Pingliang People's Hospital

Insomnia, a prevalent sleep disorder, poses significant threats to both physical and mental health. Traditional studies suggest multiple factors are associated with insomnia, yet the causal direction often remains unclear and susceptible to confounding biases. Mendelian randomization, a cutting-edge method leveraging genetic instrumental variables for causal inference, effectively overcomes these limitations by providing high-quality evidence to clarify causal relationships between insomnia and various diseases. This review systematically integrates 105 recent Mendelian randomization studies on insomnia. Evidence indicates that insomnia exerts clear causal effects on multiple diseases, though the strength of these associations and the robustness of evidence vary by disease type. Insomnia is a robust risk factor for coronary heart disease, anxiety-depressive disorders, type 2 diabetes, and chronic pain. Causal relationships with osteoarthritis and lung cancer are also supported, though effect sizes are relatively small. Conversely, associations with Alzheimer’s disease and schizophrenia remain unconfirmed. The studies establish a dominant causal direction from “insomnia → disease,” effectively correcting potential reverse causality bias in observational research. These findings reposition insomnia from a common symptom to a key modifiable cause of a range of psychosomatic disorders. Causal inferences grounded in genetic evidence provide a robust scientific foundation for early identification of high-risk populations, precision prevention targeting insomnia, and cross-system comorbid management.

BackgroundRecent studies have demonstrated an association between amino acids (AAs) and the occurrence of Type 2 diabetes mellitus (T2DM). However, whether there is an underlying causal relationship between AAs and T2DM, as well as their potential links to T2DM progression, complications, and treatment selection, still lacks sufficient clinical evidence.MethodsThis study included 205,208 participants from the UKB database, with 14,066 diagnosed with T2DM. We used LASSO regression, supplemented by Mendelian randomization (MR), to explore the causal relationship between AA levels and T2DM. Additionally, restricted cubic splines, receiver operating characteristic (ROC) curves, and multivariable‐adjusted regression models were applied to analyze the association between AA levels, insulin resistance, secondary complications, and treatment options for T2DM.ResultsAlanine and valine were positively associated with T2DM, while glutamine, glycine, and histidine were negatively associated with T2DM. In particular, the MR results indicated a causal relationship between T2DM and plasma glutamine and glycine, which were identified as protective factors. Other branched‐chain AAs, such as leucine and isoleucine, did not show significant positive associations in the regression analysis. Additionally, we integrated various AAs to develop a predictive model for secondary complications of T2DM. The model demonstrated high predictive accuracy for a range of T2DM‐related complications (all areas under the ROC curve > 0.730). In addition, specific AA profiles were related to insulin resistance and demand for insulin or oral hypoglycemic drug treatment.ConclusionOur study results demonstrate a close relationship between AA levels and the occurrence, development, and treatment demand for T2DM, offering potential biomarkers for predicting complications and guiding personalized treatment.

Recombinant human erythropoietin (rhEPO) fused with human immunoglobulin G (IgG) Fc fragment (rhEPO-Fc) is a novel erythropoiesis-stimulating agent designed to extend plasma half-life and enhance biological activity. However, data on the efficacy and safety of rhEPO-Fc in hemodialysis patients with chronic kidney disease (CKD)-related anemia remain limited. This phase 3 trial enrolled patients from 45 Chinese hospitals. Participants were randomized (2:1) to receive either rhEPO-Fc or rhEPO (Chinese hamster ovary cell-derived) for 28 weeks. The rhEPO-Fc responders were eligible for a 24-week extension period. The primary endpoint was the least square mean (LSM) change in hemoglobin (Hb) levels from baseline between weeks 21 and 28. Among 356 rhEPO-Fc and 178 rhEPO recipients, patients receiving rhEPO-Fc demonstrated non-inferiority Hb maintenance compared with rhEPO. The inter-group LSM differences in the full analysis set and per-protocol set were 3.96 g/L (95% CI: 3.02–4.89; p < 0.001) and 2.27 g/L (95% CI: 0.60–3.95; p = 0.008), respectively. Adverse drug reaction rates were comparable (rhEPO-Fc: 39.2% vs. rhEPO: 40.2%). Dose adjustments due to treatment-emergent adverse events were significantly lower with rhEPO-Fc (0.0% vs. 2.2%; p < 0.05). Deaths unrelated to the study drugs occurred in two rhEPO-Fc and four rhEPO patients. These findings indicated that rhEPO-Fc effectively maintained Hb levels in patients with CKD anemia undergoing hemodialysis, showing comparable efficacy to rhEPO with reduced dosing frequency and a similar safety profile.

Perioperative respiratory adverse events (PRAEs) are frequently encountered complications in pediatric anesthesia. The purpose of this experiment is to explore the significant role of miR-18a-5p in PRAEs, thereby providing a novel biomarker for PRAE clinical management. Clinical data from 174 children undergoing general anesthesia were analyzed. MiR-18a-5p expression in serum and cells was analyzed via real-time quantitative PCR (qRT-PCR). Its diagnostic value for PRAEs was evaluated through receiver operating characteristic (ROC) curves, while logistic regression was selected to assess independent risk factors for PRAEs. In vitro experiments were conducted to determine miR-18a-5p effects on AEC-II cells proliferation, apoptosis, and lipopolysaccharide (LPS)-induced tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) secretion. PRAEs subjects exhibited significantly elevated miR-18a-5p levels with diagnostic relevance. Expression correlated positively with TNF-α/IL-6 concentrations and was associated with age, obesity, American Society of Anesthesiologists (ASA) grade, and anesthesia duration. These parameters jointly constituted the PRAEs predictors. Furthermore, miR-18a-5p silencing enhanced AEC-II cells' viability while suppressing apoptosis and LPS-triggered TNF-α and IL-6 release. The miR-18a-5p served as a predictive factor and held diagnostic significance for PRAEs following general anesthesia in children. Additionally, miR-18a-5p may offer potential therapeutic implications for PRAEs.

Although insulin is widely used for early lipid lowering in hypertriglyceridemic acute pancreatitis, the clinical benefit of heparin combined with insulin remains unclear. To examine whether low-molecular-weight heparin (LMWH) combined with insulin is superior to insulin alone in improving clinical outcomes in hypertriglyceridemic acute pancreatitis. This multicenter, open-label, parallel-group, superiority randomized clinical trial was conducted from September 21, 2019, to April 2, 2023, across 13 tertiary hospitals in China. The duration of follow-up was 30 days after randomization. Patients aged 18 to 85 years were eligible if they met the diagnostic criteria for acute pancreatitis, presented with baseline serum triglyceride levels between 1000 and 3550 mg/dL, and were admitted within 48 hours of symptom onset. Participants received either subcutaneous LMWH (4000 IU every 12 hours for 3 days) plus insulin (LMWH plus insulin group) or insulin alone (insulin group). The primary end point was a composite of new-onset organ failure (defined as organ failure occurring after randomization but absent during the 24-hour prerandomization period) and/or all-cause mortality within 30 days after randomization. Among 533 randomized patients (median [IQR] age, 39 [33-46] years; 406 [76.2%] male), 264 were randomized to LMWH plus insulin and 269 to insulin alone. The primary end point occurred in 66 (25.0%) of the LMWH and insulin group vs 76 (28.3%) of the insulin group (relative risk [RR], 0.89; 95% CI, 0.67-1.17; P = .40). Both groups achieved the triglyceride target (<500 mg/dL) in a median (IQR) of 2 (1-3) days (P = .94). Safety outcomes were similar between groups, including new-onset bleeding events (RR, 0.61; 95% CI, 0.15-2.53; P = .73), triglyceride rebound (RR, 0.53; 95% CI, 0.28-1.01; P = .05), and drug-related adverse events (RR, 0.79; 95% CI, 0.30-2.10; P = .64). In this randomized clinical trial, the combination of LMWH and insulin failed to demonstrate superior efficacy vs insulin alone in patients with hypertriglyceridemic acute pancreatitis. LMWH might not be necessary for early lipid-lowering in hypertriglyceridemic acute pancreatitis. ChiCTR.org.cn Identifier: ChiCTR1900023640.

Abstract Soil freezing characteristics are predominantly governed by the mechanism of bound water, which essentially constitutes a multicomponent cations distribution within the electrical double‐layer (EDL) on clay particles. The freezing behavior of bound water is determined by two critical factors: (a) the distribution characteristics of cation solutions; (b) the quantitative relationship between cation concentration and freezing point. Although EDL‐based unfrozen water model has been proposed, the freezing characteristics of multicomponent cation solutions remain poorly understood. Our findings indicate that: (a) The synergistic effect of multicomponent cations increases the freezing point depression coefficient of bound water (i.e., the degree of freezing point lowering per unit concentration) by several‐fold compared to NaCl solution; (b) For typical mineral soils with low Na + content (&lt;15%), a linear freezing point depression equation can accurately characterize the freezing process of multicomponent cation solutions; (c) typical mineral soils exhibit highly similar cation distribution characteristics. By integrating the freezing point depression equation with EDL theory, this study not only improves the EDL‐based unfrozen water model but also develops a parameterized model applicable to typical mineral soils, and elucidating the intrinsic mechanisms of the model's robustness. Validation using measured data from 12 typical soil types demonstrates that this parameterized model can accurately predict unfrozen water content in sands, silts, and clays with low to moderate clay content within the temperature range of −0.263°C to −20°C. The study establishes a theoretical framework distinct from conventional water potential theory, thereby deepening the understanding of freezing characteristics in frozen soils.

We read with great interest the recent study highlighting the critical issue of patient-initiated violence in emergency departments (EDs), with a particular focus on the relationship between ED crowding and increased aggression toward ED nurses (Xie et al. 2025). While this research provides valuable insights into the relationship between ED crowding and violent behaviour, we believe that certain aspects warrant further exploration and refinement to deepen our understanding of this complex issue. Specifically, a more nuanced approach is needed to assess how crowding triggers violent behaviour, understand patients' cognitive and emotional responses, and improve reporting mechanisms for violent incidents. First, the study highlights that ED crowding is multifaceted, encompassing input, throughput, and output phases. However, a clearer distinction between how these phases influence patient aggression could improve targeted interventions. For example, the “input” phase, characterised by high patient volume, may lead to different psychological stressors for patients than the “output” phase, where delays in bed availability and patient transfers become more pressing. Future research should attempt to unpack these stages more systematically to identify which specific factors—whether it be prolonged waiting times or high patient expectations—are most likely to lead to aggressive behaviour. The notion that crowding increases dissatisfaction and perceptions of injustice among patients is consistent with relative deprivation theory, which suggests that individuals who feel they are being treated unfairly are more likely to act out. However, future studies could focus on how these perceptions vary across different patient demographics, such as age, comorbidities, and cultural background, to refine the prediction of violent tendencies. Second, the review draws attention to the vulnerability of certain patient populations, including those with severe symptoms or lower triage categories. The stress faced by critically ill patients is likely to be exacerbated by their urgent need for care and longer waiting times, which may increase frustration. However, it would be valuable to explore the emotional and psychological impact of crowding on these patients and their families. Research that examines the interplay of family expectations and their potential to escalate tensions could lead to more comprehensive prevention strategies. In addition, patient perceptions of “unfairness” often stem from a lack of clarity or understanding of the operational constraints of the ED. Addressing these cognitive biases by promoting better communication about wait times and care priorities could potentially reduce aggressive incidents. Furthermore, while the study suggests that crowding is associated with physical violence, it is important to consider that non-physical aggression, such as verbal abuse, may be underreported due to the cultural normalisation of such behaviours in ED settings. A change in the way ED staff perceive and report violence—coupled with better reporting systems—could ensure a more accurate reflection of the prevalence and nature of violent incidents. This would not only provide a clearer picture of the extent of the problem, but also facilitate the development of more effective intervention strategies. Finally, the issue of systemic violence in emergency settings requires a broader cultural shift. Although the study calls for better reporting mechanisms, it also highlights the need for organisational support and policy changes to combat the normalisation of violence as an inevitable part of ED work. This includes fostering an environment where ED nurses feel empowered to report incidents without fear of stigma or retaliation and where leadership actively promotes a zero-tolerance policy for violence. In addition, implementing training programmes that focus on de-escalation techniques and providing adequate psychological support for ED staff could help mitigate the negative impact of violence on nurses' mental health and improve retention rates. In conclusion, this study makes a compelling case for the urgent need to address ED crowding as a key factor in patient-initiated violence against emergency nurses. By refining the theoretical framework, incorporating more comprehensive assessments of crowding, and addressing patient perceptions, healthcare systems can better mitigate the risks of violence in these high-pressure environments. In addition, fostering a cultural shift in how violence is perceived and reported, while providing better psychological and operational support for nurses, is critical to ensuring both the safety and well-being of healthcare workers in emergency settings. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. The authors have nothing to report.