Critical gene signature and immunological characterization in peripheral vascular atherosclerosis: novel insights from mendelian randomization and transcriptomics.

Introduction: Peripheral vascular atherosclerosis (PVA) is a chronic inflammatory disease characterized by lipid accumulation in blood vessel walls, leading to vessel narrowing and inadequate blood supply. However, the molecular mechanisms underlying PVA remain poorly understood. In this study, we employed a combination of Mendelian randomization (MR) analysis and integrated transcriptomics to identify the critical gene signature associated with PVA. Methods: This study utilized three public datasets (GSE43292, GSE100927 and GSE28829) related to peripheral vascular atherosclerosis obtained from the Gene Expression Omnibus database. Instrumental variables (IVs) were identified through expression quantitative trait loci (eQTL) analysis, and two-sample MR analysis was performed using publicly available summary statistics. Disease critical genes were identified based on odds ratios and intersected with differentially expressed genes in the disease dataset. GSE28829 dataset was used to validate the screened disease critical genes. Functional enrichment analysis, GSEA analysis, and immune cell infiltration analysis were performed to further characterize the role of these genes in peripheral vascular atherosclerosis. Results: A total of 26,152 gene-related SNPs were identified as IVs, and 242 disease-associated genes were identified through MR analysis. Ten disease critical genes (ARHGAP25, HCLS1, HVCN1, RBM47, LILRB1, PLAU, IFI44L, IL1B, IFI6, and CFL2) were significantly associated with peripheral vascular atherosclerosis. Functional enrichment analysis using KEGG pathways revealed enrichment in the NF-kappa B signaling pathway and osteoclast differentiation. Gene set enrichment analysis further demonstrated functional enrichment of these genes in processes related to vascular functions and immune system activation. Additionally, immune cell infiltration analysis showed differential ratios of B cells and mast cells between the disease and control groups. The correlations analysis highlights the intricate interplay between disease critical genes and immune cells associated with PVA. Conclusion: In conclusion, this study provides new insights into the molecular mechanisms underlying PVA by identifying ten disease critical genes associated with the disease. These findings, supported by differential expression, functional enrichment, and immune system involvement, emphasize the role of these genes in vascular function and immune cell interactions in the context of PVA. These findings contribute to a better understanding of PVA pathogenesis and offer potential targets for further mechanistic exploration and therapeutic interventions.

Safety and efficacy of Cox-Maze procedure for atrial fibrillation during mitral valve surgery: a meta-analysis of randomized controlled trials.

BACKGROUND: Cox-Maze procedure is currently the gold standard treatment for atrial fibrillation (AF). However, data on the effectiveness of the Cox-Maze procedure after concomitant mitral valve surgery (MVS) are not well established. The aim of this study was to assess the safety and efficacy of Cox-Maze procedure versus no-maze procedure n in AF patients undergoing mitral valve surgery through a systematic review of the literature and meta-analysis. METHODS: A systematic search on PubMed/MEDLINE, EMBASE, and Cochrane Central Register of Clinical Trials (Cochrane Library, Issue 02, 2017) databases were performed using three databases from their inception to March 2023, identifying all relevant randomized controlled trials (RCTs) comparing Cox-Maze procedure versus no procedure in AF patients undergoing mitral valve surgery. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS: Nine RCTs meeting the inclusion criteria were included in this systematic review with 663 patients in total (341 concomitant Cox-Maze with MVS and 322 MVS alone). Across all studies with included AF patients undergoing MV surgery, the concomitant Cox-Maze procedure was associated with significantly higher sinus rhythm rate at discharge, 6 months, and 12 months follow-up when compared with the no-Maze group. Results indicated that there was no significant difference between the Cox-Maze and no-Maze groups in terms of 1 year all-cause mortality, pacemaker implantation, stroke, and thromboembolism. CONCLUSIONS: Our systematic review suggested that RCTs have demonstrated the addition of the Cox-Maze procedure for AF leads to a significantly higher rate of sinus rhythm in mitral valve surgical patients, with no increase in the rates of mortality, pacemaker implantation, stroke, and thromboembolism.

Prevalence of Urolithiasis in a China Hospital: A Cross-Sectional Study.

BACKGROUND: This study aimed to investigate the prevalence of urolithiasis and its association with systemic diseases among inpatients in a top hospital of China. METHODS: This cross-sectional study included all inpatients in Peking Union Medical College Hospital (PUMCH) from 1 January 2017 to 31 December 2017. Patients were divided in two groups, the urolithiasis group and non-urolithiasis group. Subgroup analysis according to payment type (General or VIP ward), hospitalization department (surgical or not) and age was performed with patients in the urolithiasis group. Additionally, Univariable and multivariable regression analyses were performed to determine factors associated with urolithiasis prevalence. RESULTS: 69518 hospitalized cases were included in this study. The age was 53.40 ± 15.05 and 48.00 ± 18.12 years, and the male-to-female ratio was 1.7:1 and 0.55:1 in the urolithiasis and non-urolithiasis groups, respectively (p < 0.01). Among all patients, urolithiasis had a prevalence of 1.78%. The rate depending on payment type (5.73% versus 9.05%, p < 0.01) and hospitalization department (56.37% versus 70.91%, p < 0.01) were significantly lower in urolithiasis group compared to the non-urolithiasis. Urolithiasis rate also showed age differences. Female was independent protective factor of urolithiasis, while age, hospitalization in the non-surgical department and payment type of general ward were risk factors of urolithiasis (all p < 0.01). CONCLUSIONS: Gender, age, hospitalization in the non-surgical department and the socioeconomic status, specifically, the payment type of general ward, are independently associated with urolithiasis.

Prevalence of Urolithiasis in a China Hospital: A Cross-Sectional Study

Background: This study aimed to investigate the prevalence of urolithiasis and its association with systemic diseases among inpatients in a top hospital of China. Methods: This cross-sectional study included all inpatients in Peking Union Medical College Hospital (PUMCH) from 1 January 2017 to 31 December 2017. Patients were divided in two groups, the urolithiasis group and non-urolithiasis group. Subgroup analysis according to payment type (General or VIP ward), hospitalization department (surgical or not) and age was performed with patients in the urolithiasis group. Additionally, Univariable and multivariable regression analyses were performed to determine factors associated with urolithiasis prevalence. Results: 69518 hospitalized cases were included in this study. The age was 53.40 ± 15.05 and 48.00 ± 18.12 years, and the male-to-female ratio was 1.7:1 and 0.55:1 in the urolithiasis and non-urolithiasis groups, respectively (p < 0.01). Among all patients, urolithiasis had a prevalence of 1.78%. The rate depending on payment type (5.73% versus 9.05%, p < 0.01) and hospitalization department (56.37% versus 70.91%, p < 0.01) were significantly lower in urolithiasis group compared to the non-urolithiasis. Urolithiasis rate also showed age differences. Female was independent protective factor of urolithiasis, while age, hospitalization in the non-surgical department and payment type of general ward were risk factors of urolithiasis (all p < 0.01). Conclusions: Gender, age, hospitalization in the non-surgical department and the socioeconomic status, specifically, the payment type of general ward, are independently associated with urolithiasis (AU)

Perceived stress and inappropriate coping behaviors associated with poorer quality of life and prognosis in patients with ulcerative colitis.

OBJECTIVE: To explore the effect of perceived stress and coping behaviors on quality of life and clinical outcomes in patients with ulcerative colitis. METHODS: This is a prospective cohort study in a tertiary inflammatory bowel disease center in China. A total of 263 ulcerative colitis patients were enrolled consecutively between June 2013 and February 2015. The Perceived Stress Scale, the Medical Coping Modes Questionnaire, and the Inflammatory Bowel Disease Questionnaire were used to assess perceived stress, medical coping and quality of life at baseline. Patients were followed up for hospitalization due to relapse over a one-year period. Multivariate analyses were performed to identify whether perceived stress and medical coping behavior were related to quality of life and hospitalization. RESULTS: Patients with invalid questionnaires (n = 6) and those lost to follow-up (n = 28) were excluded. A total of 229 ulcerative colitis patients (mean age 40.4 ±â€¯12.6, 50.7% male) were included in the final analysis, and 23 patients had been hospitalized during the one-year follow-up period. After adjusting other associated variables, perceived stress (OR: 1.13; 95% CI: 1.07 to 1.19) and acceptance-resignation behavior (OR: 1.41; 95% CI: 1.21 to 1.65) were independently associated with poor quality of life. Patients scoring highly for acceptance-resignation behavior (OR: 1.23; 95% CI: 1.04 to 1.46) were more likely to be hospitalized during the one-year follow-up period. CONCLUSION: In patients with ulcerative colitis, identifying those who adopted more acceptance-resignation behavior and improving their medical coping behavior by psychotherapy could be helpful to achieve better quality of life and disease control.

Polaprezinc combined with clarithromycin-based triple therapy for Helicobacter pylori-associated gastritis: A prospective, multicenter, randomized clinical trial.

The efficacy and safety of polaprezinc combined with triple therapy was compared with triple therapy alone in the eradication of Helicobacter pylori. A randomized, parallel-group, open-label, controlled, prospective multicenter study was conducted in 11 cities in China. Treatment-naive patients with H. pylori-associated gastritis were randomly assigned to one of three arms for a 14-day treatment: Arm A triple therapy (omeprazole 20 mg, amoxicillin 1 g, and clarithromycin 500 mg, each twice daily) plus polaprezinc 75 mg twice daily; Arm B triple therapy plus polaprezinc 150 mg twice daily, or Arm C triple therapy alone. The rate of H. pylori eradication was the primary endpoint. Secondary endpoints were symptom improvement and lower incidence of adverse events. 303 patients completed the study- 106, 96, and 101 patients in Arms A, B, and C, respectively. Intention-to-treat (ITT) analysis showed that the rate of H. pylori eradication was significantly higher for Arms A (77.0%) and B (75.9%) compared to Arm C (58.6%) (P < 0.01), whereas there was no difference between Arms A and B (P = 0.90). Per-protocol (PP) analysis showed that the rate of H. pylori eradication was significantly higher for Arms A (81.1%) and B (83.3%) compared to Arm C (61.4%) (P < 0.01), whereas there was no significant difference between Arms A and B (P = 0.62). All three groups reported significant symptom improvement at 7, 14, and 28 days after treatment, compared to baseline (P < 0.0001). The adverse event rate for Arm B (5.1%) was higher than for Arms A (2.8%) (P = 0.04) and C (1.9%) (P = 0.02). There were no serious adverse events in any group. It appears that standard dose polaprezinc combined with triple therapy can significantly improve the H. pylori eradication rate, without an increase in toxicity.

[The impact of stress and coping strategies on health-related quality of life in ulcerative colitis].

OBJECTIVE: To further understand factors that influence health-related quality of life (HRQOL) in patients with ulcerative colitis (UC), especially the role of perceived stress and coping modes in Chinese patients with UC. METHODS: This study was a cross-sectional study. Patients with UC were recruited from July 2013 to September 2014 in Peking Union Medical College Hospital. HRQOL was measured using the inflammatory bowel disease questionnaire (IBDQ). Perceived stress was measured by Perceived Stress Scale (PSS). Coping strategy was evaluated using Medical Coping Modes Questionnaire (MCMQ). Demographic data, course of the disease, clinical disease activity, and disease phenotype according to Montreal classification were also collected. Univariate analyses were conducted to determine which variables were associated with HRQOL, and those were statistically significant were entered into a multivariate regression model. RESULTS: We recruited 214 patients (response rate 92.2%), whose median age was 37.5 (29.0, 49.3) years old and median course of UC was 4 (2, 9) years. Through univariate analyses, better HRQOL was significantly associated with regular medical visits, lower number of previous relapses and hospitalizations, no steroid use, Montreal E1, lower Mayo scores, clinical remission, less perceived stress and less acceptance strategy use. However, multivariate analyses revealed that perceived stress (OR=1.112, 95% CI 1.058-1.169), acceptance (OR=0.310, 95% CI 0.141-0.685), number of hospitalizations (OR=2.924, 95% CI 1.328-6.437) and clinical activity (OR=5.058, 95% CI 2.312-11.066) were most strongly related to HRQOL. CONCLUSIONS: HRQOL of UC patients are not only associated with clinical activity of the disease, but also associated with coping strategy and perceived stress. Further research needs to focus on whether or not relieving stress and guiding patients to cope with ulcerative colitis would improve HRQOL.

The performance of three-sample qualitative immunochemical fecal test to detect colorectal adenoma and cancer in gastrointestinal outpatients: an observational study.

BACKGROUND: Repeated qualitative fecal immunochemical test (qlFIT) is a clinical strategy widely used to detect lower gastrointestinal lesions, but its diagnostic power has not been assessed in opportunistic screening for colorectal neoplasia. OBJECTIVE: This study aimed to determine the performance of three-sample qlFIT in screening for colorectal cancer and its precursors in high-risk participants. METHODS: 513 gastrointestinal outpatients yielded three qlFITs before a standard colonoscopy. We evaluated the diagnostic value of one, two, and three positive qlFITs serving as the positivity threshold. The risk factors of colorectal neoplasia to yield positive qlFITs were also determined. RESULTS: 52 patients were diagnosed with colorectal cancer and 70 with advanced adenomatous polyp. For colorectal cancer, the sensitivity and specificity of one positive qlFIT were 90.4% and 53.8%, of two were 80.8% and 75.1%, and of three were 53.9% and 88.5%, respectively. For advanced adenomatous polyp, the sensitivity and specificity of one positive qlFIT were 81.4% and 54.2%, of two were 50.0% and 72.5%, and of three were 28.6% and 86.2%. Left-sided location (OR 2.50, 95%CI 1.26-4.95) and advanced histology of tumors (OR 3.08, 95%CI 1.58-6.01) were independently associated with positive qlFITs. CONCLUSIONS: Three-sample qlFIT is a reasonably good method to detect colorectal neoplasia in high-risk population. Tumors in the left side or with advanced pathological features are more likely to produce positive qlFITs.

[An analysis of adverse drug reactions of thalidomide in treatment of immune-related bowel diseases].

OBJECTIVE: To investigate the safety of thalidomide in the treatment of immune-related bowel diseases for providing clinical reference. METHODS: Thirty-five patients with immune-related bowel diseases (31 Crohn's disease, 2 ulcerative colitis and 2 Behcet's disease) treated with thalidomide were enrolled in this study. The incidence, type, severity, duration of thalidomide related adverse drug reaction (ADR) and the dose-effect relationship of neurotoxicity were analyzed. RESULTS: All the patients were treated with a mean dose of thalidomide (109.29 ± 30.37) mg/d for (18.8 ± 12.4) months, and 33 occurred ADR. The three most frequent ADR were numbness [51.4% (18/35) ], somnolence [48.6% (17/35) ] and dermatitis [37.1% (13/35) ]. The median time to development of these three ADR were 6.50, 0.25, and 1.00 months, respectively. Severe ADR leading to withdrawal accounted for 20.0% (7/35), including reasons of peripheral neuritis (3/7), dermatitis (2/7) and myelosuppression (2/7). The incidence of peripheral neuritis was not significantly related to the maximal and initial dose of thalidomide (P > 0.05). CONCLUSIONS: Although the incidence of ADR was relatively high during the treatment of thalidomide, most of them were mild and well tolerated. Thalidomide can be safely used in patients with immune-related bowel diseases under close monitoring.

[Application of poly (N-isopropylacrylamide) and its derivatives in tissue engineering].

Poly-N-isopropylacrylamide (PNIPAAm) is a new kind of intelligent material. It shows favorable thermo sensitivity because of the structure of hydrophilic acrylamino and hydrophobic isopropyl. PNIPAAm also shows good biocompatibility and non-toxicity. All the characters as above make it an ideal extra cellular matrix material for tissue engineering. This paper reviews its application in tissue engineering.