ObjectiveTo explore the causal relationship between immune cells and heart failure (HF), and the mediating role of serum metabolites, in order to identify potential biomarkers and therapeutic targets. MethodsWe employed a two-sample Mendelian randomization (MR) analysis method based on genome-wide association study (GWAS) data, analyzing the direct and indirect effects of 731 types of immune cells and 1 400 metabolites on HF. We selected valid instrumental variables and conducted statistical analyses using R software. The primary analysis was performed using the inverse variance weighted method, supplemented by MR-Egger analysis and weighted median method. The stability of the results was assessed through tests such as Cochran’s Q. ResultsOur research found a negative causal relationship between PD-L1 on CD14−CD16+ and HF. Sensitivity analysis supported this result. The reverse MR analysis did not find an effect of HF on PD-L1 on CD14−CD16+, indicating that PD-L1 on CD14−CD16+ may play a unidirectional role in reducing the risk of HF. Further mediation MR analysis showed that PD-L1 on CD14−CD16+ might influence the risk of HF onset by regulating the levels of sphingomyelin (d17:1/14:0, d16:1/15:0), with a mediation effect ratio of 6.7%. ConclusionPD-L1 on CD14−CD16+ might reduce the risk of HF by elevating the levels of sphingomyelin (d17:1/14:0, d16:1/15:0), providing a new perspective for understanding the pathogenesis of HF.
ObjectiveTo systematically investigate the current status of reporting health economics evidence in clinical practice guidelines and expert consensuses published in China from 2021 to 2023, providing references for the formulation and revision of guidelines and consensuses in our country. MethodsComputer searches were conducted in the CNKI, CBM, WanFang Data, China Academic Journals Full-text Database, PubMed, and Web of Science to collect clinical practice guidelines and expert consensuses published in China from 2021 to 2023. Two researchers independently screened the literature, extracted information on the inclusion of economic evidence in guidelines and consensuses, and then used quantitative analysis methods for description. ResultsA total of 4 236 relevant articles were included, of which 1 066 (25.17%) reported health economics evidence; 120 (11.26%) reported health economics evidence in the formation of recommendation opinions; 109 (10.23%) reported health economics evidence in the grading of evidence quality; 832 (78.05%) reported health economics evidence in the interpretation and explanation of recommendation opinions. ConclusionThe reporting rate of health economics evidence in clinical practice guidelines and expert consensuses published in China is not high; the reporting rate of health economics evidence in consensuses is lower than that in guidelines. It is recommended that during the formulation process of guidelines and consensuses, the application of health economics evidence should be further strengthened in aspects such as the formation of recommendation opinions, the grading of evidence quality, and the interpretation and explanation of recommendation opinions, in order to improve the scientific, rigorous, and applicability of clinical practice guidelines and expert consensuses, and to play the role of guidelines and consensuses in optimizing the allocation of health resources, improving clinical diagnosis and treatment effects, and enhancing the quality of medical care.
ObjectiveTo understand the distribution of demographic sociological characteristics and co-morbidities among primiparous and multiparous pregnant women under the China's universal two-child policy, to provide baseline data for clinical high-risk management and medical resources allocation.MethodsWe included pregnant women from 24 hospitals in 16 provinces (municipality, autonomous region) of China and collected their demographic sociological characteristics and obstetrics information by questionnaires between September 19th, and November 20th, 2016. Then, we used descriptive analysis to present the distribution of demographic sociological characteristics and pregnancy co-morbidities among primiparous and multiparous women and compared differences between groups by t test or Chi-square test.ResultsAmong 12 403 investigated pregnant women, 8 268 (66.7%) were primiparous and 4 135 (33.3%) were multiparous, with highest proportion in East (931/2 008, 46.4%) and lowest in Northeast (385/2 179, 17.7%). Multiparous women, comparing to primiparous women, were more likely to be elderly than 35 years (accounting for 30.6% vs. 6.5%), lower educated with high school or below (29.7% vs. 16.9%), occupied in physical labor or unemployed (49.2% vs. 42.5%), non-local residents (12.7% vs. 10.5%), family annual income higher than 120 thousand yuan (41.3% vs. 33.3%), pre-pregnancy body mass index≥24 kg/m2 (13.6% vs. 9.9%), history of artificial abortions (44.9% vs. 24.0%), or pregnancies≥4 times (23.8% vs. 3.1%) and were less likely to receive assisted reproductive technology (2.3% vs. 4.7%). The most common co-morbidities were gynecology disease (5.5%), thyroid disease (5.4% in all women), blood system disease (5.0%), digestive system disease (4.2%) and hepatitis B infection (2.5%). Multiparous women, comparing to primiparous women, had higher proportions with blood system disease (5.7% vs. 4.7%), hepatitis B infection (3.1% vs. 2.2%) and chronic hypertension (0.6% vs. 0.2%), but lower proportions with thyroid diseases, polycystic ovary syndrome, and immune system diseases, whose distribution also showed regional differences.ConclusionThere existed distribution differences regarding demographic sociological characteristics and co-morbidities proportions between primiparous and multiparous women. Therefore, we should improve clinical risk management and medical resources allocation based on pregnant women’s baseline and gestational characteristics.