This paper is aimed to analyze the topological properties of structural brain networks in depressive patients with and without anxiety and to explore the neuropath logical mechanisms of depression comorbid with anxiety. Diffusion tensor imaging and deterministic tractography were applied to map the white matter structural networks. We collected 20 depressive patients with anxiety (DPA), 18 depressive patients without anxiety (DP), and 28 normal controls (NC) as comparative groups. The global and nodal properties of the structural brain networks in the three groups were analyzed with graph theoretical methods.The result showed that ① the structural brain networks in three groups showed small-world properties and highly connected global hubs predominately from association cortices; ② DP group showed lower local efficiency and global efficiency compared to NC group, whereas DPA group showed higher local efficiency and global efficiency compared to NC group; ③ significant differences of network properties (clustering coefficient, characteristic path lengths, local efficiency, global efficiency) were found between DPA and DP groups; ④ DP group showed significant changes of nodal efficiency in the brain areas primarily in the temporal lobe and bilateral frontal gyrus, compared to DPA and NC groups. The analysis indicated that the DP and DPA groups showed nodal properties of the structural brain networks, compared to NC group. Moreover, the two diseased groups indicated an opposite trend in the network properties. The results of this study may provide a new imaging index for clinical diagnosis for depression comorbid with anxiety.
ObjectiveTo evaluate the prognosis of benign esophageal perforation by Pittsburgh scoring system (perforation severity scores, PSS) combined with co-disease index (Charlson comorbidity index, CCI).MethodsThirty patients with benign esophageal perforation from August 2016 to August 2018 in our hospital diagnosed by imaging or endoscopy were selected, including 14 males and 16 females, aged 68.660±10.072 years. After treatment, we retrospectively analyzed whether there was any complication in the course of treatment, the healing of esophageal perforation at discharge and the follow-up after discharge. And the patients were divided into a stable group (20 patients with no complication, clear healing of esophageal perforation at discharge or death during follow-up) and an unstable condition group (10 patients with complications, esophageal perforation at discharge or death during follow-up). Complete clinical data of all the patients were obtained and were able to be calculated by the scores of PSS and CCI scoring system. The difference of PSS and CCI scores between the two groups was compared, and the clinical value of PSS combined with CCI score in the prognosis of benign esophageal perforation was analyzed.ResultsIn the stable group, the PSS was 2.750±1.372 (95%CI 2.110 to 3.390), CCI score was 2.080±1.055 (95%CI 1.650 to 2.500) with a statistical difference between the two systems (P=0.000). In the unstable group, PSS was 7.300 ±1.829 (95%CI 7.300 to 8.120), CCI was 4.640±1.287 (95%CI 4.220 to 5.060) with a statistical difference between the two systems (P<0.05). The area under the receiver operating characteristic curve of PSS and CCI scores in the prognostic evaluation of benign esophageal perforation was 0.982 and 0.870 respectively, which was statistically significant (P<0.05).ConclusionEsophageal perforation is a dangerous condition. It is of great practical value to evaluate the condition of esophageal perforation by PSS and CCI scores.
ObjectiveTo systematically evaluate the effect of repeated transcranial magnetic stimulation (rTMS) in treating epilepsy.MethodsThe randomized controlled trials (RCTs) of rTMS for epilepsy and related diseases were collected from PubMed, EMbase, Cochrane Library, CBM, CNKI, VIP, and Wanfang databases by computer. The retrieval time was from establishment to June 2019. Two researchers independently screened the literature, extracted the data and evaluated the deviation risks of the included studies. RevMan5.3 software was used for Meta analysis.ResultsA total of 21 RCTs were included, including 1 587 patients. The results showed that rTMS assisted antiepileptics drugs (AEDs) could improve the effective rate of epilepsy treatment [RR=1.28, 95% CI (1.19, 1.37)], significantly reduced HAMA, HAMD and NFDS scores in the treatment of patients with epilepsy combined with anxiety and depression [MD=−3.94, 95% CI (−4.25, −3.63)], and improve DQ and GMFM-88 scores in children with cerebral palsy combined with epilepsy [MD=7.95, 95% CI (7.00, 8.90)]. In addition, using rTMS will not cause additional adverse reaction [peto OR=0.52, 95% CI (0.31, 0.84)].ConclusionsThe current evidence showed that rTMS combined AEDs can improve the efficient of AEDs therapy. When treat anxiety depression comorbidity, it can significantly reduce the anxiety depression score. In addition in children with cerebral palsy merger, it can improve muscle strength and development. And rTMS will not cause additional adverse reactions. Limited by the quantity and quality of the selected studies, the conclusions need to be verified by more high-quality studies.
ObjectiveTo investigate and analyze comorbidities of elderly patients with total hip/knee arthroplasty, so as to provide a basis for the management of comorbidities.MethodsConvenience sampling was used to select elderly patients who underwent total hip/knee arthroplasty in the Department of Orthopedics in West China Hospital of Sichuan University from June to December 2019 as the research objects. We collected general data and comorbidity data of patients, and statistically analyzed the comorbidities of elderly patients undergoing total hip/knee arthroplasty, and the characteristics of perioperative psychology, sleep, postoperative complications, and length of hospital stay in elderly patients undergoing total hip/knee arthroplasty with comorbidities.ResultsA total of 263 patients were included, of whom 64.6% had comorbidities. The number of comorbidities in elderly patients undergoing total hip/knee arthroplasty ranged from 2 to 12. The most common comorbidity was hypertension. Between patients with comorbidities and non-comorbidities, there were statistically significant differences in age (Z=−2.225, P=0.026), preoperative Huaxi Emotion Index scores (9.6±4.6 vs. 6.4±5.0; t=5.126, P<0.001), preoperative Pittsburgh Sleep Quality Index scores (13.3±3.1 vs. 12.3±2.5; t=−2.972, P=0.003), hospital stay [(5.2±0.8) vs. (4.8±0.4) d; t=4.243, P<0.001], and incidence of postoperative complications (13.5% vs. 5.4%; χ2=4.201, P=0.040).ConclusionsComorbidities are common in elderly patients with total hip/knee arthroplasty, which may aggravate negative emotions, reduce sleep quality, increase postoperative complications and prolong length of stay. Medical staff should strengthen the management of comorbidity in elderly patients with total hip/knee arthroplasty, so as to reduce its influence on perioperative period and promote the rehabilitation of patients.
Comorbidity is a prominent public health problem in the elderly population. To carry out research on the comorbidity of the elderly is not only an important breakthrough to realize the national strategy of actively responding to the aging population, but also a vivid practice of earnestly implementing the "Healthy China" and other action programs. Based on the major public health issues of elderly comorbidity, this paper lists the main contents and methods of elderly comorbidity research from the perspective of secondary research and empirical research, and holds that this field contains both the profound thought of "holistic concept" and the advanced idea of "integrative medicine". At the same time, under the background of the new era, the gradual deepening of the research in this field may give birth to a brand-new discipline - geriatric comorbidity.
ObjectiveTo observe the effect of comorbidity for patients with non-small cell lung cancer (NSCLC) on exercise tolerance and cardiopulmonary function. MethodsNSCLC patients who underwent cardiopulmonary exercise testing (CPET) before surgery were retrospectively included. According to the Charlson comorbidity index (CCI) score, patients were divided into two groups: a CCI≥3 group and a CCI＜3 group. The patients were matched with a ratio of 1 : 1 by propensity score matching according to the age, body mass index, sex, smoking histology, exercise habits, pathological stage and type of surgery. After matching, CPET indexes were compared between the two groups to explore the differences in exercise tolerance and cardiopulmonary function. ResultsA total of 276 patients were included before matching. After matching, 56 patients were enrolled with 28 patients in each group, including 38 (67.9%) males and 18 (32.1%) females with an average age of 70.7±6.8 years. Compared with the CCI＜3 group, work rate at peak (WR peak), WR peak/predicted (WR peak%), kilogram oxygen uptake at anaerobic threshold (VO2/kg AT), VO2/kg peak, VO2/kg peak%, peak carbon dioxide output (VCO2 peak), the minute ventilation to carbon dioxide production slope (VE/VCO2 slope), O2 pulse peak and O2 pulse peak% of CCI≥3 group were statistically different (P＜0.05). Among them, the rate of postoperative pulmonary complication in the CCI≥3 group was higher than that in the CCI＜3 group (60.7% vs. 32.1%, P=0.032). ConclusionIn the NSCLC patients, exercise tolerance and cardiopulmonary function decreased in patients with CCI≥3 compared with those with CCI<3. CPET can provide an objective basis for risk assessment in patients with comorbidity scored by CCI for pulmonary resection.
Multimorbidity is becoming a major issue in global health due to the increased prevalence of chronic diseases and the accelerated aging of the population. Clinical practice guidelines, as key tools for guiding clinical practice, play an important role in the field of multimorbidity, but also face many challenges. In this paper, we will review the necessity of developing multimorbidity guidelines, the current situation, challenges and opportunities, and on this basis, we will put forward our thoughts and suggestions to promote the development of guidelines in the field of multimorbidity in China.
Objective To explore the potential categories and influencing factors of chronic comorbidity treatment burden in maintenance hemodialysis (MHD) patients. Methods Convenience sampling method was used to select MHD patients between April and May 2023 at Northern Jiangsu People’s Hospital and Jiangdu People’s Hospital as the research subjects. The general information questionnaire, Chronic Disease Comorbidity Treatment Burden Scale, and Health Literacy Scale for Chronic Disease Patients were used for the questionnaire survey. The latent class analysis was used to explore the classification of chronic comorbidity treatment burden in MHD patients, and the multi-class logistic regression analysis was used to explore the influencing factors of comorbidity treatment burden. Results A total of 450 survey questionnaires were distributed, and 406 valid questionnaires were collected, with an effective response rate of 90.22%. According to the latent class analysis results, the comorbidity treatment burden of MHD patients was divided into three potential categories. Among them, there were 26 cases in the low-burden group, 194 cases in the medium-burden group, and 186 cases in the high-burden group. The results of the ordered multi-class logistic regression analysis showed that patient age, educational level, dialysis age, number of comorbidities, and level of economic support were potential factors affecting the comorbidity treatment burden in MHD patients (P<0.05). Conclusions The comorbidity treatment burden of MHD patients can be divided into three potential categories. The age, educational level, dialysis age, number of comorbidities, and level of economic support of patients are potential factors affecting the comorbidity treatment burden in MHD patients.