Objective:To explore the predictive value of the controlling nutritional status (CONUT) score combined with the systemic immune-inflammation index (SII) for frailty and prognosis in chronic heart failure (CHF) patients with atrial fibrillation (AF). Methods:This retrospective study included 264 patients with CHF and AF who were admitted to and treated at the inpatient and outpatient departments of Nanjing Integrated Traditional Chinese and Western Medicine Hospital from January 2016 to July 2019. Follow-up ended upon patient death, with the final follow-up deadline set for September 2024. Binary logistic regression and Cox regression were used to identify factors influencing frailty and all-cause mortality. The cutoff values for the CONUT score and SII are determined by the ROC diagnostic threshold for mortality. Cutoff values for the CONUT score and SII were 6.5 and 990.2, respectively, categorizing patients into four groups: G1 (high CONUT ≥ 6.5 and high SII ≥ 990.2), G2 (high CONUT ≥ 6.5 and low SII < 990.2), G3 (low CONUT < 6.5 and high SII ≥ 990.2), and G4 (low CONUT < 6.5 and low SII < 990.2). Results:Frailty was present in 165 patients (165/264). Multivariate logistic regression identified disease duration, CONUT score, and SII as significant factors for frailty. A positive correlation between CONUT and SII was observed (r = 0.648, p < 0.001). Cox regression analysis found smoking, CONUT, and SII as risk factors for mortality. Survival analysis showed lower survival rates in high CONUT and high SII groups (p < 0.001), with the G1 group having the lowest survival rate compared to G2, G3, and G4 (p < 0.001). Conclusion:The CONUT score and SII are useful predictors of frailty and mortality in CHF patients with AF. Their combined use may improve the assessment of frailty and prognosis in this population.

The relationship between serum sodium levels and stroke prognosis has been investigated, but the effect of serum sodium fluctuations on severe stroke patients remains uncertain. We aimed to evaluate the association between serum sodium trajectories within 72 h of admission and all-cause mortality in intensive care unit (ICU) patients with ischemic stroke. This retrospective study utilized data from the Medical Information Mart for Intensive Care (MIMIC) database, including patients diagnosed with ischemic stroke from 2008 to 2022. Serum sodium trajectories within 72 h of admission were classified using a latent class trajectory model. Kaplan–Meier survival curves and Cox proportional hazards models were employed to assess the relationship between trajectories and all-cause mortality. Subgroup analyses were conducted to assess the consistency of this association across various populations. Among 881 enrolled patients, two distinct serum sodium trajectory groups were identified: class 1 (n = 778, 88.3

Objective: Frailty status is closely related to cerebral infarction, but there is a lack of objective biomarkers to determine frailty status in cerebral infarction patients. This study explores frailty status and frailty-related serum markers in patients with acute cerebral infarction and determines their diagnostic value for frailty. Methods: A total of 146 patients with acute cerebral infarction admitted to Hangzhou Third people's Hospital from January 2021 to December 2023 were enrolled prospectively. The Edmonton scale was used to evaluate the patients in the frailty and non-frailty groups. The clinical frailty scale (CFS) was used to divide frailty patients into mild, moderate, and severe frailty groups, comparing clinical data and levels of serum markers among different groups, and analyzing the risk factors for frailty in cerebral infarction. Results: Among the 146 patients, 70 cases (47.9%) were in the frailty group, and 76 cases (52.1%) in the non-frailty group. Compared with patients in the non-frailty group, patients in the frailty group had significantly lower levels of hemoglobin, triglycerides, low-density lipoprotein, and albumin (P<0.05 or 0.01), while levels of C-reactive protein (CRP), D-dimer, and homocysteine (Hcy) were significantly increased (P<0.05 or 0.01). Logistic regression analysis found that the levels of hemoglobin and Hcy were independent risk factors for frailty in acute cerebral infarction patients, with the ROC curve areas of 0.707 and 0.751, respectively. The ROC curve area for predicting frailty by combining hemoglobin and Hcy levels was 0.799. Conclusion: The incidence of frailty in patients with acute cerebral infarction is high, and serum markers of hemoglobin and Hcy have certain value in determining frailty in patients with acute cerebral infarction.

BackgroundEarly enteral nutrition (EN) is recommended for sepsis management, but its optimal timing and clinical benefits remain uncertain. This study evaluates whether early EN improves outcomes compared to delayed EN in patients with sepsis.MethodsWe analyzed data of septic patients from the MIMIC-IV 2.2 database, focusing on those in the Medical Intensive Care Unit (MICU) and Surgical Intensive Care Unit (SICU). Patients who initiated EN within 3 days were classified into the early EN group, while those who started EN between 3 and 7 days were classified into the delayed EN group. Propensity score matching was used to compare outcomes between the groups.ResultsAmong 1,111 patients, 786 (70.7%) were in the early EN group and 325 (29.3%) were in the delayed EN group. Before propensity score matching, the early EN group demonstrated lower mortality (crude OR = 0.694; 95% CI: 0.514–0.936; p = 0.018) and shorter ICU stays (8.3 [5.2, 12.3] vs. 10.0 [7.5, 14.2] days; p < 0.001). After matching, no significant difference in mortality was observed. However, the early EN group had shorter ICU stays (8.3 [5.2, 12.4] vs. 10.1 [7.5, 14.2] days; p < 0.001) and a lower incidence of AKI stage 3 (49.3% vs. 55.5%; p = 0.030). Subgroup analysis revealed that early EN significantly reduced the 28-day mortality rate in sepsis patients with lactate levels ≤4 mmol/L, with an adjusted odds ratio (aOR) of 0.579 (95% CI: 0.361, 0.930; p = 0.024).ConclusionEarly enteral nutrition may not significantly reduce overall mortality in sepsis patients but may shorten ICU stays and decrease the incidence of AKI stage 3. Further research is needed to identify specific patient characteristics that benefit most from early EN.

Background: The causal relationship between different hypothyroidism subtypes and the risk of major depression (MD) is yet to be fully elucidated. This study aimed to determine if there's a causal relationship between various hypothyroidism subtypes (and related factors) and the risk of MD. Methods: This genetic association study utilized a two-sample Mendelian Randomization (MR) approach to explore the causal relationships between various hypothyroidism subtypes and MD risk. Genome-Wide Association Study (GWAS) summary statistics were obtained from the FinnGen and the UK Biobank. Instrumental variables (IVs) were chosen based on single nucleotide polymorphisms (SNPs). Results: Among the analyzed hypothyroidism subtypes and related factors, "Hypothyroidism, strict autoimmune" (HTCBSA) and "Hypothyroidism, levothyroxin purchases" (HT/LP) demonstrated a statistically significant positive causal relationship with MD, with odds ratios of 1.020 (95 % CI: 1.004-1.037) and 1.022 (95 % CI: 1.005-1.040), respectively. The sensitivity analysis supported the robustness of these findings, showing no significant horizontal pleiotropy and confirming the stability of results when individual SNPs were removed. "Congenital iodine-deficiency syndrome/hypothyroidism" (CIDS/HT), "Postinfectious hypothyroidism" (PHT), "Hypothyroidism due to medicaments and other exogenous substances" (HDTDM and OES), "Thyroid Stimulating Hormone" (TSH), "Thyrotropin-releasing hormone" (THRH), and "Hypothyroidism, strict autoimmune, 3 medication purchases required" (HTCBSA/3MPR) showed no significant causal relationship with MD. Limitations: The study population was limited to individuals of European ancestry, and there may be certain genetic differences between different ethnic groups. Conclusions: This MR study suggests a potential causal relationship between certain hypothyroidism subtypes (specifically HTCBSA and HT/LP) and an increased risk of MD.

Introduction: Chronic kidney disease is estimated to become the fifth leading cause of death globally by 2040. Due to the high incidence of fatigue in patients with end-stage renal disease without reliable pharmacological treatments, more and more studies on non-pharmacological interventions to improve physical function appear, which might be the best approach, unknown. This study aims to compare and rank the efficacy of all known non-pharmacological interventions on improving physical function from multiple outcomes for adults with end-stage renal disease. Methods: This systematic review and network meta-analysis included searches of PubMed, Embase, CINAHL, and Cochrane Library from inception to September 1, 2022, for randomized controlled trials of non-pharmacological interventions to improve physical function in adults with end-stage renal disease. Literature screening, data extraction, and quality appraisal were performed systematically by two independent reviewers. The frequentist random-effect network meta-analysis was adopted to pool the evidence from five outcomes, namely 6-minute walk test, handgrip strength, knee extension strength, physical component summary, and mental component summary, respectively. Results: A total of 1921 citations were identified by this search, of which 44 eligible trials enrolled 2250 participants, and 16 interventions were identified. All subsequent figures refer to comparisons with usual care. For increasing walking distance, the combined resistance and aerobic exercise with virtual reality or music were the most effective interventions, with a mean difference plus 95% confidence interval of 90.69 (8.92 to 172.46) and 92.59 (23.13 to 162.06), respectively. Resistance exercise with blood flow restriction (8.13, 0.09 to 16.17) was the best treatment to improve handgrip strength. Combined resistance and aerobic exercise (11.93, 3.63 to 20.29) and whole-body vibration (6.46, 1.71 to 11.20) were associated with improving knee extension strength. For life quality, all treatment effects did not show statistically significant differences. Conclusions: It was found via network meta-analysis that combined resistance and aerobic exercise is the most effective intervention. Besides, if virtual reality or music is added to the training, there will be better results. Resistance exercise with blood flow restriction and whole-body vibration might be good alternative treatments for improving muscle strength. None of the interventions improved quality of life, suggesting a need for alternative interventions in this regard. The results of this study contribute evidence-based data to decision-making.

Recent studies have shown that mitochondrial transplantation can repair lower limb IRI, but the underlying mechanism of the repair effect remains unclear. In this study, we found that in addition to being taken up by skeletal muscle cells, human umbilical cord mesenchymal stem cells (hMSCs)-derived mitochondria were also taken up by adipocytes, which was accompanied by an increase in optic atrophy 1 (OPA1) and uncoupling protein 1. Transplantation of hMSCs-derived mitochondria could not only supplement the original damaged mitochondrial function of skeletal muscle, but also promote adipocyte browning by increasing the expression of OPA1. In this process, mitochondrial transplantation can reduce cell apoptosis and repair muscle tissue, which promotes the recovery of motor function in vivo. To the best of our knowledge, there is no study on the therapeutic mechanism of mitochondrial transplantation from this perspective, which could provide a theoretical basis.

ObjectiveTo investigate the value of neutrophil-to-lymphocyte ratio (NLR) for diagnosing sarcopenia in patients undergoing maintenance hemodialysis (MHD) and efficacy of Baduanjin exercise combined with nutritional support on MHD patients with sarcopenia.MethodsA total of 220 patients undergoing MHD in MHD centers were selected, among which 84 had occurred with sarcopenia confirmed by measurements from the Asian Working Group for Sarcopenia. Data were collected for analyzing the influencing factors that lead to the onset of sarcopenia in MHD patients with the use of one-way analysis of variance and multivariate logistic regression. The role of NLR in the diagnosis of sarcopenia was explored, and its correlation with relevant diagnostic measurement performance such as grip strength, gait speed and skeletal muscle mass index was analyzed. In the end, some 74 patients with sarcopenia that qualify for further intervention and observation standards were divided into observation group (Baduanjin exercise plus nutritional support) and control group (nutritional support only), which were both intervened for 12 weeks. A total of 68 patients finished all interventions, with 33 patients in the observation group and 35 in the control group. The grip strength, gait speed, skeletal muscle mass index as well as the NLR were compared between the two groups.ResultsWith the employment of multivariate logistic regression analysis, it was found that age, hemodialysis duration and NLR were risk factors for the onset of sarcopenia in MHD patients (P < 0.05). The area under ROC curve for NLR of MHD patients with sarcopenia was 0.695, and NLR was negatively correlated with a biochemical indicator—human blood albumin (P < 0.05). NLR was also negatively correlated with patient's grip strength, gait speed and skeletal muscle mass index, with the same correlation found in sarcopenia patients (all P < 0.05). After intervention, patient's grip strength and gait speed were both higher, and the NLR lower in the observation group than those in the control group (P < 0.05).ConclusionThe occurrence of sarcopenia in MHD patients is associated with patient's age, hemodialysis duration and NLR. Therefore, it has been concluded that NLR has certain values in the diagnosis of sarcopenia in patients undergoing MHD. Moreover, the muscular strength can be enhanced and inflammation decreased in sarcopenia patients through nutritional support and physical exercise, i.e., Bajinduan exercise.

OBJECTIVE:To observe the clinical efficacy of vacuum sealing drainage (VSD) combined with antibiotic bone cement in the treatment of skin and soft tissue defects of the extremities with bone exposure in the older population.METHOD:From January 2016 to December 2018, VSD combined with antibiotic bone cement was used to treat 12 older patients with skin and soft tissue defects of the extremities and bone exposure. The study cohort consisted of eight male patients and four female patients aged between 60-95 years, with a median of 75 years. The injury sites included four cases of hand, one case of calf, one case of ankle and six cases of back of foot. The area of skin and soft tissue defects ranged from 2.7×4.1cm to 4.8×4.9cm. There were four infected wounds and eight contaminated wounds. The time from injury to operation was 1.5-6 hours, with a median of 5 hours. In the first stage of the treatment, the wound was covered with a VSD dressing; in the second stage the VSD dressing was replaced with antibiotic bone cement after infection control; and in the third stage, the bone cement was removed and the wound was transplanted with medium-thickness skin grafts according to the wound condition. The skin graft survival and wound healing were assessed.RESULTS:After the first-stage debridement, three of the 12 patients had wound infections, including two cases of meticillin-resistant Staphylococcus aureus infection and one case of Pseudomonas aeruginosa infection. After the bone cement was removed in the third stage, five of the 12 patients underwent free medium-thickness skin grafting on the wound surface (the area of the autologous skin ranged from 2.9×4.3cm to 4.9×5.0cm), and seven patients continued to change dressing routinely. All patients were followed up for 4-15 months, with a median of 10 months. All skin grafts survived and the wounds healed. The healing time was 48-115 days, with a median of 72 days. At the last follow-up, the skin of the affected limb was slightly darker than the surrounding skin, and the appearance was smooth, without obvious scar tissue formation.CONCLUSION:VSD combined with antibiotic bone cement in the treatment of skin and soft tissue defects of the extremities with bone exposure in the older population has a high survival rate of skin grafts and good wound healing. It is worthy of clinical application.

Objective Malnutrition, accompanied by an inflammatory profile, is a risk factor for poor prognosis in hemodialysis patients. The purpose of this study was to investigate the predictive value of NLR combined with GNRI for all-cause and cardiovascular mortality in hemodialysis patients. Methods A total of 240 maintenance hemodialysis (MHD) patients in hemodialysis centers were enrolled in this retrospective study. The influencing factors of all-cause death in hemodialysis patients were analyzed by COX regression. The cut-off values of GNRI and NLR for predicting mortality in enrolled MHD patients were 89.01 and 4, respectively. Based on these cut-off values, the patients were divided into four groups: G1: high GNRI (≥ 89.01) + high NLR (≥ 4) group; G2: high GNRI (≥ 89.01) + low NLR (<4) group, G3: low GNRI (< 89.01) + high NLR (≥4) group; G4: low GNRI (< 89.01) + low NLR (<4). Results During the follow-up period (average: 58 months), the all-cause mortality was 20.83%(50/240) and the cardiovascular mortality was 12.08%(29/240). Both NLR and GNRI were independent risk factors for the prognosis of MHD patients (P<0.05). Survival analysis showed that patients with low GNRI had a lower survival rate than those with high GNRI, whereas patients with high NLR had a lower survival rate than those with low NLR. Kaplan-Meier curve for all-cause mortality revealed that compared to G1, G2, and G4, G3 had the lowest survival rate, while G2 had the highest survival rate among all groups (P < 0.05). Kaplan-Meier curve for cardiovascular mortality showed that G3 had lower survival than G1, G2, and G4 (P < 0.001). Conclusions Our study demonstrates that bothGNRI and NLR are associated with all-cause mortality and cardiovascular mortality in MHD patients. Combining these two factorsmay contribute to a prognostic evaluation for MHD patients.

Objective. To explore the clinical implications of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for diagnosing frailty in patients with maintenance hemodialysis (MHD) and their correlations with patient prognosis. Methods. A total of 185 patients with MHD admitted to the hemodialysis center of our hospital were selected, 72 of whom were diagnosed with frailty according to the Chinese version of Tilburg Frailty Indicator (TFI). The relevant data were collected, and the influencing factors of frailty in MHD patients were analyzed by one-way analysis of variance (ANOVA) and multivariate logistic regression. The value of NLR and PLR in diagnosing frailty in MHD patients was observed, and patients’ all-cause mortality was compared during the 3-year follow-up. The influences of different levels of NLR and PLR on the survival of MHD patients were investigated. Results. Multivariate regression analysis identified that serum albumin, dialysis adequacy, NLR, and PLR are independent risk factors for frailty in MHD patients ( P < 0.05 ). The area under the receiver operating characteristic (ROC) curve of NLR and PLR in diagnosing frailty in MHD patients was 0.859 and 0.799, respectively. Compared with the nonfrailty group, the 3-year mortality was higher, and the 3-year survival rate assessed by survival analysis was lower in the frailty group ( P < 0.05 ). Patients with high NLR and PLR levels showed a lower 3-year survival rate. Conclusions. Dialysis adequacy, serum albumin, NLR, and PLR are independently associated with frailty in MHD patients. NLR and PLR are of a certain diagnostic value for frailty in MHD patients. MHD patients with frailty have an unfavorable prognosis, as of those with high NLR and PLR levels.

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者衰弱发生的危险因素及运动联合营养支持小组干预的疗效观察.方法 选取南京市中西医结合医院和南京市中医院血液透析中心195例MHD患者,用Tilburg衰弱量表筛出75例发生衰弱,分析MHD患者发生衰弱的影响因素;根据不同干预方式对衰弱患者分组:常规护理干预20例(A组),常规护理结合单纯运动干预20例(B组),常规护理结合单纯营养支持18例(C组),常规护理并运动联合营养支持干预17例(D组),比较干预前后患者衰弱状态的影响.结果 衰弱组患者75例(占38.46％),其年龄、透析龄、糖尿病比例及营养风险评分高于非衰弱组(x2/t=3.491、2.805、4.309、4.242,P＜0.001、0.006、0.038、＜0.001).多因素回归分析显示,年龄(OR=1.041,95％CI 1.012～1.183,P=0.008)、血清白蛋白(OR=0.841,95％CI 0.812～1.192,P=0.001)、25-羟维生素D(OR=0.782,95％CI0.223～0.892,P=0.018)、营养风险评估得分(OR=1.157,95％CI1.092～1.523,P＜0.001)、步速(OR=0.632,95％CI 0.191～0.972,P=0.032)及握力(OR=0.767,95％CI0.309～0.589,P=0.026)是MHD患者衰弱发生的危险因素;干预后各组衰弱评分均下降,B、C、D组下降程度优于A组(t=3.956、3.258、2.254,P＜0.001、0.002、0.036),D组下降程度优于B组及C组(t=2.463、2.421,P=0.024、0.025).结论 MHD患者衰弱的发生与年龄、血清白蛋白、25-羟维生素D、营养风险评估得分、步速及握力相关,通过运动联合营养支持小组模式营养干预可以改善患者衰弱状态.

Objectives: This study aimed to analyze the risk factors for stroke-associated pneumonia (SAP) and assess the predictive effect of neutrophil-to-lymphocyte ratio (NLR) on acute SAP. Methods: The study included acute stroke patients from April 2018 to June 2019. These patients were divided into the SAP and Non-SAP groups. The patients' history of chronic diseases was assessed, including history of hypertension, diabetes, hyperlipidemia, chronic lung disease, and current smoking status. The clinical characteristics of all studied cases were recorded, including the initial stroke type (cerebral infarction or cerebral hemorrhage), National Institute of Health Stroke Scale (NIHSS) score, indwelling nasogastric tubes, stroke-associated pneumonia within 7 days of hospitalization, and length of hospitalization. The study also recorded the laboratory testing data, including fasting blood glucose, triglyceride, total cholesterol, low-density lipoprotein cholesterol, glycosylated hemoglobin, and high-sensitivity C-reactive protein (hsCRP) as well as white blood cell (WBC), neutrophil, and lymphocyte counts. SPSS 19.0 was used for statistical analysis. Results: A total of 328 eligible acute stroke patients were included. Among all participants, SAP occurred in 64 (19.5%) patients. In the SAP group, the patients were older, the proportion of cerebral hemorrhage was higher, the NIHSS score was higher, and more patients had nasogastric tubes (P < 0.05). Concomitantly, the blood glucose, hsCRP, WBC count, neutrophil count, and NLR of the SAP group were significantly higher than those of the Non-SAP group, whereas the lymphocyte count was significantly lower than that of the Non-SAP group (P < 0.05). Multivariable analysis of Binary Logistic regression revealed that stroke type (cerebral hemorrhage), indwelling gastric tube, and NLR were independent risk factors for SAP. Receiver operating characteristic curve analysis demonstrated that the area under the curve for the NCR's ability to predict SAP was 0.861. The optimal cutoff threshold, sensitivity, and specificity were 3.745, 0.891, and 0.727, respectively. Conclusions: The risk factors for SAP were multifaceted. Cerebral hemorrhage, indwelling nasogastric tube, and high NLR were independent risk factors. An early NLR had a predictive effect on the occurrence of SAP in patients with acute stroke. (C) 2020 Elsevier Inc All rights reserved.

Introduction: Influenza has been linked to the crowding in emergency departments (ED) across the world. The impact of the Coronavirus Disease 2019 (COVID-19) pandemic on China EDs has been quite different from those during past influenza outbreaks. Our objective was to determine if COVID-19 changed ED visit disease severity during the pandemic. Methods: This was a retrospective cross sectional study conducted in Nanjing, China. We captured ED visit data from 28 hospitals. We then compared visit numbers from October 2019 to February 2020 for a month-to-month analysis and every February from 2017 to 2020 for a year-to-year analysis. Inter-group chi-square test and time series trend tests were performed to compare visit numbers. The primary outcome was the proportion of severe disease visits in the EDs. Results: Through February 29 th 2020, there were 93 laboratory-confirmed COVID-19 patients in Nanjing, of which 40 cases (43.01%) were first seen in the ED. The total number of ED visits in Nanjing in February 2020, were dramatically decreased (n = 99,949) in compared to January 2020 (n = 313,125) and February 2019 (n = 262,503). Except for poisoning, the severe diseases in EDs all decreased in absolute number, but increased in proportion both in year-to-year and month-to-month analyses. This increase in proportional ED disease severity was greater in higher-level referral hospitals when compared year by year. Conclusion: The COVID-19 outbreak has been associated with decreases in ED visits in Nanjing, China, but increases in the proportion of severe ED visits. (C) 2020 Elsevier Inc. All rights reserved.

OBJECTIVE:Acute respiratory distress syndrome (ARDS) is an acute pulmonary edema induced by non-cardiac factors and a clinical syndrome characterized by respiratory distress and refractory hypoxemia. The pathogenesis of ARDS is complex. Systemic or local damaging factors can aggravate the inflammatory injury of lung tissue dependent on the activation of endoplasmic reticulum stress (ERs) and unfolded protein responses (UPR) and correlation with various damaging mechanisms such as inflammatory response, oxidative stress, apoptosis, autophagy, and calcium homeostasis. This article reviews the progress of ERs associated with ARDS to help us understand the pathogenesis of ARDS.