Effect of a Multicomponent Exercise Intervention on Recovery of Walking Ability in Stroke Survivors: A Systematic Review With Meta-analysis.

OBJECTIVE: To evaluate whether multicomponent exercise (MCE) is more effective than single exercise in improving walking ability in patients with stroke. DESIGN: A systematic review and meta-analysis. DATA SOURCES: A systematic search of PubMed, Embase, Web of Science, Cochrane Library, and CINAHL from the establishment of each database to February 2024 was performed. A combination of medical subject headings and free-text terms relating to stroke and exercise were searched. STUDY SELECTION: Randomized controlled trials treating stroke survivors with MCE were included. The control groups received conventional treatments such as conventional treatment or no intervention or sham training; the experimental groups received MCE. The outcome measures were walking endurance, gait speed, and balance ability. DATA EXTRACTION: The data extraction form was completed by 2 independent reviewers. The risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials. Review manager 5.4 software was used for data analysis. Subgroup analysis and sensitivity analysis were used to supplement the results with higher heterogeneity. The preferred reporting project for systematic reviews and meta-analyses 2020 guidelines were followed. DATA SYNTHESIS: Twelve studies were included. Meta-analyses found that compared with the control group, the MCE significantly affected gait speed (mean difference=0.11; 95% CI, 0.06-0.16; I2=0%), but the effect on balance ability was not statistically significant. Subgroup analysis showed that MCE (≥60min) was effective in improving walking endurance. These results suggest that MCE improves walking endurance and walking speed in patients with stroke. CONCLUSIONS: MCE helps improve the gait speed of stroke survivors. Prolonging the MCE time may have a better effect on improving the walking endurance of patients with stroke.

Association of serum 25-hydroxyvitamin D with metabolic syndrome and type 2 diabetes: a one sample Mendelian randomization study.

BACKGROUND: Vitamin D deficiency has been associated with type 2 diabetes (T2D) and metabolic syndrome (MS) and its components. However, it is unclear whether a low concentration of vitamin D is the cause or consequence of these health conditions. Thus, this study aimed to evaluate the association of vitamin D concentrations and its genetic risk scores (GRSs) with MS and its component diseases, such as T2D, in middle-aged and elderly participants from rural eastern China. METHODS: A subset of 2393 middle-aged and elderly individuals were selected from 70,458 participants of the Nantong Chronic Diseases Study of 2017-2018 in China. We used two 25-hydroxyvitamin D (25[OH]D) synthesis single-nucleotide polymorphisms (SNPs) (DHCR7-rs12785878 and CYP2R1-rs10741657) and two 25(OH) D metabolism SNPs (GC-rs2282679 and CYP24A1-rs6013897) for creating GRSs, which were used as instrumental variables to assess the effect of genetically lowered 25(OH) D concentrations on MS and T2D based on the Wald ratio. F statistics were used to validate that the four SNPs genetically determined 25(OH) D concentrations. RESULTS: Compared to vitamin D sufficient individuals, individuals with vitamin D insufficiency had an odds ratio (OR [95% confidence interval {CI}]) of MS of 1.30 (1.06-1.61) and of T2D of 1.32 (1.08-1.64), individuals with vitamin D deficiency had an ORs (95% CI) of MS of 1.50 (1.24-1.79) and of T2D of 1.47 (1.12-1.80), and those with vitamin D severe deficiency had an ORs (95% CI) of MS of 1.52 (1.29-1.85) and of T2D of 1.54 (1.27-1.85). Mendelian randomization analysis showed a 25-nmol/L decrease in genetically instrumented serum 25(OH) D concentrations using the two synthesis SNPs (DHCR7 and CYP2R1 genes) associated with the risk of T2D and abnormal diastolic blood pressure (DBP) with ORs of 1.10 (95%CI: 1.02-1.45) for T2D and 1.14 (95%CI: 1.03-1.43) for DBP. CONCLUSIONS: This one sample Mendelian randomization analysis shows genetic evidence for a causal role of lower 25(OH) D concentrations in promoting of T2D and abnormal DBP in middle-aged and elderly participants from rural China.

The predictive value of CHA2DS2-VASc score on the prognosis of patients with atrial fibrillation based on a prospective cohort study.

Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia encountered in clinical practice, and it is associated with an increased risk of mortality, stroke, and peripheral embolism. The risk of stroke in AF is heterogeneous and dependent on underlying clinical conditions included in current risk stratification schemes. Recently, the CHA2DS2-VASc score has been incorporated into guidelines to encompass common stroke risk factors observed in routine clinical practice. The aim of this study was to study the predictive value of CHA2DS2-VASc score on the prognosis of patients with AF to determine the correlation of major complications including cerebral infarction and intracranial hemorrhage in patients with AF with oral anticoagulant and antiplatelet aggregation drugs and to identify the risk factors for all-cause mortality. Methods: A prospective study was conducted on 181 patients with AF who underwent physical examinations at Hai'an Qutang Central Hospital from January 2020 to December 2020. The patient's general condition, chronic disease history, CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74 years, and sex category (female)] score, left ventricular ejection fraction (LVEF), lipid metabolism, and oral anticoagulant and antiplatelet aggregation medication during physical examination were recorded. By using telephone meetings to complete the follow-up, we tracked the patient's cerebral infarction, intracranial hemorrhage, and survival status within 2 years of follow-up, statistically analyzed the relationship between AF complications and medication, and grouped patients with AF based on the CHA2DS2-VASc score to evaluate its predictive ability for mortality outcomes in these patients. Results: The patients were divided into four groups according to the medication situation, and the incidence of cerebral infarction in the combination group was significantly lower than that in the non-medication group (0.0% vs. 19.2%; P<0.01). The incidence of intracranial hemorrhage in the combination group was significantly higher than that in the non-drug group (13.8% vs. 0.0%; P<0.01). The logistic regression model indicated that patients with a history of cerebral infarction had an increased risk of death compared to those without a history of cerebral infarction [odds ratio (OR) =7.404; 95% confidence interval (CI): 2.255-24.309]. After grouping according to the CHA2DS2-VASc score, we found that there was a significant difference in the 2-year survival rate between patients with CHA2DS2-VASc score <5 and those with a score ≥5 (P<0.01). The characteristic curve analysis of the participants showed that the CHA2DS2-VASc score had good predictive ability for all-cause mortality in patients with AF (area under the curve =0.754), with a cutoff value of 4, a sensitivity of 62.50%, a specificity of 86.06%, and a 95% CI of 0.684-0.815. Conclusions: The CHA2DS2-VASc score demonstrated high predictive value for all-cause mortality in patients with AF.

Development and validation of a predictive model for in-hospital mortality in patients with sepsis-associated liver injury.

Background: Sepsis is often accompanied by organ dysfunction and acute organ failure, among which the liver is commonly involved. Sepsis patients suffering from liver injury have a greater risk of mortality than patients suffering from general sepsis. As of now, there are no tools that are specifically designed for assessing the prognosis of such patients. This study aimed to develop and validate a model to predict the risk of in-hospital mortality in patients with sepsis-associated liver injury (SALI). Methods: Data were obtained from the Medical Information Mart for Intensive Care (MIMIC)-IV database. In the analysis, all patients with SALI who met the inclusion and exclusion criteria were included. A primary outcome was in-hospital mortality, and clinical data were extracted for these patients. In a ratio of 8:2, the data were divided into training and validation groups at random. Least absolute shrinkage and selection operator (LASSO) regression was used for data dimension reduction and feature selection, and independent factors related to prognosis were identified through multi-factor logistics analysis. A nomogram was developed to visualize the model, and the performance of the model was evaluated by the area under the curve (AUC) as well as calibration and decision curve analysis (DCA) through internal verification. Results: A total of 616 and 154 patients with SALI were included in the training and validation cohorts, respectively. The LASSO regression and logistic multivariate analysis showed that nine factors were associated with in-hospital mortality in patients with SALI. Both the training and validation cohorts had higher AUCs than sequential organ failure assessment (SOFA) and simplified acute physiology score 2 (SAPS2): 0.753 (95% CI: 0.715-0.791) and 0.783 (95% CI: 0.749-0.817), respectively. Both the training and validation cohorts showed good calibration results for the prediction model. In terms of clinical practicability, DCA of the predictive model demonstrated greater net benefits than the SOFA and SAPS2 scores. Conclusions: We developed a predictive model that can effectively predict the in-hospital mortality of SALI patients, with satisfactory performance and clinical practicability. This model can assist clinicians in the early identification of high-risk patients and provide a reference for clinical treatment strategies.

Intervention Effect of Probiotics in Gastric Cancer Patients with Complications of Coronary Heart Disease and Heart Failure.

OBJECTIVE: To investigate the characteristics of intestinal flora in patients with gastric cancer complicated by coronary heart disease and heart failure and the guiding value of probiotics intervention for clinical treatment. METHODS: (1) One hundred and sixty-eight gastric cancer patients with complications of coronary heart disease and heart failure from August 2017 to December 2020 were selected as the observation group. A total of 125 patients with coronary heart disease treated at the same time were selected as control group 1, and 89 healthy subjects were selected as control group 2. Fecal samples were retained to extract the total RNA, and high-throughput sequencing was applied to complete the analysis of microbial diversity and structure differences, so as to obtain the biological species information of the specimens. (2) Patients in the observation group were randomly divided into two equal groups of 84 patients, namely, group A and group B. Group A was treated with conventional methods, and group B was combined with probiotics intervention on the basis of group A; then, the differences in the intestinal mucosal barrier between the two groups were compared. RESULTS: The Chao, ACE, and Simpson index in the observation group were lower than those in control group 1 (P < 0.05), and the Shannon index was higher than that in control group 1 (P < 0.05). The Chao, ACE, and Shannon index in control group 1 were lower than those in control group 2 (P < 0.05), whereas the Simpson index was higher than in control group 2 (P < 0.05). The abundance of Bacteroidetes in the observation group was lower than that in control group 1 and control group 2 (P < 0.05). The abundance of Firmicutes was higher than that of control group 1 and control group 2 (P < 0.05). Four weeks after treatment, the levels of ET, D-lactic acid, and PCT in the group B were (0.10 ± 0.01), (3.99 ± 0.32), and (0.41 ± 0.10), respectively, which were lower than those in group A (0.19 ± 0.03), (4.51 ± 0.46), and (0.81 0.13). CONCLUSION: Gastric cancer patients with complications of coronary heart disease and heart failure are associated with intestinal flora disorder, which may be involved in the occurrence and development of the disease. Probiotics intervention is helpful to repair the intestinal mucosal barrier in patients, which is worthy of popularization and application.

The risk factors of early hemorrhage after emergency intravenous thrombolysis in patients with acute ischemic stroke.

BACKGROUND: At present, the treatment of acute ischaemic stroke (AIS) by aticepase (rt-PA) in emergency veins has become the main treatment mode in hospital, but the research on early hemorrhage complications in patients with emergency thrombolysis is rarely reported. This research aims to study the earlier warning index of early hemorrhage complications in patients with emergency thrombolysis. METHODS: A retrospective analysis was performed on the clinical data of rt-PA intravenous thrombolysis-treated AIS patients in the advanced stroke center of the emergency department of a tertiary grade hospital from January 2018 to May 2020. Patients were divided into a hemorrhage group and non-hemorrhage group according to the hemorrhage situation within 24 hours after thrombolytic therapy. The differences between the 2 groups in terms of pre-thrombolysis risk factors were analyzed. Logistic regression analysis was used to analyze the independent risk factors associated with post-thrombolysis hemorrhage. RESULTS: After intravenous thrombolysis, the hemorrhage group had 91 cases and the non-hemorrhage group had 146 cases. Logistic regression analysis showed that atrial fibrillation, systolic blood pressure before thrombolysis, platelet count, and antiplatelet drugs were independent risk factors for hemorrhage after intravenous thrombolysis (P<0.05). CONCLUSIONS: Patients with AIS have a higher incidence of hemorrhage after intravenous thrombolysis. Atrial fibrillation, systolic blood pressure before thrombolysis, platelet count, and antiplatelet drugs were independent risk factors for hemorrhage after intravenous thrombolysis. These independent risk factors can provide a basis for clinical nurses to evaluate hemorrhage risk in AIS patients after intravenous thrombolysis.

[Epidemiological survey of cervical diseases in Klmy, Xinjiang].

OBJECTIVE: To understand the prevalence and risk factors of common cervical diseases among the married women in Klmy, Xinjiang so as to take effective measures to safeguard their reproductive health and lower the morbidity rate of cervical cancer. METHODS: Employing the method of cluster sampling, the medical staff carried out a general survey on the gynecological diseases and cervical diseases among 9573 married women in Klmy. RESULTS: All these subjects suffered various kinds of gynecological diseases. The cervical diseases were concentrated among 21 to 30 years old women. The morbidity rate of cervical diseases was higher in Uigur women than that in other nationalities. There were some important risk factors for cervical diseases, such as first intercourse age under 18 years old, vaginal delivery, contraception and so on. CONCLUSION: Cervical diseases have a great impact on women's health. The preventive measures include improving unhealthy behaviors, strengthening gynecological follow-ups and conducting cytological examinations.

Diabetes health management strategy based on internet plus graded diagnosis and treatment strategy.

BACKGROUND: Type 2 diabetes (T2D) is a widespread chronic disease with high rates of morbidity and mortality worldwide. Managing risk factors can effectively prevent acute and chronic complications, improve quality of life, and reduce mortality. Therefore, implementation of a diabetes health management strategy is urgently needed. Emerging medical technologies have strengthened communication between patients and clinicians. The establishment and improvement of the graded diagnosis and treatment system has promoted the prevention, treatment, and management of diabetes. METHODS: A total of 300 patients diagnosed with T2D in the Health Management Center at the Affiliated Hospital of Nantong University were randomly divided into two groups: an internet plus graded diagnosis and treatment strategy group, and a control group. After 6 months, the physiological parameters, management indices, and complications were compared between the groups. RESULTS: Physiological indicators, such as body mass index (BMI), waist circumference, triglycerides, low-density lipoprotein, systolic and diastolic blood pressure, and blood glucose were significantly alleviated in the Internet plus graded diagnosis and treatment strategy group. Management indicators (such as blood glucose monitoring compliance rate, diet control compliance rate, and exercise compliance rate) also improved substantially. The incidence of hypoglycemia was notably increased compared to the control group. CONCLUSIONS: The new health management strategy for diabetes can improve lifestyle, ameliorate physiological indicators, reduce the complication rate, and form a virtuous cycle. This provides a positive impact on the entire life-cycle health management of diabetes, and is worthy of further promotion.

Upregulated ZO-1 correlates with favorable survival of gastrointestinal stromal tumor.

Zonula occludens-1 (ZO-1) is a membrane-scaffolding protein that plays an important role in maintaining tight-junction integrity, which is disrupted in many invasive cancers and intestinal diseases. However, the expression of ZO-1 in gastrointestinal stromal tumor (GIST) and its relationship with clinical characteristics of this disease remain poorly understood. In this study, immunohistochemical analysis using tissue microarray was employed to evaluate the expression of ZO-1 in GIST and to investigate the relationship between its expression and GIST prognosis. High ZO-1 expression was displayed in 71.8 % of GIST patients, which was related to tumor diameter (p < 0.05). The Kaplan-Meier method and log-rank test indicated that high ZO-1 expression, small tumor diameter, tumor position in the esophagus, and a borderline-to-intermediate tumor grade displayed significant correlations with longer survival of GIST patients. The data suggest that ZO-1 expression is correlated with malignant phenotypes of GIST and it may serve as a favorable prognostic factor for GIST. These results also support a role for ZO-1 as a tumor-suppressor gene in GIST.