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To solve the problem of poor generalization ability of the model on unknown data and the difference of physiological signals between different subjects. A sleep staging model based on Adversarial Domain Generalized Residual Attention Network (ADG-RANet) is designed. The model is divided into three parts: feature extractor, domain discriminator and label classifier. In the feature extractor part, the channel attention network is combined with the residual block to selectively enhance the important features and the correlation between multi-channel physiological signals. Inspired by the idea of U-shaped network, the details and context information in the input data are effectively captured through up-sampling and skip connection operations. The Bi-GRU network is used to further extract the deep temporal features. A Gradient Reversal Layer (GRL) is introduced between the domain discriminator and the feature extractor to promote the feature extractor to obtain the invariant features between different subjects through the adversarial training process. The label classifier uses the deep features learned by the feature extractor to perform sleep staging. According to the AASM sleep staging criterion, the five-classification accuracy of the model on the ISRUC-S3 dataset was 82.51%, the m-F1 score was 0.8100, and the Kappa coefficient was 0.7748. By observing the test results of each fold and comparing with the benchmark model, it is verified that the proposed model has better generalization on unknown data.

The albumin-to-globulin ratio (AGR) has been associated with infectious diseases; however, its association with pneumonia in patients with aneurysmal subarachnoid hemorrhage (aSAH) is unclear. This research aims to investigate the connection between AGR and hospital-acquired pneumonia (HAP). This retrospective analysis included 4,813 patients with aSAH from West China Hospital, Sichuan University. Serum samples were collected within seven days after admission. Logistic regression analysis was conducted to assess the association between AGR and HAP. Among the 4,813 patients, 1,249 (26.0%) developed HAP. The patients were classified into quartiles according to their AGR levels. Significant differences in odds ratios (ORs) were found in admission AGR: 0.76 (95% CI 0.63–0.93, p  = 0.007) for Q2, 0.78 (95% CI 0.64–0.94, p  = 0.016) for Q3, and 0.77 (95% CI 0.63–0.94, p  = 0.012) for Q4 versus Q1. ORs of minimum AGR were: 0.67 (95% CI 0.57–0.80, p  < 0.001) for Q2, 0.45(95% CI 0.37–0.54, p  < 0.001) for Q3, and 0.24 (95% CI 0.20–0.30, p  < 0.001) for Q4. ORs for AGR drift: 1.19 (95% CI 0.93–1.52, p  = 0.18) for Q2, 1.35 (95% CI 1.06–1.73, p  = 0.015) for Q3, and 2.00 (95% CI 1.57–2.55, p  < 0.001) for Q4. Furthermore, admission AGR (< 1.21) and minimum AGR (< 0.99) were linked to elevated CURB-65 scores 3 , 4 – 5 in HAP patients, yielding ORs of 0.46 (95% CI 0.27–0.77, p  = 0.003) and 0.44 (95% CI 0.27–0.69, p  < 0.001). AGR was associated with an increased risk of HAP. Furthermore, lower minimum AGR was associated with increased severity of HAP among aSAH patients. Further research is necessary to confirm this finding and investigate the underlying mechanisms.

To compare the rerupture rate after conservative treatment, open repair, and minimally invasive surgery management of acute Achilles tendon ruptures. Systematic review and network meta-analysis. We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to August 2022. Randomised controlled trials involving different treatments for Achilles tendon rupture were included. The primary outcome was rerupture. Bayesian network meta-analysis with random effects was used to assess pooled relative risks (RRs) and 95% confidence intervals. We evaluated the heterogeneity and publication bias. Thirteen trials with 1465 patients were included. In direct comparison, there was no difference between open repair and minimally invasive surgery for rerupture rate (RR, 0.72, 95% CI 0.10-4.4; I2 = 0%; Table 2). Compared to the conservative treatment, the RR was 0.27 (95% CI 0.10-0.62, I2 = 0%) for open repair and 0.14 (95% CI 0.01-0.88, I2 = 0%) for minimally invasive surgery. The network meta-analysis had obtained the similar results as the direct comparison. Both open repair and minimally invasive surgery were associated with a significant reduction in rerupture rate compared with conservative management, but no difference in rerupture rate was found comparing open repair and minimally invasive surgery.

The albumin to globulin ratio (AGR) has been associated with poor outcomes in various diseases, but the association with mortality in aneurysmal subarachnoid hemorrhage (aSAH) is still unclear. Our study aimed to explore the relationship between AGR and short-term case fatality in patients with aSAH. This retrospective study included 3,421 patients with aSAH at West China Hospital, Sichuan University. All Serum AGRs were obtained within 2 days of admission, and patients were categorized into four groups based on their AGR. Cox regression analyses were conducted to assess the relations between AGR and both 30-day and 90-day mortality. In 3,421 participants, 339 patients (9.9%) with 30-day mortality, and 407 patients (13.3%) with 90-day mortality. The patients were categorized into four quartiles based on their AGR levels: Q1 (AGR ≤ 1.33), Q2 (AGR: 1.33-1.50), Q3 (AGR: 1.50-1.70), and Q4 (AGR > 1.70). The HR after adjusted for confounders showed significant associations with 30-day mortality, Q2 group (HR 0.72, 95% CI 0.53-0.97), Q3 group (HR 0.72, 95% CI 0.54-0.96), Q4 group (0.53, 95% CI (0.39-0.72)) compared to Q1 group. The association was still significant for 90-day mortality, Q2 group (HR 0.77, 95% CI 0.59-1.01), Q3 group (HR 0.75, 95% CI 0.58-0.98), Q4 group (0.53, 95% CI (0.40-0.71) compared to Q1 group. A lower admission AGR was significantly associated with an increased risk for short-term case fatality and poor functional outcomes in patients with aSAH. Further prospective research is essential to confirm our findings and explore the mechanisms behind this association.

Peroxisome proliferator-activated receptors (PPARs) play crucial roles in glucose and lipid metabolism and inflammation. Sanguinarine is a natural product that is isolated from Sanguinaria Canadensis, a potential therapeutic agent for intervention in chronic diseases. In this study, biochemical and cell-based promoter-reporter gene assays revealed that sanguinarine activated both PPARα and PPARγ, and enhanced their transcriptional activity; thus, sanguinarine was identified as a dual agonist of PPARα/γ. Similar to fenofibrate, sanguinarine upregulates the expression of PPARα-target genes in hepatocytes. Sanguinarine also modulates the expression of key PPARγ-target genes and promotes adipocyte differentiation, but with a lower adipogenic activity compared with rosiglitazone. We report the crystal structure of sanguinarine bound to PPARα, which reveals a unique ligand-binding mode of sanguinarine, dissimilar to the classic Y-shaped binding pocket, which may represent a new pharmacophore that can be optimized for selectively targeting PPARα. Further structural and functional studies uncover the molecular basis for the selectivity of sanguinarine toward PPARα/γ among all three PPARs. In summary, our study identifies a PPARα/γ dual agonist with a unique ligand-binding mode, and provides a promising and viable novel template for the design of dual-targeting PPARs ligands.

As transcatheter aortic valve replacement has become an alternative treatment for patients at high risk for surgical aortic valve replacement, bicuspid aortic valve (BAV) draws our attention again. The reported frequency of BAV was 0.5% to 2% in western population. However, there was no such epidemiologic study in Chinese population. Our study sought to investigate the prevalence and complications of BAV in China by echocardiographic database. A total of 668 cases who were confirmed with BAV, identified from 195,708 echocardiographic records of 157,039 patients in the echocardiographic database of West China Hospital (between June 2008 and June 2012), were analyzed retrospectively. The incidence of BAV was 0.43% in the cohort, and 579 (86.68%) patients were complicated by various degree of aortic valve stenosis or aortic valve regurgitation. The incidence of infective endocarditis and aortic dissection was 0.68% episodes per patient-years with mean age of 42.96 ± 11.25 years and 0.18% episodes per patient-years with mean age of 43.00 ± 5.14 years, respectively. In conclusion, our study demonstrated that the prevalence of BAV and complications in Chinese was similar to that in the western population.

Transcatheter aortic valve implantation (TAVI) is an option for treatment for patients with severe aortic stenosis who are at high risk for death with surgical aortic valve replacement (SAVR). It is unknown whether TAVI can be safely introduced to intermediate- and low-risk patients. To compare the efficacy and safety of TAVI and SAVR in patients with intermediate- and low-surgical risk. Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to April 15, 2019. We included randomized controlled trials comparing TAVI with SAVR in patients with intermediate- and low-surgical risk. Meta-analyses were conducted using random-effects models to calculate risk ratios (RR) with corresponding 95% confidence interval (CI). Two independent reviewers completed citation screening, data abstraction, and risk assessment. Primary outcome was a composite of all-cause mortality or disabling stroke at 12 months. A total of 5 trials randomizing 6390 patients were included. In patients with low risk, TAVI was associated with a significant reduction in the composite of all-cause mortality or disabling stroke compared with SAVR (RR, 0.56; 95%CI, 0.40-0.79; I2 = 0%). This benefit was not replicated in patients with intermediate risk (RR, 0.96; 95% CI, 0.80-1.15; I2 = 0%). Similar results were seen separately in all-cause mortality and disabling stroke when TAVI was compared with SAVR. For patients with severe aortic stenosis who were at low risk for death from surgery, TAVI achieved superior clinical outcomes compared to SAVR; however, these benefits were not seen in those with intermediate risk. This information may inform discussions about deciding between SAVR and TAVI for patients with low to intermediate risk separately.

Deep vein thrombosis (DVT) is a common and serious complication of spontaneous intracerebral hemorrhage (ICH). The timely recognition and treatment of DVT can significantly mitigate several negative consequences. To investigate the association between the neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) and the occurrence of DVT in ICH patients. This multicenter, retrospective cohort study included patients diagnosed with ICH from three hospitals. The primary outcome was the occurrence of DVT. The NHR was calculated using complete blood counts. Receiver operating characteristic (ROC) analysis was performed to determine the optimal NHR threshold for predicting DVT and to compare its predictive performance with that of other biomarkers. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with DVT and to explore clinical complications related to NHR. A total of 5,004 patients were ultimately included in this study, among whom 359 (7.2%) were diagnosed with DVT. The optimal NHR cutoff for predicting DVT was 6.55, based on the Youden Index from the ROC curve, and was used to dichotomize the study population. In multivariable analyses, even after adjustment, a higher NHR was associated with an increased occurrence of DVT (adjusted odds ratio 1.69, 95% confidence interval 1.33–2.16) and its complications. Additionally, ROC analysis showed that NHR had superior predictive ability for DVT compared to single markers. In patients with ICH, a high NHR (≥ 6.55) independently predicts DVT and may serve as a laboratory marker for its occurrence.

This study aimed to examine the association of hemoglobin concentration with a 90-day mortality of young adult patients with ICH in a large retrospective cohort. A retrospective observational study was conducted between December 2013 and June 2019 in two tertiary academic medical centers in China. We defined patients with hemoglobin concentration < 80 g/L as severe anemia and 80–120/130 g/L as mild to moderate anemia. We also defined patients with hemoglobin concentration > 160 g/L as high hemoglobin. Associations of hemoglobin and outcomes were evaluated in multivariable regression analyses. The primary outcome was mortality at 90 days. We identified 4098 patients with ICH who met the inclusion criteria. After adjusting primary confounding variables, the 90-day mortality rate was significantly higher in young patients with severe anemia (OR, 39.65; 95% CI 15.42–101.97), moderate anemia (OR, 2.49; 95% CI 1.24–5.00), mild anemia (OR, 1.89; 95% CI 1.20–2.98), and high hemoglobin (OR, 2.03; 95% CI 1.26–3.26) group than in young patients of the normal group. The younger age was associated with a higher risk of death from anemia in patients with ICH (P for interaction = 0.01). In young adult patients with ICH, hemoglobin concentration was associated with 90-day mortality, and even mild to moderate anemia correlated with higher mortality. We also found that in ICH patients with anemia, younger age was associated with higher risk.

Background Atrial fibrillation (AF) is acknowledged as a disease continuum. Despite catheter ablation being recommended as a primary therapy for AF, the high recurrence rates have tempered the initial enthusiasm. Insulin resistance (IR) has been established as an independent predictor for the onset of AF. However, the correlation between non-insulin-based IR indices and late AF recurrence in patients undergoing radiofrequency catheter ablation remains unknown. Methods A retrospective cohort of 910 AF patients who underwent radiofrequency catheter ablation was included in the analysis. The primary endpoint was late AF recurrence during the follow-up period after a defined blank period. The relationship between non-insulin-based IR indices and the primary endpoint was assessed using multivariate Cox hazards regression models and restricted cubic splines (RCS). Additionally, the net reclassification improvement and integrated discrimination improvement index were calculated to further evaluate the additional predictive value of the four IR indices beyond established risk factors for the primary outcome. Results During a median follow-up period of 12.00 months, 189 patients (20.77%) experienced late AF recurrence, which was more prevalent among patients with higher levels of IR. The multivariate Cox hazards regression analysis revealed a significant association between these IR indices and late AF recurrence. Among the four indices, METS-IR provided the most significant incremental effect on the basic model for predicting late AF recurrence. Multivariable-adjusted RCS curves illustrated a nonlinear correlation between METS-IR and late AF recurrence. In subgroup analysis, METS-IR exhibited a significant correlation with late AF recurrence in patients with diabetes mellitus (HR: 1.697, 95% CI 1.397 − 2.063, P  < 0.001). Conclusion All the four non-insulin-based IR indices were significantly associated with late AF recurrence in patients undergoing radiofrequency catheter ablation. Addressing IR could potentially serve as a viable strategy for reducing the late AF recurrence rate.