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Abstract Background Eosinophilic granulomatosis with polyangiitis (EGPA), a rare but life-threatening systemic vasculitis, is distinguished by marked eosinophilia and presents with diverse symptoms, including asthma, cutaneous purpura, ecchymosis, skin necrosis, cardiac lesions, peripheral neuropathy, and necrotizing vasculitis. The etiology of EGPA involves a complex interaction among humoral, adaptive, innate, and allergic immune responses. Standard treatment employs prolonged high-dose glucocorticoid therapy, which is critical for survival; however, some patients’ symptoms cannot be relieved. Case report This case report details the medical management of an 11-year-old patient with EGPA, who was at risk of bilateral lower limb amputation due to differential arterial occlusion and severe, necrotizing vasculitis-induced gangrene in both feet. Treatment modalities administered included systemic infusion of Umbilical Cord Mesenchymal Stem Cells (UC-MSCs), targeted gastrocnemius muscle injections, and application of a Placenta-Derived Mesenchymal Stem Cells (PD-MSCs) hydrogel. Results After receiving a four-month regimen of allogeneic mesenchymal stem cell therapy via intravenous and local administration, the patient showed normalized eosinophil counts, reestablished blood flow in the dorsal arteries, and marked improvement in foot ulcerations. Conclusion Mesenchymal stem cell therapy is a promising option for severe EGPA cases refractory to glucocorticoids.

Abstract Objective This study aims to assess the performance of various scoring systems in predicting the 28-day mortality of patients with aortic aneurysms (AA) admitted to the intensive care unit (ICU). Methods We utilized data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) to perform a comparative analysis of various predictive systems, including the Glasgow Aneurysm Score (GAS), Simplified Acute Physiology Score (SAPS) III, SAPS II, Logical Organ Dysfunction System (LODS), Sequential Organ Failure Assessment (SOFA), Systemic Inflammatory Response Syndrome (SIRS), and The Oxford Acute Illness Severity Score (OASIS). The discrimination abilities of these systems were compared using the area under the receiver operating characteristic curve (AUROC). Additionally, a 4-knotted restricted cubic spline regression was employed to evaluate the association between the different scoring systems and the risk of 28-day mortality. Finally, we conducted a subgroup analysis focusing on patients with abdominal aortic aneurysms (AAA). Results This study enrolled 586 patients with AA (68.39% male). Among them, 26 patients (4.4%) died within 28 days. Comparative analysis revealed higher SAPS II, SAPS III, SOFA, LODS, OASIS, and SIRS scores in the deceased group, while no statistically significant difference was observed in GAS scores between the survivor and deceased groups (P = 0.148). The SAPS III system exhibited superior predictive value for the 28-day mortality rate (AUROC 0.805) compared to the LODS system (AUROC 0.771), SOFA (AUROC 0.757), SAPS II (AUROC 0.759), OASIS (AUROC 0.742), SIRS (AUROC 0.638), and GAS (AUROC 0.586) systems. The results of the univariate and multivariate logistic analyses showed that SAPS III was statistically significant for both 28-day and 1-year mortality. Subgroup analyses yielded results consistent with the overall findings. No nonlinear relationship was identified between these scoring systems and 28-day all-cause mortality (P for nonlinear > 0.05). Conclusion The SAPS III system demonstrated superior discriminatory ability for both 28-day and 1-year mortality compared to the GAS, SAPS II SIRS, SOFA, and OASIS systems among patients with AA.

Abstract Background Carotid endarterectomy (CEA) is a surgical procedure that can reduce the risk of stroke in patients with carotid artery stenosis. However, controversy still exists regarding the optimal surgical technique for CEA. Objective To compare the safety and effectiveness of different techniques. Methods Data on baseline characteristics as well as perioperative and postoperative complications from patients who underwent CEA at the Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, were retrospectively collected and analyzed. Results A total of 262 CEA patients included in study, with a total of 265 CEA operations. The mean age of 69.95 ± 7.29 (range, 44–89) years. 65 (24.5%) patients underwent cCEA, 94 (35.5%) underwent pCEA, and 106 (40.0%) underwent eCEA. The use of shunt (1.9%) and the mean operation time were lower in eCEA group (P

OBJECTIVE: Takayasu arteries (TAK) is a rare and unexplained inflammatory arterial disease that can occur in both children and adults. Our goal was to clarify the clinical features and surgical outcomes of aortitis in children and adults. METHODS: A retrospective cohort study was conducted on patients with TAK treated at tertiary care centers between 2012 and 2020. The American College of Rheumatology’s TAK criteria were used to select patients. Study results were reported using descriptive statistics and Kaplan–Meier methods. RESULTS: The cohort included 106 TAK patients with a median follow-up of 69 (interquartile range 80) months. Childhood TAK (c-TAK) differed from adult TAK (a-TAK) in terms of baseline: the predominant Nomo staging for c-TAK was Type IV (70.4), while the predominant staging for a-TAK was Type I (68.4%). Sixty-eight of them underwent surgical intervention, with a total of 85 vascular procedures (77 endoluminal procedures and 8 open procedures). c-TAK group had more endoluminal interventions (100%), while the a-TAK group had a higher proportion of open procedures (17.8%) than the c-TAK group, and the main complication in both groups was restenosis. Kaplan–Meier curves showed that c-TAK had a significantly higher rate of restenosis than a-TAK and had a significantly higher reintervention rate (logrank, P < 0.001). CONCLUSION: In conclusion, the main difference between c-TAK and a-TAK is that Nomo typing c-TAK is mainly Type IV, while a-TAK is mainly Type I. Furthermore, c-TAK has a higher rate of reintervention after surgical treatment than a-TAK, more attention should be paid to the postoperative follow-up of c-TAK patients, and further large sample studies are needed to confirm this.

Abstract Objective This study aims to establish and validate a nomogram model for the all-cause mortality rate in patients with diabetic nephropathy (DN). Methods We analyzed data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2016. A random split of 7:3 was performed between the training and validation sets. Utilizing follow-up data until December 31, 2019, we examined the all-cause mortality rate. Cox regression models and Least Absolute Shrinkage and Selection Operator (LASSO) regression models were employed in the training cohort to develop a nomogram for predicting all-cause mortality in the studied population. Finally, various validation methods were employed to assess the predictive performance of the nomogram, and Decision Curve Analysis (DCA) was conducted to evaluate the clinical utility of the nomogram. Results After the results of LASSO regression models and Cox multivariate analyses, a total of 8 variables were selected, gender, age, poverty income ratio, heart failure, body mass index, albumin, blood urea nitrogen and serum uric acid. A nomogram model was built based on these predictors. The C-index values in training cohort of 3-year, 5-year, 10-year mortality rates were 0.820, 0.807, and 0.798. In the validation cohort, the C-index values of 3-year, 5-year, 10-year mortality rates were 0.773, 0.788, and 0.817, respectively. The calibration curve demonstrates satisfactory consistency between the two cohorts. Conclusion The newly developed nomogram proves to be effective in predicting the all-cause mortality risk in patients with diabetic nephropathy, and it has undergone robust internal validation.

Abstract Background The objective of this study was to investigate the relationship between the prognostic nutritional index (PNI) and peripheral artery disease (PAD). Methods The present study is a cross-sectional study based on the National Health and Nutrition Survey (1999–2004). The laboratory-calculated PNI was divided into four groups based on quartiles(Q1:PNI ≤ 50.00; Q2: 50.01–53.00; Q3:53.01–56.00; Q4: > 56.00). PAD was defined as an ankle brachial pressure index (ABPI) ≤ 0.9 on the left or right. The relationship between PNI and PAD was examined using multifactor weighted logistic regression analysis, as well as subgroup analysis. Subgroup analyses were conducted based on demographic and clinical variables. Results A total of 5,447 individuals were included in our final analysis. The age of the participants was 59.56 ± 13.10 years, and males accounted for 52.8% (n = 2820). The prevalence of PAD was 6.7% (n = 363). After adjusting for all factors, participants with Q1 still had an increased risk of PAD, with an OR value of 1.593 and a 95% CI of 1.232–1.991. Subgroup analysis showed no significant interaction among multiple factors. Conclusions In summary, we report that lower PNI are associated with a higher risk of PAD in US adults. It is hoped that this discovery can provide a reference for the prevention of PAD.

PurposeFemoropopliteal artery disease (FPAD) is a common vascular disease that usually requires surgical treatment. The aim of this study was to apply predictive modeling to develop predictive models for predicting clinically driven target revascularization (CD-TLR) events 1 year after intervention in patients with FPAD.Materials and methodsIn this study, clinical data were collected from a total of 484 patients who underwent FPAD endovascular intervention from 2014 to 2019. According to the inclusion and exclusion criteria, 400 patients will be finally included and assigned to the training cohort and test cohort in the ratio of 7:3. By analyzing these data through statistical methods, we will explore the effects of different factors on target revascularization events 1 year after intervention in FPAD patients, and build the corresponding prediction model of the column line graph.ResultsThe final nomogram model consisted of 5 independent predictors: history of cerebrovascular disease, lesion length >15 cm, no atherectomy device used, no medicated balloon used and procedure time. The C-index of the model was 0.766 and 0.726 for the training cohort and validation cohort, respectively. The calibration curves also showed that the model had satisfactory agreement in both cohorts.ConclusionsThe newly developed prediction model can accurately predict clinically driven target revascularization events at 1 year in patients with FPAD, providing valuable information for the development of individualized treatment plans.

BackgroundDrawing on prospective data from the National Health and Nutrition Examination Survey (NHANES), our goal was to construct and validate a 5-year survival prediction model for individuals with cognitive impairment (CI).MethodsThis study entailed a prospective cohort design utilizing information from the 2011–2014 NHANES dataset, encompassing individuals aged 40 years or older, with updated mortality status as of December 31, 2019. Predictive models within the derivation and validation cohorts were assessed using logistic proportional risk regression, column-line plots, and least absolute shrinkage and selection operator (LASSO) binomial regression models.ResultsThe study enrolled a total of 1,439 participants (677 men, mean age 69.75 ± 6.71 years), with the derivation and validation cohorts consisting of 1,007 (538 men) and 432 (239 men) individuals, respectively. The 5-year mortality rate stood at 16.12% (n = 232). We devised a 5-item column-line graphical model incorporating age, race, stroke, cardiovascular disease (CVD), and blood urea nitrogen (BUN). The model exhibited an area under the curve (AUC) of 0.772 with satisfactory calibration. Internal validation demonstrated that the column-line graph model displayed strong discrimination, yielding an AUC of 0.733, and exhibited good calibration.ConclusionTo sum up, our study successfully developed and internally validated a 5-item nomogram integrating age, race, stroke, cardiovascular disease, and blood urea nitrogen. This nomogram exhibited robust predictive performance for 5-year mortality in individuals with CI, offering a valuable tool for prognostic evaluation and personalized care planning.

Abstract Objective There are studies on the nutritional status of type 2 diabetes (T2D), but there are no large cohort studies on the prognosis of Controlling Nutritional Status (CONUT) score for T2D. The aim of this study was to examine the association between CONUT score and all-cause mortality as well as cancer mortality in adults with T2D. Methods For this study, we analyzed a total of 3763 adult patients with T2D who were part of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Mortality outcomes were determined by linking to the National Death Index records as of December 31, 2019. Cox proportional risk models were used to estimate risk ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cancer deaths. Results During the mean follow-up of 8.17 years, there were 823 deaths from all causes and 155 deaths from cancer. After adjusting for multiple variables, the risk of all-cause mortality was higher in patients with a Mild (CONUT score ≥ 2), compared with patients with a Normal (CONUT score of 0–1). All-cause mortality risk was 39% higher, and cancer mortality risk was 45% higher. Consistent results were observed when stratified by age, sex, race, BMI, smoking status, and glycated hemoglobin levels. Conclusions In a nationally representative sample of American adults with T2D, we found an association between CONUT score and all-cause mortality and cancer mortality.

Conclusion: The newly developed nomogram has proved to be an important tool for accurately predicting cognitive impairment in elderly patients with diabetes, providing important information for targeted prevention and intervention measures.

Background. The mortality rate among older persons with diabetes has been steadily increasing, resulting in significant health and economic burdens on both society and individuals. The objective of this study is to develop and validate a predictive nomogram for estimating the 5-year all-cause mortality risk in older persons with T2D (T2D). Methods. We obtained data from the National Health and Nutrition Survey (NHANES). A random 7 : 3 split was made between the training and validation sets. By linking the national mortality index up until December 31, 2019, we ensured a minimum of 5 years of follow-up to assess all-cause mortality. A nomogram was developed in the training cohort using a logistic regression model as well as a least absolute shrinkage and selection operator (LASSO) regression model for predicting the 5-year risk of all-cause mortality. Finally, the prediction performance of the nomogram is evaluated using several validation methods. Results. We constructed a comprehensive prediction model based on the results of multivariate analysis and LASSO binomial regression. These models were then validated using data from the validation cohort. The final model includes four independent predictors: age, gender, estimated glomerular filtration rate, and white blood cell count. The C-index values for the training and validation cohorts were 0.748 and 0.762, respectively. The calibration curve demonstrates satisfactory consistency between the two cohorts. Conclusions. The newly developed nomogram proves to be a valuable tool in accurately predicting the 5-year all-cause mortality risk among older persons with diabetes, providing crucial information for tailored interventions.

Abstract The prevalence of peripheral artery disease continues to rise, with major amputations and mortality remaining prominent. Frailty is a significant risk factor for adverse outcomes in the management of the vascular disease. The geriatric nutritional risk index has been used to predict adverse outcomes in lower extremity peripheral artery disease and is a nutrition‐based surrogate for frailty. The authors recruited 126 patients with peripheral artery disease who underwent endovascular stent implantation. As in previous reports, malnutrition was diagnosed by the geriatric nutritional risk index. The authors used Kaplan‐Meier and multivariate Cox proportional hazards regression analyses to analyze the risk of major adverse limb events, which included mortality, major amputation, and target limb revascularization. There were 67 major adverse limb events during a median follow‐up of 480 days. Malnutrition on the basis of the geriatric nutritional risk index was present in 31% of patients. Cox regression analysis showed that malnutrition based on the geriatric nutritional risk index was an independent predictor of major adverse limb events. Kaplan‐Meier analysis showed that major adverse limb events increased with worsening malnutrition. Our single‐center, retrospective evaluation of geriatric nutritional risk index (as a synonym for body health) correlates with an increased risk of major adverse limb events. Future directions should focus not only on identifying these patients but also on modifying risk factors to optimize long‐term outcomes.

Introduction There is little bulk clinical evidence on nutritional status and mortality in patients with diabetes. The purpose of this study was to examine the relationship between prognostic nutritional index (PNI) and all-cause mortality and cardiovascular mortality in adults with diabetes.Research design and methods This study included 5916 adult patients with diabetes from the National Health and Nutrition Examination Survey 1999–2018. Cox proportional risk models were used to estimate risk ratios (HRs) and 95% CIs for all-cause mortality, cardiovascular disease (CVD) mortality.Results During a mean follow-up of 8.17 years, there were 1248 deaths from all causes and 370 deaths from CVD. After multivariate adjustment, the risk of all-cause mortality was reduced by 24%, 38%, and 28% in Q2 (49.0–52.99), Q3 (53.0–57.99), and Q4 (≥58.0), respectively, compared with Q1 (PNI

Lipoprotein (a) [Lp (a)] is a complex polymorphic lipoprotein consisting of one low-density lipoprotein particle with one molecule of apolipoprotein B100 and another apolipoprotein (a) linked by a disulfide bond. In recent years, due to its causal role in premature atherosclerotic cardiovascular diseases and calcified aortic stenosis, Lp (a) has attracted more and more attention. Our study aimed to illustrate the trend of Lp (a) research in atherosclerosis (AS) through bibliometric analysis. The Science Citation Index-Expanded was used to locate Lp (a) and AS studies published between December 1, 2012 and December 1, 2022. VOSviewer and CiteSpace bibliometric software packages were used to analyze literature information. LP (a) has seen an overall increase in annual publications. The United States had the highest number of publications worldwide, with 192 publications. The University of California, San Diego, has contributed significantly to Lp (a) with 29 publications and led research collaboration. In the past few decades, there has been close collaboration between countries or regions, institutions, and authors. In addition, the European Heart Journal was the most cited, followed by the Journal of Lipid Research and AS with 2033, 1096, and 806 citations, respectively. Recent studies were on genes and lipid-lowering therapies. Our study comprehensively evaluated the research status and trends of Lp (a) in AS worldwide for the first time and provided a valuable reference for clinical researchers.