Studies have yielded contradictory results concerning the association between dehydroepiandrosterone sulfate (DHEAS) and mortality in the elderly population. This meta-analysis aimed to evaluate the association of low serum DHEAS level with cardiovascular or all-cause mortality in the elderly population. A comprehensive literature search was conducted in PubMed and Embase databases up to 4 February, 2019. Longitudinal observational studies reporting multivariate adjusted risk ratio (RR) and corresponding 95% confidence intervals (CI) for cardiovascular or all-cause mortality with respect to baseline low DHEAS level were included. Both fixed-effect and random effect model were used to pool the overall risk estimate. Methodological quality of the included studies was evaluated using a 9-point Newcastle-Ottawa Scale. Six prospective studies enrolling 6,744 individuals were identified. Five studies were graded as high methodological quality. When compared the lowest to the reference higher circulating DHEAS level, the pooled RR of all-cause and cardiovascular mortality was 1.46 (95% CI 1.25-1.70) and 1.49 (95% CI 1.11-1.99), respectively. Subgroup analysis indicated that the association of low DHEAS level with all-cause mortality risk was only found in men (RR 1.41;95% CI 1.18-1.69) but not in women (RR 1.72; 95% CI 0.99-2.99). This meta-analysis provides evidence that low circulating DHEAS level is associated with increased risk all-cause mortality in the elderly population.Pulsed radiofrequency (PRF) stimulation has been safely and effectively applied for controlling various types of pain. Here, we aimed to systematically review the literature pertaining to the efficacy of PRF stimulation for managing pain associated with spinal disorders. We conducted a PubMed search for papers published until August 20, 2019, that used PRF to treat pain resulting from spinal disorders. The following inclusion criteria were applied when selecting the articles (I) patients’ pain was caused by spinal disorders; (II) PRF stimulation was applied on the spinal structure; and (III) after PRF stimulation, follow-up evaluation was performed to assess the change in pain intensity. Review articles were excluded. The primary literature search yielded 168 relevant papers. After reading their titles and abstracts and evaluating their eligibility based on the full-text articles, we finally included 59 publications in this review. The therapeutic outcomes reported in the selected studies showed that PRF is an effective treatment for cervical and lumbar radicular pain. Similarly, PRF stimulation seems to be effective for treating cervical joint (cervical facet and atlantoaxial joints) pain and lumbar facet joint pain. PRF stimulation has also resulted in positive outcomes in some studies, in which patients were treated for other disorders, including cervicogenic headache, discogenic neck pain, thoracic facet joint pain, discogenic back pain, and coccydynia. Nevertheless, there is insufficient evidence for the efficacy of PRF stimulation in these disorders. In conclusion, our review provides insights into the degree of evidence available on the effectiveness of PRF stimulation for treating pain associated with each of the spinal disorders reviewed. This information will help clinicians make informed decisions on using PRF stimulation to treat various spinal conditions and manage the associated pain.

Trimethylamine N-oxide (TMAO) has been identified as a new biomarker of cardiovascular disease. find more Our aim was to evaluate the plasma levels of TMAO in patients with or without heart failure (HF), and to indicate the correlation between plasma TMAO level and HF classification in northern Chinese patients.

A total of 112 control participants and 184 HF patients participated in this study. Plasma levels of TMAO and N-terminal probrain natriuretic peptide (NT-proBNP) in all participants were examined and analyzed.

The plasma TMAO levels were remarkably higher in HF patients than that in control participants (7.0±0.6 vs. 1.5±0.1 μmol/L; P<0.01). In addition, the plasma TMAO levels of significantly increased from NYHA II to NYHA IV group (3.5±0.9, 6.0±0.8 and 8.1±1.0 μmol/L, respectively). The receiver operating characteristic analysis (ROC) showed that area under the curve (AUC) of TMAO was 0.881 (P<0.01). Furthermore, the AUC value for TMAO was 0.857 (95% CI 0.674-1.000; P<0.01), 0.845 (95% CI 0.778-0.911; P<0.01) and 0.914 (95% CI 0.872-0.956; P<0.01) in NYHA II, NYHA III and NYHA IV groups, respectively. Univariate and multivariate logistic regression analysis indicated that TMAO was an independent risk factor for HF in patients. The level of TMAO was positively correlated with NT-proBNP. However, the diagnostic ability of TMAO was lower than that of NT-proBNP.

TMAO was an independent predictor of HF, moreover, the TMAO levels were highly associated with HF classification in northern Chinese patients.

TMAO was an independent predictor of HF, moreover, the TMAO levels were highly associated with HF classification in northern Chinese patients.

Patients and their family have resistance in withholding parenteral nutrition (PN) when patient become unable to intake food in the end-of-life. We aimed to investigate whether the preference for PN is changed after receiving an individual education about the risk and benefit of PN. Additionally, we focused on the preferences of patients and their family and why they prefer it about the nutritional support in the end of life.

This is prospective study. Patients are eligible if they cannot tolerate oral intake and enteral feeding and have Palliative Performance Scale (PPS) ≤50% due to progressive cancer. After informed consent, investigators educated patients and family for an hour using the handouts. Then, patients decided if they will receive PN. Quality of life (QOL) was checked by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C15-PAL) weekly during 3 weeks. Symptoms related to fluid overloading or dehydration was surveyed weekly also. A social anthropologist participated as an observer or interviewer during whole process of this study.