General Hospital of Shenyang Military Region

The safety and efficacy of aspirin combined with ticagrelor or clopidogrel remain unclear in ST-segment elevation myocardial infarction (STEMI) patients with Diabetes mellitus (DM) and poor glycemic control. This study aims to assess the efficacy and safety of ticagrelor versus clopidogrel-based dual antiplatelet therapy in STEMI patients with DM and poor glycemic control undergoing pPCI. We evaluated 2732 STEMI patients with DM and poor glycemic control who underwent primary percutaneous coronary intervention (pPCI) and were registered in the "Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS)" program between November 2014 and December 2019. Using propensity score matching (PSM) and cox proportional hazards regression, we compared the in-hospital risk of major adverse cardiovascular events (MACCE), TIMI bleeding events, and net adverse clinical events (NACE) between patients receiving aspirin combined with either ticagrelor or clopidogrel. After PSM, the risk of in-hospital MACCE (HR = 0.545, 95% CI: 0.321-0.926, p = 0.025), Cardiac death (HR = 0.380, 95% CI: 0.149-0.971, p = 0.043) and NACE (HR = 0.728, 95% CI: 0.560-0.947, p = 0.018) was significantly lower in the ticagrelor group compared with the clopidogrel group (p < 0.05), while no significant difference was observed in the incidence of TIMI-bleeding events between the two groups (p > 0.05). Among STEMI patients with DM and poor glycemic control undergoing pPCI, ticagrelor use was associated with a low rate of MACCE, without an excessive risk of bleeding. The information of clinical trial registration for CCC-ACS project can be found at http://clinicaltrials.gov/study/NCT02306616.

This study evaluated the clinical diagnostic efficacy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for recurrence and/or metastasis in patients with radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC) and analyzed its correlation with serum thyroglobulin (Tg), BRAFV600E mutation status, and postoperative clinical risk stratification. A retrospective analysis was conducted on the 18F-FDG PET/CT images and clinical data of 47 patients with RAIR-DTC. The diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated, and the receiver operating characteristic curve was used to determine the optimal cutoff value of Tg. The correlation between maximum standardized uptake value (SUVmax) and clinical pathological characteristics was analyzed. For 18F-FDG PET/CT in detecting RAIR-DTC recurrence/metastasis, the diagnostic sensitivity was 94.87%, specificity 64.71%, PPV 92.50%, and NPV 73.33%. Regarding Tg, the optimal cutoff value for predicting RAIR-DTC recurrence/metastasis was 29.6 ng/mL, with an area under the curve of 0.7677. Further subgroup analysis showed that the serum Tg level in the PET/CT-positive group (212.56 ± 102.90 ng/mL) was significantly higher than that in the PET/CT-negative group (86.53 ± 69.67 ng/mL; t = 2.119, p = 0.039). In terms of clinical stage, the PET/CT positivity rate was significantly higher in patients with advanced RAIR-DTC (clinical stage III/IV) than in those with early-stage disease (81.82% versus 57.14%; p = 0.033). Correlation analysis revealed a positive correlation between 18F-FDG PET/CT- derived SUVmax and clinical stage (Pearson correlation coefficient, r = 0.361, p = 0.042). Furthermore, the SUVmax in the BRAFV600E-mutant group was significantly higher than that in the BRAFV600E wild-type group (7.84 ± 3.50 versus 3.85 ± 1.26; t = -4.219, p = 0.039). In addition, the detection rate of 18F-FDG PET/CT for RAIR-DTC recurrence/metastasis was significantly superior to that of Iodine-131 (131I) single-photon emission computed tomography/computed tomography (SPECT/CT) (88.89% versus 52.78%; Z = 2.652, p = 0.041). 18F-FDG PET/CT exhibits high diagnostic efficacy for RAIR-DTC recurrence/metastasis, with its positivity and SUVmax significantly correlated with serum Tg, clinical stage, and BRAFV600E mutation. Clinically, this supports three key strategies: (1) Prioritize 18F-FDG PET/CT follow-up for patients with Tg > 29.6 ng/mL, BRAFV600E positivity or postoperative high risk; (2) consider treatment escalation for PET/CT-positive patients with SUVmax > 7.0; and (3) combine 18F-FDG PET/CT with 131I SPECT/CT to guide personalized management of RAIR-DTC.

Metabolic syndrome is common among infertile women and is closely related to insulin resistance (IR). Triglyceride glucose-body mass index (TyG BMI) is a newly explored indicator of IR. Currently, the association between TyG BMI and live birth outcomes has been studied in women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF), However, there is a lack of research on the general population of frozen-thawed embryo transfer (FET). This is a cohort study based on data from a reproductive center in China from January 2016 to December 2023. The association between TyG BMI and live birth outcomes in women with clinical pregnancy after FET was evaluated using generalized additive model(GAM) and threshold saturation effect analysis. A total of 3,709 cycles resulted in clinical pregnancy after FET, with a mean age of 32.76 ± 3.99 years. Among these, 2860 cycles (77.11%) resulted in live births, with a mean age of 32.46 ± 3.81 years. After adjusting for confounding factors, TyG BMI was negatively correlated with live birth outcomes (OR = 0.994, 95% CI: 0.992, 0.996; p < 0.001). GAM analysis showed that the smooth term of TyG BMI was significant (p < 0.001), indicating a nonlinear relationship. Threshold effect analysis identified a breakpoint (K) of 176.849 (95% CI: 168.097, 186.702). When TyG BMI was below 176.849, The increase in the live birth rate was not significant, but when TyG BMI exceeded 176.849, for each additional unit, the chance of a live birth decreases by approximately 0.8% (OR = 0.992, p < 0.001). Our findings suggest that a higher TyG BMI is negatively associated with live birth outcomes in women with clinical pregnancy after FET. Further research is needed to validate these findings.

Physical activity (PA) has been associated with subjective well-being (SWB) among adolescents. However, the processes underlying this association, particularly the role of physical activity enjoyment (PAE) in PA, have been less explored. This study aimed to examine the associations among PA, PAE, and SWB among Chinese adolescents. A cross-sectional study was conducted among 947 students recruited from two junior high school and two senior high schools in a city in Shanxi Province, China. Participants completed validated questionnaires assessing PA, PAE, and SWB. Using the SPSS macro PROCESS, a mediation model was tested with PA as the independent variable, SWB as the dependent variable, and PAE as the mediator while controlling for gender and grade. The bootstrap method was employed to examine the significance of the mediating effect. Mediation analysis revealed that PA was a significant positive predictor of both PAE (β = 0.529, P < 0.001) and SWB (β = 0.147, P < 0.001). However, when PAE was included in the model, the direct effect of PA on SWB became nonsignificant. Bootstrap results (based on 5000 samples) confirmed that the direct effect was not significant (β = -0.010, 95% CI [-0.039, 0.031]), whereas the indirect effect through PAE was significant (β = 0.157, 95% CI [0.110, 0.209]). PAE mediates the relationship between PA and SWB in adolescents. These findings highlight the potential importance of promoting enjoyable PA experiences to support adolescent well-being.

The Argatroban Plus Recombinant Tissue-Type Plasminogen Activator for Acute Ischemic Stroke (ARAIS) trial did not show the benefit of argatroban as an adjunct in patients with acute ischemic stroke who received intravenous alteplase. This post hoc exploratory analysis aimed to determine whether the circadian rhythm can affect the efficacy of argatroban as an adjunct in this population. From the per-protocol population of the ARAIS trial, patients were divided into 2 groups based on the beginning time of intravenous thrombolysis: daytime (06:00-17:59) and nighttime (18:00-05:59) groups. Each group was divided into argatroban plus alteplase and alteplase alone groups. The primary outcome was excellent functional outcome, defined as a modified Rankin Scale (mRS) score of 0 to 1 at 90 days. The safety outcome was symptomatic intracerebral hemorrhage (sICH). Among 692 patients from the per-protocol analysis, 489 were in the daytime group, and 203 in the nighttime group. In the daytime group, the proportion of patients with an excellent functional outcome was 60.5% (144/238) in the argatroban plus alteplase group versus 66.9% (168/251) in the alteplase-alone group, respectively, without significant difference between two groups (adjusted odds ratio [aOR] = 1.19; 95% CI 0.80-1.78; p = 0.40). In the nighttime group, argatroban plus alteplase was significantly associated with higher proportion of excellent functional outcome compared with alteplase alone (75.9% vs 60.3%; aOR = 0.47; 95% CI 0.24-0.93; p = 0.03). An interaction effect was found between intervention (argatroban plus alteplase or alteplase only) by different treatment period on primary outcome (P for interaction = 0.02). For safety outcomes, no significant differences in sICH rates were observed between treatment groups within either time stratum. This is the first report that suggested a potential association between argatroban and a higher rate of excellent functional outcome in patients with acute ischemic stroke who received intravenous alteplase during the nighttime. This finding requires further validation in future studies. ClinicalTrials.gov Identifier: NCT03740958.

Alzheimer's disease (AD) and cancer are among the most prevalent age-related diseases. Despite previous research into their potential relationship, the nature of their association remains poorly understood. This study aims to examine the clinical characteristics of AD and various cancers using data from the Surveillance, Epidemiology, and End Results (SEER) database, investigate the causal relationship between AD and cancers through Mendelian randomization (MR) analysis, and identify potential shared underlying mechanisms through transcriptomic profiling. Clinical data from AD patients were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database, and survival analysis was conducted using Kaplan-Meier curves. For the two-sample Mendelian randomization (MR) analysis, data were obtained from genome-wide association study (GWAS) databases. Multiple MR approaches, including inverse-variance weighted, MR-Egger, and weighted median methods, were applied, along with assessments of heterogeneity and sensitivity to ensure the robustness and reliability of the results. Transcriptomic data for AD, colorectal cancer (CRC), and breast cancer (BC) were downloaded from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were identified through differential expression analysis, followed by functional enrichment analysis using Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. A total of 42,768 cancer patients who died from AD were included from the SEER database. Survival analysis revealed a more favorable prognosis (p < 0.01) in patients younger than 65 years. Asian or Pacific Islander patients exhibited better survival outcomes compared with White patients. Regarding tumor sites, patients with uterine corpus cancer had the best prognosis, while lung cancer patients had the poorest outcomes. Patients who received surgery, radiotherapy, or chemotherapy showed significantly improved survival compared to those who received no cancer treatment. Higher household income and being married were also associated with better prognosis, although no significant difference was observed by gender. MR analysis demonstrated a significant positive causal relationship between AD and CRC, and a weak inverse relationship between AD and BC, suggesting that increased genetic susceptibility to AD is associated with elevated CRC risk and reduced BC risk. Intersection analysis of DEGs revealed that shared DEGs between AD and BC were enriched in GO terms related to amino acid transport regulation, organic acid transport regulation, positive regulation of vesicle docking, and myo-inositol transmembrane import. Shared DEGs between AD and CRC were enriched in presynaptic actin cytoskeleton organization, proteasome ubiquitin-independent protein catabolic process, negative regulation of cellular amide metabolic process, and adenylate cyclase binding. KEGG enrichment analysis indicated that AD and BC may share the synaptic vesicle cycle pathway. Our study reveals significant subgroup heterogeneity among cancer patients who died from AD. MR analysis demonstrates that AD increases the risk of CRC while showing weak evidence for a decreased risk of BC. These associations may be mediated by mechanisms involving amino acid transport regulation, myo-inositol transmembrane import, and synaptic vesicle cycling. These findings offer new perspectives on the AD-cancer relationship and may guide future investigations into shared mechanisms.