Assessment of efficacy and safety of clindamycin with nicotinamide in mild to moderate acne vulgaris: a prospective study

Background: Acne vulgaris is a very common skin disease that is usually treated with topical products, systemic medications, or a combination of both. Acne vulgaris affects approximately 9% of the population worldwide causing permanent physical scarring, negatively affects the quality of life and self-image, and has been associated with increased rates of anxiety, depression, and suicidal ideation. Methods: This was a prospective study conducted at BMCRI including thirty-five subjects who were diagnosed with mild to moderate acne vulgaris. Patients were treated with topical clindamycin 1% with nicotinamide 4%. Efficacy was assessed by mean change in acne severity index (ASI) and total lesion count (TLC) from baseline and at the end of 4, 8 and 12 weeks. Safety was assessed by adverse events reported. Results: There was statistically significant improvement noted at the end of each visit. Baseline ASI was 88.05±4.02 and end of 12 weeks was 14.17±2.7. Baseline TLC was 30.17±1.33 and at the end of 12 weeks was 4.25±0.99. Both the ASI and TLC results were statistically significant at the end of fourth, eighth and twelfth-week p value <0.0001. Conclusions: Combination topical formulations are the most broadly used treatment regimen for Acne vulgaris to target one or more steps in the pathogenesis of acne. From the results of the present study the participants on combination of clindamycin with nicotinamide had a significant improvement in acne lesions at end of 12th week of topical application and were satisfied with the therapy with no major adverse effects.

Evaluation of ovarian mass in reproductive age group: a 2 years prospective study in a tertiary care hospital in Haryana

Background: In pre-eclampsia, there is increased uteroplacental resistance and reduced fetal perfusion due to inadequate invasion of spiral arterioles by trophoblast cells. This causes impaired fetal growth and fetal hypoxia. The objective was to assess the usefulness of fetal Doppler in predicting adverse perinatal outcome in preeclampsia.Methods: It was a prospective study conducted in Adesh medical college and hospital, Mohri, KKR, Haryana, India during the period of 2 years (2021-2022) on 92 women of reproductive age group from menarche to menopause, attending the hospital with complaints of lower abdomen pain, flatulence, lump in abdomen, changes in urinary and bowel habits and ovarian mass detected on clinical examination, or on ultrasound done for another reason. All details were filled in predesigned Performa.Results: There was a great deal of variation in the occurrence, behaviour, and clinical presentation of ovarian tumors. In addition to physical examination, laboratory investigations such as immunological testing and serum biomarkers and imaging procedures pelvic ultrasonography), can assist to determine the kind of pathology. The diagnosis of non-neoplastic and neoplastic ovarian lesions can be confused due to similar clinical presentations. Ovarian cancers have one of the worst prognoses of any cancer since there is insufficient screening to identify the disease early.Conclusions: It is imperative to raise awareness of this malignancy among Indian women. Because of the diversity of the Indian population, it is necessary to raise awareness of this issue across all linguistic and cultural divides. Not only should early detection be emphasized, but also “how to live well” with the illness should be discussed. All of these sophisticated, more recent diagnostic methods, along with the clinical and histo-morphological factors, can aid in early diagnosis, treatment planning, and prognostic importance.

Detection of molecular affecting sensitivity to local glucocorticoid therapy in oral lichen planus through transcriptome sequencing / 北京大学学报(医学版)

Objective:To detect key genes of local glucocorticoid therapy in oral lichen planus(OLP)through transcriptome sequencing.Methods:The study prospectively enrolled 28 symptomatic patients who visitied Department of Oral Mucosa,Peking University Hospital of Stomatology from November 2019 to March 2023.Topical inunction of 0.1 g/L of dexamethasone was applied for 1 min,3 times daily for 4 weeks.The patients'signs and pain symptoms were recorded and they were classified as effective group and ineffective group according to the treatment outcome.Their mucosa samples were collected before treatment.After isolating total RNA,transcriptome sequencing was performed.The gene expression data obtained by sequencing were analyzed differently using the DESeq2 package in R software,and the Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis was performed on the basis of the hypergeometric distribution algorithm to describe the biological function of differentially expressed genes(DEGs),accordingly detecting sensitivity related molecular affecting therapeutic effect of dexamethasone.Results:After 4 weeks treatment by topical dexamethasone,13 cases of the 28 OLP pa-tients responding well with the sign score reducing from 7.0(4.5,9.0)to 5.0(3.0,6.3),pain score decreasing from 5.0(2.0,5.5)to 2.0(0.0,3.5),oral health impact profile lessening from 5.0(3.5,9.0)to 1.0(0.0,5.0)significantly(P＜0.01)were classified as effective group and 15 cases with poor response to the drug were sorted as ineffective group.There were no significant differences of demographic and baseline levels of clinical features,especially disease severity between these two groups.A total of 499 DEGs including 274 upregulated and 225 downregulated genes were identified between ef-fective group and ineffective group.KEGG enrichment analysis showed that upregulated genes in effective group compared with ineffective group including CLDN8,CTNNA3,MYL2 and MYLPF were associated with leukocyte transendothelial migration,while downregulated genes were significantly enriched in tumor necrosis factor(TNF),interleukin-17(IL-17),nuclear factor kappa B(NF-κB)signaling pathways,and cortisol synthesis and secretory.Conclusion:High expressions of CLDN8,CTNNA3,MYL2 and MYLPF genes in patients with oral lichen planus have a good clinical response to topical dexamethasone,while patients with high expression genes of inflammation pathway such as TNF,IL-17,NF-κB and corti-sol synthesis and secretion received poor effect.

Early clinical outcomes of the domestic KokaclipTM transcatheter edge-to-edge mitral valve repair system for severe degenerative mitral regurgitation: A single-arm, prospective, single-group target value clinical trial / 中国胸心血管外科临床杂志

@#Objective To summarize and analyze the preliminary clinical outcomes of the KokaclipTM transcatheter edge-to-edge mitral valve repair system for severe degenerative mitral regurgitation (DMR). Methods This study was a single-arm, prospective, single-group target value clinical trial that enrolled patients who underwent the KokaclipTM transcatheter edge-to-edge repair (TEER) system for DMR in the Department of Heart Surgery of Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute from June 2022 to January 2023. Differences in the grade of mitral regurgitation (MR) during the perioperative and follow-up periods were compared, and the incidences of adverse events such as all-cause death, thoracotomy conversion, reoperation, and severe recurrence of MR during the study period were investigated. Results The enrolled patient population consisted of 14 (50.0%) females with a mean age of 70.9±5.4 years. Twenty-eight (100.0%) patients were preoperatively diagnosed with typeⅡ DMR, with a prolapse width of 12.5 (11.0, 16.1) mm, a degree of regurgitation 4+ leading to pulmonary venous reflux, and a New York Heart Association cardiac function class≥Ⅲ. All patients completed the TEER procedure successfully, with immediate postoperative improvement of MR to 0, 1+, and 2+ grade in 2 (7.1%), 21 (75.0%), and 5 (17.9%) patients, respectively. Mitral valve gradient was 2.5 (2.0, 3.0) mm Hg. Deaths, thoracotomy conversion, or device complications such as unileaflet clamping, clip dislodgement, or leaflet injury were negative. Twenty-eight (100.0%) patients completed at least 3-month postoperative follow-up with a median follow-up time of 5.9 (3.6, 6.8) months, during which patients had a mean MR grade of 1.0+ (1.0+, 2.0+) grade and a significant improvement from preoperative values (P<0.001). There was no recurrence of ≥3+ regurgitation, pulmonary venous reflux, reoperation, new-onset mitral stenosis, or major adverse cardiovascular events. Twenty-two (78.6%) patients’ cardiac function improved to classⅠorⅡ. Conclusion The domestic KokaclipTM TEER system has shown excellent preliminary clinical results in selected DMR patients with a high safety profile and significant improvement in MR. Additional large sample volume, prospective, multicenter studies, and long-term follow-up are expected to validate the effectiveness of this system in the future.

Correlation between urinary protein levels and the incidence of chronic obstructive pulmonary disease in middle-aged and elderly population / 公共卫生与预防医学

Objective To explore the relationship between baseline urinary protein levels and the onset of chronic obstructive pulmonary disease (COPD). Methods A questionnaire survey, blood and urine sample collection, physical examination, and pulmonary function test were conducted among permanent residents over 40 years old in Pudong New Area, Shanghai. The subjects were divided into four groups based on the baseline urine albumin-to-creatinine ratio (ACR) quartiles (0~1.65 mg/g, 1.65~4.89 mg/g, 4.89~10.78 mg/g, and ≥10.78 mg/g). Cox regression analysis was used to explore the relationship between ACR levels and the incidence of COPD in middle-aged and elderly people. Results Among the 3 105 subjects, the median follow-up time was 3.212 years (P25~P75：3.102~3.473). 116 new cases of COPD were observed, with an incidence density of 10.423 per 1000 person-years. The incidence densities for COPD at four ACR levels were 7.922 per 1 000 person-years, 8.300 per 1 000 person-years , 11.419 per 1 000 person-years, and 13.843 per 1 000 person-years, respectively. Cox regression analysis revealed that as the ACR level increased, there was a rising trend in the incidence rate of COPD (χ2=4.396, P=0.036). After adjusting for gender, age, education level, occupational exposure to dust, history of childhood pneumonia, smoking, family history of COPD, central obesity, and hypertension, the risk of developing COPD was 2.499 times higher (95% CI: 1.460~4.276) for ACR levels ≥10.78 mg/g compared to the reference group with a baseline ACR level of 0~1.65 mg/g. Conclusion Elevated ACR levels in middle-aged and elderly population may increase the risk of COPD, and early monitoring of urine protein levels is beneficial for COPD prevention.

Development and internal validation of a clinical prediction model for spontaneous abortion risk in early pregnancy

Abstract Objective: This study aimed to develop and internally validate a prediction model for estimating the risk of spontaneous abortion in early pregnancy. Methods: This prospective cohort study included 9,895 pregnant women who received prenatal care at a maternal health facility in China from January 2021 to December 2022. Data on demographics, medical history, lifestyle factors, and mental health were collected. A multivariable logistic regression analysis was performed to develop the prediction model with spontaneous abortion as the outcome. The model was internally validated using bootstrapping techniques, and its discrimination and calibration were assessed. Results: The spontaneous abortion rate was 5.95% (589/9,895) 1. The final prediction model included nine variables: maternal age, history of embryonic arrest, thyroid dysfunction, polycystic ovary syndrome, assisted reproduction, exposure to pollution, recent home renovation, depression score, and stress score 1. The model showed good discrimination with a C-statistic of 0.88 (95% CI 0.87‒0.90) 1, and its calibration was adequate based on the Hosmer-Lemeshow test (p = 0.27). Conclusions: The prediction model demonstrated good performance in estimating spontaneous abortion risk in early pregnancy based on demographic, clinical, and psychosocial factors. Further external validation is recommended before clinical application.

Evaluation of Four Predictive Models for Identifying Malignancy of Solitary Pulmonary Nodules in Health Check-up Population / 肿瘤防治研究

Objective To compare and validate the efficiency of four models predicting the malignancy of solitary pulmonary nodules (SPN). Methods Patients diagnosed with SPN during health check-up were selected as the research subjects. Risk assessment was conducted using four predictive models. Outcomes were obtained through prospective follow-up. Statistical description and univariate analysis were performed for all risk factors of the four models. ROC curve was applied to compare the efficiency of the four predictive models. Results A total of 479 cases were included in this study. Among these patients, 82 were diagnosed with lung tumor, and the malignant rate was 17.12%. Age, nodule diameter, smoking, family history of tumor, history of extrapulmonary tumor ≥5 years, upper lobe site, unclear boundary, and spiculation rates were higher in the malignancy group than those in the benign group (P < 0.05). The efficiency of Brock model was the best. Its AUC was 0.833, sensitivity was 80.49%, and specificity was 74.31%. Its Youden index, positive likelihood ratio, positive predictive value, and negative predictive value were the highest, and its negative likelihood ratio was the lowest. The AUC, sensitivity, and specificity of Mayo model were 0.815, 81.71%, and 67.51%, respectively; those of PKUPH model were 0.754, 69.51%, and 73.55%, respectively; and those of VA model were 0.738, 68.29%, and 67.55%, respectively. Conclusion The Brock model might be the most appropriate predictive model for the risk assessment of SPN among the health check-up population, and the VA model is the worst. The combination of Brock, Mayo, and PKUPH models requires further study.

Injury profile in male collegiate rugby union players / 体力科学

The purpose of this study was to describe the incidence, severity, and burden of injuries in Japanese male collegiate rugby union players. Initially, 170 male collegiate rugby union players from one university club were registered in this epidemiological surveillance study. The occurrence of injuries was recorded by a team medical staff during the 2017–2021 playing seasons. The incidence of injuries was 6.87 injuries/1000 h. This incidence was significantly higher during matches (100.37 injuries/1000 h) than that during training (3.63 injuries/1000 h). The severity of injuries was 31.0 days, and there were no significant differences between matches and training, or forwards and backs. The burden of injuries was 213.1 days/1000 h. This burden was significantly higher during matches (2887.8 days/1000 h) compared to training (120.1 days/1000 h). Matches had higher incidence of ankle sprain/ligament injuries (15.80 injuries/1000 h) and concussion (15.36 injuries/1000 h). The most common injury site was the ankle (1.24 injuries/1000 h). However, the greatest severity and burden were observed for knee injuries (severity: 59.1 days, burden: 48.6 days/1000 h). Furthermore, the greatest burden of injury type was knee sprain/ligament injuries (39.4 days/1000 h). In addition, the incidence of acromioclavicular joint injury was significantly higher in forwards, whereas hamstring strain was significantly higher in backs. The common injury mechanisms identified were being tackled (16.0%) and tackling (14.7%), followed by overuse (12.1%). In order to improve the player welfare of the Japanese collegiate rugby union players, it is necessary to work on the prevention strategy considering the injury profile.

HLA-B27 did not protect against COVID-19 in patients with axial spondyloarthritis - data from the ReumaCov-Brasil Registry

Abstract Background Some studies have suggested the HLA-B27 gene may protect against some infections, as well as it could play a benefit role on the viral clearance, including hepatitis C and HIV. However, there is lack of SARS-CoV-2 pandemic data in spondyloarthritis (SpA) patients. Aim To evaluate the impact of HLA-B27 gene positivity on the susceptibility and severity of COVID-19 and disease activity in axial SpA patients. Methods The ReumaCoV-Brasil is a multicenter, observational, prospective cohort designed to monitor immunemediated rheumatic diseases patients during SARS-CoV-2 pandemic in Brazil. Axial SpA patients, according to the ASAS classification criteria (2009), and only those with known HLA-B27 status, were included in this ReumaCov-Brasil's subanalysis. After pairing them to sex and age, they were divided in two groups: with (cases) and without (control group) COVID-19 diagnosis. Other immunodeficiency diseases, past organ or bone marrow transplantation, neoplasms and current chemotherapy were excluded. Demographic data, managing of COVID-19 (diagnosis, treatment, and outcomes, including hospitalization, mechanical ventilation, and death), comorbidities, clinical details (disease activity and concomitant medication) were collected using the Research Electronic Data Capture (REDCap) database. Data are presented as descriptive analysis and multiple regression models, using SPSS program, version 20. P level was set as 5%. Results From May 24th, 2020 to Jan 24th, 2021, a total of 153 axial SpA patients were included, of whom 85 (55.5%) with COVID-19 and 68 (44.4%) without COVID-19. Most of them were men (N = 92; 60.1%) with mean age of 44.0 ± 11.1 years and long-term disease (11.7 ± 9.9 years). Regarding the HLA-B27 status, 112 (73.2%) patients tested positive. There were no significant statistical differences concerning social distancing, smoking, BMI (body mass index), waist circumference and comorbidities. Regarding biological DMARDs, 110 (71.8%) were on TNF inhibitors and 14 (9.15%) on IL-17 antagonists. Comparing those patients with and without COVID-19, the HLA-B27 positivity was not different between groups (n = 64, 75.3% vs. n = 48, 48%, respectively; p = 0.514). In addition, disease activity was similar before and after the infection. Interestingly, no new episodes of arthritis, enthesitis or extra-musculoskeletal manifestations were reported after the COVID-19. The mean time from the first symptoms to hospitalization was 7.1 ± 3.4 days, and although the number of hospitalization days was numerically higher in the B27 positive group, no statistically significant difference was observed (5.7 ± 4.11 for B27 negative patients and 13.5 ± 14.8 for B27 positive patients; p = 0.594). Only one HLA-B27 negative patient died. No significant difference was found regarding concomitant medications, including conventional or biologic DMARDs between the groups. Conclusions No significant difference of COVID-19 frequency rate was observed in patients with axial SpA regarding the HLA-B27 positivity, suggesting a lack of protective effect with SARS-CoV-2 infection. In addition, the disease activity was similar before and after the infection. Trial registration This study was approved by the Brazilian Committee of Ethics in Human Research (CONEP), CAAE 30186820.2.1001.8807, and was registered at the Brazilian Registry of Clinical Trials - REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.

Simultaneous integrated boost vs. routine IMRT in limited-stage small-cell lung cancer: an open-label, non-inferiority, randomized, phase 3 trial / 中华放射肿瘤学杂志

Objective:Simultaneous integrated boost radiation technique in limited-stage small cell lung cancer is lack of evidence. This prospective study aims to evaluate whether the simultaneous integrated boost is as efficacious and safe as conventional fractionated radiotherapy.Methods:Patients diagnosed with treatment-naive and confirmed limited-stage SCLC were eligible. Participants were randomly assigned (1: 1) to receive simultaneous integrated boost radiotherapy (PGTV 60.2 Gy/2.15 Gy/28F, PTV 50.4 Gy/1.8 Gy/28F) or conventional fractionated radiotherapy (PTV 60 Gy/2 Gy/30F). The primary endpoint was 2-year progression-free survival, and the secondary endpoints were 2-year overall survival, 2-year local-regional recurrence-free survival and toxicity.Results:Between February 2017 and July 2019, 231 patients were enrolled. We analyzed 216 patients whose follow-up time was more than 2 years or who had died, among whom 106 patients in the conventional fractionated radiotherapy group and 110 patients in the simultaneous integrated boost radiotherapy group. The median follow-up time was 37 months (95% CI: 35.2-38.7). The 2-year progression-free survival rates were 45.2% vs. 38.2%( HR=1.22, 95% CI: 0.87-1.72, P=0.2). The 2-year overall survival rates were 73.5% vs. 60.9%( HR=1.35, 95% CI: 0.90-2.04, P=0.14). The 2-year local-regional recurrence-free survival rates were 68.7% vs. 69.9%( HR=0.98, 95% CI: 0.62-1.56, P=1.0). Multivariate analysis showed that early radiotherapy yielded better 2-year progression-free survival, overall survival and local-regional recurrence-free survival than delayed radiotherapy in two groups ( HR=1.69, 95% CI: 1.18-2.41, P=0.003; HR=1.72, 95% CI: 1.09-2.70, P=0.018; HR=1.66, 95% CI: 1.01-2.73, P=0.046). Tumor staging was an influencing factor of overall survival (stage Ⅲ vs. stage Ⅰ-Ⅱ, HR=3.64, 95% CI: 1.15-11.57, P=0.028). The most common grade 3-4 adverse events were myelosuppression (21.7% vs. 15.4%, P=0.83), radiation pneumonitis (4.7% vs. 2.7%, P=0.44) and radiation esophagitis (3.8% vs. 1.8%, P=0.51). Conclusions:Simultaneous integrated boost radiotherapy yields equivalent efficacy and toxicities to conventional fractionated radiotherapy for limited-stage small cell lung cancer. Early radiotherapy can enhance clinical prognosis.

Cardiometabolic index and metabolic syndrome in the population over 40 years old in Guiyang city: A prospective cohort study / 中华内分泌代谢杂志

Objective:To investigate the relationship between cardiometabolic index and metabolic syndrome in people aged 40 and beyond in Guiyang city.Methods:A total of 4 506 residents over 40 years(including 3 067 females and 1 439 males) were enrolled in the analysis from those who participated in the epidemiological study of cancer risk in Chinese patients with type 2 diabetes in 2011 in Guiyang City. The cardiometabolic index (CMI) is calculated by triglycerides(TG)/high-density lipoprotein-cholesterol(HDL-C)×waist-to-height ratio (WHtR). Multivariable logistic regression was used to analyze the correlation between cardiometabolic index and metabolic syndrome, and ROC was used to analyze the predictive ability of CMI on the incidence of metabolic syndrome. Results:The average follow-up period was 3 years. According to the International Diabetes Federation (IDF) diagnostic criteria for metabolic syndrome in 2005, 985 patients (774 women and 211 males) had metabolic syndrome. The incidence rate of metabolic syndrome in the general population was 21.86%, the incidence rate of male metabolic syndrome was 14.66%, and that of women was 25.24%, and the incidence of CMI increased with the increase of the number of women. After multivariable logistic regression analysis, the odds ratio of CMI for metabolic syndrome in women is 1.303(95% CI 1.263-1.344) and 1.724(95% CI 1.162-2.558) in men, respectively. ROC results showed that CMI had a good ability to predict the incidence (AUC: 0.759 for men and 0.852 for women). Conclusion:CMI is positively associated with the incidence of metabolic syndrome. It supports CMI as a useful method to screen metabolic syndrome in China′s general population.

Clinical value of activin A in early identification of moderate and severe acute pancreatitis: a prospective study / 中华危重病急救医学

Objective:To explore the value of serum activin A (ACT-A) level in early identification of moderate and severe acute pancreatitis (AP).Methods:A prospective case control study was conducted. A total of 120 patients with AP admitted to department of hepatobiliary surgery of Affiliated Nanhua Hospital of Hengyang Medical College of University of South China between October 2020 and April 2022 were recruited. According to the revised Atlanta classification, all patients were classified into mild AP group and moderate-to-severe AP group. The blood samples within 24 hours of onset were drawn, and the serum ACT-A and C-reactive protein (CRP) levels were detected by enzyme-linked immunosorbent assay (ELISA). The Ranson score and the modified CT severity index (MCTSI) were performed. Pearson correlation method was used to analyze the correlation of various parameters. The receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive value of ACT-A and CRP for moderate-to-severe AP.Results:A total of 120 patients with AP were enrolled, including 83 patients with mild AP and 37 patients with moderate-to-severe AP. Serum ACT-A and CRP levels within 24 hours of onset in the moderate-to-severe AP group were significantly higher than those in the mild AP group [ACT-A (ng/L): 140.4±37.7 vs. 53.9±30.5, lg CRP: 1.42±0.91 vs. 0.77±0.70, both P < 0.01], and the Ranson score and MCTSI score were also significantly higher than those in the mild AP group (Ranson score: 5.3±1.3 vs. 1.8±1.6, MCTSI score: 5.5±1.0 vs. 2.7±1.2, both P < 0.01). Correlation analysis showed that the serum ACT-A level was positively correlated with serum CRP level, Ranson score and MCTSI score ( R2 value was 0.272, 0.841, 0.616, respectively, all P < 0.05). ROC curve analysis showed that the serum ACT-A, CRP and Ranson score had predictive value for moderate-to-severe AP. The area under the ROC curve (AUC) was 0.948 [95% confidence interval (95% CI) was 0.909-0.986], 0.711 (95% CI was 0.606-0.815), 0.946 (95% CI was 0.910-0.982), respectively. When serum ACT-A > 112.6 ng/L, the sensitivity and specificity of predicting moderate-to-severe AP were 78.38% and 96.39%, respectively, which was better than serum CRP with sensitivity and specificity of 72.92% and 66.27%, respectively, and the specificity was better than Ranson score (71.08%). Conclusion:ACT-A can be detected in the early stage of AP, and it is positively correlated with the disease severity, which can early identify moderate-to-severe AP.

Age differences in the association of physical leisure activities with incident disability among community-dwelling older adults

BACKGROUND@#The relationship between leisure activities (LA) in old age and prevention of disability has not been fully investigated, and age and gender differences of these relationships are unknown. This study aimed to investigate whether physical and cognitive LA predicted incident disability among community-dwelling older adults by age and gender.@*METHODS@#We prospectively observed 8,275 residents aged 65 or above without disability at baseline for 3 years. Incident disability was defined as a new certification of the public long-term care insurance system. LA were classified into two types: physical LA and cognitive LA. The frequency of LA was categorized into frequent (i.e., once a week or more), moderate (i.e., monthly or yearly), and non-engagement. Covariates included age, gender, family number, education, perceived economic situation, body mass index, chronic medical conditions, alcohol consumption, smoking status, regular dental visits, depression, cognitive functioning, and social participation. Multivariable Poisson regression models were used to estimate adjusted cumulative incidence ratio (CIR) and 95% confidence interval (CI) for incident disability. We performed stratified analyses by age groups (i.e., the young-old aged 65-74 and the old-old aged 75-97) and gender (i.e., men and women).@*RESULTS@#The 3-year cumulative incidence of disability was 7.5%. After adjustment for covariates and mutual adjustment for both types of LA, a significant dose-response relationship between more frequent LA and lower risk of incident disability was found in young-old physical LA (P-trend < 0.001), in old-old cognitive LA (P-trend = 0.012), in male cognitive LA (P-trend = 0.006), and in female physical LA (P-trend = 0.030). Compared with people without LA, adjusted CIR (95% CI) of frequent LA was 0.47 (0.30-0.74) in young-old physical, 0.75 (0.58-0.96) in old-old cognitive, 0.65 (0.46-0.89) in male cognitive, and 0.70 (0.52-0.95) in female physical. Regarding the effect modification according to age and gender, only interaction between age and physical LA significantly prevented incident disability (P for interaction = 0.019).@*CONCLUSION@#We found age differences in the association of physical LA with incident disability among community-dwelling older adults. An effective measure to prevent long-term care in the community would be to recommend frequent physical LA for the young-old.

Seguimiento de pacientes con pie diabético en un hospital de alta complejidad del norte del Perú / Follow-up of patients with diabetic foot in a highly complex hospital in northern Peru

RESUMEN Introducción. El pie diabético es una complicación frecuente de la diabetes. Los datos son escasos en el norte peruano. Objetivo. Describir la evolución clínica del pie diabético en un hospital de Lambayeque-Perú, entre los años 2018 y 2019. Métodos. Estudio descriptivo, prospectivo. Los pacientes fueron captados por emergencia/consulta y seguidos por la unidad de pie diabético mediante visitas diarias y curaciones. Resultados. Seguimiento desde agosto del 2018 a octubre 2019. Hubo 136 pacientes; mediana de edad: 63 años (RIC= 54-86) y 50,38% fueron hombres. La mediana de años con diabetes y tiempo de hospitalización fue 10 años y 10 días; 40% y 21% tuvo trauma y amputación previa. Las frecuencias de hipertensión arterial, nefropatía diabética, enfermedad renal crónica, síndrome coronario agudo y evento cerebrovascular previo fueron: 52,9%, 26,4%, 33,3%, 2,9% y 16,6%, respectivamente; 50,7% tuvo compromiso de pie derecho, 58,1% del izquierdo y 8,6%, de ambos. El Wagner inicial más frecuente fue IV: 30,16%, seguido de II: 25,40% y el final más frecuente fue IV: 42,15% seguido del II: 22,31%. Se amputaron 41,22%, mayores: 28,24% y menores 11,8%; 25,6% fueron supracondíleas; 39,6% tuvo sepsis, evolución desfavorable 38,58% y fallecieron 9,44%. En los amputados, la mediana de días antes de la amputación fue 12. Conclusiones. La frecuencia de amputación y mortalidad fue mayor a la de estudios anteriores. Hubo una alta frecuencia de evolución desfavorable: amputación/muerte o empeoramiento de la gangrena.

ABSTRACT Introduction. Diabetic foot is a frequent complication of diabetes. Data are scarce in northern Peru. Objective. To describe the clinical evolution of the diabetic foot in a hospital in Lambayeque-Peru, between 2018 and 2019. Methods. Descriptive, prospective study. The patients were recruited by emergency/consultation and followed by the diabetic foot unit through daily visits and dressings. Results. Follow-up from August 2018 to October 2019. There were 136 patients; median age: 63 years (IQR = 54-86) and 50.38% were men. The median number of years with diabetes and hospitalization time was 10 years and 10 days; 40% and 21% had trauma and previous amputation. The frequencies of high blood pressure, diabetic nephropathy, chronic kidney disease, previous acute coronary syndrome and cerebrovascular event were: 52.9%, 26.4%, 33.3%, 2.9% and 16.6%, respectively; 50.7% had involvement of the right foot, 58.1% of the left and 8.6% of both. The most frequent initial Wagner was IV: 30.16%, followed by II: 25.40% and the most frequent final was IV: 42.15% followed by II: 22.31%. 41.22% were amputated, mayor amputations: 28.24% and minor amputations 11.8%; 25.6% were supracondylar; 39.6% had sepsis, 38.58% unfavorable evolution and 9.44% died. In amputees, the median number of days before amputation was 12. Conclusions. The frequency of amputation and mortality was higher than in previous studies. There was a high frequency of unfavorable evolution: amputation/death or worsening of gangrene.

Risk of developing tuberculosis in T-cell spot test of tuberculosis infection positive close contacts of tuberculosis patients in Shanghai: a prospective observational study / 中华传染病杂志

Objective:To investigate the risk and temporal characteristics of tuberculosis (TB) in persons with latent tuberculosis infection (LTBI) among close contacts of TB patients in Shanghai.Methods:This was a prospective observational study, the study subjects were the close contacts of TB patients who tested positive for Mycobacterium tuberculosis infection by T-cell spot test of tuberculosis infection (T-SPOT.TB) among the registered population in seven districts of Shanghai from 2009 to 2010. Questionnaire interview was applied to investigate the basic information and contact history.The LTBI cases during nine consecutive years were identified through the TB registration and reporting system.Cumulative incidence rate and incidence density of TB in tuberculosis-infected close contacts were estimated. Chi-square test was used to compare the incidence rate among different sex and age groups. Results:In total, 376 pulmonary TB patients and their 982 close contacts were enrolled in the baseline survey from 2009 to 2010. Of them, 287 close contacts were tested positive for Mycobacterium tuberculosis infection by T-SPOT.TB.The median age of persons with LTBI at the time of survey was 54 years old, and 36.6%(105/287) were male. By the end of December 2019, five new TB cases were detected among the 287 close contacts with LTBI. The two-year and five-year cumulative incidence were 0.35% and 1.05%, respectively. The nine-year cumulative incidence was 1.74%(95% confidence interval 0.57%-4.02%). The median duration for TB occurrence was 3.67 years. The incidence density of TB was 1.875/1 000 person-years with a total of 2 666.75 observation person-years. There were no significant differences in the nine-year cumulative incidence of TB among close contacts with LTBI by age and sex ( χ2=0.600, <0.001, respectively, both P>0.05). Conclusion:The occurrence of TB among close contacts with LTBI is concentrated in the first five years after TB contact.

Effect assessment of caries management by risk assessment in children in the Minhang district of Shanghai / 口腔疾病防治

Objective@#To assess the effect of caries management based on risk assessment in children and to provide the basis for the government to develop strategies to prevent and treat oral diseases.@*Methods@# From March 2018 to March 2019, 512 3-year-old children and 502 6-year-old children were selected by cluster sampling from kindergartens and primary schools, respectively, in the Minhang district of Shanghai, and oral examinations and questionnaires were carried out to assess baseline status. Then, the children were divided into 3 groups, including low-, middle- and high-risk groups, according to caries risk assessment. In each caries risk group, the children were randomly divided into an experimental group and a control group. The experimental groups were managed by risk assessment, and the control groups were provided basic oral public health services by the Shanghai government. The effect of caries prevention was evaluated 12 months later.@*Results@#Among the children with a high risk of caries, the incidence of caries was 51.22% in the 3-year-old control group, 34.17% in the experimental group, 51.27% in the 6-year-old control group and 33.15% in the experimental group, with statistical significance (P < 0.05). Among the children with a middle risk of caries, the incidence of caries was 38.71% in the 3-year-old control group and 7.32% in the experimental group, with statistical significance (P < 0.05). However, there was no significant difference in caries incidence between the control group and the experimental group for the children with low risk in the 3-year-old or 6-year-old groups and middle risk caries risk in the 6-year-old group. Both 3-year-old and 6-year-old children in the experimental group had a lower risk of caries than those in the observation group in 2019.@*Conclusion@#The caries prevention effect is remarkable in high-risk children, and caries management by risk assessment is probably recommended for children with high caries risk.

Urinary N-terminal pro-B-type natriuretic peptide as a biomarker for cardiovascular events in a general Japanese population: the Hisayama Study

BACKGROUND@#Epidemiological evidence has shown that serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, a diagnostic biomarker for heart failure, are positively associated with cardiovascular risk. Since NT-proBNP in serum is excreted in urine, it is hypothesized that urinary NT-proBNP concentrations are correlated with serum concentrations and linked with cardiovascular risk in the general population.@*METHODS@#A total of 3060 community-dwelling residents aged ≥ 40 years without history of cardiovascular disease (CVD) were followed up for a median of 8.3 years (2007-2015). Serum and urinary concentrations of NT-proBNP at baseline were compared. The hazard ratios (HRs) and their 95% confidence intervals (CIs) for the association between NT-proBNP concentrations and the risk of developing CVD were computed using the Cox proportional hazards model.@*RESULTS@#The median values (interquartile ranges) of serum and urinary NT-proBNP concentrations at baseline were 56 (32-104) pg/mL and 20 (18-25) pg/mL, respectively. There was a strong quadratic correlation between the serum and urinary concentrations of NT-proBNP (coefficient of determination [R@*CONCLUSIONS@#The present study demonstrated that urinary NT-proBNP concentrations were well-correlated with serum concentrations and were positively associated with cardiovascular risk. Given that urine sampling is noninvasive and does not require specially trained personnel, urinary NT-proBNP concentrations have the potential to be an easy and useful biomarker for detecting people at higher cardiovascular risk.

Strategies for monitoring 24-hour intraocular pressure curve: 41 cases of prospective clinical study / 南方医科大学学报

OBJECTIVE@#To investigate accuracy of the currently used strategies for intraocular pressure measurements for reflecting actual 24-hour intraocular pressure fluctuations.@*METHODS@#From September, 2018 to January, 2019, the patients with a suspected diagnosis of primary open angle glaucoma at our hospital were prospectively enrolled to receive 24-hour intraocular pressure monitoring using a Goldmann tonometer. With the intraocular pressure measurements at 0:00, 2:00, 5:00, 7:00, 8:00, 10:00, 11:00, 14:00, 16:00, 18:00, 20:00, and 22:00 as the gold standard (strategy 1), we compared the measurements taken at 5:00, 7:00, 10:00, 14:00, 18:00, and 22:00 (strategy 2) and at 8:00, 11:00, 14:00, and 16:00 (strategy 3) for their accuracy in reflecting 24-h intraocular pressure fluctuations.@*RESULTS@#A total of 41 patients (82 eyes) were enrolled in this study. The peak intraocular pressures measured using the 3 strategies were 21.09±4.15 mmHg, 20.54±4.10 mmHg, and 19.91±4.38 mmHg, respectively, showing significant differences among them (@*CONCLUSIONS@#For suspected cases of glaucoma, intraocular pressure measurements at 4 and 6 time points of a day can not precisely reflect the actual range of intraocular pressure fluctuations, and may lead to a missed diagnosis of glaucoma.

Clinical study of tubectomy and it’s complications

Background: Tubectomy is most accepted method of contraception in India. Female sterilization may be performed in several ways such as abdominal tubal ligation, laparoscopic and hysteroscopic methods. Although considered as minor and safe procedure, complications leading to even death have been reported. So, this study was taken up to study complications of different types of tubal ligation. Objective of this study was to study complications of different types of tubal ligation.Methods: This is a prospective analytical study over the period of 18 months. This study includes all cases that have reported or referred as female sterilization complication.Results: At study institute both laparoscopic tubal ligation (TL) and abdominal tubal ligation are done. During the period of 18 months, 50 cases of tubectomy complications were noted at our institute, out of 40 cases (80%) were of abdominal method and rest 10 (20%) were of laparoscopic method. In 33 cases (66%) sterilization was performed at primary health centre. 3 cases of death reported in this study.Conclusions: At study institute both laparoscopic tubal ligation (TL) and abdominal tubal ligation are done. During the period of 18 months, 50 cases of tubectomy complications were noted at our institute, out of 40 cases (80%) were of abdominal method and rest 10 (20%) were of laparoscopic method. In 33 cases (66%) sterilization was performed at primary health centre. 3 cases of death reported in this study.

Approach for reporting serous effusion fluid in pleural, peritoneal and pericardial cavity and immunohistochemistry

Background: The aim of this study is to make a detailed cytological study of effusion fluids and compare with cell block study of the representative cases and IHC studies were done.Methods: Prospective study of 216 cases effusion fluids from in and around hospitals, Mangalore. This study conducted over a period of 18 months from October-2014 to April-2016. This study scrutinized and approved by Institutional Ethics Committee. The samples were processed by conventional cytology using Papanicolaou-stain and Cell Block (CB) method using 10% Alcohol-formalin fixative and stained with H and E. The cellularity, architectural patterns, morphological details were studied both smears. Ancillary immunohistochemical staining with calretinin and EMA are done.Results: A total of 216 cases of effusion fluids with cell block study were included, age range of 13 years to 93 years. Pleural fluid comprised of 55.09%, peritoneal fluid of 43.51% and pericardial fluid of 1.38%. 71% were clinically diagnosed as non-neoplastic and 29% were neoplastic condition. In CS study, 84.5% cases were benign/reactive effusion and 8.5% were positive for malignancy. In CB study, 84.5% were benign/reactive effusion and 10.2% were positive for malignancy. In comparison authors found an increase in diagnostic efficacy by 18%. IHC EMA for adenocarcinoma cells has sensitivity of 100% and calretinin for reactive mesothelial cells has specificity of 100%.Conclusions: Authors concluded that cell block technique when used as an adjuvant to routine smear examination in effusion fluids has increased the diagnostic yield and better preservation of architectural pattern. IHC is helpful in differentiating between reactive mesothelial and adenocarcinoma cells.