A risk model for the early diagnosis of acute myocardial infarction in patients with chronic kidney disease.

Introduction: Acute myocardial infarction (AMI) remains a critical disease, characterized by a high fatality rate in several countries. In clinical practice, the incidence of AMI is increased in patients with chronic kidney disease (CKD). However, the early diagnosis of AMI in the above group of patients is still poor. Methods: In the present study, a total of 829 patients with CKD, defined by an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m2 or 60-90 ml/min/1.73 m2 for patients with mildly reduced kidney function, who attended the Sichuan Provincial People's Hospital (SPPH) between January 2018 and November 2022 were enrolled. All patients underwent coronary angiography due to the presence of typical or atypical symptoms of AMI. Patients were divided into the following two groups: The training cohort, including 255 participants with AMI and 242 without AMI; and the testing cohort, including 165 and 167 subjects with and without AMI, respectively. Furthermore, a forward stepwise regression model and a multivariable logistic regression model, named SPPH-AMI-model, were constructed to select significant predictors and assist the diagnosis of AMI in patients with CKD, respectively. Results: The following factors were evaluated in the model: Smoking status, high sensitivity cardiac troponin I, serum creatinine and uric acid levels, history of percutaneous coronary intervention and electrocardiogram. Additionally, the area under the curve (AUC) of the receiver operating characteristic curve were determined in the risk model in the training set [AUC, 0.78; 95% confidence interval (CI), 0.74-0.82] vs. the testing set (AUC, 0.74; 95% CI, 0.69-0.79) vs. the combined set (AUC, 0.76; 95% CI, 0.73-0.80). Finally, the sensitivity and specificity rates were 71.12 and 71.21%, respectively, the percentage of cases correctly classified was 71.14%, while positive and negative predictive values of 71.63 and 70.70%, respectively, were also recorded. Discussion: The results of the current study suggested that the SPPH-AMI-model could be currently considered as the only risk scoring system for the early diagnosis of AMI in patients with CKD. This method could help clinicians and emergency physicians to quickly and accurately diagnose AMI in patients with CKD to promote the immediate and effective treatment of these patients.

Association between Serum Cystatin C levels and long-term cardiovascular outcomes and all-cause mortality in older patients with obstructive sleep apnea.

Background and Aims: To investigate the association between obstructive sleep apnea (OSA) severity and baseline serum cystatin C (Cys-C) concentration and to explore the association between baseline serum Cys-C and long-term cardiovascular outcomes and mortality in older patients with OSA. Methods: Between January 2015 and October 2017, a total of 1107 consecutive eligible older patients (≥60 years) with OSA were included in this multicenter, prospective cohort study, and baseline demographics, clinical characteristics, sleep parameters, and follow-up outcomes were collected. Participants were divided into different groups based on baseline serum Cys-C levels. The primary end point was major adverse cardiovascular events (MACE) and the secondary end point was all-cause mortality. The correlation between OSA severity and baseline serum Cys-C was evaluated by Spearman correlation analysis. Multivariate Cox regression was used to analyze the association between Cys-C and the incidence of MACE and mortality. Results: Participants included 672 men and 435 women, with a median age of 66 (range, 60-96) years. At baseline, apnea-hypopnea index (AHI) (r = 0.128, p < 0.05), oxygen desaturation index (ODI) (r = 0.116, p < 0.05), and the lowest pulse oxygen saturation (LSpO2) (r = -0.097, p < 0.05) were correlated with serum Cys-C concentration. During the median follow-up period of 42 months, 97 patients (8.8%) experienced MACE and 40 patients (3.6%) experienced death. The association between serum Cys-C levels and the risk of MACE and all-cause mortality was slow rising shaped. The multivariable Cox regression analysis showed patients with a serum Cys-C concentration of ≥1.14 mg/L had higher risks of MACE (HR = 5.30, 95% CI: 2.28-12.30, p < 0.05) and all-cause mortality (HR = 9.66, 95% CI: 2.09-44.72, p < 0.05) compared with patients with serum Cys-C of ≤0.81 mg/L in older patients with OSA. The receiver-operating characteristic curve showed baseline serum Cys-C levels exhibited moderately capable of identifying patients with a long-term risk of clinical adverse events (MACE and mortality). Conclusion: OSA severity was positively correlated with serum Cys-C concentration. High levels of Cys-C were independently associated with increased risks of MACE and all-cause mortality in older patients with OSA, suggesting that lowering Cys-C levels should be considered as a therapeutic target, and monitoring serum Cys-C may be beneficial to the favorable prognosis of older patients with OSA.

Anticipated Regret, Entrepreneurial Cognition, and Entrepreneurial Persistence.

Based on the regret regulation theory and entrepreneurial cognition theory, this study aims to investigate the relationship between entrepreneurs' anticipated regret and entrepreneurial persistence through the mediator of entrepreneurial cognition. To that end, we distributed surveys to entrepreneurs who were supported by the "Xing Chuang Tian Di" project and used 248 questionnaire data to examine the hypotheses. The results show that entrepreneurs' anticipated regret has a significant and direct impact on entrepreneurial persistence. Also, entrepreneurship cognition plays a mediating role between anticipated regret and entrepreneurial persistence. In addition, the entrepreneurial environment plays a positive role in moderating the relationship between anticipated regret and entrepreneurial persistence.

A Novel Electrocardiography Model for the Diagnosis of Acute Pulmonary Embolism.

Acute pulmonary embolism (acPE) is a severe disease that is often misdiagnosed as it is difficult to detect quickly and accurately. In this study, a novel electrocardiogram (ECG) model was used to estimate the probability of acPE rapidly via analysis of ECG characteristics. A total of 327 patients with acPE who were diagnosed at the Sichuan Provincial People's Hospital (SPPH) between 2018 and 2021 were retrospectively studied. A total of 331 patients were randomly selected as the control group, which included patients hospitalized during the same time period. The control group included patients who presented with characteristic symptoms of acPE, but this diagnosis was ruled out following further diagnostic testing. This study compared the diagnostic value of the ECG model with those of another ECG scoring model (Daniel-ECG score) and the most common prediction models (Wells score and Geneva score). This study established an ECG-predictive model using analysis of the ECG abnormalities in patients with acPE. The final ECG model included certain novel ECG signs that had not been incorporated in the previous ECG score of the patients, and thus, compared to the previous ECG score, exhibited a more favorable area under the receiver operating characteristic curve (AUC) value (0.8741). The model developed in this study was named the SPPH-ECG model. Furthermore, this study compared the SPPH-ECG model with Daniel-ECG score, Wells score, and Geneva score, and the SPPH-ECG model was demonstrated to exhibit a superior AUC value (0.8741), sensitivity (79.08%), negative predictive value (79.52%), and test accuracy (79.42%), while the Geneva score presented superior specificity (100%) and positive predictive value (100%) compared with the SPPH-ECG model. In conclusion, the SPPH-ECG model may play a role in ruling out acPE in patients during diagnostic testing and diagnose acPE rapidly and accurately in combination with the Geneva scoring system.

Chinese men living in urban areas of Shijiazhuang, Hebei at higher risk of overweight or obesity.

OBJECTIVE: The prevalence of overweight/obesity in China has increased dramatically in recent years; being overweight/obese can increase the risk of type 2 diabetes and cardiovascular disease. The purpose of this study was to determine the population in China at high risk of being overweight or obese, to explore the relationships between various relevant factors and overweight/obesity, and to identify preventive efforts for high-risk populations. METHODS: We administered a questionnaire survey among a group of 536 social workers in Shijiazhuang City in 2017. We used the Pearson chi-square test, Spearman's rho test, multivariate linear regression, univariate and multivariate logistic regression, and receiver operating characteristic curve analysis to investigate factors that influence overweight/obesity. RESULTS: The prevalence of overweight/obesity was 13.7% among the study participants. Urban residence, eating speed, number of daily meals, overeating, and a high-fat diet were associated with overweight/obesity. In multivariate linear regression analysis, overweight/obesity was correlated with sex, urban residence, eating speed, number of daily meals, and a high-fat diet. CONCLUSION: Among all influencing factors, dietary factors, place of residence, and sex were most closely related to being overweight/obese. Furthermore, living in an urban area and male sex were independent risk factors for being overweight/obese.

Low-temperature liquid phase reduced TiO2 nanotube arrays: synergy of morphology manipulation and oxygen vacancy doping for enhancement of field emission.

The partially reduced TiO(2) nanotube arrays (TNAs) are prepared via an uncomplicated and low-cost liquid phase reduction strategy using NaBH(4) as the reducing agent. By controlling and adjusting the reduction temperatures from 30 to 90 °C, the reduction treatment can not only change their surface morphology but also introduce oxygen vacancies into them, resulting in an optimized morphology, elevated Fermi-level, reduced effective work function and improved conductivity of the TNAs. Meanwhile, the thermal and long-term stability of oxygen vacancy are also investigated, indicating that the oxygen vacancies retain long-term stability from room temperature up to 150 °C. More interesting, partially reduced TNAs show drastically enhanced field emission (FE) performances including substantially decreased turn-on field from 18.86 to 1.53 V µm(-1), a high current density of 4.00 mA cm(-2) at 4.52 V µm(-1), and an excellent FE stability and repeatability. These very promising results are attributed to the combination of the optimized morphology and introduced oxygen vacancies, which can increase FE sites, reduce effective work function and increase conductivity.

Detection of eukaryotic translation initiation factor 4E and its clinical significance in hepatocellular carcinoma.

AIM: To study the expression of eukaryotic translation initiation factor 4E (eIF4E), which is closely correlated with malignant tumors, and its relationship to prognosis in hepatocellular carcinoma. METHODS: Western blotting was performed to quantify the elF4E protein expression in the normal human liver cell line L02 and the hepatoma cell lines Hep3B, HepG2, and Huh7. Forty-six hepatocellular carcinoma samples with complete clinical data were obtained from Changzheng Hospital during the period of December 2008 to July 2009. The expression of eIF4E in the tumor samples and their adjacent tissues were detected by immunohistochemistry. The relationship between the test results and hepatocellular carcinoma (HCC) prognosis was statistically analysed by using a COX proportional hazard model. RESULTS: Western blotting analysis showed that there were distinct eIF4E protein bands in all three of the hepatoma cell lines. In particular, the HepG2 cell line had the highest level of eIF4E protein expression. The L02 cell group had a low eIF4E expression. Immunohistochemical assay showed that there were 32 cases in which the tumour tissue expression was higher than their adjacent tissues, accounting for 69.57%. There were also 14 cases in which the tumour tissue expression was lower or no significant difference was found, accounting for 30.43%. COX proportional hazards model analysis showed that HCC prognosis was related to the depth of invasion, the overexpression of eIF4E and p53, possibly as independent HCC prognostic predictors. CONCLUSION: In summary, eIF4E expression is associated with liver cancer, and patients with high eIF4E expression levels have a higher risk of recurrence.