Cancer screening in hospitalized ischemic stroke patients: a multicenter study focused on multiparametric analysis to improve management of occult cancers.

Background/aims: The reciprocal promotion of cancer and stroke occurs due to changes in shared risk factors, such as metabolic pathways and molecular targets, creating a "vicious cycle." Cancer plays a direct or indirect role in the pathogenesis of ischemic stroke (IS), along with the reactive medical approach used in the treatment and clinical management of IS patients, resulting in clinical challenges associated with occult cancer in these patients. The lack of reliable and simple tools hinders the effectiveness of the predictive, preventive, and personalized medicine (PPPM/3PM) approach. Therefore, we conducted a multicenter study that focused on multiparametric analysis to facilitate early diagnosis of occult cancer and personalized treatment for stroke associated with cancer. Methods: Admission routine clinical examination indicators of IS patients were retrospectively collated from the electronic medical records. The training dataset comprised 136 IS patients with concurrent cancer, matched at a 1:1 ratio with a control group. The risk of occult cancer in IS patients was assessed through logistic regression and five alternative machine-learning models. Subsequently, select the model with the highest predictive efficacy to create a nomogram, which is a quantitative tool for predicting diagnosis in clinical practice. Internal validation employed a ten-fold cross-validation, while external validation involved 239 IS patients from six centers. Validation encompassed receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and comparison with models from prior research. Results: The ultimate prediction model was based on logistic regression and incorporated the following variables: regions of ischemic lesions, multiple vascular territories, hypertension, D-dimer, fibrinogen (FIB), and hemoglobin (Hb). The area under the ROC curve (AUC) for the nomogram was 0.871 in the training dataset and 0.834 in the external test dataset. Both calibration curves and DCA underscored the nomogram's strong performance. Conclusions: The nomogram enables early occult cancer diagnosis in hospitalized IS patients and helps to accurately identify the cause of IS, while the promotion of IS stratification makes personalized treatment feasible. The online nomogram based on routine clinical examination indicators of IS patients offered a cost-effective platform for secondary care in the framework of PPPM. Supplementary Information: The online version contains supplementary material available at 10.1007/s13167-024-00354-8.

Associations of type 2 diabetes and the risk of migraine in Chinese populations.

AIM: We aimed to explore the relationship between type 2 diabetes mellitus (T2DM) and the incidence rate of migraine in a Chinese population, and analyze the clinical characteristics of migraine patients with T2DM. METHODS: Data on the study cohort of 9873 individuals were obtained from the China Health and Retirement Longitudinal Study (CHARLS). The incidence rate of migraine from 2015 to 2018 was assessed. The Cox proportional hazards model was used to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs) for the relationship between T2DM and the incidence of migraine. In addition, a cross-sectional study including 168 migraine patients was conducted in Xiamen, China. Migraine patients were grouped according to their T2DM status. Multivariable linear regression models were used to estimate ßs and their 95% CIs for the relationship between migraine characteristics and T2DM. RESULTS: The cumulative incidence rate of migraine from 2015 to 2018 in the T2DM group and control group was 7.26% [6.04%.8.65%] and 8.91% [8.27%.9.58%], respectively. The risk of migraine in patients with T2DM was reduced by 21% (HR 0.79 [0.65;0.95]) compared to patients with no T2DM after adjustment for confounders. The cross-sectional study showed that the presence of T2DM significantly reduced migraine frequency and relieved migraine intensity. CONCLUSION: This was the first study to validate that T2DM reduced the risk of migraine in a Chinese population cohort. Patients with migraine and T2DM may experience significant relief from their headache symptoms. Carrying out relevant mechanistic research may help to identify new targets for migraine treatment and contribute to further understanding the impact of T2DM or related metabolic disorders on an individual's health.

Serum neurofilament light chain levels in migraine patients: a monocentric case-control study in China.

PURPOSE: Serum neurofilament light chain (sNfL) can reflect nerve damage. Whether migraine can cause neurological damage remain unclear. This study assesses sNfL levels in migraine patients and explores whether there is nerve damage in migraine. METHODS: A case-control study was conducted in Xiamen, China. A total of 138 migraine patients and 70 healthy controls were recruited. sNfL (pg/mL) was measured on the single-molecule array platform. Univariate, Pearson correlation and linear regression analysis were used to assess the relationship between migraine and sNfL levels, with further subgroup analysis by migraine characteristics. RESULTS: Overall, 85.10% of the 208 subjects were female, with a median age of 36 years. sNfL levels were higher in the migraine group than in the control group (4.85 (3.49, 6.62) vs. 4.11 (3.22, 5.59)), but the difference was not significant (P = 0.133). The two groups showed an almost consistent trend in which sNfL levels increased significantly with age. Subgroup analysis showed a significant increase in sNfL levels in patients with a migraine course ≥ 10 years (ß = 0.693 (0.168, 1.220), P = 0.010). Regression analysis results show that age and migraine course are independent risk factors for elevated sNfL levels, and there is an interaction between the two factors. Patients aged < 45 years and with a migraine course ≥ 10 years have significantly increased sNfL levels. CONCLUSIONS: This is the first study to evaluate sNfL levels in migraine patients. The sNfL levels significantly increased in patients with a migraine course ≥ 10 years. More attention to nerve damage in young patients with a long course of migraine is required.

Investigation of element migration characteristics and product properties during biomass pyrolysis: a case study of pine cones rich in nitrogen.

To further understand the element migration characteristics and product properties during biomass pyrolysis, herein, pine cone (PC) cellulose and PC lignin were prepared, and their pyrolysis behavior was determined using thermogravimetric analysis (TGA). Subsequently, the PC was pyrolyzed in a vertical fixed bed reactor system at 400-700 °C for 60 min. The characteristics of element migration and the physicochemical properties of the pyrolysis products were analyzed and discussed. In the pyrolysis temperature range from 200 °C to 500 °C, there were two distinct weight loss peaks for PC. During the pyrolysis process, the C element was primarily retained in the biochar, while the O element mainly migrated into liquid and gaseous products in the form of compounds such as CO2, CO, and H2O. Besides, 28.42-76.01% of the N element in PC migrated into biochar. Of the three-phase products, the gases endow the lowest energy yield, while the energy of the biochar dominates the pyrolysis of the PC. Additionally, the N content and specific surface area for the PC-derived biochar obtained at 400 °C in a N2 atmosphere were higher than those of the biochar derived from fiberboard.

Primary care reforms in managing chronic diseases in Xiamen, China: A tentative assessment.

BACKGROUND: The primary care reform developed in Xiamen City stood out among the dozens of pilot reforms conducted in China. The aim of this study was to investigate the effects of the reform. METHODS: The data were collected from the Annual Statistical Report on Xiamen's Hospitals and face-to-face questionnaire interviews among physicians (n = 107) and community members (n = 399). Binary logistic regression was performed to analyze the factors influencing the community members' preference for treatment in community health centers (CHCs). RESULTS: The drug cost declined nearly 3.0% in hospitals, and outpatient visits increased more quickly (27.1%) in CHCs. A total of 86.2% of community members preferred to receive treatment for slight illness or chronic diseases in CHCs, and 77.9% of them were willing to be referred to CHCs during the recovery period. Patients who were managed by the general practice (GP) team showed higher percentages in examining and controlling blood pressure and blood glucose. CONCLUSION: The reform in Xiamen was easily accepted by physicians and community members. The reform had rendered initial achievements in reducing drug income in hospitals, increasing outpatient visits in CHCs, seeking health care in CHCs, and controlling blood pressure and glucose for patients with chronic diseases.

Joint associations of smartphone use and gender on multidimensional cognitive health among community-dwelling older adults: a cross-sectional study.

BACKGROUND: Smartphone use has become an increasingly pervasive part of our daily lives, and as a portable media device, smartphones provide good support for cognitive training during aging. However, little is known about the joint association of smartphone use and gender on the cognitive health of older adults, particularly with regard to multi-domain cognition. METHODS: A face-to-face survey of 3230 older adults aged 60+ years was conducted in Xiamen, China, in 2016. The Montreal Cognitive Assessment (MoCA) score was used to measure both general and multi-domain cognition. Smartphone use was self-reported and the number of the smartphone functions used (NSFU) was classified as 0, 1, and 2+. General and subdomain cognitive functions were modelled on NSFU only, gender only, and NSFU and gender combined by using a series of proportional-odds cumulative logit models. Furthermore, joint associations of gender and NSFU on both general and multi-domain cognition were estimated, and a four-category quantile classification was used to evaluate the total MoCA score. RESULTS: Among all 3230 respondents, 2600 remained after exclusion of respondents with very low MoCA scores (below the education-adjusted cut-offs for dementia). Only 29.96% of older adults used smartphones, 473 (60.72%) of which were men. Respondents who had a higher NSFU maintained a better general and sub-domain cognition except for memory and orientation. Although women had lower values compared to men in visuospatial ability (OR (95% CI): 0.46 (0.37-0.57)), they outperformed their male counterparts in memory (OR (95% CI): 1.38 (1.10-1.73)). The results of the joint association showed that women's inferiority in visuospatial ability diminished when they had a NSFU of 2+. However, a significantly better improvement in memory for male was achieved when they had a NSFU of 1 rather than 2 + . CONCLUSIONS: A higher NSFU was positively associated with increased general and partial subdomain cognitive functions. However, gender differences were found in visuospatial ability and memory, which could be alleviated by smartphone use.

Association of the combination of sleep duration and sleep quality with quality of life in type 2 diabetes patients.

PURPOSE: Sleep problems are very common in people with diabetes. The aim of this study was to assess the association of the combination of self-reported sleep duration and sleep quality on quality of life (QOL) in Chinese patients with type 2 diabetes mellitus (T2DM). METHODS: We analyzed the community-based cross-sectional data of 798 patients with T2DM in Xiamen, China, in 2016. Sleep duration was measured as self-reported average sleep time during the previous month. Sleep quality was evaluated as self-rated reports. QOL was assessed by the Diabetes-specific Quality of Life (DSQL), with scores < 40 and ≥ 80 set as cut-off values for differentiating good, fair, and poor QOL. Ordinal logistic regression was performed to model the associations of QOL with sleep duration, sleep quality, and their combined effects by adjusting for certain covariates. RESULTS: The separate associations of sleep duration and sleep quality in relation to QOL in T2DM patients were significant (P < 0.05). After controlling for sleep quality, there was no significant correlation between sleep duration and QOL. The combined analysis suggested that the association of sleep duration with QOL in T2DM patients was sleep quality-dependent. Longer sleep duration was associated with higher odds ratios (ORs) of better QOL for patients who reported fair sleep quality and good sleep quality, but no such trend was observed for patients who reported poor sleep quality (P> 0.05). Excessive sleep duration (≥ 9 h per day) was detrimental to QOL in T2DM only when they reported poor sleep quality. CONCLUSIONS: Specific disparities exist in the association of sleep quality with sleep duration and QOL in T2DM patients. Failures to take into account the effect of sleep quality when evaluating the impact of sleep on QOL significantly bias the results. It is important to integrate duration and quality of sleep as a composite sleep index when assessing sleep of patients with T2DM.

Educational disparities in the associations between self-monitoring of blood glucose and glycemic control in type 2 diabetes patients in Xiamen, China.

BACKGROUND: This study examined the combined effects of self-monitoring of blood glucose (SMBG) and educational attainment on glycemic control in type 2 diabetes mellitus (T2DM) patients. METHODS: A cross-sectional survey was performed among community residents with T2DM. Good glycemic control was defined as HbA1c <7% in the most recent measurement. Multivariable logistic regression was used to examine associations of glycemic control with SMBG, educational attainment, and their combined effects by controlling for certain covariates, with further stratification by sex. RESULTS: Complete data were available for 798 patients, of which 58.52% had good glycemic control. Higher education and SMBG were associated with good glycemic control (P < 0.05). In the SMBG group, tertiary-educated patients had the greatest odds of good glycemic control (odds ratios 2.56; 95% confidence interval 1.31-4.99). Among those performing SMBG, the odds of good glycemic control were higher for those with higher education levels (Ptrend = 0.003), whereas there was no clear trend for those not performing SMBG (Ptrend = 0.071). For subjects attaining secondary and tertiary education levels, the odds of good glycemic control were higher in those performing SMBG, although there was no significant difference between the two groups for those with a primary education. Glycemic control decreased slightly among males with a primary level education, but showed an increasing trend among females with a primary level education. CONCLUSIONS: Sex-specific educational disparities exist in the association between SMBG and glycemic control. More detailed guidelines for SMBG according to a subject's socioeconomic position and sex are required.