Qinghai Red Cross Hospital

Neonatal obesity has profound effects across the entire life. Although maternal diet and environmental exposures such as high altitude are potential influencing factors, the modulating effects of the unique high-altitude environment and distinct ethnic dietary patterns prevalent on the Tibetan Plateau remain unexplored. To investigate this association, we utilized Compositional Data Analysis (CoDA) to model dietary patterns. This study aims to investigate the associations between maternal dietary patterns during pregnancy and neonatal obesity, examining the potential modification effect by altitude and ethnicity. Furthermore, we apply the CoDA approach to quantify the impact of dietary redistribution on obesity risk. The findings are expected to inform targeted dietary interventions and public health strategies for high-risk populations. A birth cohort study encompassed 1173 pregnant women from the Tibetan Plateau. Dietary intake frequency during pregnancy was assessed using the food frequency questionnaire. Principal component analysis was used to identify the dietary patterns. Linear and logistic regression was used to examine the associations between dietary patterns and neonatal obesity. CoDA was employed to assess the association between redistribution of diet servings during pregnancy and altered risk of high ponderal index (HPI). Of the total 1173 mother-neonate pairs, 40.3% were Tibetans, 22.7% resided in ultra-high altitude areas, and 4.9% of neonates had obesity. Four dietary patterns were identified. A higher protein-fruit pattern score was significantly associated with a lower risk of HPI (OR = 0.66, 95% CI 0.47-0.93). We also observed a modification effect by altitude (Pinteraction = 0.026). Stratified by living altitude, this association was statistically significant only in Tibetans who lived in ultra-high altitude areas (OR = 0.39, 95% CI 0.20-0.69, P = 0.003). Composition of data analysis showed that when fruit consumption increased, estimated Δβ of HPI and z-score of ponderal index (PI) decreased. Higher adherence to protein-fruit dietary patterns during pregnancy was negatively associated with neonatal obesity in the Tibetans living in ultra-high altitude areas. Encouraging healthy diets during pregnancy, particularly through initiatives such as increasing fruit intake, may help to prevent neonatal obesity.

The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

<title>Abstract</title> There is insufficient unified research on the effects of propofol and dexmedetomidine on brain functional activity and synchronization. We collected resting-state functional magnetic resonance imaging (rsfMRI) data from 21 healthy subjects in four different levels of consciousness induced by propofol (awake, mild sedation, deep sedation, and recovery), and other 21 healthy subjects in three different levels of consciousness induced by dexmedetomidine (awake, mild sedation and recovery). The results showed that with the increasing of sedation levels of propofol or dexmedetomidine, fractional amplitude of low-frequency fluctuations (fALFF) and regional homogeneity (ReHo) values decreased in the frontal lobe, while they increased in the temporal and parietal lobes. Under propofol sedation, functional connectivity (FC) decreased both within and between sensorimotor network and attention network, and within and between the frontoparietal network (FPN) and default mode network (DMN). Simultaneously, a small number of increased connections were observed between the FPN, DMN, and other networks. Under dexmedetomidine sedation, generally decreased FC was observed in the whole brain. This study shows consistent effects on brain functional activity, but distinct impacts on functional synchronization, providing new insights into the understanding of anesthetic mechanisms.

Background: The therapeutic efficacy and safety profile of immune checkpoint inhibitors (ICIs) across various treatment phases for unresectable locally advanced or metastatic gastric cancer (GC) remain inadequately characterized. This investigation se

ObjectiveThis study aimed to evaluate and compare the clinical efficacy of three surgical procedures for lumbar degenerative disease (LDD): full-endoscopic posterior lumbar interbody fusion (Endo-PLIF), biportal endoscopic lumbar interbody fusion (ULIF), and conventional posterior lumbar interbody fusion (PLIF). This comparison was intended to inform and support clinical decision-making.MethodsA total of 193 patients diagnosed with LDD were enrolled between January 2021 and July 2023. Among them, 63 underwent ULIF, 73 received Endo-PLIF, and 57 underwent PLIF. The collected variables included patient demographics, incision length, length of hospital stay, and changes in both disc height and foraminal height. Outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), modified MacNab criteria, fusion rate, and the incidence of complications. Descriptive statistics and multiple group comparisons were conducted to analyze intergroup differences. Generalized mixed linear models were applied to assess longitudinal outcomes.ResultsThere were no statistically significant differences in preoperative VAS scores among the three groups (P > 0.05). On postoperative day 3, VAS scores for back pain were significantly lower in the ULIF group compared to the Endo-PLIF and PLIF groups (P < 0.001). At 3 months and during long-term follow-up, VAS scores showed no significant differences among the groups. ODI scores in the ULIF group were significantly lower than those in the other two groups (P = 0.004). At final follow-up, modified MacNab ratings showed no significant differences among the groups. All three surgical techniques provided effective symptom relief and were associated with favorable clinical outcomes.ConclusionThis study provides important insights into the clinical efficacy of ULIF, Endo-PLIF, and PLIF in the treatment of lumbar degenerative diseases. Although ULIF demonstrates superior outcomes in terms of early postoperative pain control and functional recovery, the long-term results are similar across the three techniques. Spine surgeons can make individualized decisions regarding the choice of surgical approach based on specific patient factors, such as disease severity, comorbidities, and recovery goals.

Postoperative diaphragmatic hernia is an uncommon complication following esophagectomy for esophageal cancer. Once it occurs, emergency surgical intervention is typically required. However, the optimal surgical repair approach remains debatable depending on the specific clinical scenario. Therefore, we aim to investigate the common etiological factors and optimal surgical strategies for post-esophagectomy diaphragmatic hernia, and share our therapeutic experience to provide optimal treatment for patients. A 70-year-old male patient developed sudden chest tightness and retrosternal pain during nocturnal sleep 17 months after radical esophagectomy, accompanied by persistent pain in the left upper abdomen that prevented standing, with nausea (no vomiting), and absence of defecation or flatus. Diaphragmatic hernia, strangulated intestinal obstruction, and esophageal cancer (postoperative status). Emergency transthoracic diaphragmatic hernia repair with partial small bowel resection was performed via thoracic approach. On postoperative day 9, the patient's bowel and urinary functions returned to normal, resumed a semiliquid diet, was discharged after suture removal. Post-esophagectomy diaphragmatic hernia represents a severe complication. Open transthoracic surgery proves to be a safe and effective approach for cases complicated by strangulated intestinal obstruction. However, in cases of diaphragmatic hernia following minimally invasive esophagectomy without preoperative evidence of strangulation, laparoscopic exploration and repair could be considered. Regardless of open or minimally invasive esophagectomy, meticulous operative techniques should be employed to minimize the risk of diaphragmatic hernia formation.

Gastric cancer (GC) is a highly heterogeneous and complex disease. Recently, integrin β (ITGB) superfamily members have been shown to play crucial roles in the initiation and progression of various human cancers. However, the precise role and molecular mechanisms of ITGB1 in GC are yet to be fully elucidated. This bioinformatics and clinical study systematically analyzed the pan-cancer expression patterns and prognostic significance of ITGBs using data from The Cancer Genome Atlas and Genotype-Tissue Expression portals. Multivariate regression analysis was performed to identify key factors influencing GC prognosis. Candidate noncoding RNAs (ncRNAs) potentially regulating ITGB1 expression were identified via expression profiling, coexpression assessment, and survival correlation studies. Furthermore, the associations of ITGB1 and its related long ncRNA MIR99AHG with tumor-infiltrating immune cells, immune cell markers, and immune checkpoint molecules in GC were explored. Compared with adjacent normal tissues, the ITGB1, ITGB2, ITGB4, ITGB5, and ITGB8 mRNA levels were significantly upregulated in GC tissues (p < 0.05). Cox regression and Kaplan-Meier survival analyses indicated that ITGB1 upregulation was associated with poor prognosis (univariable hazards ratio = 1.40, 95% confidence interval 1.008-1.956, p = 0.045) and served as an independent prognostic factor (multivariate hazards ratio = 1.46, 95% confidence interval 1.004-2.140, p = 0.048) in patients with GC. The MIR99AHG/hsa-mir-17-5p axis(r = - 0.56, p < 0.001) was identified as the most promising upstream ncRNA-related pathway regulating ITGB1 expression in GC. In addition, ITGB1 expression in GC and adjacent nontumorous tissues was validated using immunohistochemistry(H-score: 35.4 ± 19.2 vs. 28.4 ± 16.2, respectively; p = 0.035). MIR99AHG expression was similarly assessed through in situ hybridization (H-score: 32.4 ± 15.6 vs. 20.5 ± 11.0, respectively; p < 0.001). There was a positive correlation between ITGB1 expression and infiltrating CD4 + T cells (r = 0.17, p < 0.001), M2 macrophages (r = 0.37, p < 0.001), dendritic cells (r = 0.19, p < 0.001), and immune checkpoints (PD-L1, CTLA-4, and CD28). Particularly, high macrophage infiltration was associated with favorable prognosis in GC (p = 0.004). Our findings suggest that ncRNA-mediated ITGB1 expression is associated with poor prognosis and tumor-immune infiltration in GC. However, further validation through extensive mechanistic studies and large-scale clinical trials is warranted.

To retrospectively analyze the influencing factors of coagulation dysfunction caused by intravenous infusion of cefoperazone-sulbactam in elderly patients, and to provide a safety reference for the clinical selection of treatment. A total of 113 patients aged ≥60 years who were hospitalized in different departments of Qinghai Red Cross Hospital from January 2020 to November 2022 and treated with cefoperazone-sulbactam were selected as the research objects. From multiple aspects such as the patients' gender, ethnicity, medication time, liver and kidney function, blood cell analysis, procalcitonin, and coagulation function, logistic regression analysis combined with receiver operating characteristic (ROC) curve analysis were used to analyze the influencing factors of coagulation disorders caused by cefoperazone-sulbactam in elderly patients. Among the 113 patients treated with cefoperazone sodium-sulbactam sodium, 49 cases (43.4%) had coagulation disorders. Logistic regression analysis showed that age, platelet count, and creatinine level of the patients were the influencing factors of coagulation disorders caused by cefoperazone-sulbactam (P<0.05). The older the age and the lower the platelet count and the higher the creatinine level, the greater the risk of coagulation disorders in patients. The area under the ROC curve of the combined predictor was 0.820 (P<0.05), which was better than other single factors. When elderly patients are older, with lower platelet counts and higher creatinine levels, the diagnostic efficacy of combining the above indicators is better than that of a single indicator. Therefore, detecting the levels of the above indicators is helpful for the diagnosis and disease evaluation of coagulation dysfunction caused by cefoperazone sodium-sulbactam sodium.

To investigate the causes of fetal death, focusing on maternal antiphospholipid syndrome diagnosis, and to follow the patients for changes in antiphospholipid antibodies, subsequent pregnancy outcomes, and thrombotic events. This is a prospective longitudinal cohort study that recruited patients who were hospitalized for fetal death at ≥ 10 weeks of gestation from three tertiary hospitals in China. Antiphospholipid syndrome was diagnosed according to the 2006 Sydney classification criteria. In total, 159 patients were recruited to the study; 3 were excluded and 144 of whom tested for aPLs. Among these, 126 (87.5%) were available for diagnostic analysis of antiphospholipid syndrome, 13 (10.3%) of which carried a diagnosis of antiphospholipid syndrome. Meanwhile, 136 of 156 patients had fetal samples for which copy number variation sequencing was completed, and 12 (8.8%) of which carried a diagnosis of fetal chromosomal abnormalities. During later follow-up, among the 13 patients with antiphospholipid syndrome, seven were persistently positive serostatus of antiphospholipid antibodies, four exhibited fluctuation, and one had negative conversion; four patients with subsequent pregnancies received guideline-based therapy and had term livebirths. None of the participants experienced thrombotic events. Maternal antiphospholipid syndrome was found to be one of the important causes of fetal death, contributing 10.3% of cases of fetal death at ≥ 10 weeks of gestation, slight ahead of fetal chromosomal abnormalities. Follow-up indicated that the serostatus of antiphospholipid antibodies may fluctuate significantly in some patients with antiphospholipid syndrome.Clinical trial registration:As this study was an observational study, we did not register it as a clinical trial.

BackgroundDay surgery has developed rapidly in China in recent years, although it still faces a shortage of anesthesiologists to handle pre-anesthesia routine before surgery. We hypothesized that ChatGPT may assist anesthesia practitioners in preoperative assessment and answer questions on the concerns of patients. The aims of this study were to examine the ability of ChatGPT to assess preoperative risk and determine its accuracy in answering questions regarding knowledge and management of day surgery anesthesia.MethodsOne-hundred fifty patient profiles were generated to simulate day surgery patient presentations that involved complications of varying acuity and severity. The ChatGPT group and the expert group were both required to evaluate the profiles of 150 simulated patients to determine their ASA-PS classification and whether day surgery was recommended. ChatGPT was then asked to answer 131 questions about day surgery anesthesia that represented the most common issues encountered in clinical practice. The performance of ChatGPT was assessed and graded independently by two experienced anesthesiologists.ResultsA total of 150 patient profiles were included in the study (75 males [50.0%] and 75 females [50.0%]). There was no difference between the ChatGPT group and the expert group for the ASA-PS classification and assessment of anesthesia risk in the patient profiles (P > 0.05). Regarding recommendation for day surgery in patients with certain comorbidities (ASA ≥ II), the expert group was inclined to require further examination or treatment. In addition, the proportion of conclusions made by ChatGPT was smaller than that of the experts (i.e., ChatGPT n (%) vs. expert n (%): day surgery can be performed, 67 (47.9) vs. 31 (25.4); needs further treatment and evaluation, 56 (37.3) vs. 66 (44.0); and day surgery is not recommended, 18 (12.9) vs. 29 (9.3), P < 0.05). We showed that ChatGPT had extensive knowledge related to day surgery anesthesia (94.0% correct), with most of the points (70%) considered comprehensive. The performance of ChatGPT was also better in the domains of peri-anesthesia concerns, lifestyle, and emotional support.ConclusionsChatGPT can assist anesthesia practitioners and surgeons by alerting them to the ASA-PS classification and assessing perioperative risk in day surgery patients. ChatGPT can also be trusted to answer questions and concerns related to pre-anesthesia and therefore has the potential to provide important assistance in clinical work.