The incidence of depression in patients with rheumatoid arthritis is higher. The concomitant depression will increase medical expense, reduce drug efficacy, lower its compliance, increase the incidence of complication, and affect the cure of rheumatoid arthritis. The influence of depression to rheumatoid arthritis is usually ignored in clinical work. In recent years, the pertinence between depression and immune disease in pathogenesis is found in research: depression will increase the risk of immune diseases in activate inflammation as well as extend and promote the release of inflammatory factors. This article reviews research progress of correlation between depression and rheumatoid arthritis.
Patients with hypercortisolism may experience cutaneous atrophy, weakened cutaneous barrier function, decreased immunity, opportunistic bacteria or fungal infections, which hinder the healing of cutaneous wounds, and even the ulcers will not heal for a long time, and may progress to chronic ulcers, which are difficult and expensive to treat. It affects the quality of life of patients, and can lead to the spread of infection and life-threatening in severe cases. The pathological mechanism of cutaneous ulcers and delayed healing caused by hypercortisolism is complicated, which is a clinical problem that needs to be solved urgently. This article explains the possible mechanism of hypercortisolism hindering the healing of cutaneous ulcers from the aspects of leading to cutaneous atrophy, pathophysiological abnormalities affecting wound healing, hyperglycemia inhibiting wound healing, and infection and hypercoagulable state, and discusses the possible mechanisms of hypercortisolism hindering the healing of cutaneous ulcers, and its treatment methods, aiming to provide a basis for more in-depth mechanism research and clinical prevention and treatment.
Pragmatic randomized controlled trials can provide high-quality evidence. However, pragmatic trials need to frequently encounter the missing outcome data due to the challenges of quality assurance and control. The missing outcome could lead to bias which may misguide the conclusions. Thus, it is crucial to handle the missing outcome data appropriately. Our study initially summarized the bias structures and missingness mechanisms, and then reviewed important methods based on the assumption of missing at random. We referred to the multiple imputations and inverse probability of censoring weighting for dealing with missing outcomes. This paper aimed to provide insights on how to choose the statistical methods on missing outcome data.
Objective To explore the association between 25-hydroxyvitamin D (25OHD) level and risk of the onset of metabolic syndrome (MS) in people in Chengdu. Methods In total, 474 participants were selected randomly by cluster sampling from one urban district and two rural villages in Longquanyi district of Chengdu. The data of sociodemographic information, lifestyle and family history were collected by questionnaires. Binary logistic regression was performed to assess the relationship between baseline 25OHD level and incident of MS, while multiple linear regression was conducted to analyze the relationship between baseline 25OHD level and insulin resistance. Results Four hundred seventy-four people were enrolled in the cohort study, 39 of them developed MS, with the incidences of 20.8 events per 1 000 person years. Among women, low 25OHD status was significantly associated with the risk of developing MS (OR=4.29, 95%CI 1.05 to 29.50, P=0.044) after adjustment for multiple potential confounders. In a multiple linear regression analysis, low 25OHD level of baseline was independently associated with the increased HOMA-IR over a 4-year period among Chengdu individuals (P<0.05) and was independently related to the decreased ISIcomp over a 4-year period in female (P<0.05). Conclusions The current prospective study suggests that low 25OHD level may contribute to increase insulin resistance in Chengdu population. Furthermore, low 25OHD level may increase the risk of MS among women in Chengdu.
ObjectiveTo examine statistical performance of different rare-event meta-analyses methods.MethodsUsing Monte-Carlo simulation, we set a variety of scenarios to evaluate the performance of various rare-event meta-analysis methods. The performance measures included absolute percentage error, root mean square error and interval coverage.ResultsAcross different scenarios, the absolute percentage error and root mean square error were similar for Bayesian logistic regression model, generalized mixed linear effects model and continuity correction, but the interval coverage was higher with Bayesian logistic regression model. The statistical performances with Mantel-Haenszel method and Peto method were consistently suboptimal across different scenarios.ConclusionsBayesian logistic regression model may be recommended as a preferred approach for rare-event meta-analysis.
ObjectiveTo screen pathogenic gene mutations of Gitelman syndrome (GS).MethodsPatients with GS diagnosed and treated in the Department of Endocrinology and Metabolism, West China Hospital of Sichuan University from January 2015 to December 2020 and their family members were included. The pathogenic genes were screened by second-generation sequencing combined with first-generation validation.ResultsA total of 15 GS patients were included. Gene analysis of patients indicated SLC12A3 gene mutation, including 9 cases of compound heterozygous mutation and 6 cases of heterozygous mutation. A total of 12 reported pathogenic sites and 8 new pathogenic mutations were found. Among the newly discovered pathogenic mutations, four were missense mutations (c.539C>A, p.T180K; c.1077C>G, p.N359K; c.1967C>T, p.P656L; and c.2963T>C, p.I988T), one was frame shift mutation caused by single base deletion (c.2543delA, p.D848fs), one was nonsense mutation (c.2129C>A, p.S710X), one was large fragment deletion (exon 7-8 partial coding sequence deletion), and one was coding sequence deletion and abnormal base sequence insertion (IVS7-1 to c.976 deletion GCGGACATTTTTG insertion into ACCGAAAATTTT).ConclusionIn this study, 8 new gene mutations leading to GS were found, and the exact pathogenesis of GS remains to be further confirmed.
Research of generating real-world evidence using real world data has attracted considerable attention globally. Outcome research of treatment based on existing health and medical data or registries has become one of the most important topics. However, there exists certain confusions in this line of research on how to design and implement appropriate statistical analysis. Therefore, in the fourth chapter of the series technical guidance to develop real world evidence by China REal world data and studies Alliance (ChinaREAL), we aim to provide an guidance on statistical analysis in the study to assess therapeutic outcomes based on existing health and medical data or registries.In this chapter, we first emphasize the significance of pre-specified statistical analysis plan, recommending key components of the statistical analysis plan. We then summarize the issue of sample size calculation in this content and clarify the interpretation of statistical p-value. Secondly, we recommend procedures to be considered to tackle the issue related to the selection bias, information bias and most importantly, confounding bias. We discuss the multivariable regression analysis as well as the popular causal inference models. We also suggest that careful consideration should be made to deal with missing data in real-world databases. Finally, we list core content of the statistical report.
ObjectiveTo explore the mechanism of volume-related mitral regurgitation (MR) from the anatomy of mitral valve.MethodsA total of 32 patients with ventricular septal defect (VSD) combined MR meeting inclusion criteria in West China Hospital from September 2018 to November 2019 were enrolled in this study. The direction relative to the cardiac axis: the deviation of the MR bundle along the left atrial wall was eccentric, otherwises it was central. There were 23 patients of VSD and eccentric MR (EMR, a VSD-EMR group), including 10 males and 13 females aged 21 (10, 56) months, and 9 patients of VSD and central MR (CMR, a VSD-CMR group), including 4 males and 5 females aged 26 (12, 87) months. Besides, 9 healthy children were enrolled in a control group, including 4 males and 5 females aged 49 (15, 72) months. All patients underwent transthoracic echocardiography (TTE) examination at 2 weeks before surgery and 6 months after surgery, respectively, The MR degree, end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), antero-posterior diameter (AP), annulus circumference (AC), commissural diameter (CD) were assessed.ResultsBefore operation, EDV, ESV, SV, AP, AC and CD in the VSD-EMR and VSD-CMR groups were significantly larger or longer than those in the control group (P<0.05); after operation, EDV, ESV, SV, AP and CD decreased compared with those before operation (P<0.05), but there was no significant difference compared with the control group (P>0.05). Compared with the control group, AC was slightly decreased (P<0.05). There was no significant difference in EF between and within groups before and after operation (P>0.05). The improvement rate of MR was 78.9% (15/19) in the VSD-EMR group and 100.0% (9/9) in the VSD-CMR group.ConclusionAfter unloading of volume, the valve structure is back to normal except AC. The improvement rate of MR in the VSD-EMR group is lower than that in the VSD-CMR group, which may indicate that the mechanism of VSD-EMR is more complicated.
Objective To demonstrate the efficacy, tolerability, and safety of domestic Acarbose tablet compared with Glucobay (Acarbose tablet produced by Bayer company) in patients with type 2 diabetic patients. Method A multicenter randomized controlled parallel-group comparison study was conducted. 177 Chinese type 2 diabetic patients were recruited from 4 clinical centers. The patients were divided randomly into domestic Acarbose tablet (A group) or Glucoby (B group) treatment group. The trial consisted of a 2-4 weeks equilibrated period followed by an 8 week course of treatment. Results 165 patients have finished the trial (81 in A group and 84 in B group). After 4 weeks of treatment, the mean of fasting blood glucose (FBG) in A and B group were reduced 1.61 and 2.08 mmol/L respectively, and mean of postprandial blood glucose (PBG) lowered 5.06 and 5.09mmol/L respectively. After 8 weeks of treatment, the mean of FBG were reduced 1.95 and 2.62mmol/L respectively, and mean of PBG lowered 4.88 and 5.98 mmol/L, respectively, and mean of HbA1c were lowered 1.13% and 1.20% respectively in A and B group. The differences in reduction of FBG, PBG, and HbA1c between A and B group were no statistic significance. The serum triglyceride levels and BMI were decreased significantly in both A, B groups. 3 patients who drinking wine during trial on A group had asymptomatic elevations in serum transaminases that normalized in 2 weeks after stopped drinking and Acarbose withdrawal. Flatulence was the most common side effect. Conclusions In this multicenter study, domestic Acarbose tablet 50 mg t.i.d. was an effective, safe, and generally well-tolerated therapy as similar as Glucobay in type 2 diabetic patients.