Association between KLB gene and susceptibility to sarcopenia among the elderly / 预防医学

Objective@#To examine the associations of fibroblast growth factor 19 (FGF19), its co-receptor KLB gene and its receptor FGFR4 with susceptibility to sarcopenia, so as to provide insights into elucidation of sarcopenia pathogenesis and formulation of precision interventions for sarcopenia.@*Methods@#A case-control study was conducted. Patients with sarcopenia at ages of 60 years and older included in the Zhejiang Provincial Elderly Health Surveillance Cohorts were selected as the sarcopenia group, and normal residents at ages of 60 years and older were served as controls. Subjects' demographics were collected using questionnaire surveys, and the height, body weight, appendicular skeletal muscle mass and grip strength were measured. Genomic DNA was extracted from blood samples for multiplex PCR targeted capture. The associations between the KLB gene single-nucleotide polymorphisms (SNPs) and susceptibility to sarcopenia were evaluated using multivariable logistic regression models. @*Results@#There were 200 cases in the sarcopenia group, including 91 men and 109 women, and 180 cases in the control group, including 70 men and 110 women. All SNPs satisfied the Hardy-Weinberg equilibrium, and the minor allele frequencies were all > 0.05. There were no significant differences in the distribution of SNPs between the sarcopenia and control groups (all P>0.05). Multivariable logistic regression analysis showed that the SNP rs2687968 locus in the KLB gene was significantly associated with the susceptibility to sarcopenia among the elderly men (superdominant model), and individuals carrying the AC allele had a 2.332-fold higher risk of sarcopenia than those carrying the AA/CC allele (95%CI: 1.882-3.313). @*Conclusions@#KLB gene may correlate with the susceptibility to sarcopenia among the elderly men.

Modeling of a coronavirus disease outbreak at the beginning of 2021 in Shijiazhuang， Hebei Province， China / 上海预防医学

Objective:To model an outbreak of coronavirus disease 2019 （COVID-19） in Shijiazhuang and forecast its spread trend. Method:We collected confirmed COVID-19 cases from the Health Commission of Hebei Province during the period of January 2 to January 27， 2021. We built a new model （SEIaIcRK）， including the contribution of asymptomatic cases， based on the traditional SEIR model to explore and analyze the transmission of COVID-19. Results:A total of 863 confirmed cases were reported during the study period （ended on January 27， 2021）. Our model fitted well with the daily cumulative incidence data and showed that the effective reproductive number decreased sharply from 3.80 on January 2 to 1.54 on January 4， then further decreased to <1 afterwards. Our model also predicted that number of COVID-19 cases would not increase after Feb 16， 2021. Conclusion:The SEIaIcRK model can be used to predict the spread trend of COVID-19 in Shijiazhuang. The current COVID-19 countermeasures effectively contain the disease spread.

Efficacy and safety of segmental radiofrequency ablation for isolation of the superior vena cava in patients with atrial fibrillation / 中华心血管病杂志

Objective: To analyze the three-dimensional distribution of functional sinus node, right phrenic nerve and superior vena cava(SVC)-right atrial muscle sleeves by three-dimensional electrophysiological technique in patients with atrial fibrillation (AF), and to investigate the efficacy and safety of segmental radiofrequency catheter ablation (RFCA) for isolation of superior vena cava in these patients . Methods: In this retrospective study, we enrolled 136 AF patients who underwent first RFCA in the First Affiliated Hospital of Zhengzhou University from July 2018 to June 2019 and all patients underwent SVC isolation under sinus rhythm. Baseline clinical data of patients were collected. The functional sinus node was defined by activation mapping, pacing was guided by three-dimensional mapping (Carto) system, localization of the right phrenic nerve was defined by pacing map, the superior vena cava-right atrial muscle sleeves was determined according to the change of potential during SVC isolation, segmental RFCA was performed for SVC isolation, the three-dimensional distribution of functional sinus node, right phrenic nerve and superior vena cava(SVC)-right atrial muscle sleeves was determined by three-dimensional electrophysiological technique. Immediate SVC isolation was achieved in all patients. Patients were evaluated immediately after RFCA and patients were followed at 3, 6, 9, and 12 months after RFCA. Holter monitoring was performed every 3 months, the chest radiograph and the SVC ultrasonic examination were performed every 6 months after RFCA. Postoperative complications were assessed. Results: The mean age of the 136 patients with AF was (51.6±14.2) years, 86 (63.2%) were male, 98 cases (72.1%) were paroxysmal AF and 38 cases (27.9%) were persistent AF. Right atrium activation mapping revealed that 17 (12.5%) functional sinus node were located in the SVC, 78 (57.4%) were located at the SVC-right atrium junctions, 41 (30.1%) were located below the junction level. From the head to foot view, 83 (61.0%) functional sinus node were located at the anterior lateral segment of the SVC-right atrium three-dimensional reconstruction model, 34 (25.0%) located at the posterior lateral segment, 15 (11.0%) located at the anterior wall, 4 (2.9%) located at posterior wall or anterior septum. A total of 294 SVC muscle sleeves were detected among all patients, 94 (32.0%) SVC muscle sleeves were located at the anterior septum of the SVC-right atrium three-dimensional reconstruction model, 76 (25.9%) were located at the posterior septum, 21(7.1%) were located at the posterior free wall, 11 (3.7%) were located at the posterior lateral, 27 (9.2%) were located at anterior lateral wall and 65 (22.1%) were located at the anterior free wall. Right phrenic nerve positioned relatively fix, 133 (97.8%) were located at the lateral segment of the SVC-right atrium three-dimensional reconstruction model, 3 (2.2%) were located at the anterior free wall. Sinus rhythm and SVC isolation were successfully restored immediately after RFCA, no significant SVC stenosis, right phrenic nerve palsy and functional sinus node injury occurred immediately post procedure. All patients were followed up for (11.2±3.6) months and none had postoperative complication. Conclusions: Three-dimensional electrophysiological can determine the spatial location of functional sinus node, right phrenic nerve and SVC-right atrial sleeves. On this basis, segmental RFCA is a safe and effective method to achieve complete isolation of SVC.

Retroperitoneal laparoscopic nephroureterectomy with distal and intramural ureter resection for a tuberculous non - functional kidney

ABSTRACT Objective: To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection for a tuberculous nonfunctional kidney. Materials and Methods: A total of 27 individuals diagnosed with unilateral nonfunctional kidney secondary to tuberculosis were treated between June 2011 and June 2015. All patients had normal renal function on the contralateral side and underwent the standard four-drug anti-tuberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the urinary-bladder junction of distal ureter was managed using different auto-suture techniques. Results: Nineteen male and 8 female patients with an average age of 47.3 years (range, 36-64 years) underwent surgery. All the operations were successfully performed without conversion. The median operative time was 109.3 min (range, 75-138 min), the median blood loss was 157.5 mL (range, 70-250 mL), and the median hospitalization time was 3.7 days (range, 3-6 days). No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting six months. No recurrence of tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 26.7 months (range, 6-54 months). Conclusion: Retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection is a safe and feasible approach for the treatment of tuberculous non-functional kidneys.

Application of enteral nutrition in the advanced elderly with multiple organ dysfunction syndromes / 中华老年医学杂志

Objective To explore the effects of different ways of nutritional support on organ functional recovery and prognosis in the elderly with multiple organ dysfunction syndromes (MODS).Methods 85 patients with MODS were randomized into enteral nutrition(EN) group (n=43 cases)and total parenteral nutrition(TPN) as control group (n=42 cases).EN group received nutritional support by nasogastric feeding tube or percutaneous endoscopic gastrotomy (PEG)/ percutaneous endoscopic jejunostomy (PEJ),and TPN group got nutrition by central vein for at least 2 months of therapeutic course.Body mass index (BMI),hemoglobin (HB),functions of liver and kidney,electrolytes,blood glucose and lipid,serum albumin(ALB),transferring(TRF),prealbumin (PA),immunoglobulin(IgA,IgG,IgM),leukomonocyte (CD3+,CD4+,CD4+/CD8+) were compared between two groups before and after treatment.Results The levels of Hb,BMI,ALB,TRF and PA after treatment for 1 and 2 months significantly improved (t1EN =2.672,2.440,2.209,3.331,5.025,t1TpN=2.720,2.337,2.179,3.418,2.221 and tEN2nd maonh=2.279,3.021,2.337,3.005,5.779,tTPN2nd month=2.118,2.956,3.018,3.310,2.119,all P＜0.05) in two groups as compared with before treatment,and there was remarkable difference in the level of PA between EN group and TPN group(t=2.336,P＜0.05).Hyperlipemia at 1 and 2 months after treatment occurred in TPN group (t1TPN =3.609,t2TPN =3.114,P＜0.05).The levels of IgG (t1st month=2.664,t2nd month =2.983,P＜0.05) and IgA (t1st month =2.437,t2nd month =3.005,P＜0.05) were higher after treatment for 1 and 2 months than before treatment.The levels of CD3+,CD4+ and CD4+/CD8+ cells improved (t2nd month =2.399,3.478,2.579,3.995,P ＜ 0.05 ) and IgM (t2nd month =3.886,P＜0.05) increased after treatment for 2 months in EN group.In EN group,aspiration pneumonia appeared in 34 cases and the occurrence rate decreaed (x2 =51.12,P ＜ 0.05 ) after PEG/PEJ operation (only 5 cases).Reflux esophagitis reduced and alleviated 2 months after PEG/PEJ operation (x2=13.53,P＜ 0.05).ConclusionsTimely sufficient EN support may improve nutritional and immunological status in elderly patients with MODS.PEG/PEJ can reduce the occurrence of aspiration pneumonia and reflux esophagitis caused by the nasogastric feeding tube.