Objective To study the relationship between vitamin D deficiency, defined as 25-hydroxyvitamin D3 (25 (OH) D3) deficiency and the risk of orthostatic hypotension (OH) in the elderly population. Methods From the establishment of the database to June 2023, a systematic literature search was conducted on Pubmed, Embase, Web of Science, Scopus, and Cochrane databases. Two researchers independently screened the included literatures, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was performed using Stata software (version 17.0) and RevMan5.4 software. Results A meta-analysis was conducted using the random-effect model involving 9,155 participants from 9 cross-sectional studies. Serum 25-hydroxyvitamin D levels were measured by radioimmunoassay (RIA) and liquid chromatography mass spectrometry (LC-MS). The overall analysis results showed that vitamin D deficiency was directly correlated with OH in the elderly population. Compared with individuals with normal vitamin D levels, low serum vitamin D levels significantly increased the risk of OH in the elderly (OR=1.22, 95%CI=1.12-1.33,P<0.05). Conclusion There is a clear correlation between vitamin D deficiency and the risk of OH in the elderly.

Objective To systematically evaluate the serum von Willebrand factor (vWF) levels in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Methods Relevant literatures on the serum vWF levels in ALI/ARDS patients were searched in online databases, including the China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials up to April 2024. The studies were screened according to predefined criteria, and their quality was assessed. A meta-analysis was conducted using STATA17 and Revman5.3 on the collected original data. Results A total of 6 studies involving 260 ALI/ARDS patients were included in the present meta-analysis on exploring the correlation between serum vWF and risk of ALI/ARDS. The pooled standardized mean difference (SMD) was 0.95, with a 95% confidence interval (CI) of 0.64 to 1.25(P<0.01). A total of 8 studies involving 3,198 ALI/ARDS patients were included in the present meta-analysis on exploring the role of serum vWF in predicting the prognosis of ALI/ARDS. The pooled odds ratio (OR) was 1.61, with a 95%CI of 1.44 to 1.80(P<0.01). Conclusion The high serum vWF is significantly associated with the risk of ALI/ARDS and its prognosis. As a convenient testing method, measurement of serum vWF presents a high value for clinical practice.

Objective Circadian rhythm disorders links with autoimmune diseases. This study aims to explore the influencing factors for circadian rhythm disorders in patients with rheumatoid arthritis (RA) combined with insomni.Methods This was a multicenter cross-sectional clinical survey. Deputy chief physicians or above experienced in rheumatology were uniformly trained to collect relevant information through questionnaire surveys. The surveying questionnaire was designed from two dimensions of the insomnia severity index (ISI) and clinical information of RA patients. In 13 research centers in Hebei Province, RA outpatients or inpatients were screened according to inclusion and exclusion criteria. Relevant factors for insomnia in RA patients were compared and analyzed. Results A total of 181 RA patients were included in the analysis, including 60 (33.1%) with insomnia, and 121 without it. The male-to-female ratio was 1∶5. The average age of RA patients with insomnia was significantly older than those without insomnia (P<0.01). RA patients with comorbidities like hypertension, respiratory diseases, thyroid diseases, osteoporosis, or osteoarthritis had a significantly higher incidence of insomnia than those without comorbidities (P<0.05). RA patients taking traditional Chinese herbal medicine/ extracts of traditional Chinese medicine (TCM) had a significantly higher incidence of insomnia than those without TCM treatment (P=0.019). There was a significant difference in the incidence of insomnia among RA patients with varied disease activity scores and X-ray grading of hands (P<0.05). There were no significant differences in biochemical and immunological indicators between RA patients with or without insomnia (P>0.05). Conclusion A high proportion of RA patients suffer from insomnia, and the circadian rhythm disorder is associated with age, comorbidities, moderate-to-high disease activity, and radiographic grading.

Objective To evaluate the correlation of serum lipids before radical gastrectomy for gastric cancer (GC) with clinicopathological characteristics and prognosis. Methods A total of 307 GC patients underwent radical gastrectomy in the Second Hospital of Lanzhou University from October 2019 to May 2020 were retrospectively analyzed. The clinical data were compared to explore the correlation between serum lipids 2 weeks before radical gastrectomy and the prognosis. Results The follow-up time of 307 GC patients was 1-79 months, with a median follow-up time of 52 months. As of the final follow-up time, a total of 72 patients were lost to follow-up in this study, and 235 patients were finally included, of which 111 patients died. The preoperative increase in total cholesterol (TC) was significantly correlated with gender, pathological T stage(pT), pathological N stage(pN), carcinoembryonic antigen (CEA) and neurovascular invasion (P<0.05). High levels of triglyceride (TG) was significantly correlated with tumor maximum diameter, vascular invasion, pathological differentiation, pT, pN, and body mass index (BMI) (P<0.05). The increase in the low-density lipoprotein cholesterol (LDL-C) was significantly correlated with increased BMI, pT, pN,CEA and perineural invasion (P<0.05). Cox univariate risk analysis was performed on 235 GC patients treated with radical gastrectomy. Tumor maximum diameter, tumor location, vascular invasion, nerve invasion, CEA, carbohydrate antigen (CA) 125, CA199, pT, pN, TC, TG and LDL-C were all risk factors for the overall survival after radical gastrectomy (P<0.05). Multivariate analysis showed that after excluding other confounding factors, tumor size, CEA, CA125, CA199, pT, BMI and LDL-C were the independent risk factors for the prognosis of gastric cancer (P<0.05). Conclusion Preoperative LDL-C can be used as an independent factor to predict the prognosis of GC after radical gastrectomy.

Objective To compare and analyze the effects of different courses and reduction methods of glucocorticoids on preventing esophageal stenosis after endoscopic submucosal dissection (ESD). Methods A total of 67 patients who underwent ESD surgery for early esophageal cancer and precancerous lesions and orally medicated with glucocorticoids postoperatively to prevent esophageal stricture in our department from January 2017 to January 2023 were retrospectively included. According to the postoperative oral corticosteroids, patients were divided into the 3-week group, 8-week group, and 12-week group. Esophageal stricture, number of balloon dilations after stricture, and hormone-related complications were compared among the three groups. Results The esophageal stricture rate after ESD in the 3-week group, 8-week group, and 12-week group was 23.8%(5/21), 22.9%(8/35), and 18.2%(2/11), respectively, without a significant difference (P>0.05). The average number of endoscopic balloon dilations after stenosis in the 3-week group, 8-week group, and 12-week group was (2.80±0.84) times, (2.25±0.71) times and (2.50±0.71) times, respectively, without a significant difference (P>0.05). The incidence of hormone-related adverse reactions was 0, 5.7%(2/35), and 27.3%(3/11), respectively, without a significant difference (P>0.05). There was a significant difference in the incidence of hormone-related adverse reactions between the 3-week group and the 12-week group (P=0.012), and that between the 8-week group and the 12-week group (P=0.045).Conclusion Oral glucocorticoids can prevent esophageal stenosis after extensive ESD. Three-week therapy, eight-week therapy and twelve-week therapy have similar effects in the prevention of stenosis and the number of balloon dilatation after stenosis. However, short-term and low-dose hormone use has the least adverse reactions and high safety.

Objective To study the correlation of triglyceride-glucose (TyG) and its derivative index with the risk of diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM), and to explore its clinical application value. Methods This was a cross-sectional study including 895 T2DM patients hospitalized in the Endocrinology Department of Tianjin People's Hospital from 2018 to 2022. Patients were divided into DKD group (n=326) and non-DKD group (n=569) according to whether they had DKD or not. The clinical data of the two groups were compared. The correlation of TyG, triglyceride glucose-waist circumference (TyG-WC), triglyceride glucose-body mass index (TyG-BMI), and homeostatic model assessment for insulin resistance (HOMA-IR) with DKD was identified. The interaction of TyG and its derivatives with stratification factors was explored. Results There were significant differences in TyG, TyG-WC, TyG-BMI and HOMA-IR between the two groups (P<0.05). TyG and TyG-WC were independent influencing factors of the risk of DKD before and after adjusting for influencing factors (P<0.05). The prevalence of DKD in T2DM patients increased gradually with the increased TyG, TyG-WC and HOMA-IR (trend test P<0.05). In the T3 subgroup of TyG and TyG-WC, the prevalence of DKD was significantly higher than that of T1 subgroup (P<0.05). At varied levels of TyG, it was an independent risk factor for the risk of DKD before and after adjusting for the influencing factors (P<0.05). Conclusion As an independent risk factor for the risk of DKD, continuous and categorical variables of TyG and its derivatives as well as HOMA-IR stably predict DKD in T2DM patients.

Objective To investigate the clinical efficacy of empagliflozin combined with liraglutide on obese/overweight patients with type 2 diabetes mellitus (T2DM) and its effects on inflammatory factors and islet function. Methods A total of 58 obese/overweight T2DM patients hospitalized and treated at the Second Hospital of Hebei Medical University from June 2021 to September 2023 were selected as the study subjects. They were randomly assigned into the experimental group (Lira+Empa group) and the control group (Lira group), with 29 cases in each group. Patients in the experimental group received a combination therapy of empagliflozin and liraglutide, while those in the control group received liraglutide monotherapy. Pre- and post-treatment glycometabolic indicators, lipid metabolic indicators, inflammatory factors, islet function indicators, and adverse events were compared between groups. Results After treatment, the levels of fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2 hPPG), glycated albumin (GA), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), body mass index (BMI), interleukin-6 (IL-6), and interleukin-10 (IL-10) in both groups were significantly lower than those before treatment. The levels of FPG, 2 hPPG, GA, BMI, IL-6, and IL-10 in the Lira+Empa group were all significantly lower than those of the Lira group (P<0.05). After treatment, the levels of C-peptide (C-P), fasting insulin (FINS), and homeostasis model assessment of β-cell function (HOMA-β) in both groups were significantly higher than those before treatment, and HOMA-β was significantly higher in the Lira+Empa group than the Lira group (P<0.05). There was no significant difference in the incidence of adverse events between the two groups. Conclusion Compared with liraglutide monotherapy, the combination therapy of empagliflozin and liraglutide can further improve the blood glucose-lowering effect, lower blood sugar levels, promote islet function of patients, reduce body weight, and reduce inflammatory factors in obese/overweight T2DM patients, with a good safety.

Objective To evaluate the efficacy and safety of high-power short-duration (HPSD) on the modified box isolation (BOXI) for persistent atrial fibrillation (AF). Methods A total of 122 patients with persistent AF who were admitted to the Second Department of Cardiovascular Medicine, Zhangzhou Municipal Hospital of Fujian Province from June 2020 to November 2022 were randomly divided into HPSD group (n=61) and routine group (n=61). Bilateral pulmonary venous isolation (PVI) by the modified BOXI ablation in the HPSD group, and that by low-power long-term ablation in the routine group were performed. A cold saline perfusion pressure sensing catheter with a power setting of 45 W, guided by the ablation index was given in the HPSD group. Ablation at 35 W for 25-30 seconds was performed in the routine group, and the ablation index and pressure index were consistent with those of the HPSD group. Baseline data, time to complete PVI and modified BOXI, total operation time, perioperative complications, and non-atrial arrhythmia rate at 12 months after a single operation were compared between the two groups. Results The time to complete bilateral pulmonary vein isolation and modified BOXI and the total operation time in the HPSD group were significantly shorter than those of the routine group (P<0.05). There was 1 case of postoperative pericardial tamponade in the routine group. No esophageal injury, stroke or transient ischemic attack and pulmonary vein stenosis or death occurred in both groups. The non-atrial arrhythmia rate was 70.5% in the HPSD group and 63.9% in the routine group at 12 months after a single surgery, showing no significant difference (P=0.440). There was no significant difference in the recovery rate of pulmonary vein and modified BOX potential between the two groups during the second operation (P>0.05). Conclusion The use of HPSD in the modified BOXI procedure for persistent AF is effective, feasible, and safe, which significantly reduces total ablation time and procedure time without compromising clinical efficacy.

Objective To evaluate the efficacy and safety of the direct-acting anti-HCV therapy based on the efavirenz (EFV)-containing regimen in patients with co-infection of human immunodeficiency virus (HIV) and hepatitis C virus (HCV).Methods A total of 21 HIV/HCV co-infected patients treated with the direct-acting anti-HCV therapy using sofosbuvir/velpatasvir in the EFV-containing regimens for HIV from January 2020 to September 2023 in the Department of Infectious Diseases of the Third People's Hospital of Wuzhou were collected. The treatment duration was 12 weeks, followed by a 12-week follow-up period after cessation of treatment. Baseline characteristics of the patients were analyzed. Changes in white blood cells, hemoglobin, platelets, liver and kidney function before and after treatment were compared to evaluate the efficacy of direct anti-HCV therapy based on the anti-HIV condition, and the sustained virologic response rate and safety at 12 weeks after cessation of treatment. Results All 21 HIV/HCV co-infected patients achieved a 100% of HCV viral response rate after receiving sofosbuvir/velpatasvir treatment for 12 weeks and a 12-week follow-up period under EFV-containing regimens for HIV. Serum alanine transaminase (ALT) and aspartate transaminase (AST) levels of all patients were significantly lower than those before treatment (P<0.01), while there were no significant changes in white blood cells, platelets, serum creatinine compared to before treatment (P>0.05).Conclusion Direct-acting anti-HCV treatment under EFV-containing regimens for HIV in HIV/HCV co-infected patients is effective without significant toxic side effects.

Objective To explore the differential diagnosis of kidney cancer with bone metastasis combined with multiple myeloma and to share experience. Methods A case of renal clear cell carcinoma combined with multiple myeloma admitted to the Third Hospital of Hebei Medical University was retrospectively analyzed, and the related literature was reviewed. Results The middle-aged male had the history of renal cancer with 3 years. The patient was treated for “back pain”, and pathological biopsy of vertebral mass after systematic examination revealed that the patient had kidney cancer with bone metastasis complicated with multiple myeloma. Conclusion Clinicians should improve the understanding of the coexistence of these two malignant tumors, especially when new osteolytic lesions are present in patients with renal cell carcinoma, a comprehensive examination is conducted to distinguish bone metastasis and multiple myeloma.

Objective To investigate the clinical characteristics, diagnosis and differential diagnosis of gastric adenocarcinoma of fundic gland type (GA-FG).Methods The diagnosis and treatment of a GA-FG patient were retrospectively analyzed, and the related literatures were reviewed. Results A 54-year-old woman had fading lesions of submucosal tumors (SMT) found in the upper part of the gastric body during gastroscopy. The mucosal surface of the lesion was smooth, and dilated dendritic vascular changes could be seen. Magnification endoscopy (ME) plus narrow-band imaging (NBI) showed typical honeycomb changes in the surrounding mucosa of the brown lesion, fused surface microglandular ducts, varied opening of the glandular ducts, irregular white area and surface microvessels. Ultrasonic gastroscopy showed that the mucosal lesions of the gastric body were visible, with moderate to low echo, originated from the mucosal layer; unclear boundary in the muscular layer of the mucosa; the submucosa was intact, with a size of about 0.8 cm×0.5 cm. Pathology after endoscopic resection showed: fundic adenocarcinoma with 0.3 cm×0.3 cm under the microscopy, infiltrated into the submucosa (diffuse depth of about 220 μm); negative vascular and nerve invasion; no cancer was found in the horizontal and vertical margins. Chronic inflammation of the surrounding mucosa. Immunohistochemistry: positive MUC6; negative mUC5AC; negative p53 nonsense mutation; positive desmin (incomplete mucosal muscle); positive Syn in individual cells; positive CgA in individual cells; positive CD31 and D2-40 (no tumor thrombus in the vessel) ; 10% positivity for Ki-67. Conclusion GA-FG is a new histological type of gastric cancer with unique clinical endoscopic and pathological features. The prognosis of GA-FG is good, but a long-term follow-up is needed.