Objective To explore the association between triglyceride glucose-waist circumference (TyG-WC) index and the risk of stroke among the middle-aged and older people, and compare the differences among TyG-WC, triglyceride glucose (TyG), and waist circumference (WC) in the prediction of stroke. Methods The data of adults aged 45 years or older enrolled in the China Health and Retirement Longitudinal Study registry in 2011 were collected, and the endpoint was self-reported or physician-diagnosed new stroke event by 2015. According to the baseline TyG-WC tertile, individuals were divided into three groups: TyG-WC tertile 1, tertile 2, and tertile 3 groups. Multiple logistic regression analyses were performed to analyze the associations of TyG-WC, TyG, and WC with the risk of stroke. The area under the curve (AUC) of receiver operating characteristic (ROC) curve, integrated discrimination improvement (IDI) score, and net reclassification improvement (NRI) score were calculated to evaluate the predictive value of TyG-WC, TyG, and WC in stroke. Results A total of 5847 participants were finally included, with 1949 in each group. After 4 years of follow-up, there were 252 cases of new stroke. There was significant difference in the incidence of stroke among the three groups (TyG-WC tertile 1 group: 2.57%, TyG-WC tertile 2 group: 4.16%, TyG-WC tertile 3 group: 6.21%; P<0.05). The results of multiple logistic regression analyses showed that the risk of new stroke in the third tertile group of TyG-WC and WC was higher than that in the first tertile group, respectively [TyG-WC: odds ratio (OR)=1.465, 95% confidence interval (CI) (1.033, 2.078), P=0.032; WC: OR=1.717, 95%CI (1.190, 2.478), P=0.004], while TyG was not the risk factor of stroke (P>0.05). The ROC curve analysis showed that the AUC of WC (0.566) was slightly higher than that of TyG-WC (0.556) and TyG (0.527). The IDI of TyG-WC (0.25%) was slightly higher than that of WC (0.22%), and the both were higher than that of TyG (0.07%). The NRI of WC (25.04%) was slightly higher than that of TyG-WC (19.68%), and the both were high than that of TyG (12.02%). Conclusions Compared with TyG, higher TyG-WC and WC are associated with the increased risk of new stroke among the middle-aged and older people. The predictive value of TyG-WC and WC for the risk of new stroke in the middle-aged and elderly is similar, and is better than that of TyG.
Objective To explore the association between procalcitonin (PCT) level and the development of malignant brain edema (MBE) after acute cerebral infarction. Methods The data on patients with stroke admitted to the Department of Neurology of West China Hospital, Sichuan University between January 1, 2017 and December 31, 2018 were retrospective collected. Patients were divided into MBE group and non-MBE group based on whether MBE had occurred. The basic information and neuroimaging data of two groups of patients were compared and analyzed. Results A total of 798 patients were included. Among them, there were 93 cases of MBE (11.65%) and 705 cases of non-MBE (88.35%). The median time of MBE occurrence (lower quartile, upper quartile) was 29 (24, 54) hours after onset. The difference in the National Institutes of Health Stroke Scale, large-scale middle cerebral artery infarction, dysarthria, low fever, consciousness status, chronic heart failure, TOAST typing, mechanical ventilation, gastric tube placement, PCT on the first and third day of admission between the two groups were statistically significant (P<0.05). There was no statistically significant difference in the other indicators between the two groups (P>0.05). The results of multivariate logistic regression analysis showed that both day 1 PCT and large-scale middle cerebral artery infarction were associated with MBE. Conclusions Elevated PCT within 24 hours from onset is independently associated with the development of MBE after acute cerebral infarction. Patients with elevated PCT after cerebral infarction may require careful clinical management.
ObjectiveTo bioinformatically analyze the gene chip data of chondrocytes from osteoarthritis patients from the Gene Expression Omnibus (GEO) database, and explore the molecular mechanisms of osteoarthritis.MethodsWe searched the GEO database (up to April 23rd, 2021) for data of chondrocytes and gene expression profiling in human knee osteoarthritis via the key words of “osteoarthritis OR cartilage OR chondrocyte*”. Then, we selected the samples by our inclusion criteria. The data were normalized before analysis. After differentially expressed genes were identified, Gene Ontology, Kyoto Encyclopedia of Genes and Genomes, Search Tool for the Retrival of Interacting Genes/Proteinsm, R language, Perl language, Cytoscape software, and DAVID database were used to perform differentially expressed gene analysis, functional annotation, and enrichment analysis.ResultsThe differentially expressed genes were mostly enriched in cell components and some extracellular regions, which participated in cell division, mitosis, cell proliferation and inflammatory response mainly via the regulation of protein kinase activity. The differentially expressed genes were mainly involved in the cell proliferation signaling pathway, mitogen-activated protein kinase signaling pathway, oocyte meiosis, cell cycle and so on.ConclusionsMultiple signaling pathways are involved in the changes of chondrocytes in human knee osteoarthritis, mainly about cell cycle and protein metabolism genes/pathways. Inflammatory factors and cytokines may be the most important links in the pathogenesis of osteoarthritis.
ObjectiveTo construct the occupational therapy core items oriented by life return for stroke patients, and provide a reliable tool to promote the comprehensive rehabilitation and successful return for stroke patients.MethodsFrom January to February 2020, the primary items were summarized through literature analysis and research group discussion, and then Delphi method was used to determine which items should be included by two rounds of experts consultation.ResultsA total of 22 experts were selected. After two rounds of experts consultation, 60 items in 6 domains were included. The effective recovery rates of the two rounds of experts consultation were both 100%, the mean expert authority coefficient was 0.87±0.54. In the two rounds of experts consultation, the importance scores of consulted items were 7.60±0.97 and 8.06±0.35, respectively; the variation coefficients were 0.14±0.05 and 0.11±0.03, respectively; the Kendall coefficients of concordance were 0.522 (P<0.001) and 0.578 (P<0.001), respectively.ConclusionThrough the Delphi method, the core items oriented by life return are identified with high recognition and consistency from experts, which can be used as a guideline tool for stroke patients in in-hospital occupational therapy, discharge guidance, and community/home rehabilitation.
Objective To construct the expert consensus on comprehensive rehabilitation assessment system for the elderly in the hospital and community. MethodsMedline, Embase, Cochrane Library, China National Knowledge Infrastructure and VIP databases were searched for geriatric rehabilitation assessment materials from June 2016 to June 2021. The primary items were summarized through literature review and research group discussion, and then Delphi method was used among 20 experts in geriatric rehabilitation medicine to develop consensus-based core items for the elderly comprehensive rehabilitation assessment system. Results A total of 158 references were included. Through integration, sorting and screening, the research team initially formulated 41 items and four major sections including cardiopulmonary exercise, sensory perception, cognition and psychology (speech contained), and swallowing, urination and defecation. The effective recovery rates of the two rounds of experts consultation were both 100%, the mean expert authority coefficient was 0.92±0.05, the variation coefficients were 0.174±0.043 and 0.172±0.063, respectively; the Kendall coefficients of concordance were 0.587 and 0.601, with P values<0.05 for both, respectively. Finally, The comprehensive rehabilitation assessment system for the elderly including 16 items would be formed. Conclusion The expert consensus on comprehensive rehabilitation assessment system for the elderly constructed by Delphi method includes motor, sensory perception, cognition, swallowing, speech, cardiopulmonary, defecation, mental and psychological elements, which are identified with high recognition and consistency from experts.
ObjectiveTo systematically review the effect of clamping catheter and free drainage for patients with neurogenic bladder with indwelling catheter. MethodsThe PubMed, EMbase, CINAHL, EBSCO, Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) related to the objects from inception to January 8, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 7 RCTs involving 586 patients were included. Meta-analysis showed that clamping catheter significantly reduced time of first void (SMD=−1.03, 95%CI −1.71 to −0.36, P=0.03) and increased volume of first void (MD=52.72, 95%CI 28.84 to 76.59, P<0.01). However, there was no significant difference in residual urine volume, incidence of urinary retention or urinary tract infection between the two groups. ConclusionCurrent evidence shows that the advantage of clamping catheter for patients with neurogenic bladder with indwelling catheter is not obvious. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Tracheotomy is a commonly used measure in clinical rescue of critically ill patients, and it has an important impact on the survival outcome of patients. The time of extubation directly affects the recovery process of the patient. This article reviews the research progress of extubation management of tracheotomy patients at home and abroad, and mainly summarizes and elaborates from four aspects, including the role of the multidisciplinary team in tracheostomy management, where tracheostomy patients are extubated, conditions for extubation in tracheotomy patients, and wound care after extubation in tracheotomy patients. The purpose is to provide a reference for the selection of extubation timing and extubation management for patients with tracheotomy, to improve the success rate of extubation and improve the quality of life of patients.