total of 278 smokers who experienced moderate-to-severe nicotine dependence and visited a Chinese smoking cessation outpatient clinic from March 2017 to February 2021 were enrolled. This was a retrospective, observational, cohort study. Participants were divided into two groups by the cessation strategy they received: the abrupt cessation group (n=139, tobacco was not controlled during the first 3 weeks before the target cessation date and smoking was entirely discontinued on the 22nd day) and the gradual cessation group (n=139, tobacco was gradually reduced in the first 3 weeks before the target cessation date and smoking was discontinued on the 22nd day). The abstinence rates were compared between groups (7-day point prevalence abstinence rates at 1, 3 and 6 months post-treatment; and 1-month and 3-month continuous abstinence rates of 6-month follow-up). Possible factors that influence efficacy, reasons for smoking cessation failure, and associated adverse events were also analyzed. RESULTS: No significant difference in the 7-day point prevalence abstinence rates at 1, 3 and 6 months post-treatment was observed between the groups (p>0.05). The 1-month continuous abstinence rate of the gradual cessation group was higher than that of the abrupt cessation group (51.1% vs 31.7%; χ2=10.812, p=0.001). The 3-month continuous abstinence rate of the gradual cessation group was also higher than that of the abrupt cessation group (42.4% vs 27.3%; χ2=6.983, p=0.008). Abrupt cessation was a risk factor for successful smoking cessation than gradual cessation (AOR=2.39; 95% CI: 1.15-3.85, p=0.013),the motivation of 'prevention and treatment of own diseases' reduced the risk of incomplete abstinence (AOR=0.87; 95% CI: 0.38-0.99, p=0.049). The incidence of adverse events was higher in the abrupt cessation group than in the gradual cessation group. The incidence rates of nausea and insomnia were statistically significant differences. CONCLUSIONS: Compared with abrupt cessation, gradual smoking cessation with pre-cessation varenicline therapy produced higher abstinence rates and relatively milder withdrawal symptoms.
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BACKGROUND: Presently, there are limited reports in the literature on the postoperative (midterm) clinical outcome for pure aortic regurgitation (AR) following transcatheter aortic valve replacement (TAVR). METHODS: Between March 2014 and June 2019, a total of 134 high-risk patients with pure, symptomatic severe AR patients were enrolled in the current study. The outcome was assessed according to the Valve Academic Research Consortium-2 criteria. Procedural results, clinical outcomes, and the patients' hemodynamics for a period of 1 year were analyzed. RESULTS: The patient mean was 73.1 ± 6.4 years and 25.4% were female. The average Society of Thoracic Surgeons score was 9.8 ± 5.3%. Procedural success was 97.1% (130/134), and the device success rate was 96.3% (129/134). Five cases were converted to open surgery, while two patients underwent valvular reinterventions (surgical aortic valve replacement for thrombosis and increasing paravalvular regurgitation). The mean aortic valve gradient was 10.2 ± 4.1 mmHg, while the moderate and severe AR was 1.6% at 1 year. Paravalvular regurgitation was none/trivial in 79.8% and mild in 18.5%. The 1-year all-cause mortality rate was 7.4%. At 1 year, the stroke incidence rate was 2.2%, and a pacemaker was implanted in 8.9% of the enrolled patients. CONCLUSIONS: In high-risk patients undergoing transapical TAVR for AR, the use of the J-Valve is safe, and effective TAVR should be considered as a reasonable option for high-risk patients with pure AR.
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Insuficiencia de la Válvula Aórtica , Estenosis de la Válvula Aórtica , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/etiología , Estenosis de la Válvula Aórtica/cirugía , Femenino , Humanos , Diseño de Prótesis , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
As a common clinical emergency, pulmonary embolism (PE) is the third most fatal cardiovascular disease worldwide. Although current sophisticated medical technology has considerably improved the prognosis of patients with PE, they remain at risk of developing long-term complications such as post-PE syndrome. Pulmonary rehabilitation is of great value for patients with chronic lung diseases since it can improve their quality of life while also relieving clinical symptoms. Rehabilitation therapy has been demonstrated to improve recovery and prognosis of patients with PE. Due to short implementation time and the small number of studies, its effectiveness and safety in PE warrant further investigation. The present review focused on elucidating PE pathogenesis, post-PE syndrome and the clinical application of pulmonary rehabilitation in patients with PE.
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BACKGROUND: This study was performed to investigate clinical features of patients with severe SARS-CoV-2 pneumonia and identify risk factors for converting to severe cases in those who had mild to moderate diseases at the start of the pandemic in China. METHODS: In this retrospective, multicenter cohort study, patients with mild to moderate SARS-CoV-2 pneumonia were included. Demographic data, symptoms, laboratory values, and clinical outcomes were collected. Data were compared between non-severe and severe patients. RESULTS: 58 patients were included in the final analysis. Compared with non-severe cases, severe patients with SARS-CoV-2 pneumonia had a longer: time to clinical recovery (12·9 ± 4·4 vs 8·3 ± 4·7; P = 0·0011), duration of viral shedding (15·7 ± 6·7 vs 11·8 ± 5·0; P = 0·0183), and hospital stay (20·7 ± 1·2 vs 14·4 ± 4·3; P = 0·0211). Multivariate logistic regression indicated that lymphocyte count was significantly associated with the rate of converting to severe cases (odds ratio 1·28, 95%CI 1·06-1·54, per 0·1 × 109/L reduced; P = 0·007), while using of low-to-moderate doses of systematic corticosteroids was associated with reduced likelihood of converting to a severe case (odds ratio 0·14, 95%CI 0·02-0·80; P = 0·0275). CONCLUSIONS: The low peripheral blood lymphocyte count was an independent risk factor for SARS-CoV-2 pneumonia patients converting to severe cases. However, this study was carried out right after the start of the pandemic with small sample size. Further prospective studies are warranted to confirm these findings. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2000029839 . Registered 15 February 2020 - Retrospectively registered.
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COVID-19/diagnóstico , COVID-19/fisiopatología , Corticoesteroides/administración & dosificación , Adulto , Anciano , COVID-19/epidemiología , COVID-19/virología , China/epidemiología , Femenino , Humanos , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Pandemias , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2/patogenicidad , Tamaño de la Muestra , Esparcimiento de VirusRESUMEN
BACKGROUND: Lower urinary tract symptoms (LUTS) is the most common complication of diabetes. However, the underlying pathogenesis of cultured negative LUTS (cn-LUTS) in diabetic patients has not been well understood. Numerous evidence indicates that urinary dysbiosis is related to urologic disorders. We aim to study alterations of the urinary microbiota of cn-LUTS in type 2 diabetes (T2D) patients. METHODS: Female T2D patients and controls were recruited and requested to finish the American Urological Association Symptom Index. Mid-stream urine was collected for culturing and extracting DNA. Microbial diversity and composition were analyzed by targeting to 16S rDNA. Linear discriminant analysis effect size (LEfSe) was carried out to identify significantly different bacteria. RESULTS: 32 female T2D patients and 26 controls were enrolled. No significant differences in alpha diversity were observed between patients and controls. However, statistically decreased richness (ACE index and Chao 1 index, 85.52(13.75, 204.84) vs. 129.82(63.89, 280.30) and 83.86(11.00, 210.77) vs. 125.19(62.00, 251.77), P = 0.005; Observed Species, 76(10, 175) vs. 98(54, 234), P = 0.011) and decreased species diversity (Shannon index, 1.37(0.04, 3.48) vs. 2.09(0.98, 3.43), P = 0.033; Simpson index, 0.46 (0.06, 0.99) vs. 0.23(0.07, 0.64), P = 0.029) were shown in moderate-to-severe LUTS group and high Hemoglobin A1c group, respectively. A significant difference of beta diversity was found between T2D patients and controls and T2D patients with different severity of cn-LUTS as well as the different level of Hemoglobin A1c. LEfSe revealed that 10 genera (e.g., Escherichia-Shigella and Klebsiella) were increased and 7 genera were decreasing in T2D patients, 3 genera (e.g., Escherichia-Shigella and Campylobacter) were increased and 16 genera (e.g., Prevotella) were reduced in moderate-to-severe LUTS group, 2 genera (Escherichia-Shigella and Lactobacillus) were over-represented and 10 genera (e.g., Prevotella) were under-represented in high Hemoglobin A1c group. Finally, Hemoglobin A1c was found positively correlated with the total score of the American Urological Association Symptom Index (r = 0.509, P = 0.003). CONCLUSIONS: Urinary dysbiosis may be related to cn-LUTS in female T2D patients. A better understanding of urinary microbiota in the development and progression of cn-LUTS in female T2D patients was necessary. The severity of cn-LUTS was correlated to hyperglycemia and chronic hyperglycemia might induce or promote cn-LUTS by influencing urinary microbiota.
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Complicaciones de la Diabetes/microbiología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/microbiología , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/microbiología , Microbiota , Anciano , Estudios Transversales , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Objective: The aim of the present study was to explore the diagnostic value and safety of color Doppler ultrasound (US)-guided transthoracic core needle biopsy (CNB) of peripheral lung, chest wall and mediastinal lesions using automated biopsy guns.Materials and methods: We analyzed clinical and image data, histopathologic and microbiologic details and complications from 121 patients with peripheral lung, chest wall and mediastinal lesions who underwent color Doppler US-guided transthoracic CNB in Ningbo First Hospital between January 2015 and June 2018.Results: Color Doppler US-guided transthoracic CNB performed with a freehand technique using automated biopsy guns had a sensitivity of 93.94%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 78.57%, and a diagnostic accuracy of 95.04%. Lesion size did not affect the diagnostic rate (P=0.40). No serious complications of the procedure were noted.Conclusion: Color Doppler US-guided transthoracic CNB of peripheral lung, chest wall and mediastinal lesions is a safe and inexpensive procedure. The diagnostic accuracy of color Doppler US-guided transthoracic CNB was higher than that of color Doppler US-guided transthoracic fine needle aspiration biopsy (FNAB).
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Neoplasias Pulmonares , Pulmón , Neoplasias del Mediastino , Mediastino/patología , Ultrasonografía Doppler en Color , Anciano , Biopsia con Aguja Gruesa , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Masculino , Neoplasias del Mediastino/diagnóstico por imagen , Neoplasias del Mediastino/patología , Persona de Mediana EdadRESUMEN
OBJECTIVE: The aim of this study was to develop and validate Chinese versions of the International Consultation on Incontinence Modular Questionnaire for Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) and ICIQ-MLUTS Long Form (LF), and to discuss their potential functions. METHODS: The original ICIQ-MLUTS and ICIQ-MLUTS LF were translated into Chinese after obtaining permission from the International Consultation on Incontinence Modular Questionnaire Advisory Board. Between November 2017 and August 2018, the Chinese versions of the ICIQ-MLUTS and ICIQ-MLUTS LF were validated by administering them to male patients with lower urinary tract symptoms attending the urology department in 6 and 12 hospitals, respectively, in China. RESULTS: In all, 135 and 230 patients completed the first administration of the Chinese version of the ICIQ-MLUTS and ICIQ-MLUTS LF, respectively. Both questionnaires had good internal consistency (Cronbach's α = 0.797 and 0.853 for the ICIQ-MLUTS and ICIQ-MLUTS LF, respectively) and good criterion validity (Pearson's correlation of 0.846 and 0.833 with the International Prostate Symptom Score for the ICIQ-MLUTS and ICIQ-MLUTS LF, respectively). Satisfactory test-retest reliability was demonstrated, with an intraclass correlation coefficient for both questionnaires >0.9. Good responsiveness of both questionnaires was also noticeable (marked improvements between scores before and after treatment; P < 0.001 for both). CONCLUSIONS: The Chinese versions of the ICIQ-MLUTS and ICIQ-MLUTS LF were valid and reliable in Chinese population, which will be useful for clinical practice and research in China.