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Background Nanjing City has a high-incidence gastric cancer (GC), but the epidemiology of gastric precancerous lesions (GPLs) remains poorly understood. This study aimed to investigate the epidemiological characteristics of Helicobacter pylori ( H. pylori ) infection, GPLs, and GCs in patients undergoing endoscopic examination in Lishui District, Nanjing. Methods This retrospective, population-based, cross-sectional study was conducted collaboratively by the Nanjing Lishui People’s Hospital and six medical community units within the county between July 2022 and June 2023. Data on biopsies and 13 C urea breath tests ( 13 C-UBT) were collected. Results A total of 15,668 individuals were included, among whom 259 had GPL (1.65%) and 218 had GC (1.39%). The H. pylori infection rate in total patients was 5014 (32.00%) (males: 2684 (34.06%); females: 2335 (29.92%)). The H. pylori infection rate is 31.45% in benign gastric lesions, 44.40% in GPLs, and 55.50% in GC, respectively. The multivariable logistic regression analysis showed that male (OR = 3.156, 95% CI: 2.865–3.376, P  < 0.001), age (OR = 1.785, 95% CI: 1.703–1.876, P  < 0.001), fresh vegetable, fruit, and white meat intake frequently (OR = 0.865, 95% CI: 0.506–2.061, P  = 0.029), high-salt diet and high-fat diet intake frequently (OR = 1.906, 95% CI: 1.101–2.932, P  = 0.014), rural residence (OR = 2.682, 95% CI: 1.010–4.754, P  = 0.040), H. pylori infection (OR = 2.022, 95% CI: 1.155–2.865, P  < 0.001) and atrophic gastritis and/or intestinal metaplasia (OR = 4.875, 95% CI: 2.229–10.663, P  < 0.001) were associated with GPLs. Male (OR = 2.021, 95% CI: 1.080–3.780, P  = 2.028), age (OR = 1.201, 95% CI: 1.174–1.238, P  < 0.001), digestive symptoms (OR = 2.256, 95% CI: 1.548–3.289, P  < 0.001), bachelor degree below (OR = 4.792, 95% CI: 3.439–6.837, P  < 0.001), farmer (OR = 1.039, 95% CI: 1.026–1.159, P  < 0.001), fresh vegetable, fruit, and white meat intake (OR = 0.231, 95% CI: 0.141–0.379, P  < 0.001), fried/barbecue/pickled food intake (OR = 6.781, 95% CI: 3.783–12.153, P < 0.001), high-salt diet and high-fat diet intake (OR = 4.374, 95% CI: 2.363–8.097, P  < 0.001), rural residence (OR = 1.230, 95% CI: 1.121–1.437, P  < 0.001), H. pylori infection (OR = 3.248, 95% CI: 2.357–4.477, P  < 0.001) and atrophic gastritis and/or intestinal metaplasia (OR = 4.875, 95% CI: 2.636–9.016, P  < 0.001) were associated with GCs. Conclusions These findings underscore the importance of implementing targeted prevention strategies and early detection programs in high-risk populations to mitigate the burden of GPLs and GCs in Nanjing.

The correlation between serum sodium and sporadic Parkinson's disease remains unclear currently. This study aimed to assess the association between serum sodium and sporadic Parkinson's disease. The ultimate goal is to gain a deeper understanding of the implications of this relationship between serum sodium and sporadic Parkinson's disease. We conducted a retrospective cross-sectional study involving 1,189 participants in PPMI cohort. Age, sex, education years, race, body mass index, calcium, alanine aminotransferase, aspartate aminotransferase, white blood cell, lymphocytes, neutrophils, monocytes, red blood cell, hemoglobin, platelets, total protein, albumin, serum uric acid, serum sodium, serum potassium, urea nitrogen, creatinine, serum glucose were obtained from all participants. Logistic regression, and smooth curve fitting were utilized to substantiate the research objectives. The overall sporadic Parkinson's disease was 77.5% (921/1189); it was 71.9% (143/199), 75.4% (295/391), 76.7% (171/223), and 83% (312/376) for serum sodium quantile1 (Q1, 130-138.9 mmol/L), quantile 2 (Q2, 139-140.9 mmol/L), quantile 3 (Q3, 141-141.9 mmol/L), and quantile 4 (Q4, 142-155 mmol/L), respectively (  = 0.011). Multivariate odds ratio regression adjusted for risk factors demonstrates a 1-unit increment in the serum sodium raises the risk of sporadic Parkinson's disease by 1.11 times, respectively. Smooth splines analysis suggested a linear association between levels of serum sodium and risk of sporadic Parkinson's disease (P nonlinearity = 0.5). An interaction was observed between serum sodium and sex in their influence on sporadic Parkinson's disease (  < 0.05). Further exploratory subgroup analysis within the age and BMI groups showed that there were no significant interactions between the subgroups (all values for interaction were > 0.05). Additional sensitivity analyses supported the primary findings and indicated the conclusions are robust. This study highlights the influence of inappropriate serum sodium on the risk of incident sporadic Parkinson's disease, independent of confounders. The link between serum sodium and sporadic Parkinson's disease is linear.

Heart failure (HF) is a significant global public health concern and the leading cause of morbidity and mortality worldwide, imposing a substantial economic burden on society. Guideline-directed medical therapy (GDMT) refers to the standardized pharmacological treatment for specific diseases based on recommendations from authoritative clinical guidelines and evidence from large-scale randomized clinical trials. GDMT serves as the cornerstone of drug therapy for heart failure patients. This study describes hospitalized HF patients and focuses on drug prescription and readmission rates. This study is a retrospective cross-sectional study with data from HF patients obtained from the Second Affiliated Hospital of Chongqing Medical University between January 2016 and June 2021. Patients were considered to have received GDMT if they were prescribed any guideline-recommended medication. Multilevel logistic regression was used to obtain the relationship between medication and readmission rates. The odds ratios (ORs) and 95% confidence intervals (CIs) have been reported. In this study, a total of 5,356 HF patients (51.0% female; average age 77 years) were included. Among these patients, the most commonly used medications were mineralocorticoid receptor antagonists (MRA) (69.3%), Beta-blockers (54.2%), and lipid-lowering agents (46.0%). Currently, GDMT recommendations mainly include five types of drugs: diuretics, angiotensin receptor-neprilysin inhibitors (ARNIs), renin-angiotensin system inhibitors (ACEIs/ARBs), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i). Among them, the utilization rates of ARNIs, SGLT-2i, triple therapy, and quadruple therapy are relatively low, accounting for 12.7%, 8.1%, 33.2%, and 3.75% respectively. The usage rates of these drugs are gradually increasing, especially after pharmacists participate in clinical decision-making and assist doctors in selecting therapeutic drugs, leading to a significant increase in the utilization rates of guideline-recommended drugs. Additionally, a multivariate logistic regression analysis of all drugs recommended by GDMT showed that ARBs (OR 0.681, CI 0.511-0.908), ARNIs (OR 0.191, CI 0.089-0.406), anticoagulants (OR 0.578, CI 0.403-0.829), tolvaptan (OR 0.340, CI 0.124-0.929), and SGLT-2i (OR 0.238, CI 0.058-0.969) significantly reduced the readmission rate of patients. Further subgroup analysis showed that the efficacy of the drugs varied slightly depending on the type of HF, but was consistent with guideline recommendations and clinical study results. In our hospital, the utilization rate of guideline-recommended drugs is gradually increasing, especially after pharmacists participate in rational drug use in clinical practice, the rate of increase is more significant, which is more in line with GDMT recommendations. Additionally, despite some limitations in our study, most of the guideline-recommended drugs show good therapeutic effects. And, we found that drugs such as SGLT-2i and ivabradine, despite their low usage rates, also demonstrate good therapeutic effects, providing significant implications for clinical decision-making.

Objectives Vascular stiffening is highly predictive of major adverse cardiovascular events. It is not clear whether microangiopathy, such as fundus arteriosclerosis, is related to carotid atherosclerosis. Hence, this study was designed to investigate the relationship between carotid atherosclerosis and fundus arteriosclerosis among individuals of different sexes in the Chinese health-examination population. Methods This retrospective cross-sectional study involved 20,836 participants, including 13050 males and 7786 females. All participants underwent a detailed health examination, including medical history assessment, physical examination, assessment of lifestyle factors, fundus photography, Doppler ultrasound examination of the neck, and laboratory examinations. Two trained ophthalmologists analysed fundus arteriosclerosis based on fundus photographs, while carotid atherosclerosis was diagnosed using colour Doppler sonography of the neck. Binary logistic regression was used to analyse the relationship between carotid atherosclerosis and fundus arteriosclerosis. Results In participants with fundus arteriosclerosis, the incidence of carotid atherosclerosis was higher than that of participants without fundus arteriosclerosis (52.94% vs. 47.06%). After adjustments for potential confounding factors, fundus arteriosclerosis was significantly associated with the risk of carotid atherosclerosis. The OR with 95% CI for fundus arteriosclerosis was 1.17 (1.02, 1.34) with p  = 0.0262, and individuals who did not have fundus arteriosclerosis were used as a reference in the total population. Fundus arteriosclerosis was associated with the incidence of carotid atherosclerosis in males ( p  = 0.0005) but not in females ( p  = 0.0746). Conclusions Fundus arteriosclerosis was closely associated with carotid atherosclerosis in the Chinese population. This association was found in males but not in females.

Sexually transmitted infections (STIs) are frequently underdiagnosed, representing a serious public health concern, especially during adolescence and in more vulnerable communities. Aim: to describe the last ten years of emergency department (ED) visits for STIs among adolescents. Methods: a retrospective cross-sectional observation was carried out in the Piedmont region in Italy. Data were retrieved through the Italian National Information System database. ED visits related to specific ICD-9-CM codes carried out on 11 to 19-year-old youths between 2011 and 2020 were investigated. Age-specific, crude, and standardized rates and admission ratios, with 95% confidence intervals (CIs), were calculated to estimate the STI trend. Results: from a total of 1,219,075 ED visits, 339 were related to STIs, representing an increasing ratio of 28 per 100,000 visits, primarily in females. Most infections occurred in girls (83.5%) and among 17 to 19-year-olds (71.5%). A drop in both ED visits and STI cases was observed in 2020. Genital Herpes and Genital Warts were more frequent in girls while Gonorrhea was more frequent in boys. Conclusions: the increasing trend of ED visits for STIs, particularly in girls, represents an emerging relevant public health issue that needs to be urgently tackled.

(1) Background: Patients who deserve intensive care unit (ICU) admission may be denied due to a lack of resources, complicating ICU triage decisions for intensive care unit (ICU) clinicians. Among the resources that may be unavailable are trained personnel and monitored beds. In South Africa, the distribution of healthcare resources is reflected in the availability of ICU beds, with more ICU beds available in more affluent areas. Data on ICU refusal rates, reasons for refusal, patient characteristics, and outcomes are scarce in resource-constrained rural settings. Hence, this study sheds light on the ICU refusal rates, reasons for refusal, characteristics, and outcomes of refused patients at NMAH. (2) Methods: This was a three-month retrospective cross-sectional record review of refused and admitted patients from January to March 2022. COVID-19 patients and those younger than 13 years old were excluded. Refusal rates, reasons for refusal, characteristics, and outcomes of refused patients were analysed quantitatively using SPSS VS 20 software. Reasons for refusal were categorised as “too well”, “too sick”, and “suitable for admission but no resources”. (3) Results: A total of 135 patients were discussed for ICU admission at NMAH during the study period; 73 (54.07%) were refused admission, and 62 (45.92%) were admitted. Being considered too sick to benefit from ICU was the most common reason for refusal (53.23%). Too well and no resources contributed 27.42% and 19.35%, respectively. Patients with poor functional status, comorbidities, medical diagnoses, and those referred from the ward or accident and emergency unit rather than the operating room were more likely to be refused ICU admission. Refused patients had a seven-day mortality rate of 47%. (4) Conclusions and recommendations: The study found an unmet need for critical care services at our institution, as well as a need for tools to help clinicians make objective triage decisions for critically ill patients. Therefore, the study suggests a need to improve the quality of services provided outside of the ICU, particularly for patients who were refused ICU admission, to improve their outcomes.

Background: Breast cancer risk for postmenopausal women is positively associated with circulating concentrations of oestrogens and androgens, but the determinants of these hormones are not well understood. Methods: Cross-sectional analyses of breast cancer risk factors and circulating hormone concentrations in more than 6000 postmenopausal women controls in 13 prospective studies. Results: Concentrations of all hormones were lower in older than younger women, with the largest difference for dehydroepiandrosterone sulphate (DHEAS), whereas sex hormone-binding globulin (SHBG) was higher in the older women. Androgens were lower in women with bilateral ovariectomy than in naturally postmenopausal women, with the largest difference for free testosterone. All hormones were higher in obese than lean women, with the largest difference for free oestradiol, whereas SHBG was lower in obese women. Smokers of 15+ cigarettes per day had higher levels of all hormones than non-smokers, with the largest difference for testosterone. Drinkers of 20+ g alcohol per day had higher levels of all hormones, but lower SHBG, than non-drinkers, with the largest difference for DHEAS. Hormone concentrations were not strongly related to age at menarche, parity, age at first full-term pregnancy or family history of breast cancer. Conclusion: Sex hormone concentrations were strongly associated with several established or suspected risk factors for breast cancer, and may mediate the effects of these factors on breast cancer risk.

To investigate the factors associated with the recurrence of colorectal polyps. Data on polyp recurrence and related factors, including gender, age, BMI, family history, smoking history, alcohol consumption history, gallbladder disease history, food allergy, polyp size, number, and pathological classification, (Hp) infection, parathyroid hormone, gastrin, and blood lipid levels, were collected as exposure factors. Polyp recurrence was used as the outcome measure. Logistic regression analysis was used to evaluate risk and protective factors for colorectal polyp recurrence. The diagnostic performance of the identified risk factor model was assessed using ROC curve analysis. Among the 318 patients, 170 experienced polyp recurrence, while 148 did not. Logistic regression analysis revealed that gender (OR = 1.927, 95% CI = 1.134-3.276, = 0.015), age (OR = 3.228, 95% CI = 1.846-5.647, < 0.001), history of gallbladder disease (OR = 2.011, 95% CI = 1.147-3.523, = 0.015), food allergy (OR = 2.246, 95% CI = 1.211-4.545, = 0.012), pathological classification (OR = 5.023, 95% CI = 2.932-8.606, < 0.001), and Hp infection (OR = 1.970, 95% CI = 1.171-3.312, = 0.011) were positively associated with polyp recurrence. Conversely, polyp size (OR = 0.324, 95% CI = 0.127-0.827, = 0.018) was negatively associated with recurrence. Logit(p) = -2.459 + 0.656 × Gender + 1.172 × Age 61-80 years + 0.698 × Gallbladder Disease + 0.853 × Food Allergy-1.127 × Polyp Size + 1.164 × Pathological Classification + 0.678 × Hp Infection. The risk prediction model can be used to predict post-surgical recurrence of colorectal polyps with a sensitivity of 0.88 and specificity of 0.56. The cutoff value for this odds prediction model is 0.44. Elderly (61-80 years old) male patients with adenomatous colorectal cancer and the history of (Hp) infection, gallbladder disease and food allergy have higher odds to experience recurrence after surgical resection. On the contrary, those patients with a larger polyp size (≥2 cm) are less odds to experience recurrence. Patients with a risk prediction model value greater than or equal to 0.44 have increased odds to experience postoperative recurrence.

ObjectiveThe safety and efficacy of surgical microvascular decompression (MVD) in elderly patients with trigeminal neuralgia (TN) is controversially discussed in the literature. A widespread reluctance to expose this cohort to major intracranial surgery persists. Our aim was to compare the efficacy and safety between older and younger patients with TN.MethodsIn this cross-sectional study, 139 MVD procedures (103 patients < 70 and 36 patients ≥ 70) were included. Surgical fitness was assessed by the American Society of Anesthesiology (ASA) grade. The pain-free interval was evaluated using Kaplan–Meier analysis only in patients with a recent follow-up visit. Independent risk factors for recurrence in patients with a minimum 12-month follow-up were determined.ResultsPatients ≥ 70 showed a significantly higher number of comorbidities. Pain intensity, affection of trigeminal branches and symptom duration was similar between groups. No significant difference in treatment associated complications and permanent neurological deficits was shown. There was no treatment-related mortality. A tendency towards a lower recurrence rate in patients < 70 did not reach statistical significance (17.6% vs. 28.6%, P = 0.274). Pain-free interval was not different between both cohorts (78.7 vs. 73.5 months, P = 0.391).ConclusionDespite a higher prevalence of comorbidities in elderly patients, complication rates and neurological deficits after MVD were comparable to younger patients. Rates of immediate and long-term pain relief compared favorably to previous studies and were similar between elderly and younger patients. These data endorse MVD as a safe and effective first-line surgical procedure for elderly patients with TN and neurovascular conflict on MRI.

Zusammenfassung Hintergrund Es existieren derzeit widersprüchliche Daten hinsichtlich des Stellenwertes des männlichen Präputiums bzw. der Zirkumzision im Hinblick auf Erektionsfähigkeit und sexuelle Zufriedenheit des Mannes. Material und Methoden Einen 35 Items umfassenden Fragebogen erhielten 10.000 entsprechend der stadtbezogenen Altersstruktur ausgewählte Männer in Cottbus (Bundesland Brandenburg), der den „International Index of Erectile Function“ (IIEF-6) integrierte und weitere Fragen zur sexuellen Lebensqualität, zu speziellen Erkrankungen und zu verschiedenen Operationen stellte. 2499 der Männer, die den Fragebogen komplett ausfüllten, lebten in einer Partnerschaft und bildeten die Studiengruppe dieser Untersuchung. Anhand des IIEF-6 wurden zwei Studienendpunkte (SEP) definiert (Punktwerte ≤ 25/SEP1 bzw. ≤ 21/SEP2 Punkte). Mittels multivariater logistischer Regressionsmodelle wurde der unabhängige Einfluss der Zirkumzision auf die beiden SEP geprüft. Zudem wurde die Korrelation zwischen der sexuellen Zufriedenheit des Mannes und der Zirkumzision analysiert. Ergebnisse 167 Männer der Studiengruppe waren zirkumzidiert (6,7%). Die erektile Dysfunktion (ED) betrug im SEP1 40,1% (leichte bis schwere ED) und im SEP2 27,8% (moderate bis schwere ED). Einen unabhängigen Einfluss auf die ED wiesen sowohl für den SEP1 als auch den SEP2 die Kriterien Alter, Raucheranamnese, arterieller Hypertonus, Diabetes mellitus, chronisch-ischämische Herzerkrankung, periphere arterielle Verschlusskrankheit, Leberzirrhose und Zustand nach beckenchirurgischem Eingriff auf. Die Zirkumzision zeigte keinen unabhängigen Einfluss auf die SEP1 [Odds Ratio (OR)  = 1,36; p = 0,174] und 2 (OR = 1,42; p = 0,175). Darüber hinaus bestand kein signifikanter Zusammenhang zwischen der sexuellen Zufriedenheit des Mannes und einer erfolgten Zirkumzision. Schlussfolgerungen In dieser weltweit größten Fragebogenstudie zur männlichen ED, die sich des IIEF als hierfür validiertes Instrument bediente, konnte keine höhere ED-Prävalenz bei zirkumzidierten Männern festgestellt werden. Die sexuelle Zufriedenheit des Mannes war in dieser Untersuchung unabhängig vom Vorhandensein seines Präputiums.