Search

Na Cui,1 Xue Li,1 Xin Wen,1 JingJing Xu,2 Li Chen1 1Department of Obstetrics and Gynecology, Baoding No.1 Central Hospital, Baoding City, Hebei Province, 071000, People’s Republic of China; 2Department of Ultrasound, Baoding No.1 Central Hospital, Baoding City, Hebei Province, 071000, People’s Republic of ChinaCorrespondence: Li Chen, Department of Obstetrics and Gynecology, Baoding No.1 Central Hospital, No. 320 Changcheng North Street, Baoding City, Hebei Province, 071000, People’s Republic of China, Email chenliphd1407@outlook.comObjective: Analyze women treated with underwent cold knife conization (CKC) to remove advanced squamous intraepithelial lesions (CIN) of the cervix. The histopathological upgrading of the lesions previously detected on vaginal biopsy and postoperative pregnancy outcomes of were investigated, to identify high-risk subgroups in women.Methods: A retrospective study was conducted at the First Central Hospital of Baoding City from June 2019 to December 2022 to analyze confirmed cases of Cervical Intraepithelial Neoplasia CIN-II and CIN-III. Investigation of pathological changes in postoperative pathological tissues, and to perform binary logistic analysis to identify risk factors for histopathological escalation in postoperative lesions. We analyze the effects of CKC surgery on pregnancy outcomes in patients by comparing against a control group of healthy pregnant women.Results: Out of the 176 patients diagnosed with CIN-II who underwent cervical biopsy, 39 (22.16%) were found to have a final specimen diagnosis of CIN-III, while 7 (3.98%) were downgraded to CIN-I. Among the 108 patients diagnosed with CIN-III who underwent cervical biopsy, 7 cases (6.48%) were ultimately confirmed to have CIN-III. Ki67-positive, p16-positive (OR = 1.13, 95% CI 1.01– 1.15), and colposcopy biopsy for CIN-II (OR = 1.59, 95% CI 1.33– 3.6) were independent risk factors for pathological upgrade after CKC. Compared with healthy pregnant women, CIN patients had higher rates of premature birth (14.4%), premature rupture of the fetal membrane (13.6%), and cesarean section (37.5%) (P < 0.05). The mode of conception, abortion rate, ectopic pregnancy rate, and postpartum hemorrhage were not different between healthy pregnant women and CIN patients (P > 0.05).Conclusion: Following cervical multi-point biopsy or CKC, along with pathological examination, the accurate diagnosis of cervical lesions is crucial as it allows for more precise identification of such lesions. Additionally, CKC increases the risk of premature birth, premature rupture of membranes, and the need for cesarean section.Keywords: cervical intraepithelial neoplasia, cold knife conization, pregnant women, colposcopy biopsy

Ning Cui,1 Feng Ding2 1Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China; 2Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of ChinaCorrespondence: Feng Ding, Email dingfengkt@163.comBackground: Tumor-Node-Metastasis (TNM) stage of gastric cancer (GC) is one of the main factors affecting clinical outcome. The aim of this study was to explore the targets related to TNM stage of GC, and screening natural bioactive drug.Methods: RNA sequencing data of the TCGA-STAD cohort were downloaded from UCSC database. Genes associated with TNM staging were identified by weighted gene co-expression network analysis (WGCNA). Univariate Cox regression, least absolute shrinkage and selection operator (LASSO), extreme gradient boosting (Xgboost), random forest (RF) and cytohubba plug-in of cytoscope were applied to screen hub genes. Natural bioactive ingredients were available from the HERB database. Molecular docking was used to evaluate the binding activity of active ingredients to the hub protein. CCK-8, flow cytometry, transwell and Western blot assays were used to analyze the effects of diosgenin on GC cells.Results: 898 TNM-related genes were screened out through WGCNA. Three genes associated with GC progression/prognosis were identified, including nuclear receptor subfamily 3 group C member 2 (NR3C2), solute carrier family 1 member 5 (SLC1A5) and FAT atypical cadherin 1 (FAT1) based on the machine learning algorithms and hub co-expression network analysis. Diosgenin had good binding activity with SLC1A5. SLC1A5 was highly expressed in GC and was closely associated with tumor stage, overall survival and immune infiltration of GC patients. Diosgenin could inhibit cell viability and invasive ability, promote apoptosis and induce cell cycle arrest in G0/G1 phase. In addition, diosgenin promoted cleaved caspase 3 expression and inhibited Ki67, cyclin D1, p-S6K1, and SLC1A5 expression levels, while the mTORC1 activator (MHY1485) reversed this phenomenon.Conclusion: For the first time, this work reports diosgenin may inhibit the activation of mTORC1 signaling through targeting SLC1A5, thereby inhibiting the malignant behaviors of GC cells.Keywords: gastric cancer, weighted gene co-expression network analysis, diosgenin, molecular docking, diosgenin

Nianqi Cui,1,2,&ast; Hui Zhang,3,&ast; Sijie Gan,4 Yuping Zhang,1 Dandan Chen,5 Pingping Guo,5 Jingjie Wu,5 Zhuang Li,6 Jingfen Jin1,7,8 1Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang, People’s Republic of China; 2School of Nursing, Kunming Medical University, Kunming, Yunnan, People’s Republic of China; 3Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, People’s Republic of China; 4Product Development Center, Zhejiang Xinhua Mobile Media Co. Ltd, Hangzhou, Zhejiang, People’s Republic of China; 5Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 6Medical Faculty, Yunnan College of Business Management, Kunming, Yunnan, People’s Republic of China; 7Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China; 8Dean’s Office, Changxing Branch Hospital of SAHZU, Huzhou, Zhejiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhuang Li, Medical Faculty, Yunnan College of Business Management, No. 296 Haitun Road, Wuhua District, Kunming, Yunnan, 650106, People’s Republic of China, Tel + 86 15198859387, Fax +86 0871-68314770, Email lz15198859387@163.com Jingfen Jin, Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), No. 88 Jiefang road, Shangcheng District, Hangzhou, Zhejiang, 310009, People’s Republic of China, Tel + 86 137 5711 8239, Fax +86 0571-87783887, Email zrjzkhl@zju.edu.cnPurpose: Physical restraints are used routinely in intensive care units (ICUs) and have negative effects. It is critical to identify the impact factors of physical restraints on critically ill patients. The present study investigated the prevalence of physical restraints and impact factors associated with their use in a large cohort of critically ill patients over one year.Patients and Methods: A retrospective cohort study was performed in multiple ICUs at a tertiary hospital in China in 2019 using observational data from electronic medical records. The data consisted of demographics and clinical variables. Logistic regression was used to assess the independent impact factors for the use of physical restraint.Results: The analysis consisted of 3776 critically ill patients with a prevalence of physical restraint use of 48.8%. The logistic regression analysis indicated that physical restraint use was associated with independent risk factors, including surgical ICU admission, pain, tracheal tube placement, and abdominal drainage tube placement. Physical restraint use was associated with independent protective factors, including male sex, light sedation, muscle strength, and ICU length of stay.Conclusion: The prevalence of physical restraint use in critically ill patients was high. Tracheal tubes, surgical ICU, pain, abdominal drainage tubes, light sedation, and muscle strength were independent variables associated with the use of physical restraint. These results will assist health professionals in identifying high-risk physical restraint patients based on their impact factors. Early removal of the tracheal tube and abdominal drainage tube, pain relief, light sedation, and improvements in muscle strength may help reduce the use of physical restraints.Keywords: critical care, restraints, physical, epidemiology, nursing

Aim Saline contrast-enhanced electrical impedance tomography (EIT) has been used to identify the respiratory failure etiologies through assessment of regional lung perfusion at the bedside. In this study, we introduce a novel approach to detect right-to-left intracardiac shunt based on the center of heart (CoH) parameter determined from the early phase of impedance–time curve after saline bolus injection. Methods and result The timepoints when the saline bolus enter the heart (T0) and the lung regions (T1) are identified at first. A moving time window from T0 to T1 is then generated with steps of 0.5 s and the slope of the impedance–time curve in each pixel within the window calculated. CoH is calculated as the geometric center of pixel slope values in the right-to-left image direction. To illustrate how this method works in practice, we calculated the CoH values at T0 to T1 in 10 control hypoxic patients with no right-to-left shunt. In addition, we examined two critically ill patients with right-to-left intracardiac shunt. One was postcardiac surgery patient who had a residual atrial septal defect by color doppler of transesophageal echocardiograph. The other patient had a congenital heart disease of ventricular septal defect by color doppler of trans-thoracic echocardiography. A large difference in CoH between T0 to T1 was observed in the two patients with intracardiac shunt than in the control patients (11.06 ± 3.17% vs. 1.99 ± 1.43%, P  = 0.030). Conclusion Saline bolus EIT for lung perfusion might be used as ventriculography to identify the right-to-left intracardiac shunt at the bedside. [ABSTRACT FROM AUTHOR]

Hui Zhang,1,&ast; Dandan Chen,1,&ast; Jing Shao,1 Ping Zou,2 Nianqi Cui,3 Leiwen Tang,1 Xiyi Wang,4 Dan Wang,1 Jingjie Wu,1 Zhihong Ye1 1Department of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Scholar Practitioner Program, School of Nursing, Nipissing University, Toronto, Ontario, Canada; 3Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 4Department of Nursing, School of Nursing, Shanghai JiaoTong University, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhihong YeDepartment of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3# Qingchun Dong Road, Jianggan District, Hangzhou, Zhejiang, People’s Republic of ChinaTel +86 13606612119Email 3192005@zju.edu.cnPurpose: Machine learning (ML) techniques have emerged as a promising tool to predict risk and make decisions in different medical domains. We aimed to compare the predictive performance of machine learning-based methods for 4-year risk of metabolic syndrome in adults with the previous model using logistic regression.Patients and Methods: This was a retrospective cohort study that employed a temporal validation strategy. Three popular ML techniques were selected to build the prognostic models. These techniques were artificial neural networks, classification and regression tree, and support vector machine. The logistic regression algorithm and ML techniques used the same five predictors. Discrimination, calibration, Brier score, and decision curve analysis were compared for model performance.Results: Discrimination was above 0.7 for all models except classification and regression tree model in internal validation, while the logistic regression model showed the highest discrimination in external validation (0.782) and the smallest discrimination differences. The logistic regression model had the best calibration performance, and ANN also showed satisfactory calibration in internal validation and external validation. For overall performance, logistic regression had the smallest Brier score differences in internal validation and external validation, and it also had the largest net benefit in external validation.Conclusion: Overall, this study indicated that the logistic regression model performed as well as the flexible ML-based prediction models at internal validation, while the logistic regression model had the best performance at external validation. For clinical use, when the performance of the logistic regression model is similar to ML-based prediction models, the simplest and more interpretable model should be chosen.Keywords: prognosis model, metabolic syndrome, calibration, discrimination, machine learning

Hui Zhang1 &ast;, Dandan Chen2 &ast;, Nianqi Cui,3 Ping Zou,4 Jing Shao,2 Xiyi Wang,5 Yichi Zhang,6 Jiao Du,6 Chunxue Du,6 Guanglan Zhou,6 Deyi Zheng6 1Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang, People’s Republic of China; 2Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China; 3The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 4School of Nursing, Nipissing University, Toronto, Ontario, Canada; 5Shanghai JiaoTong University, School of Nursing, Shanghai, People’s Republic of China; 6Department of Burn and Plastic Surgery, Guizhou Provincial People’s Hospital, Guiyang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Deyi ZhengDepartment of Burn and Plastic Surgery, Guizhou Provincial People’s Hospital, Guiyang, People’s Republic of ChinaTel +86 13984826262Email deyizheng@126.comBackground: Despite a flood of research on job satisfaction, few studies have examined how and why social support influences job satisfaction. This study aimed to explore how social support has an indirect effect on job satisfaction by examining its impact on emotional exhaustion and anxiety symptoms among residents of the physicians standardized residency training program in China.Methods: This cross-sectional study adopted questionnaires to collect data from residents in the standardized residency training program in China. The PROCESS macro for SPSS based on ordinary least-squares regression and the bootstrap method was used. The indirect effect of social support was examined using bootstrapping procedures. A serial multiple mediation model was examined in which social support was associated with job satisfaction via emotional exhaustion and anxiety symptoms.Results: There were 269 residents who provided usable data for the analysis. The mean age of residents was 25.98 years old. Close to half (52%) of the participants were female. The total indirect effect of social support on job satisfaction was significant (ab=0.21, SE=0.05, CI=0.12 to 0.32). The specific indirect effect 1 (social support→emotional exhaustion→job satisfaction) was significant (a1b1=0.12, SE=0.04, CI=0.05 to 0.19). The specific indirect effect 2 (social support→anxiety symptoms→job satisfaction) was significant (a2b2=0.07, SE=0.03, CI=0.02 to 0.13).The specific indirect effect 3 (social support→emotional exhaustion→anxiety symptoms→job satisfaction) was also found to be significant through both optimism and work engagement (a1a3b2=0.03, SE=0.01, CI=0.01 to 0.05).Conclusion: It seems critical for hospital management to develop a supportive work environment to improve the effects of emotional exhaustion and anxiety symptoms and to provide sufficient support to improve job satisfaction among residents in standardized residency training programs.Keywords: residents, social support, emotional exhaustion, job satisfaction, anxiety symptoms, standardized residency training programs

Sepsis is a common critical illness in the Intensive care unit(ICU) and its management and treatment has always been a major challenge in critical care medicine. The dysregulated host response to infection, causing systemic multi-organ and multi-system damage is the main pathogenesis. Notably, intense stress during sepsis can lead to metabolic disturbances of ions, lipids and energy in the organism. Ferroptosis is an iron-dependent, non-apoptotic cell death distinguished by a disruption of iron metabolism and iron-dependent accumulation of lipid peroxides. Mounting researches have established that ferroptosis has an essential part in anti-inflammatory and sepsis, and drugs targeting ferroptosis-related molecules, such as ferroptosis inhibitors, are gradually proving their effectiveness in sepsis. This paper summarizes and reviews the pathogenesis of ferroptosis, its regulatory network, and its vital involvement in the initiation of sepsis and related organ damage, and finally discusses the possible target drugs provided by the above mechanisms, describes the dilemmas as well as the outlook, in the hope of finding more links between ferroptosis and sepsis and providing new perspectives for the future treatment of sepsis.

Hui Zhang,1 Dandan Chen,1 Jin Shao,1 Ping Zou,2 Nianqi Cui,3 Leiwen Tang,1 Xiyi Wang,4 Dan Wang,1 Zhihong Ye1 1Department of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, People’s Republic of China; 2School of Nursing, Nipissing University, Toronto, Ontario, Canada; 3Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 4School of Nursing, Shanghai JiaoTong University, Shanghai, People’s Republic of ChinaCorrespondence: Zhihong YeDepartment of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Qingchun Dong Road, Jianggan District, Hangzhou, Zhejiang, People’s Republic of ChinaTel +86 13606612119Email 3192005@zju.edu.cnPurpose: A prediction model for 4-year risk of metabolic syndrome in adults was previously developed and internally validated. However, external validity or generalizability for this model was not assessed so it is not appropriate for clinical application. We aimed to externally validate this model based on a retrospective cohort.Patients and Methods: A retrospective cohort design and a temporal validation strategy were used in this study based on a dataset from 1 January 2015 to 31 December 2018. Multiple imputation was used for missing values. Model performance was evaluated by using discrimination, calibration (calibration plot, calibration slope, and calibration intercept), overall performance (Brier score), and decision curve analysis.Results: In external validation, the C-statistic was 0.782 (95% CI, 0.771– 0.793). The calibration plot shows good calibration, calibration slope was 1.006 (95% CI, − 0.011– 1.063), and calibration intercept was − 0.045 (95% CI, − 0.113– 0.022). Brier score was 0.164.The discrimination and calibration of the prediction model were good in temporal external validation.Conclusion: The discrimination and calibration of the prediction model were satisfactory in the temporal external validation. However, clinicians should be aware that this prediction model was developed and validated in a tertiary setting. It is strongly recommended that further studies validate this model in international cohorts and large, prospective cohorts in different institutions.Keywords: prediction model, prognosis, metabolic syndrome, algorithms, calibration, discrimination

Changli Tu,1,* Guojie Wang,2,* Yayuan Geng,3 Na Guo,3 Ning Cui,4 Jing Liu1 1Department of Pulmonary and Critical Care Medicine (PCCM), The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China; 2Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China; 3Huiying Medical Technology Co., Ltd, Room A206, B2, Dongsheng Science and Technology Park, Beijing, People’s Republic of China; 4Medical Imaging Center, Shiyan Taihe Hospital, Shiyan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ning Cui; Jing LiuDepartment of Pulmonary and Critical Care Medicine (PCCM), Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Zhuhai, People’s Republic of ChinaTel +867562528733Email cuixitong@139.com; liujing25@mail.sysu.edu.cnBackground: Coronavirus disease 2019 (COVID-19) is a worldwide public health pandemic with a high mortality rate, among severe cases. The disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. It is important to ensure early detection of the virus to curb disease progression to severe COVID-19. This study aims to establish a clinical-nomogram model to predict the progression to severe COVID-19 in a timely and efficient manner.Methods: This retrospective study included 202 patients with COVID-19 who were admitted to the Fifth Affiliated Hospital of Sun Yat-sen University and Shiyan Taihe Hospital from January 17 to April 30, 2020. The patients were randomly assigned to the training dataset (n = 163, with 43 progressing to severe COVID-19) or the validation dataset (n = 39, with 10 progressing to severe COVID-19) at a ratio of 8:2. The optimal subset algorithm was applied to filter for the clinical factors most relevant to the disease progression. Based on these factors, the logistic regression model was fit to distinguish severe (including severe and critical cases) from non-severe (including mild and moderate cases) COVID-19. Sensitivity, specificity, and area under the curve (AUC) were calculated using the R software package to evaluate prediction performance. A clinical nomogram was established and performance assessed using the discrimination curve.Results: Risk factors, including demographic data, symptoms, laboratory and image findings, were recorded for the 202 patients. Eight of the 53 variables that were entered into the selection process were selected via the best subset algorithm to establish the predictive model; they included gender, age, BMI, CRP, D-dimer, TP, ALB, and involved-lobe. AUC, sensitivity, and specificity were 0.91, 0.84 and 0.86 for the training dataset, and 0.87, 0.66, and 0.80 for the validation dataset.Conclusion: We established an efficient and reliable clinical nomogram model which showed that gender, age, and initial indexes including BMI, CRP, D-dimer, involved-lobe, TP, and ALB could predict the risk of progression to severe COVID-19.Keywords: clinical nomogram model, COVID-19, progression risk, logistic regression

Yongqiang Fan,1,* Min Liu,1,* Anquan Liu,1 Nailing Cui,2 Zhimei Chen,1 Qian Yang,1 Aihua Su3 1Department of Gastroenterology, Sunshine Union Hospital, Weifang City, Shandong Province, People’s Republic of China; 2Department of Gastroenterology, Weifang Medical University, Weifang City, Shandong Province, People’s Republic of China; 3Department of Emergency, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Aihua SuDepartment of Emergency, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, People’s Republic of ChinaTel +86-0536-3081100Email jleruf@163.comBackground: Gastric cancer (GC) is a common and deadly malignancy in the world. CircRNAs have emerged as important regulators in human diseases, including GC. In this work, we intended to explore the role of circ_CORO1C in GC progression and potential mechanism.Methods: Quantitative real-time PCR (qRT-PCR) or Western blot assay was performed to examine the expression of circRNA coronin-like actin-binding protein 1C (circ_CORO1C), microRNA (miR)-138-5p and Krueppel-like factor 12 (KLF12) in clinical samples and cells. Cell colony formation ability and viability were measured by colony formation assay and methyl thiazolyl tetrazolium (MTT) assay, respectively. Expression of cell proliferation and epithelia-mesenchymal transition (EMT) biomarker was detected by Western blot analysis. And cell metastasis, including migration and invasion, and apoptosis were analyzed via Transwell assay and flow cytometry, respectively. Target relationship among circ_CORO1C, miR-138-5p and KLF12 was validated by dual-luciferase reporter assay. The in vivo role of circ_CORO1C was investigated by tumor xenograft assay.Results: Circ_CORO1C and KLF12 were upregulated, while miR-138-5p was downregulated in GC tissues and cells. Circ_CORO1C knockdown suppressed colony formation ability, viability, migration, invasion and EMT in GC cells, while promoted cell apoptosis in vitro. Circ_CORO1C targeted miR-138-5p, the inhibition of which could attenuate silenced circ_CORO1C-induced inhibitory effects on GC progression. MiR-138-5p repressed the aggressive malignant behaviors of GC cells by directly targeting KLF12. Circ_CORO1C deficiency inhibited GC tumor growth in vivo.Conclusion: Depletion of circ_CORO1C suppressed GC progression by regulating miR-138-5p/KLF12 axis, offering a potential molecular target for GC therapy.Keywords: gastric cancer, circ_CORO1C, miR-138-5p, KLF12, tumor growth

Hui Zhang,1 Dandan Chen,1 Jing Shao,1 Ping Zou,2 Nianqi Cui,3 Leiwen Tang,1 Dan Wang,1 Zhihong Ye1 1Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, People’s Republic of China; 2School of Nursing, Nipissing University, Toronto, Ontario, Canada; 3Department of Nursing, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Zhihong YeZhejiang University, School of Medicine, Sir Run Run Shaw Hospital, Qingchun Dong Road, Jianggan Strict, Hangzhou, Zhejiang, People’s Republic of ChinaTel +86 13606612119Email 3192005@zju.edu.cnPurpose: A prognostic prediction model for metabolic syndrome can help nurses or physicians evaluate the future individual absolute risk of MetS in order to develop personalized care strategies. We aimed to derive and internally validate a prognostic prediction model for 4-year risk of metabolic syndrome in adults.Patients and Methods: This was a retrospective cohort study conducted in a tertiary care setting, and the dataset was obtained from the Healthcare Information and Management Systems of a tertiary hospital. The cohort included Chinese adults attending health examination from 1 January 2011 to 31 December 2014. A total of 6793 participants without metabolic syndrome were included in the cohort and were followed up for 4 years. Available candidate predictors in the dataset were weight, MCV, MCH, AST, ALT, BMI, NGC, TC, serum uric acid, gender, smoking, WBC, LC, Hb, HCT, and age. A logistic regression model was adopted to build the risk equation, and bootstrapping was used when considering internal validation. Calibration, discrimination, and the clinical utility were calculated for the model’s performance.Results: Of the 6793 participants, 1750 participants were diagnosed with metabolic syndrome within 4 years. The developed prediction model contained 5 predictors (body mass index, age, total cholesterol, alanine transaminase, and serum uric acid). After internal validation, the C-statistic was 0.783 (95% CI, 0.772– 0.795). Additionally, the current model had good calibration. Calibration slope was 0.995 (95% CI, 0.934– 1.058), and calibration intercept was − 0.008 (95% CI, − 0.088– 0.073). The Brier score was 0.156. The decision-curve analysis indicated that the prediction model provided greater net benefit than the default strategies of providing treatment or not providing treatment for all patients.Conclusion: A prognostic risk prediction model for determining 4-year risk of metabolic syndrome onset in adults was developed and internally validated. This model was based on routine clinical measurements that quantified individual future risk of metabolic syndrome.Keywords: prediction model, prognosis, metabolic syndrome, algorithms, calibration, discrimination

Dandan Chen,1 Feng Song,2 Nianqi Cui,3 Leiwen Tang,1 Hui Zhang,4 Jing Shao,1 Ruolin Qiu,1 Dan Wang,1 Xiyi Wang,1 Zhihong Ye1 1Zhejiang University School of Medicine, Affiliated Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, People’s Republic of China; 2Yunnan College of Business Management, Medical Faculty, Kunming, Yunnan, People’s Republic of China; 3The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 4Guizhou Provincial People’s Hospital, Department of Cardiology, Guiyang, Guizhou, People’s Republic of ChinaCorrespondence: Zhihong YeAffiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, Zhejiang, 310016, People’s Republic of ChinaTel +86 136 0661 2119Email yezh@zju.edu.cnIntroduction: With the effective treatments of novel coronavirus disease 2019 (COVID-19), thousands of patients have recovered from COVID-19 globally. The public perceptions and views are vital to facilitate recovered COVID-19 patients reintegrate into society. In China, the rural population accounts for nearly 70% of the total population. Therefore, we chose to evaluate perceptions and views of rural residents towards COVID-19 recovered patients in China.Methods: Fifteen participants were sampled from a village with the severe COVID-19 epidemic in Zibo city, Shandong Province. The fifteen participants who lived in the village with COVID-19 recovered patients were included. They were over 18 years of age and were voluntary to participant in the study. A descriptive qualitative design using semi-structured telephone interviews was undertaken. Thematic analysis was undertaken.Results: Five main themes emerged from the data: (1) Perceived personal characteristics of COVID-19 recovered patients; (2) Perceived difficulties faced by COVID-19 recovered patients; (3) Perceptions on the social relationship with COVID-19 recovered patients; (4) Views on COVID-19 recovered patients going to public venues; (5) Views on helping COVID-19 recovered patients. Each theme was supported by several subthemes.Conclusion: Our study showed that discrimination and reduced social intimacy exist among rural residents. To improve their views or the situation, relevant departments could lead health educational programs and encourage supportive social connections. Through these strategic messaging, rural residents are expected to recognize that COVID-19 recovered patients need more social support, rather than discrimination and resistance, which helps recovered patients better return to society.Keywords: rural residents, perceptions, views, COVID-19 recovered patients, China

Hui Zhang,1 Jing Shao,1 Dandan Chen,1 Ping Zou,2 Nianqi Cui,3 Leiwen Tang,1 Dan Wang,1 Zhihong Ye1 1Department of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Scholar Practitioner Program, School of Nursing, Nipissing University, Toronto, Ontario, Canada; 3Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Zhihong YeDepartment of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang 310016, People’s Republic of ChinaTel +86-13606612119Email 3192005@zju.edu.cnPurpose: A prognostic prediction model for metabolic syndrome can calculate the probability of risk of experiencing metabolic syndrome within a specific period for individualized treatment decisions. We aimed to provide a systematic review and critical appraisal on prognostic models for metabolic syndrome.Materials and Methods: Studies were identified through searching in English databases (PubMed, EMBASE, CINAHL, and Web of Science) and Chinese databases (Sinomed, WANFANG, CNKI, and CQVIP). A checklist for critical appraisal and data extraction for systematic reviews of prediction modeling studies (CHARMS) and the prediction model risk of bias assessment tool (PROBAST) were used for the data extraction process and critical appraisal.Results: From the 29,668 retrieved articles, eleven studies meeting the selection criteria were included in this review. Forty-eight predictors were identified from prognostic prediction models. The c-statistic ranged from 0.67 to 0.95. Critical appraisal has shown that all modeling studies were subject to a high risk of bias in methodological quality mainly driven by outcome and statistical analysis, and six modeling studies were subject to a high risk of bias in applicability.Conclusion: Future model development and validation studies should adhere to the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) statement to improve methodological quality and applicability, thus increasing the transparency of the reporting of a prediction model study. It is not appropriate to adopt any of the identified models in this study for clinical practice since all models are prone to optimism and overfitting.Keywords: prediction model, risk, prognosis, metabolic syndrome, systematic review

Wenping Mao,1,2 Jing Wang,1,2 Liming Zhang,1,2 Ying Wang,1,2 Wenjun Wang,1,2 Na Zeng,3 Jun Zhang,1,2 Qian li,1,2 Fengwei Jiao,1,2 Jie Li,1,2 Na Cui,1,2 Song Mi,1,2 Yi Xue,1,2 Zhaomei Wang,1,2 Sun Ying,4 Kewu Huang1,2 1Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People’s Republic of China; 2Beijing Institute of Respiratory Medicine, Beijing 100020, People’s Republic of China; 3Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People’s Republic of China; 4Department of Immunology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, People’s Republic of ChinaCorrespondence: Kewu HuangDepartment of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing 100020, People’s Republic of ChinaTel + 86-10-85231167Email kewuhuang@126.comPurpose: We hypothesized that increased level of serum β 2-microglobulin (β 2M) is an independent factor associated with higher mortality in hospitalized patients with exacerbated chronic obstructive pulmonary disease (COPD).Patients and Methods: We retrospectively analyzed 488 hospitalized patients with exacerbated COPD as the first diagnosis at Beijing Chao-Yang hospital, P. R. China between December 31st, 2012 and December 28th, 2017. Concentrations of serum β 2M and other clinical indexes were measured or collected on admission, and all patients were followed up to 90 days. The relationship between β 2M and 30- and 90-day all-cause mortality was explored by Cox regression analysis adjusted for age, C-reactive protein values, N-terminal pro-brain natriuretic peptide/100, respiratory failure [RF, defined as partial arterial oxygen pressure (PaO2) < 60 mmHg on room air or PaO2 over the fraction of inspired oxygen (PaO2/FiO2) < 300], eosinopenia, consolidation, and acidaemia.Results: Median concentrations of β 2M were significantly higher in non-survivals compared to survivals within 30 days (4.11 mg/L (IQR 3.10– 6.60) vs 2.79mg/L (IQR 2.13– 3.76), P < 0.001) and 90 days (3.79 mg/L (IQR 2.61– 6.69) vs 2.79 mg/L (IQR 2.13– 3.73), P < 0.001). Serum levels of β 2M were correlated with 30-day and 90-day mortality in overall exacerbated COPD patients, with hazard ratios (HRs) of 1.09 (95% CI 1.04– 1.14, P = 0.001) and 1.09 (95% CI 1.05– 1.14, P < 0.001). In exacerbated COPD patients without RF and with RF, the HRs were 1.06 (95% CI 0.995– 1.137, P = 0.069) and 1.14 (95% CI 1.02– 1.27, P = 0.021) for 30-day mortality, 1.09 (95% CI 1.02– 1.15, P = 0.010) and 1.14 (95% CI 1.03– 1.26, P = 0.014) for 90-day mortality, respectively.Conclusion: Our data showed that concentrations of serum β 2M were associated with an increased risk of mortality, suggesting that β 2M might be a valuable predictor of poor prognosis for hospitalized patients with exacerbated COPD.Keywords: β 2-microglobulin, COPD, exacerbation, predictor, prognosis

Nan Cui,1 Jing Cui,2 Jianping Sun,2 Xinping Xu,1 Bilal Aslam,3,4 Lan Bai,1 Decheng Li,1 Di Wu,1 Zhongren Ma,3 Hai Gu,1 Zulqarnain Baloch3 1Research Center for Health Policy and Management, Nanjing University, Nanjing, People’s Republic of China; 2Qingdao Centers for Disease Control and Prevention, Qingdao Institute for Preventive Medicine, Qingdao, People’s Republic of China; 3Biomedical Research Center, Northwest Minzu University, Lanzhou 730030, People’s Republic of China; 4Department of Microbiology, Government College University Faisalabad, Faisalabad, Punjab, PakistanCorrespondence: Hai GuResearch Center for Health Policy and Management, Nanjing University, 101 Longmian Avenue, Jiangning District, Nanjing 210093, People’s Republic of ChinaTel/Fax +8613687616923Email njuhaigu@126.comZulqarnain BalochBiomedical Research Center, Northwest Minzu University, Minying Road, Lanzhou 730030, People’s Republic of ChinaTel +86-18344564625Email znbalooch@yahoo.comObjective: To assess the association between triglycerides (TG), total cholesterol (TC) and hyperuricemia (HUA) in the general Chinese population.Methods: A population-based cross-sectional survey included 9680 participants aged 35– 74 years in 2006 and 2009 in Qingdao, China. TG, TC and uric acid (UA) were measured. The logistic regression model was performed to estimate the association between TG, TC, and HUA with an odds ratio (OR) and 95% confidence intervals (CI). Meanwhile, age stratification analysis (< 55 years group and ≥ 55 years group) was performed to evaluate whether age potentially affects the association between TG, TC and HUA using multivariable logistic regression.Results: Higher TG and TC showed significantly increased HUA prevalence in both men and women (Ptrend all < 0.05). Multivariate logistic regression indicated that borderline high TG (OR: 1.68, 95% CI: 1.31, 2.15 and HTG (OR: 2.98, 95% CI: 2.39, 3.72) indicated increased risk for HUA in men, and borderline high TG (OR: 2.09; 95% CI: 1.68,2.62); HTG (OR: 3.62; 95% CI: 2.90,4.51), borderline high TC (OR: 2.09, 95% CI: 1.68, 2.62) and HTC (OR: 3.62, 95% CI: 2.90, 4.51) showed significant association with HUA in women after adjusted age, school years, marital status, geographic division, personal monthly income, BMI and HDL-C. Age stratification analyses demonstrated that the association between TG and HUA was stronger in males aged ≥ 55 years and female aged < 55 years, and the association between TC and HUA was stronger in both gender aged < 55 years.Conclusion: This large cross-sectional study focusing on the association between single indictor of blood lipid as exposure and HUA as outcome on the east coast of China for the first time. From a sample of Chinese adults, this study demonstrated that elevated TG in men and women and TC in women were associated with increased HUA prevalence.Keywords: triglycerides, total cholesterol, hyperuricemia, Qingdao, Chinese population

Jian Zhang, 1 Hongyan Zhang, 2 Jianqi Jiang, 2 Nan Cui, 2 Xiao Xue, 2 Tianying Wang, 2 Xiaoqiang Wang, 3 Yunpeng He, 2 Dongkai Wang 2 1Department of Chinese Medicine Pharmacology, School of Traditional Chinese Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, People’s Republic of China; 2Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, People’s Republic of China; 3Department of Pharmaceutical Chemistry, School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016, People’s Republic of ChinaCorrespondence: Dongkai WangDepartment of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, People’s Republic of ChinaTel +86 24-43520529Email wangycsyphu@126.comBackground: Carbon dots (CDs) have attracted extensive attention in recent years because of their high biocompatibility and unique optical property. But they could not be well applied in the drug delivery system to enable distribution in tumor sites with their low pH sensitivity. They are barriers for drug delivery. CDs as an imaging proper were conjugated with doxorubicin (DOX) lipid-coated calcium phosphate (LCP) nanoparticle, for a pH-sensitive nanocarrier and delivery of the antitumor drugs.Materials and Methods: CDs were prepared by one-step hydrothermal treatment of citric acid and ethylenediamine. The nanoparticles were simply prepared by using microemulsion technology to form calcium phosphate (CaP) core and further coated with cationic lipids.Results: The structure was characterized by FTIR, XRD and TEM. In vitro release study revealed that DOX-CDs@LCP was pH dependent. The cytotoxicity assay demonstrated that it exhibited enhanced efficiency compared to the control group (DOX-CDs), but weaker than free DOX. The cellular uptake revealed that these pH-sensitive nanoparticles could be taken up effectively and deliver DOX into the cytoplasm to reach antitumor effect. The fluorescence imaging indicated that DOX-CDs@LCP mostly distributed in the tumor region due to the enhanced permeability and retention effect (EPR) to reduce its systematical toxicity. Importantly, an antitumor activity study demonstrated that the DOX-CDs@LCP nanoparticles had higher antitumor activity than any other groups and lower toxicity. The results showed that LCP could significantly promote the release in tumor microenvironment due to pH-response. The DOX-CDs could enhance load capacity and reduce drug premature releasing; real-time tracking of efficacy as confocal imaging contrast agent. Thus, DOX-CDs@LCP had antitumor capacity and lower systematic toxicity in tumor therapy.Conclusion: DOX-CDs@LCP were proven as a promising tumor pH-sensitive and imaging-guided drug delivery system for liver cancer chemotherapy.Keywords: carbon dots, calcium phosphate photodynamic therapy, pH-sensitive, bioimaging, tumor targeting, therapy

Kai Dong,* Qiuya Lei,* Runhao Guo, Xianglong Wu, Yanni Zhang, Ning Cui, Jian-Yu Shi, Tingli LuKey Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi’an, Shaanxi, People’s Republic of China*These authors contributed equally to this workPurpose: The levels of reactive oxygen species (ROS) in tumor cells are much higher than that in normal cells, and rise rapidly under the influence of exogenous or endogenous inducing factors, eventually leading to the apoptosis of tumor cells. Therefore, this study prepared a dual pH/reducing-responsive poly (N-isopropylacrylamide-co-Cinnamaldehyde-co-D-α-tocopheryl polyethylene glycol 1000 succinate, PssNCT) nanogels, which employed two exogenous ROS inducers, cinnamaldehyde (CA) and D-α-tocopheryl polyethylene glycol 1000 succinate (TPGS), to selectively induce apoptosis by regulating ROS levels in tumor cells.Methods: The PssNCT nanogels were prepared by the free radical precipitation polymerization under the crosslink between pH-sensitive hydrazone and reducing-sensitive disulfide bonds, followed by the physicochemical and morphological characteristics investigations. Plasma stability, dual pH/reducing responsive degradation and in vitro release were also assessed. In cell experiments, cytotoxicity in different cells were first detected. The intracellular ROS levels and mitochondrial functions of tumor cells were then evaluated. Moreover, the apoptosis and western-blot assays were employed to verify the association between ROS levels elevation and apoptosis in tumor cells.Results: The nanogels exhibited a round-like hollow structure with the diameter smaller than 200nm. The nanogels were stable in plasma, while showed rapid degradation in acidic and reducing environments, thus achieving significant release of CA and TPGS in these media. Furthermore, the sufficient amplification of ROS signals was induced by the synergistically function of CA and TPGS on mitochondria, which resulted in the opening of the mitochondrial apoptotic pathway and enhanced cytotoxicity on MCF-7 cells. However, nanogels barely affected L929 cells owing to their lower intracellular ROS basal levels.Conclusion: The specific ROS regulation method achieved by these nanogels could be explored to selectively kill tumor cells according to the difference of ROS signals in different kinds of cells.Keywords: reactive oxygen species, oxidative stress, cinnamaldehyde, TPGS, nanogels

BACKGROUND/OBJECTIVES: Previous studies have indicated that higher levels of food consumption are associated with fatty liver disease (FLD), but few studies have investigated the relationship between this disease and different dietary patterns. The aim of this cross-sectional study was to examine the association between dietary patterns and FLD in adults. SUBJECTS/METHODS: Dietary intakes of participants in the Tianjin were assessed via questionnaire. Factor analysis was used to identify dietary patterns, and FLD was defined as having a FLD diagnosis using liver ultrasonography. Relationships between dietary patterns and FLD were assessed using multiple logistic regression analysis. RESULTS: Female participants in the highest quartile of high-carbohydrate/sweet pattern scores had a 2.19-fold greater risk (95% confidence interval (CI), 1.40-3.46) of developing non-alcoholic FLD (NAFLD) than those in the lowest quartile after adjusting for confounding factors. No significant differences were found between any dietary pattern and NAFLD in males. In males, a significantly increasing trend of alcoholic FLD (AFLD) prevalence was associated with increasing high- protein/cholesterol pattern scores (P for trend = 0.03; odds ratio (OR), 2.08; 95% CI, 1.15-3.81) while an increased high- carbohydrate/sweet pattern score appeared protective against AFLD (P for trend = 0.02; OR, 0.55; 95% CI, 0.29-1.00). CONCLUSIONS: Our study demonstrates that high-protein/cholesterol pattern scores are associated with higher prevalence of AFLD in males. We also show high-carbohydrate/sweet pattern scores are associated with higher prevalence of NAFLD in females;but, interestingly, this pattern shows a favorable effect on AFLD in males. European Journal of Clinical Nutrition (2015) 69, 914-921; doi: 10.1038/ejcn.2014.297; published online 4 February 2015, INTRODUCTION Fatty liver disease (FLD) can be divided into non-alcoholic FLD (NAFLD) and alcoholic FLD (AFLD), depending on the history of alcohol use. NAFLD develops without alcohol abuse and is [...]

Second, targeting neutrophil glycolysis inhibition or increasing neutrophil OxPhos levels may be a viable treatment approach for neutrophilic asthma. Learning points for clinicians Neutrophilic asthma is a subtype of asthma that is more difficult to treat. We labeled neutrophils emerging during remission as "recovery-specific neutrophils (rs-Neus)" and neutrophils present before remission as "pathological neutrophils (pNeus)". [Extracted from the article]