A secondary abdominal aorta-duodenal fistula accompanied with acquired Immune Deficiency Syndrome presented with recurrent sepsis: a case report.

BACKGROUND: Abdominal aorta-duodenal fistulas are rare abnormal communications between the abdominal aorta and duodenum. Secondary abdominal aorta-duodenal fistulas often result from endovascular surgery for aneurysms and can present as severe late complications. CASE PRESENTATION: A 50-year-old male patient underwent endovascular reconstruction for an infrarenal abdominal aortic pseudoaneurysm. Prior to the operation, he was diagnosed with Acquired Immune Deficiency Syndrome and Syphilis. Two years later, he was readmitted with lower extremity pain and fever. Blood cultures grew Enterococcus faecium, Salmonella, and Streptococcus anginosus. Sepsis was successfully treated with comprehensive anti-infective therapy. He was readmitted 6 months later, with blood cultures growing Enterococcus faecium and Escherichia coli. Although computed tomography did not show contrast agent leakage, we suspected an abdominal aorta-duodenal fistula. Esophagogastroduodenoscopy confirmed this suspicion. The patient underwent in situ abdominal aortic repair and received long-term antibiotic therapy. He remained symptom-free during a year and a half of follow-up. CONCLUSIONS: This case suggests that recurrent infections with non-typhoidal Salmonella and gut bacteria may be an initial clue to secondary abdominal aorta-duodenal fistula.

Flexible Puncture-Resistant Composites for Antistabbing Applications: Silica and Silicon Carbide Nanoparticle-/TPU-Coated Aramid Fabrics.

In harsh environments, it is crucial to design personal protective materials that possess both puncture/cut resistance and chemical resistance. In order to fulfill these requirements, this study introduces an innovative approach that combines hydrophobically modified rigid nanoparticles with thermoplastic polyurethane elastomers. These materials are then laminated with high-performance aramid fabrics through a scraping process, resulting in a multifunctional composite with puncture/cut resistance, superhydrophobicity, self-cleaning properties, and acid/alkali resistance. The quasi-static puncture tests conducted reveal the remarkable performance of the composite. The maximum spike puncture resistance reaches 267.62 N, which is 17.14 times higher than that of the pure fabric (15.61 N). Similarly, the maximum knife puncture resistance reaches 115.02 N, exhibiting a 5.01 times increase compared to that of the pure aramid fabric (22.97 N). Furthermore, the results obtained from the yarn pull-out, fabric burst strength, and tearing experiments demonstrate that the incorporation of rigid nanoparticles significantly enhances the friction between the yarns, enabling a greater number of yarns to participate in the dissipation of impact energy. As a result, the puncture resistance of the fabric is greatly improved. Significantly, the composite exhibits sustained superhydrophobicity even after exposure to harsh chemicals such as concentrated sulfuric acid and sodium hydroxide as well as undergoing cyclic mechanical wear. These findings highlight the composite's exceptional durability and resistance to corrosion. Overall, this study offers insights and methods for the development of multifunctional flexible puncture-resistant equipment for individuals.

Relationship between lipid parameters and vascular mechanical characteristics among a normotensive population without diabetes mellitus residing at the Qinghai-Tibet plateau: a cross-sectional study.

BACKGROUND: There is limited evidence regarding the relationship between lipid parameters and vascular mechanical characteristics in the normotensive population without diabetes mellitus. The aim of this study was to identify an association between lipid parameters and changes in vascular mechanical characteristics between men and women, and in women before and after menopause. METHODS: Six hundred-seventy patients who underwent vascular functional testing and who fulfilled the inclusion and exclusion criteria were enrolled in our cross-sectional study. All participants were from the Qinghai-Tibet Plateau (Luhuo County, Ganzi Tibetan Autonomous Prefecture, Sichuan Province, China; mean altitude: 3860 m). Trained clinical physicians assessed brachial-ankle pulse wave velocity (Ba-PWV) and augmentation index adjusted to a 75-beats-per-minute heart rate (AIx@75). To investigate the relationship between lipid parameters and vascular mechanical characteristics in different sexes and menstrual stages, partial correlation analysis and multiple linear regression were used. RESULTS: The 670 participants comprised 445 women (103 post-menopausal). Mean Ba-PWV and AIx@75 were 1315.56 ± 243.41 cm/s and 25.07% ± 15.84%, respectively. Men had greater Ba-PWV values compared with women (1341.61 ± 244.28 vs 1302.39 ± 242.17 cm/s, respectively; P < 0.05), while AIx@75 values were higher in women compared with men (27.83% ± 15.85% vs 19.64% ± 14.40%, respectively; p < 0.001). In the partial correlation analysis adjusted for age, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (HDL-C) were associated with Ba-PWV in both men and women (p < 0.05); however, the magnitude was larger in men. Statistical significance was not seen for AIx@75 among both men and women. Multiple linear regression analysis revealed that TC (ß = 0.165, p = 0.024) and non-HDL-C (ß = 0.151, p = 0.042) remained independent predictors of change in Ba-PWV in men after adjusting for age, mean arterial pressure, waist circumference, hemoglobin, platelet count, fasting blood glucose, estimated glomerular filtration rate, and uric acid. After adjusting for traditional cardiovascular risk factors, pre-menopausal women had a similar association to that of men between LDL-C (ß = 0.126, p = 0.030), non-HDL-C (ß = 0.144, p = 0.013), TC/HDL-C (ß = 0.162, p = 0.005), LDL-C/HDL-C (ß = 0.142, p = 0.013) and Ba-PWV; however, post-menopausal women had no association between the lipid parameters and vascular function. CONCLUSIONS: Overall, TC and non-HDL-C were independent associated factors for vascular compliance alterations evaluated through Ba-PWV in normotensive men. In pre-menopausal women, LDL-C, non-HDL-C, TC/HDL-C and LDL-C/HDL-C were independent associated factors for vascular compliance alterations. After controlling for traditional risk factors, lipid profiles were not associated with these metrics for AIx@75, which can measure the amplification of reflex flow, because of the high number of confounding factors that do not genuinely reflect changes in vascular characteristics. Lipid factors did not appear to be linked to vascular function in post-menopausal women.

[The Disparities of Hypertension Control Rate and Risk Factors among Hypertensive Residing in High-altitude and Plain in Sichuan Province].

OBJECTIVE: To explore the disparities of hypertension control rate and its affecting factors between plateau and plain regions in Sichuan province. METHODS: The cross-sectional study was conducted from May to September 2017. We recruited 231 subjects in Jinyang and Chenghua community health service center in Chengdu and 220 subjects in Jiulong County in Ganzi Autonomous Prefecture, Sichuan Province. Demographic characteristics, medical history, family history, lifestyle, cognitive function and medication compliance were collected using a structured questionnaire. Blood pressure and electrocardiogram were measured, and blood samples were collected among participants included in the study. Bivariate logistic regression analysis was used to investigate the affecting factors of hypertension control rate. All the statistical analyses were stratified by plateau and plain regions. RESULTS: Hypertension control rate in the plain group was higher than the plateau group (19.05% vs. 8.64%). The logistic regression model showed that the control rate of hypertension was higher among the participants who were 70-80 years old than 40-50 years old in the plain group ( OR=4.037, 95% CI: 1.269-12.848). Central obesity ( OR=0.480, 95% CI: 0.233-0.987) and high uric acids ( OR=0.994, 95% CI: 0.989-0.998) were the risk factors of control rate. In the plateau group, high medication compliance ( OR=4.793, 95% CI: 1.407-16.326) and high uric acids ( OR=1.008, 95% CI: 1.003-1.012) were the protective factors, and low cognitive function ( OR=0.234,95% CI：0.071-0.767) was risk factor. CONCLUSION: The control rate of hypertension in the plain is higher than that in the plateau. In the plain, the risk factors are central obesity and high uric acids, and aged 40-50 years. In the plateau, the risk factors are poor medication compliance and low cognitive function.

Association of Elevated Plasma Homocysteine Level with Restenosis and Clinical Outcomes After Percutaneous Coronary Interventions: a Systemic Review and Meta-analysis.

PURPOSE: We conducted this systemic review and meta-analysis to investigate the association between elevated plasma homocysteine (Hcy) levels and recurrent restenosis and clinical outcomes after percutaneous coronary intervention (PCI). METHODS: PubMed, EMBASE, and Web of Science were systematically searched prior to May 2018. Studies evaluating the association between plasma Hcy levels and the occurrence of restenosis, major adverse cardiac events (MACE), all-cause mortality, cardiac death, non-fatal myocardial infarction (MI), and target lesion revascularization were identified. RESULTS: A total of 19 articles with 4340 participants were identified. Higher Hcy levels were not associated with an increased risk of restenosis (relative risk (RR) = 1.10, 95% CI 0.90-1.33). Hcy levels in the restenosis group were not significantly higher than in the non-restenosis group (weighted mean difference = 0.70, 95% CI - 0.23-1.63). Subgroup analysis revealed that higher Hcy levels were not associated with restenosis after stenting but appeared to increase the risk of restenosis after angioplasty. Elevated Hcy levels increased the risk of all-cause mortality by an average of 3.19-fold (RR = 3.19, 95% CI 1.90-5.34, P = 0.000), the risk of MACE by 1.51-fold (RR = 1.51, 95% CI 1.23-1.85, P = 0.000), and the risk of cardiac death by 2.76-fold (RR = 2.76, 95% CI 1.44-5.32, P = 0.000) but appeared not to increase the risk of non-fatal MI (RR = 1.36, 95% CI 0.89-2.09). CONCLUSIONS: Our meta-analysis suggests that although there is no clear association between higher Hcy levels and restenosis following stent implantation, higher Hcy levels appeared to increase the risk of restenosis after coronary angioplasty and also increased the risk of all-cause mortality, MACE, and cardiac death after PCI. REGISTRATION DETAILS: The protocol of this meta-analysis was registered on PROSPERO (CRD42018096466). ( http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018096466 ).

The efficacy and safety of acupuncture and moxibustion for the management of nausea and vomiting in pregnant women: A systematic review and meta-analysis.

Background: Nausea and vomiting, which cause considerable multifaceted effects, are commonly experience in early pregnancy. Various therapeutic strategies are employed, including both conventional agents and complementary medicine. However, the effectiveness of complementary medicine remains controversial. The objective of this meta-analysis is to evaluate efficacy and safety of acupuncture and moxibustion in pregnant women. Methods: We conducted a comprehensive search using electronic databases such as PubMed, Embase, ISI Web, Medline, Cochrane, clinicaltrial.gov, and several Chinese databases. A total of 21 randomized controlled trials were included in this study for quantitative analysis. Forest plots were utilized to evaluate the efficacy and safety of acupuncture and moxibustion. Egger's test was employed to assess publication bias. Results: The pooled analysis revealed that the acupuncture/moxibustion group was more effective than control group in alleviating nausea and vomiting in early pregnant women (RR: 0.28; 95%CI: 0.21, 0.37). Similar results were observed when comparing the acupuncture group to traditional herbs (RR: 0.08; 95 % CI: 0.01, 0.60), conventional therapy (RR: 0.15; 95 % CI: 0.04, 0.57), and the blank control group (RR: 0.33; 95 % CI: 0.22, 0.51). Moxibustion also exhibited the ability to alleviate nausea and vomiting compared with the blank control group (RR: 0.21; 95 % CI: 0.08, 0.52). As for safety, there were no significant differences in severe adverse events between the acupuncture group and the control group (RR: 0.77; 95%CI: 0.52, 1.14), the blank control group (RR: 0.61; 95%CI: 0.34, 1.10), the sham acupuncture group (RR: 1.05; 95%CI: 0.63, 1.73), or the conventional therapy group (RR: 0.32; 95%CI: 0.06, 1.55). Conclusion: Acupuncture and moxibustion might be effective for the management of nausea and vomiting in early pregnant women. Moreover, acupuncture might be a relatively safe treatment for pregnancy.

Modification of traditional composite nonwovens with stable storage of light absorption transients and photodynamic antibacterial effect.

Combining photodynamic antimicrobials with nonwovens is prospective. However, common photosensitizers still have drawbacks such as poor photoactivity and the inability to charge. In this study, a photodynamic and high-efficiency antimicrobial protective material was prepared by grafting bis benzophenone-structured 4,4-terephthaloyl diphthalic anhydride (TDPA) photosensitizer, and antimicrobial agent chlorogenic acid (CA) onto spunbond-meltblown-spunbond (SMS) membranes. The charging rates for ·OH and H2O2 were 6377.89 and 913.52 µg/g/h. The light absorption transients structural storage remained above 69% for 1 month. High electrical capacity remained after seven cycles indicating its rechargeability and recyclability. The SMS/TDPA/CA membrane has excellent bactericidal performance when under illumination or lightless conditions, and the bactericidal efficiency of Escherichia coli and Staphylococcus aureus reached over 99%. The construction of self-disinfection textiles based on the photodynamic strategies proposed in this paper is constructive for expanding and promoting the application of textile materials in the medical field.

Biomimetic helical fiber cellulose acetate/thermoplastic polyurethanes photodynamic antibacterial membrane: Synthesis, characterization, and antibacterial application.

This study designed a novel co-electrospun cellulose acetate (CA)/thermoplastic polyurethane (TPU) photodynamic helical fiber antibacterial membrane as a potential environmentally friendly medical protective material. A central combined design method (CCD) based on response surface methodology (RSM) was used to analyze essential variables' influence. The optimized parameters for CCD were TPU (wt%) 11.68 %, CA (wt%) 13.89 %, DMAc/ACE volume ratio 0.147, LiCl (wt%) 1.39 %, and voltage (kV) 14.43 V. Pitch and pitch diameter were the response process as the critical output variable. The membranes were characterized by SEM, TG, FT-IR, and molecular structure analysis. The results showed that the photodynamic helical fiber antimicrobial membrane exhibited synergistic effects of the antibacterial photodynamic therapy (APDT) and antimicrobial agent under average daylight irradiation. The release rate of -OH was 98.22 %, and H2O2 was 88.36 % under the action of 20 min of light. The bactericidal rates of S. aureus and E. coli reached 99.9 % and 99.7 %, respectively. The fiber helical structure can increase the light absorption rate, thus increasing the release rate and amount of reactive oxygen species (ROS) species, increasing the antibacterial rate. After washing five times, the antibacterial membrane has excellent antibacterial performance and a dark antibacterial effect.

Effect of aspirin in patients with established asymptomatic carotid atherosclerosis: A systematic review and meta-analysis.

Background: Aspirin is widely used as an antiplatelet agent for secondary prevention in patients with atherosclerotic cardiovascular disease. However, it remains unclear whether aspirin can prevent the progression of carotid atherosclerosis or reduce vascular events and all-cause death. Methods: We performed a meta-analysis of the effect of aspirin in asymptomatic carotid atherosclerotic patients. Electronic databases including Pubmed, EMBase, ISI Web, Medline, Cochrane, and clinicaltrial.gov were searched for relevant randomized controlled trials. A total of five studies (841 individuals, 2,145 person-years) were included in this study. Two reviewers independently performed the study assessment and data extraction. Forest plots were used to assess the efficacy of aspirin. Egger's test was used to evaluate publication bias. Results: Aspirin did not alleviate the progression of carotid intima-media thickness (cIMT) compared with control patients (WMD: -0.05 mm, 95% confidence interval 95%CI: -0.12, 0.03). In subset analysis, aspirin was only associated with regression of cIMT when compared with the empty/placebo group (WMD: -0.10 mm, 95%CI: -0.18, -0.02). In type 2 diabetes mellitus, there were no statistical significance between groups (WMD: 0.10 mm, 95%CI: -0.31, 0.50). For the main vascular events and all-cause death, there were no differences between the aspirin group (RR: 0.73, 95%CI: 0.41, 1.31) and the control group (RR: 0.88, 95%CI: 0.41, 1.90). For outcome events, similar results were observed when patients were classified by different cIMT value (p > 0.05). The risk of gastrointestinal bleeding was similar between participants receiving and not receiving aspirin therapy (RR: 1.04, 95%CI: 0.07, 16.46). Conclusion: In patients with asymptomatic carotid atherosclerosis, low-dose aspirin may slightly alleviate the progression of cIMT, but does not reduce vascular events and all-cause death. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier PROSPERO.

Associations of urinary sodium excretion with central hemodynamics and changes in vascular structure and function at high altitude.

Research reports on associations of urinary sodium excretion with central hemodynamic parameters and vascular changes are quite limited in general or non-hypertensive population. The purpose of the current study was to explore such associations in Chinese general Tibetans living at high altitude. This cross-sectional study was conducted in Luhuo County, Ganzi Tibetan Autonomous Prefecture with average elevation of 3800 meters from December 2018 to January 2019. A total of 294 Tibetans were included in the current study. Twenty-four hour urinary sodium excretion was estimated by second fasting spot urine in the morning using Kawasaki formula. Central hemodynamic parameters, including central systolic blood pressure (CSBP), central diastolic blood pressure (CDBP), central pulse pressure (CPP), central mean arterial pressure (CMAP), augmentation pressure (AP), and augmentation index standardized for heart rate of 75 (AIx75 ), were evaluated using the SphygmoCor system. Vascular structures and functions were assessed by carotid intima media thickness (CIMT) test and brachial ankle pulse wave velocity (baPWV), respectively. Estimated mean 24h urinary sodium excretion of Tibetans in Luhuo County was 5.26±1.61 g. After adjustment, estimated 24h urinary sodium was positively associated with CSBP (ß = 1.15, p = .008) and CPP (ß = 0.87, p = .013). Line graph of means across urinary sodium quartiles showed that associations of 24 h urinary sodium excretion with AIx75 and baPWV presented approximate "J" shape after controlling for confounders. Estimated 24 h sodium excretion was independently and positively associated with CSBP and CPP. Moreover, association between urinary sodium excretion and arterial elasticity, as evaluated by baPWV and AIx75 , presented "J" shape. Further studies are needed to verify J-shaped association and "safe" zone of sodium intake.

Optimization of Preparation Conditions for Side-Emitting Polymer Optical Fibers Using Response Surface Methodology.

Polymer optical fibers (POFs) were used for preparing side-emitting polymer optical fibers (SPOFs), which were processed with acetone and n-hexane combined in selected proportions by a solvent treatment method. The effects of the volume ratio of acetone to n-hexane and treatment time on response variable factors were investigated. The center composite design (CCD) based response surface methodology (RSM), a quadratic model, and a two-factor interaction model were developed to relate the preparation variables of illumination intensity, breaking strength, and rigidity. According to analysis of variance (ANOVA), the factors affecting the optimization of each response factor were determined. The predicted values after process optimization were found to be highly similar to the experimental values. The optimal conditions for the preparation of SPOF were as follows: the volume ratio of acetone to hexane was 1.703, and the treatment time was 2.716 s. The three response variables of SPOF prepared under the optimal conditions were: illumination intensity 19.339 mV, breaking strength 5.707 N, and rigidity 572.013 N·mm2.

Early age at menarche is associated with insulin resistance: a systemic review and meta-analysis.

OBJECTIVES: We aimed to conduct a systemic review and meta-analysis of the relevant studies to further investigate the association between age at menarche and insulin resistance. METHODS: PubMed, EMBASE, and Web of Science (SCI) databases were systemically searched until December 2017. Observational studies comparing the incidences of insulin resistance in patients with early, average, and late menarchal ages were identified. Weighted mean difference (WMD) for HOMA-IR scores and fasting serum insulin levels in early vs late, early vs average. and average vs late comparisons were calculated with a random- or fixed-effects model. RESULTS: A total of eight articles involving 5504 subjects were finally included. In the analysis of HOMA-IR, the pooled WMDs in five studies were 0.45 (95% confidence interval [CI] 0.31-0.60, p < 0.001), 0.40 (95% CI 0.28-0.52, p < 0.001), and -0.01 (95% CI -0.09 to 0.07, p = 0.854) for early vs late, early vs average, and average vs late comparisons, respectively. The fasting serum insulin levels in eight studies were analyzed, and it was significantly higher in subjects with earlier age at menarche (WMD 1.28, 95% CI 0.92-1.63, p < 0.001 for early vs late comparison, WMD 1.28, 95% CI 1.13-1.43, p < 0.001 for early vs average comparison) with mild and acceptable heterogeneity (I2 = 42.5% and 7.4%, respectively). Publication bias was not detected via funnel plots and Egger's tests. CONCLUSIONS: Our study revealed that earlier age at menarche was significantly associated with insulin resistance. TRIAL REGISTRATION NUMBER: CRD42018083874.