Background: Higher arterial stiffness contributes to atherogenesis and arterial calcification, resulting in cardiovascular morbidity and mortality. Research Question: The relations of lifestyle, measured by the AHA Life’s Essential 8 (LE8), with arterial health (AH) and CVD outcomes are incompletely understood. Aims: To examine the association of LE8 with AH and extent to which carotid-femoral pulse wave velocity (PWV) mediates the association of LE8 with outcomes in a sample free of CVD. Methods: In 3 Framingham Heart Study cohorts, we studied the relations of LE8 (total score and components) with AH, assessed by arterial stiffness (PWV, by tonometry) and coronary calcification score (CAC, by computed tomography) using multivariable-adjusted linear regression (p<0.01 considered significant after Bonferroni correction). We evaluated the extent to which PWV mediates the association of LE8 with outcomes using Cox proportional hazards regression models (p<0.05 considered significant). Results: We studied 5222 participants, aged 50±15 years, 56% women. Characteristics of the sample are presented in Table . Higher LE8 score (better cardiovascular health) was associated with more favorable AH measures (PWV inverse transformed, standardized; CAC log(CAC+1); all β±SE, x10 -3 ): β PWV =-14.4±0.7, β CAC= -51.9±7.8, both p<0.01). Of the LE8 components, BMI (β PWV =-1.53±0.31), BP (β PWV =-9.74±0.36), fasting glucose (β PWV =2.03±0.45), lipids (β PWV =-1.54±0.31, β CAC =-16.14±3.30) and smoking (β CAC =-17.9±2.8) were the greater contributors to AH (all p<0.01). PWV mediated modest degrees of the associations between LE8 and CHD, HF, CVD, and CVD mortality [ Figure ]. Conclusions: In people without prevalent CVD, healthier lifestyle was associated with better AH. Arterial stiffness mediates the association between lifestyle measures and CHD, HF, CVD, and CVD-mortality. Our results support studying lifestyle interventions to improve arterial health and their benefits for CVD outcomes.
Chronic alcohol consumption causes liver steatosis, cell death, and inflammation. Melatonin (MLT) is reported to alleviate alcoholic liver disease (ALD)-induced injury. However, its direct regulating targets in hepatocytes are not fully understood. In the current study, a cell-based screening model and a chronic ethanol-fed mice ALD model were used to test the protective mechanisms of MLT. MLT ameliorated ethanol-induced hepatocyte injury in both cell and animal models (optimal doses of 10 μmol/L and 5 mg/kg, respectively), including lowered liver steatosis, cell death, and inflammation. RNA-seq analysis and loss-of-function studies in AML-12 cells revealed that telomerase reverse transcriptase (TERT) was a key downstream effector of MLT. Biophysical assay found that epidermal growth factor receptor (EGFR) on the hepatocyte surface was a direct binding and regulating target of MLT. Liver specific knock-down of Tert or Egfr in the ALD mice model impaired MLT-mediated liver protection, partly through the regulation of nuclear brahma-related gene-1 (BRG1). Long-term administration (90 days) of MLT in healthy mice did not cause evident adverse effect. In conclusion, MLT is an efficacious and safe agent for ALD alleviation. Its direct regulating target in hepatocytes is EGFR and downstream BRG1-TERT axis. MLT might be used as a complimentary agent for alcoholics.
To study the efficacy and safety of transvaginal natural orifice transluminal endoscopic Sacrospinous Ligament Fixation in the treatment of moderate and severe pelvic organ prolapse.Patients were selected into this study on a voluntary basis to evaluate the short-term efficacy of this surgery by comparing the OP-Q scores before the operation, three months after the operation, and six months after the operation.Evaluate the clinical efficacy and safety by a retrospective analysis of the clinical data of the 18 patients with POP-Q grade III-IV pelvic organ prolapse treated by the Department of Gynecology of Nanjing Medical University Affiliated Changzhou No.2 People's Hospital from April 2020 to November 2020, and their post-operation follow-ups.Patients with postoperative follow-ups found no obvious relapse without intervention measures.The transvaginal natural orifice transluminal endoscopic Sacrospinous Ligament Fixation was performed successfully, and the anterior and posterior walls of vagina and/or trans-vaginal hysterectomy were repaired as appropriate. Except the total vaginal length (TVL), the P values of numerical analysis for all points before, three months after, and six months after the operation were all <0.05, being statistically significant.This method is effective in the treatment of moderate and severe pelvic organ prolapse with few complications, but more cases and longer-term follow-up data are needed to determine the long-term effect of this procedure. For the selection of puncture sites, more anatomical data are needed to get more accurate result.
Objective: The purpose of this review is to summarize drug selection for peri-menopausal symptoms caused by gonadotropin releasing-hormone agonist (GnRH-a) in the treatment of endometriosis. Mechanism: GnRH-a treatment often leads to low estrogen levels, resulting in peri-menopausal symptoms and osteoporosis. Add-back therapy relieves clinical symptoms by supplementing low-dose estrogen. The idea of “combined regulation” is to improve symptoms by adding plant preparations or proprietary Chinese medicines. Studies have shown that they may play a role by regulating serotonin activity. Findings in Brief: For patients treated with GnRH-a for less than 3 months, the combined-regulation regimen can be considered, whereas for patients who have had more than 3 courses of GnRH-a, add-back therapy with sex hormones must be used because the patients will have begun to have obvious bone-mass loss and even bone pain; this bone-mass loss is often irreversible. Conclusions: In the early treatment of endometriosis with GnRH-a, non-hormone combined-regulation therapy is a relatively safe and feasible choice, but hormone add-back therapy should be selected for patients who have had more than 3 courses of GnRH-a.
Objective To evaluate the major point and the indication of internal fixation for odontoid process fracture.Methods twenty-three patients with odontoid process fracture from Jun 2005 to Dec 2009 were analyzed retrospectively,15 patients were treated by anterior screw fixation,8 patients were treated by posterior pedicle screw internal fixation and bone graft fusion.Results All the patients were followed up from 3 to 24 months.X-ray showed well reduction.The upper cervical spinal stability were restored.Patients with nerve symptom were improved in some degree.Osseous fusion was obtained after 3 months.Conclusion Odontoid process fractures fixation can reestablish the upper cervical spinal stability and obtain better clinical effect.
Background: There is limited understanding of the association of the AHA's Life's Essential 8 (LE8), reflecting cardiovascular health (CVH) behaviors and factors, with vascular stiffness and hemodynamics in adults without cardiovascular diseases (CVD). Methods: In 2330 Framingham Heart Study Offspring participants (Exam 7, 1998-2002) with applanation tonometry and LE8 data (diet, physical activity, smoking, sleep health, BMI, lipids, glucose, blood pressure), we calculated CVH scores per AHA guidelines. In multivariable linear regression analyses adjusting for CV risk factors, we analyzed LE8 as a predictor of vascular health, assessed by carotid femoral pulse wave velocity (PWV) and central pulse pressure (CPP). We examined for effect modification by age (dichotomized at median) and sex in the associations between LE8 and arterial stiffness. We set p=0.05 and p=0.10 as thresholds for significance in primary and secondary analyses, respectively. Mediation analysis was utilized to discern the indirect effects of PWV and CPP on the relationship between LE8 and both all-cause and CVD mortality. Results: In our sample (60±9 years; 57% women; LE8 = 69±12), higher LE8 indicating better CVH, was associated with lower PWV and CPP (Table). Age and sex interactions were noted for PWV (p=0.01 and 0.07, respectively). Higher LE8 was associated with lower PWV in adults ≥59 years and women but not in <59 years or men (Table). With low CVH category as referent, intermediate CVH category had no significant association with PWV and high CVH category had lower PWV. CPP was lower in the intermediate and high CVH categories compared to low CVH category (Table). PWV mediated 19% and CPP 10% of the association between LE8 and CVD mortality and 17% and 15%, respectively, for all-cause mortality. Conclusion: In our community cohort, we observed age and sex differences in the relationship between CVH and vascular health. Mediation analyses revealed indirect effects on mortality, warranting further study. Table
Background: Adenomyosis is caused by endometrial glands and stroma invading the myometrium. It is more common in parturients after the age of 30. At present, there are many drugs for the treatment of adenomyosis, and drug treatment is also one of the important treatments for adenomyosis. Objective: To summarize the drugs that can be used for the treatment of adenomyosis, hoping to be helpful to the clinical treatment. Method: Relevant studies were retrieved from the MEDLINE, Embase, Cochrane Library, CENTRAL and ClinicalTrials.gov. The retrieval time range was from January 2000 to March 2022. English search terms included "(treatment)","(adenomyosis) OR (endometrioma) OR (adenomyoma)". Result: Drug therapy can relieve the clinical symptoms of patients, inhibit the proliferation of lesions, and cooperate with surgical treatment to improve the curative effect. The efficacy and adverse reactions of the drug are closely related to the duration of use. At present, there is no specific drug for the treatment of adenomyosis, and there is a certain degree of recurrence after drug withdrawal. Some clinical scholars have adopted a combination regimen for the treatment of adenomyosis and achieved certain results. Conclusion: About the drug treatment of adenomyosis, it is necessary to personalize the treatment plan by combining the severity of the patients' clinical symptoms, age, fertility needs, patients' economic conditions, whether they can regulate the use of drugs, and the adverse reactions after the use of drugs.
Abstract Coral nurseries play a critical role in solving the technical and ecological problems that hinder the large-scale and long-term culture of coral populations, which has become an effective tool for the coral culture and the restoration of coral reefs. We need to conduct a profound study of the hydrodynamic characteristics of individuals in coral nurseries to ensure that the coral nurseries achieve long-term, industrialized, and batch coral cultivation. In this paper, the calcified coral skeletons of Acropora cervicornis are selected, followed by refined statistical analysis of the characteristic dimensions of individual corals to calculate the average density, and fitted equations for the horizontal projected area and volume. In addition, we also analyze the force of the individual coral, which lays a foundation for studying the hydrodynamic characteristics of corals under wave action.
Compared with traditional laparotomy, laparoscopic surgery has obvious advantages (smaller incisions, shorter hospital stays, and reduced blood loss). At present, more and more gynecological surgeries can be completed under laparoscopy. With the increasement of clinical treatment of gynecological laparoscopic surgery, the complications related to gynecological laparoscopic surgery and their prevention measures have become a continuous concern in the field of gynecology. The risk of injury to the lower urinary tract, consisting of the bladder and ureters, is inherent to gynecologic surgery regardless of operative technique, because the bladder and ureters lie adjacent to other critical structures. Ureteral injury caused by gynecological laparoscopic surgery is a relatively rare complication. Clinicians do not pay enough attention to it because of its low incidence. However, once it happens, the consequences are often serious. The clinical manifestations of ureteral injury caused by gynecological laparoscopic surgery vary greatly according to the location and severity of the injury. Patients with mild injury can heal themselves after conservative treatment, and patients with severe injury can have serious consequences such as peritonitis and acute renal insufficiency, and even lead to death. This paper will focus on ureteral anatomy, common causes, clinical manifestations, key points of diagnosis, treatment measures and prevention strategies of ureteral injury caused by laparoscopic surgery.
Drug disposition undergoes significant alteration in patients with inflammatory bowel disease (IBD), yet circadian time-dependency of these changes remains largely unexplored. In this study, we aimed to determine the temporal effects of experimental colitis on drug disposition and toxicity.
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