Clinical prognostic impact of C-NLR in heart failure patients with different ejection fractions: a retrospective study.

OBJECTION: Inflammatory conditions and immune disorders may worsen the prognosis of chronic heart failure (CHF) patients. The aim of this study was to evaluate the prognostic value of a new indicator, C-NLR, composed of C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR), for the risk of all-cause mortality in HF patients with different ejection fractions. METHODS: A total of 1221 CHF patients admitted to the First Affiliated Hospital of Kunming Medical University from January 2017 to October 2021 were enrolled in this study. All patients were divided into 2 groups according to the median C-NLR. Kaplan-Meier survival curves were used to compare the all-cause mortality among CHF patients with different ejection fractions. Cox proportional hazards analysis was used to evaluate the relationships between variables and mortality. The predictive value of the C-NLR was assessed by using receiver operating characteristic (ROC) analyses. RESULTS: We collected data from 1192 patients with CHF. Kaplan-Meier survival analysis revealed that patients with low LCR levels had better overall survival (OS). After multivariate adjustment Cox proportional hazards analysis, the level of C-NLR was still independently related to mortality. CONCLUSIONS: C-NLR was a competent independent predictor in HF with different ejection fractions, and routine measurement of C-NLR would help clinical doctors identify patients with a poor prognosis.

Construction of Machine Learning Models to Predict Changes in Immune Function Using Clinical Monitoring Indices in HIV/AIDS Patients After 9.9-Years of Antiretroviral Therapy in Yunnan, China.

Objective: To investigate trends in clinical monitoring indices in HIV/AIDS patients receiving antiretroviral therapy (ART) at baseline and after treatment in Yunnan Province, China and to provide the basis for guiding clinical treatment to obtain superior clinical outcomes. Methods: A total of 96 HIV/AIDS patients who had started and persisted in highly active ART treatment from September 2009 to September 2019 were selected. Of these, 54 had a CD4 cell count < 200 cells/µl while 42 had a CD4 cell count ≥ 200 cells/µl. Routine blood tests, liver and renal function, and lipid levels were measured before and 3, 6, 9, and 12 months after treatment. Lymphocyte subset counts and viral load were measured once per year, and recorded for analysis and evaluation. Three machine learning models (support vector machine [SVM], random forest [RF], and multi-layer perceptron [MLP]) were constructed that used the clinical indicators above as parameters. Baseline and follow-up results of routine blood and organ function tests were used to analyze and predict CD4+ T cell data after treatment during long-term follow-up. Predictions of the three models were preliminarily evaluated. Results: There were no statistical differences in gender, age, or HIV transmission route in either patient group. Married individuals were substantially more likely to have <200 CD4+ cells/µl. There was a strong positive correlation between ALT and AST (r = 0.587) and a positive correlation between CD4 cell count and platelet count (r = 0.347). Platelet count was negatively correlated with ALT (r = -0.229), AST (r = -0.251), and positively correlated with WBCs (r = 0.280). Compared with the CD4 cell count < 200 cells/µl group, all three machine learning models exhibited a better predictive capability than for patients with a CD4 cell count ≥ 200 cells/µl. Of all indicators, the three models best predicted the CD4/CD8 ratio, with results that were highly consistent. In patients with a CD4 cell count < 200 cells/µl, the SVM model had the best performance for predicting the CD4/CD8 ratio, while the CD4/CD8 ratio was best predicted by the RF model in patients with a CD4 cell count ≥ 200 cells/µl. Conclusion: By the incorporation of clinical indicators in SVM, RF, and MLP machine learning models, the immune function and recuperation of HIV/AIDS patients can be predicted and evaluated, thereby better guiding clinical treatment.

Safety of Different Anesthesia Methods Combined with Intravenous Fast Channel Anesthesia in Lower Extremity Orthopedic Surgery of the Elderly.

OBJECTIVE: To compare the safety of different anesthesia methods combined with intravenous fast channel anesthesia in elderly lower extremity surgery and the effect on postoperative outcome. METHODS: A total of 106 elderly patients who underwent lower extremity orthopedic surgery in our hospital from February 2018 to February 2021 were selected and randomly divided into the control group (n = 53) and the observation group (n = 53) according to random number table. All patients received intravenous fast-track anesthesia. On this basis, the control group received spinal-epidural anesthesia, and the observation group received iliac fascial space block on the affected side combined with sciatic nerve block. The operation conditions, blood pressure and heart rate changes, awakening time, postoperative ICU admission rate, and complications were compared between the two groups. RESULTS: There was no statistical difference in the success rate of one-time operation between the two groups (P > 0.05). The times of using analgesics and vasoactive drugs and the dosage of propofol in the observation group during the operation were lower than those in the control group, and the difference was statistically significant (P < 0.05). At T2, T3, and T4, the levels of HR, DBP, and SBP in the observation group were lower than those in the control group, and the difference was statistically significant (P < 0.05). After operation, the time of awakening, spontaneous breathing recovery, and extubation in the observation group were lower than those in the control group, and the difference were statistically significant (P < 0.05). The incidence of complications in the observation group was lower than that in the control group, the cognitive impairment was the most significant one in the incidence of single complication, and the difference was statistically significant (P < 0.05). CONCLUSION: Based on the combined intravenous fast channel anesthesia, the operation difficulty of the affected side iliac fascial space block combined with sciatic nerve block is the same as that of spinal-epidural anesthesia. It has a higher success rate of one operation, better analgesic and anesthetic effects during the operation, and little effect on blood flow of patients. It can maintain relatively stable heart rate and blood pressure and does not easily cause postoperative complications. Its safety is higher than that of spinal-epidural anesthesia.

Detection of an anti-angina therapeutic module in the effective population treated by a multi-target drug Danhong injection: a randomized trial.

It's a challenge for detecting the therapeutic targets of a polypharmacological drug from variations in the responsed networks in the differentiated populations with complex diseases, as stable coronary heart disease. Here, in an adaptive, 31-center, randomized, double-blind trial involving 920 patients with moderate symptomatic stable angina treated by 14-day Danhong injection(DHI), a kind of polypharmacological drug with high quality control, or placebo (0.9% saline), with 76-day following-up, we firstly confirmed that DHI could increase the proportion of patients with clinically significant changes on angina-frequency assessed by Seattle Angina Questionnaire (ΔSAQ-AF ≥ 20) (12.78% at Day 30, 95% confidence interval [CI] 5.86-19.71%, P = 0.0003, 13.82% at Day 60, 95% CI 6.82-20.82%, P = 0.0001 and 8.95% at Day 90, 95% CI 2.06-15.85%, P = 0.01). We also found that there were no significant differences in new-onset major vascular events (P = 0.8502) and serious adverse events (P = 0.9105) between DHI and placebo. After performing the RNA sequencing in 62 selected patients, we developed a systemic modular approach to identify differentially expressed modules (DEMs) of DHI with the Zsummary value less than 0 compared with the control group, calculated by weighted gene co-expression network analysis (WGCNA), and sketched out the basic framework on a modular map with 25 functional modules targeted by DHI. Furthermore, the effective therapeutic module (ETM), defined as the highest correlation value with the phenotype alteration (ΔSAQ-AF, the change in SAQ-AF at Day 30 from baseline) calculated by WGCNA, was identified in the population with the best effect (ΔSAQ-AF ≥ 40), which is related to anticoagulation and regulation of cholesterol metabolism. We assessed the modular flexibility of this ETM using the global topological D value based on Euclidean distance, which is correlated with phenotype alteration (r2: 0.8204, P = 0.019) by linear regression. Our study identified the anti-angina therapeutic module in the effective population treated by the multi-target drug. Modular methods facilitate the discovery of network pharmacological mechanisms and the advancement of precision medicine. (ClinicalTrials.gov identifier: NCT01681316).

Impact of childbirth policy changes on obstetric workload over a 13-year period in a regional referral center in China - implications on service provision planning.

BACKGROUND: We aimed to appraise the impact of the changing national childbirth policy since 2002, currently allowing two children per family, on obstetric workload in a regional referral center in China. METHODS: In a retrospective cohort study, temporal changes were examined in relation with maternal demographics, incidence of women with high risk pregnancies and resource statistics in our hospital in managing singleton viable pregnancies (birth from 28 weeks gestational age onwards) for the period 2005-2017. RESULTS: During this 13-year period, the number of singleton livebirths from 28 weeks gestational age onwards was 49,479. Annual numbers of births increased from 1,941 to 2005 to 5,777 in 2017. There were concomitant and significant increases in the incidence of multiparous women (10.6-50.8 %), of age ≥35 years (6.5-24.3 %), with prior caesarean Sec. (2.6-23.6 %), with ≥3 previous pregnancy terminations (1.0-4.9 %), with pre-gestational diabetes (0.2-0.9 %), and with chronic hypertension (0.2-1.2 %). There were associated increases in beds and staff complement and reduced average hospital stay. Nevertheless, while the workload of medical staff remained stable with increasing staff complement, that of midwives increased significantly as reflected by the total births: midwife ratio which increased from 194.1:1 to 320.9:1 (p < 0.001). CONCLUSIONS: In our hospital, progressively increasing numbers of annual births in combination with an increased incidence of women with high risk pregnancies took place following the revised national childbirth policy. Only the increase in medical and nursing, but not midwifery, staff was commensurate with workload. Remedial measures are urgently required before the anticipated progressive increase in care demand would overwhelm maternity care with potentially disastrous consequences.

Conditional Deletion of Foxg1 Alleviates Demyelination and Facilitates Remyelination via the Wnt Signaling Pathway in Cuprizone-Induced Demyelinated Mice.

The massive loss of oligodendrocytes caused by various pathological factors is a basic feature of many demyelinating diseases of the central nervous system (CNS). Based on a variety of studies, it is now well established that impairment of oligodendrocyte precursor cells (OPCs) to differentiate and remyelinate axons is a vital event in the failed treatment of demyelinating diseases. Recent evidence suggests that Foxg1 is essential for the proliferation of certain precursors and inhibits premature neurogenesis during brain development. To date, very little attention has been paid to the role of Foxg1 in the proliferation and differentiation of OPCs in demyelinating diseases of the CNS. Here, for the first time, we examined the effects of Foxg1 on demyelination and remyelination in the brain using a cuprizone (CPZ)-induced mouse model. In this work, 7-week-old Foxg1 conditional knockout and wild-type (WT) mice were fed a diet containing 0.2% CPZ w/w for 5 weeks, after which CPZ was withdrawn to enable remyelination. Our results demonstrated that, compared with WT mice, Foxg1-knockout mice exhibited not only alleviated demyelination but also accelerated remyelination of the demyelinated corpus callosum. Furthermore, we found that Foxg1 knockout decreased the proliferation of OPCs and accelerated their differentiation into mature oligodendrocytes both in vivo and in vitro. Wnt signaling plays a critical role in development and in a variety of diseases. GSK-3ß, a key regulatory kinase in the Wnt pathway, regulates the ability of ß-catenin to enter nuclei, where it activates the expression of Wnt target genes. We then used SB216763, a selective inhibitor of GSK-3ß activity, to further demonstrate the regulatory mechanism by which Foxg1 affects OPCs in vitro. The results showed that SB216763 clearly inhibited the expression of GSK-3ß, which abolished the effect of the proliferation and differentiation of OPCs caused by the knockdown of Foxg1. These results suggest that Foxg1 is involved in the proliferation and differentiation of OPCs through the Wnt signaling pathway. The present experimental results are some of the first to suggest that Foxg1 is a new therapeutic target for the treatment of demyelinating diseases of the CNS.

Micron-sized SiO x /N-doped carbon composite spheres fabricated with biomass chitosan for high-performance lithium-ion battery anodes.

To achieve superior lithium storage performance, SiO x is usually designed into nanostructured SiO x /C composites by complex or expensive methods. Here, micron-sized interconnected SiO x /N-doped carbon (NC) microspheres composed of evenly dispersed SiO x nano-domains and NC have been fabricated by a scalable microemulsion method and following pyrolysis, using vinyltriethoxysilane and chitosan as precursors. The unique structure of the micron-sized SiO x /NC spheres leads to enhanced structural integrity and enables stable long-term cycling (800 cycles at 2 A g-1). Benefiting from the enhanced electron/Li+ diffusion kinetics originated from the unique structure and N-doping, SiO x /NC-2 presents considerable capacitive-controlled Li storage capacity, which leads to outstanding rate capability. Consequently, the assembled SiO x /NC-2//LiFePO4 full cell exhibits superior rate capability (106 mA h g-1 at 4C) and stable long-term cycling at 2C (102 mA h g-1 after 350 cycles). This work opens a new door for the application of chitosan in building micron-sized high-performance SiO x /C anode materials, and to some extent facilitates the recycling of waste seafood shells.

2D ultrathin carbon nanosheets with rich N/O content constructed by stripping bulk chitin for high-performance sodium ion batteries.

Two-dimensional (2D) nanomaterials hold considerable potential in reforming the energy storage performance, and the efficient production of high-performance 2D energy storage materials through facile and sustainable approaches is highly desirable. Herein, for the first time, large-area and ultrathin carbon nanosheets doped with N/O were constructed by stripping bulk chitin via a "top-down" method. On the basis of the specific layered structure composed of nanofibers, chitin samples after removing the protein and CaCO3 could be efficiently exfoliated into nanosheets (CNs) via the hydrothermal method, which were then carbonized into N/O co-doped porous carbon nanosheets (CCNs). The CCNs with a thickness of about 3.8 nm retained the original nanosheet structure consisting of nanofibers, leading to a 2D structure with hierarchical porosities. When used as anode materials for sodium-ion batteries, the 2D porous nanostructures and abundant N/O doping of CCNs-600 (carbonized at 600 °C) enable a high reversible capacity of 360 mA h g-1 at 50 mA g-1, a good rate capability of 102 mA h g-1 at 10 A g-1, and an excellent cycling stability of 140 mA h g-1 after 10 000 cycles at a high density of 5 A g-1. Full cells consisting of a CCN anode and a Na3V2(PO4)3/C cathode exhibited favorable rate performance and cycling stability, showing potential application prospects in highly efficient energy storage systems.

AIDS prevention and control in the Yunnan region by T cell subset assessment.

BACKGROUND: Prior to being spread throughout broader China, multiple human immunodeficiency virus (HIV)-1 genotypes were originally discovered in the Yunnan Province. As the HIV-1 epidemic continues its spread in Yunnan, knowledge of the influence of gender, age, and ethnicity to instances of HIV reservoirs will benefit monitoring the spread of HIV. METHODS: The degree to which T cells are depleted during an HIV infection depends on the levels of immune activation. T-cell subsets were assessed in newly-diagnosed HIV/AIDS patients in Yunnan, and the influence of age, gender, and ethnicity were investigated. Patients that were newly diagnosed with the HIV-infection between the years 2015 and 2018 at the First Affiliated Hospital of Kunming Medical College were selected for this study (N = 408). The lymphocyte levels and T cell subsets were retrospectively measured in whole blood samples by FACS analysis. RESULTS: The median CD4 count was 224 ± 191 cells/µl. Significantly higher mean frequencies and absolute numbers were observed in CD3+, CD3+CD4+, CD3+CD8+, CD45+, and CD3+CD4+/CD45+ in females compared to males. Han patients showed a higher total number of CD3+T cells and the ratio of CD3+ /CD45+ cells compared to any other ethnic minority (P < 0.001). The numbers of CD3+ T-cells, CD3+CD8+ T cells, and CD45+ T cells were highest in the age group ≥ 60. Significant differences were observed in the counts of CD3+, CD3+CD8+, and CD45+ cells and the ratio of CD3+/CD45+ and CD3+CD4+/CD45+ cells between the ≤ 29 and 30-59 age groups. CONCLUSION: This study has revealed that low levels of CD4+ T cells can be observed in newly-diagnosed HIV/AIDS patients in the Yunnan province. It has also been demonstrated that gender, age, and ethnicity have a significant association with the ratio of T-cell subsets that may contribute to virus progression and disease prognosis in individuals belonging to certain subsets of the population. This study has highlighted the importance of HIV/AIDS screening in at-risk populations to ensure timely and adequate clinical management in Yunnan.

Efficacy of canagliflozin combined with antidiabetic drugs in treating type 2 diabetes mellitus: Meta-analysis of randomized control trials.

AIMS/INTRODUCTION: Canagliflozin has been proposed as an effective treatment for type 2 diabetes. This meta-analysis of randomized control trials aimed to evaluate the effect of canagliflozin combined with other hypoglycemic drugs. MATERIALS AND METHODS: We searched Medline, Embase, Cochrane Library, Google Scholar and ClinicalTrials.gov for randomized control trials comparing canagliflozin combined with conventional antidiabetic drugs vs placebo. Our main end-points were glycemic control and change in weight. We assessed pooled data by use of a random-effects model. RESULT: Of 161 identified studies, six were eligible and were included in our analysis (n = 4670 participants). Compared with the placebo, mean changes in glycosylated hemoglobin were -0.60% (95% confidence interval -0.67 to -0.54%; I (2) = 0%) for canagliflozin 100 mg, and -0.76% (95% confidence interval -0.84 to -0.68%; I (2) = 20%) for canagliflozin 300 mg with bodyweight loss. CONCLUSION: Canagliflozin as an add-on drug to other antidiabetic drugs effectively lowers blood glucose without significant weight gain.

[Primary drug resistance of human immunodeficiency virus (HIV)among the treatment-naive individuals with HIV in China: a meta-analysis].

OBJECTIVE: To estimate the prevalence of antiretroviral drug resistance in treatment-naive individuals with human immunodeficiency virus (HIV) in China. METHODS: Five electronic databases [Chinese BioMedical Literature Database (CBM), Chinese Journal Full-text Database (CNKI), Chinese Science-Technology Journal Database (VIP), Wanfang Data, and PubMed] were searched for studies of HIV drug resistance in untreated individuals. Drug resistance data were abstracted then pooled using the random effect model. Subgroup analysis was done across sampling time, location, study population (mean age and infection status), and sample size. RESULTS: Seventy-six studies were included for our meta-analysis (46 in Chinese, 30 in English). The pooled rates of drug resistance to total, to non-nucleoside reverse transcriptase inhibitor (NNRTI), to nucleoside reverse transcriptase inhibitor (NRTI), and to protease inhibitor (PI) were 4.7% (95%CI:4.0%-5.4%), 2.3% (95%CI:1.8%-2.8%), 1.8% (95%CI:1.3%-2.3%), and 1.4% (95%CI: 1.1%-1.8%), respectively. All the rates before 2007 were higher than those for 2008 or later. Meanwhile, significant differences were found in the sample areas (P<0.05), in which, the rates in South-central and Southwest were both higher than 5%. The difference was complex between mean age and infection status subgroup, and we found the total prevalence in the group under 25 years and the newly infected, and confirmed group was lower than in the others. For sample size, all the rates in the group under 100 samples were higher than in the others, and the difference was significant (P<0.05). CONCLUSION: The prevalence of HIV primary drug resistance in China was 4.7%, which stayed low, but was also close to the line set by WHO. Enhanced surveillance for drug resistance is necessary in high epidemic areas including the South-central and Southwest China whose prevalence has crossed the line.