rss_2.0Journal of Translational Internal Medicine FeedSciendo RSS Feed for Journal of Translational Internal Medicine of Translational Internal Medicine 's Cover lifetime cost estimation of human papillomavirus-related diseases in China: a modeling study<abstract> <title style='display:none'>Abstract</title> <sec id="j_jtim-2021-0039_s_007"> <title style='display:none'>Objectives</title> <p>To estimate the lifetime treatment costs of patients with human papillomavirus (HPV) infection-related diseases in China and to provide cost estimates for the economic evaluation of HPV intervention strategies.</p> </sec> <sec id="j_jtim-2021-0039_s_008"> <title style='display:none'>Methods</title> <p>We extracted real-world hospital data from 2012 to 2019 and screened for subjects who met the criteria of clinical diagnosis of HPV-related diseases to obtain country-specific inputs into a Markov decision model. The model simulated lifetime treatment costs for HPV from the perspective of a national payer. A 5% discount rate was applied. Costs were converted and inflated to 2020 US dollars (USD)</p> </sec> <sec id="j_jtim-2021-0039_s_009"> <title style='display:none'>Results</title> <p>Using 2021 as the base year, the lifetime costs per patient for carcinoma in situ, local metastasis, and distant metastasis cervical cancer are $24,208 (95%CI: 18,793–30,897), $19,562 (95%CI: 14,456–25,567), and $17,599 (95%CI: 10,604–25,807), respectively. For carcinoma in situ, local metastasis, and distant metastasis vaginal cancer, the lifetime costs are $17,593 (95%CI: 14,962–23,596), $17,120 (95%CI: 13,215–22,417), and $22,411 (95%CI: 12,172–22,249), respectively. The base-case lifetime cost per patient for different stages of vulvar cancer/penile cancer/anal cancer/oral cancer/oropharyngeal cancer/laryngeal cancer falls within $17,120–$58,236.</p> </sec> <sec id="j_jtim-2021-0039_s_010"> <title style='display:none'>Conclusions</title> <p>Using real-world data, we calculated lifetime treatment costs of HPV-related cancer in China and found that the lifetime cost for patients exceeded $17,000 for various stages of disease. The national burden of HPV-related disease could be significantly reduced by eliminating HPV infection.</p> </sec> </abstract>ARTICLE2021-09-28T00:00:00.000+00:00Malnutrition and venous thromboembolism are specific issues in elderly patients with coronavirus disease 2019 transmural drainage and necrosectomy in acute necrotizing pancreatitis: A review<abstract> <title style='display:none'>Abstract</title> <p>Acute necrotizing pancreatitis occurs in 10%–20% of patients with acute pancreatitis (AP) which is one of the most important acute abdominal diseases that require hospital admission. Pancreatic necrosis is also associated with high mortality and morbidity. In the past 20 years, the treatment of pancreatic necrosis has shifted from open necrosectomy to minimally invasive techniques, such as endoscopic interventions. With the development of endoscopic techniques, the safety and effectiveness of endoscopic interventions have improved, but there exist several unresolved problems. Currently, there is no unified standard approach for endoscopic treatment of pancreatic necrosis that takes into account local expertise, anatomical features of necrosis, patients’ preferences, and comorbidity profile. We reviewed the current status of endoscopic therapy for acute necrotizing pancreatitis, focusing on the new endoscopic drainage technique and necrosectomy protocol.</p></abstract>ARTICLE2021-09-28T00:00:00.000+00:00Acute bronchiolitis: Why put an IV line?<abstract> <title style='display:none'>Abstract</title> <sec id="j_jtim-2021-0013_s_007"> <title style='display:none'>Background</title> <p>Acute bronchiolitis is the most frequent cause of respiratory distress in pediatric emergency medicine. The risk of respiratory failure is frequently over evaluated, and results in systematic vascular access.</p> </sec> <sec id="j_jtim-2021-0013_s_008"> <title style='display:none'>Methods</title> <p>We conducted a prospective observational study in children under 18 months of age hospitalized for bronchiolitis. The aim of the study was to evaluate whether catheter insertion was useful for management. We monitored the number of catheters inserted in the emergency department and their subsequent use for rapid sequence intubation, adrenaline administration, or antimicrobial therapy. We recorded the number of secondary pediatric intensive care unit (ICU) admissions.</p> </sec> <sec id="j_jtim-2021-0013_s_009"> <title style='display:none'>Results</title> <p>We followed 162 patients and compared two populations, children with (population A, <italic>n</italic> = 35) and without (population B, <italic>n</italic> = 127) catheter insertion. There were no significant differences in age, oxygen saturation, heart rate, c-reactive protein, neutrophil count and the number of times nebulization was conducted at admission. Population A compared to B had a significantly higher temperature (38.1 ± 0.9 <italic>vs</italic>. 37.6 ± 0.7°C, <italic>P</italic> = 0.004) and respiratory rate (64 ±13 <italic>vs</italic>. 59 ±17, <italic>P</italic> = 0.033). Twelve patients were secondarily transferred to pediatric ICU, 3 from population A and 9 from B (NS). In a multivariate analysis, no significant relationship was found between ICU admission, venous access placement and potential confounding factors (pneumonia, age &lt; 6 months, age &lt; 3 months, food intake &lt; 60%, temperature &gt; 38° C, heart rate &gt; 180 bpm, respiratory rate &gt; 60/min, SpO<sub>2</sub> &lt; 95%, Spo<sub>2</sub> &lt; 90%, oxygen therapy, positive respiratory syncytial virus [RSV] sampling). Except for antimicrobial therapy (<italic>n</italic> = 32), catheters inserted in the emergency department were used in 5 patients for intravenous rehydration and in one patient in pediatric ICU for rapid sequence intubation.</p> </sec> <sec id="j_jtim-2021-0013_s_010"> <title style='display:none'>Conclusions</title> <p>There were no life-threatening events that required immediate venous access for cardiopulmonary resuscitation. Medical treatment could be administered orally or via nasogastric tube in most cases. Peripheral catheterization was useless in immediate emergency management and only one child required a differed rapid sequence intubation.</p> </sec> </abstract>ARTICLE2021-09-28T00:00:00.000+00:00Cardiovascular involvement in patients with 2019 novel coronavirus disease<abstract> <title style='display:none'>Abstract</title> <p>2019 novel coronavirus disease (COVID-19) is caused by the infection of severe acute respiratory syndrome novel coronavirus (SARS-CoV-2). It is characterized by substantial respiratory symptoms and complicated with widespread other organ injuries. Cardiovascular impairment is one of the notable extrapulmonary manifestations, in terms of the deterioration of pre-existing cardiovascular diseases and newly onset acute events. We hereby review the high-quality reports about cardiovascular involvement in COVID-19 and summarize the main clinical characteristics of cardiac relevance for the all the first line clinical physicians. Additionally, the possible underlying mechanisms and the rationale for the application of specific medications, such as renin-angiotensin-aldosterone system inhibitors and hydroxychloroquine are also discussed.</p></abstract>ARTICLE2021-09-28T00:00:00.000+00:00Advances in clinical research in chronic kidney disease predictive value of cTnI and NT-proBNP on mortality in patients with coronavirus disease 2019: A retrospective research in Wuhan, China<abstract> <title style='display:none'>Abstract</title> <sec id="j_jtim-2021-0034_s_007"> <title style='display:none'>Background and Objectives</title> <p>The pandemic of coronavirus disease 2019 (COVID-19) remains to be the biggest public threat all over the world. Because of the rapid deterioration in some patients, markers that could predict poor clinical outcomes are urgently required. This study was to evaluate the predictive values of cardiac injury parameters, including cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, on mortality in COVID-19 patients.</p> </sec> <sec id="j_jtim-2021-0034_s_008"> <title style='display:none'>Methods</title> <p>COVID-19 patients in Zhongfaxincheng branch of Tongji Hospital (Wuhan, China) from February 8–28, 2020, were enrolled in this study. We followed up the patients for 30 days after admission.</p> </sec> <sec id="j_jtim-2021-0034_s_009"> <title style='display:none'>Results</title> <p>A total of 134 patients were included in the study. Multivariate Cox regression showed that 1) patients with elevated cTnI levels had a higher risk of death (hazard ratio [HR] 7.33, 95% confidence interval [CI] 2.56–21.00) than patients with normal cTnI levels; 2) patients with elevated NT-proBNP levels had a higher risk of death (HR 27.88, 95% CI 3.55–218.78) than patients with normal NT-proBNP levels; 3) patients with both elevated cTnI and NT-proBNP levels had a significantly higher risk of death (HR 53.87, 95% CI 6.31–459.91, <italic>P</italic> &lt; 0.001) compared to patients without elevated cTnI or NT-proBNP levels; 4) the progressions of cTnI and NT-proBNP levels were also correlated with death (HR 12.70, 95% CI 3.94–40.88, <italic>P</italic> &lt; 0.001 and HR 51.09, 95% CI 5.82–448.26, <italic>P</italic> &lt; 0.001).</p> </sec> <sec id="j_jtim-2021-0034_s_010"> <title style='display:none'>Conclusions</title> <p>In COVID-19 patients, cTnI and NT-proBNP levels could be monitored to identify patients at a high risk of death in their later course of disease.</p> </sec> </abstract>ARTICLE2021-09-28T00:00:00.000+00:00The prognostic value of Krebs von den Lungen-6 and surfactant protein-A levels in the patients with interstitial lung disease<abstract> <title style='display:none'>Abstract</title> <sec id="j_jtim-2021-0040_s_006"> <title style='display:none'>Background and Objectives</title> <p>The highly variable clinical course of interstitial lung disease (ILD) makes it difficult to predict patient prognosis. Serum surfactant protein-A (SP-A) and Krebs von den Lungen-6 (KL-6) are known prognostic biomarkers. However, the clinical or pathophysiological differences in patients with these biomarkers have not been well evaluated. We investigated the clinical and pathophysiological differences through the comparison of SP-A and KL-6 levels before and after treatment.</p> </sec> <sec id="j_jtim-2021-0040_s_007"> <title style='display:none'>Methods</title> <p>This study included retrospective data from 91 patients who were treated for ILD between August 2015 and September 2019. Serum SP-A and KL-6 levels were measured before and after treatment. The patients were followed up for 3 months.</p> </sec> <sec id="j_jtim-2021-0040_s_008"> <title style='display:none'>Results</title> <p>Changes in the serum biomarkers (Delta SP-A and Delta KL-6) were found to be significantly correlated (rs = 0.523, <italic>P</italic> &lt; 0.001); Delta SP-A and Delta KL-6 were inversely correlated with changes in pulmonary function (% predicted values of diffusing capacity for carbon monoxide [DLCO], forced vital capacity [FVC], and forced expiratory volume in 1 s [FEV1]). Patients were divided into four groups based on their Delta SP-A and Delta KL-6 levels in a cluster analysis (G1, G2, G3, and G4). Both SP-A and KL-6 were elevated in the G1 group, with all the patients enrolled classified as progressive or unchanged, and 86.4% of patients showed improved disease activity in the G4 group, where both SP-A and KL-6 levels were reduced. In the G2 group, only SP-A levels decreased post-treatment, indicating an improvement in respiratory function; the patients were not at the end stage of the disease. Only the SP-A levels increased in the G3 group with immunosuppressive treatment.</p> </sec> <sec id="j_jtim-2021-0040_s_009"> <title style='display:none'>Conclusions</title> <p>Reduced serum SP-A and/or KL-6 levels are associated with improved lung function in patients with ILD. Some patients only showed a decrease in SP-A levels could prognosis an improvement in respiratory function. When only SP-A is increased, it may imply that the patients are at an early stage of disease progression. As a result, for proper disease monitoring, measuring both markers is important.</p> </sec> </abstract>ARTICLE2021-09-28T00:00:00.000+00:00Traditional Chinese medicine in treating IgA nephropathy: from basic science to clinical research<abstract> <title style='display:none'>Abstract</title> <p>IgA nephropathy (IgAN) is a major cause of chronic kidney disease (CKD) and end-stage renal disease worldwide. Currently, clinical interventions for IgAN are limited, and many patients seek out alternative therapies such as traditional Chinese medicine (TCM). In the last several years, TCM has accumulated ample application experiences and achieved favorable clinical effects. This article summarizes high-quality research from basic science to clinical applications aimed to provide more evidence-based medicine proof for the clinical treatment of IgAN. In summary, qi and yin deficiency accounted for the largest proportion in IgAN patients, and the treatment of IgAN should be based on supplementing qi and nourishing yin. Further, for patients with severe IgAN, the treatment combination of Chinese and Western medicines is better than pure Chinese medicine or hormone therapy. In addition, the pharmacological mechanism of Chinese herbal medicines is mostly based on restoring the immune function, relieving the inflammation damage, and inhibiting proliferation of the glomerular mesangial cells.</p></abstract>ARTICLE2021-09-28T00:00:00.000+00:00Repair of damaged pancreatic β cells: New hope for a type 2 diabetes reversal? of fungal-based peptides as modulators of angiotensin-converting enzyme-related carboxypeptidase, SARS-coronavirus HR2 domain, and coronavirus disease 2019 main protease<abstract> <title style='display:none'>Abstract</title> <sec id="j_jtim-2021-0038_s_006"> <title style='display:none'>Background and Objectives</title> <p>Angiotensin-converting enzyme-related carboxypeptidase, SARS-Coronavirus HR2 Domain, and COVID-19 main protease are essential for the cellular entry and replication of coronavirus in the host. This study investigated the putative inhibitory action of peptides form medicinal mushrooms, namely <italic>Pseudoplectania nigrella</italic>, <italic>Russula paludosa</italic>, and <italic>Clitocybe sinopica</italic>, towards selected proteins through computational studies.</p> </sec> <sec id="j_jtim-2021-0038_s_007"> <title style='display:none'>Materials and Methods</title> <p>The respective physicochemical properties of selected peptides were predicted using ProtParam tool, while the binding modes and binding free energy of selected peptides toward proteins were computed through HawkDock server. The structural flexibility and stability of docked protein–peptide complexes were assessed through iMODS server.</p> </sec> <sec id="j_jtim-2021-0038_s_008"> <title style='display:none'>Results</title> <p>The peptides showed an optimum binding afinity with the molecular targets; plectasin from <italic>P. nigrella</italic> showed the highest binding free energy compared to peptides from <italic>R. paludosa</italic> and <italic>C. sinopica</italic>. Besides, molecular dynamic simulations showed all fungal-based peptides could influence the flexibility and stability of selected proteins.</p> </sec> <sec id="j_jtim-2021-0038_s_009"> <title style='display:none'>Conclusion</title> <p>The study revealed fungal-based peptides could be explored as functional modulators of essential proteins that are involved in the cellular entry of coronavirus.</p> </sec> </abstract>ARTICLE2021-09-28T00:00:00.000+00:00Comparing the performance of the ABC, AIMS65, GBS, and pRS scores in predicting 90-day mortality or rebleeding among emergency department patients with acute upper gastrointestinal bleeding: A prospective multicenter study<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Background and Objectives</title><p>Acute upper gastrointestinal bleeding (UGIB) is a common problem that can cause significant morbidity and mortality. We aimed to compare the performance of the ABC score (ABC), the AIMS65 score (AIMS65), the Glasgow-Blatchford score (GBS), and the pre-endoscopic Rockall score (pRS) in predicting 90-day mortality or rebleeding among patients with acute UGIB.</p></sec><sec><title style='display:none'>Methods</title><p>This was a prospective multicenter study conducted at 20 tertiary hospitals in China. Data were collected between June 30, 2020 and February 10, 2021. An area under the receiver operating characteristic curve (AUC) analysis was used to compare the performance of the four scores in predicting 90-day mortality or rebleeding.</p></sec><sec><title style='display:none'>Results</title><p>Among the 1072 patients included during the study period, the overall 90-day mortality rate was 10.91% (117/1072) and the rebleeding rate was 12.03% (129/1072). In predicting 90-day mortality, the ABC and pRS scores performed better with an AUC of 0.722 (95% CI 0.675–0.768; <italic>P</italic>&lt;0.001) and 0.711 (95% CI 0.663–0.757; <italic>P</italic>&lt;0.001), respectively, compared to the AIMS-65 (AUC, 0.672; 95% CI, 0.624–0.721; <italic>P</italic>&lt;0.001) and GBS (AUC, 0.624; 95% CI, 0.569–0.679; <italic>P</italic>&lt;0.001) scores. In predicting rebleeding in 90 days, the AUC of all scores did not exceed 0.70.</p></sec><sec><title style='display:none'>Conclusion</title><p>In patients with acute UGIB, ABC and pRS performed better than AIMS-65 and GBS in predicting 90-day mortality. The performance of each score is not satisfactory in predicting rebleeding, however. Newer predictive models are needed to predict rebleeding after UGIB.</p></sec></abstract>ARTICLE2021-06-16T00:00:00.000+00:00Prone positioning in coronavirus disease 2019 patients with acute respiratory distress syndrome: How and when is the best way to do it? plasma for coronavirus disease 2019: Dose is the key of des-acyl ghrelin on insulin sensitivity and macrophage polarization in adipose tissue<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Background and Objectives</title><p>Obesity is the accumulation of adipose tissue caused by excess energy in the body, accompanied by long-term chronic low-grade inflammation of adipose tissue. More than 50% of interstitial cells in adipose tissue are macrophages, which produce cytokines closely related to insulin resistance. Macrophage biology is driven by two polarization phenotypes, M1 (proinflammatory) and M2 (anti-inflammatory). This study aimed to investigate the effect of gastric hormone des-acyl ghrelin (DAG) on the polarization phenotype of macrophages and elucidate the role of macrophages in adipose tissue inflammation and insulin sensitivity and its molecular mechanism.</p></sec><sec><title style='display:none'>Methods</title><p>Mice were subcutaneously administrated with DAG in osmotic minipumps. The mice were fed a normal diet or a high-fat diet (HFD). Different macrophage markers were detected by real-time revere transcription polymerase chain reaction.</p></sec><sec><title style='display:none'>Results</title><p>Exogenous administration of DAG significantly inhibited the increase of adipocyte volume caused by HFD and reduced the number of rosette-like structures in adipose tissue. HFD in the control group significantly increased M1 macrophage markers, tumor necrosis factor α (TNFα), and inducible NO synthase (iNOS). However, these increases were reduced or even reversed after DAG administration <italic>in vitro</italic>. The M2 markers, macrophage galactose type C-type Lectin-1 (MGL1), arginase 1 (Arg1), and macrophage mannose receptor 1 (MRC1) were decreased by HFD, and the downward trend was inhibited or reversed after DAG administration. Although Arg1 was elevated after HFD, the fold increase after DAG administration <italic>in vitro</italic> was much greater than that in the control group.</p></sec><sec><title style='display:none'>Conclusion</title><p>DAG inhibits adipose tissue inflammation caused by HFD, reduces infiltration of macrophages in adipose tissue, and promotes polarization of macrophages to M2, thus alleviating obesity and improving insulin sensitivity.</p></sec></abstract>ARTICLE2021-07-02T00:00:00.000+00:00A network pharmacology approach to explore the mechanism of HuangZhi YiShen Capsule for treatment of diabetic kidney disease<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Background and Objective</title><p>HuangZhi YiShen Capsule (HZYS) is a Chinese patent herbal drug that protects kidney function in diabetic kidney disease (DKD) patients. However, the pharmacologic mechanisms of HZYS remain unclear. This study would use network pharmacology to explore the pharmacologic mechanisms of HZYS.</p></sec><sec><title style='display:none'>Methods</title><p>Chemical constituents of HZYS were obtained through the Traditional Chinese Medicine Systems Pharmacology Database (TCMSP) and literature search. Potential targets of HZYS were identified by using the TCMSP and the SwissTarget Prediction databases. DKD-related target genes were collected by using the Online Mendelian Inheritance in Man, Therapeutic Target Database, GeneCards, DisGeNET, and Drugbank databases. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were carried out to further explore the mechanisms of HZYS in treating DKD. Molecular docking was conducted to verify the potential interactions between the prime compounds and the hub genes.</p></sec><sec><title style='display:none'>Results</title><p>179 active compounds and 620 target genes were obtained, and 571 common targets were considered potential therapeutic targets. The top 10 main active compounds of HZYS were heparin, quercetin, kaempferol, luteolin, methyl14-methylpentadecanoate, methyl (Z)-11-hexadecenoate, 17-hydroxycorticosterone, 4-pregnene-17α, 20β, 21-triol-3, 11-dione, wogonin, and hydroxyecdysone. Hub signaling pathways by which HZYS treating DKD were PI3K-Akt, MAPK, AGE-RAGE in diabetic complications, TNF, and apoptosis. The top 10 target genes associated with these pathways were <italic>IL6, MAPK1, AKT1, RELA, BCL2, JUN, MAPK3, MAP2K1, CASP3,</italic> and <italic>TNF</italic>. Quercetin and Luteolin were verified to have good binding capability with the hub potential targets <italic>IL6, MAPK1, AKT1</italic> through molecular docking.</p></sec><sec><title style='display:none'>Conclusion</title><p>HZYS appeared to treat DKD by regulating the inflammatory, oxidative stress, apoptotic, and fibrosis signaling pathways. This study provided a novel perspective for further research of HZYS.</p></sec></abstract>ARTICLE2021-06-18T00:00:00.000+00:00Thyroid autoimmunity in adverse fertility and pregnancy outcomes: Timing of assisted reproductive technology in AITD women<abstract><title style='display:none'>Abstract</title><p>Thyroid autoimmunity (TAI) is prevalent in women of live-birthing age and has independently been associated with complications of fertility and pregnancy, in the case of spontaneous conception or after assisted reproductive technology (ART) treatment. However, it remains challenging to identify causation between infertility and TAI, even interventional trials looking at the impact of levothyroxine (LT4) treatment on fertility and pregnancy outcomes due to differences among study results which related to small scales, impropriate study designs, enrollment criteria of infertility cause and titer/hormone concentration measurements. Furthermore, many questions remain unsettled in ART management in AITD infertile women attempt pregnancy. Therefore, further observational and interventional trials are needed more comprehensive multiple-center, double blinded, and randomized.</p></abstract>ARTICLE2021-01-05T00:00:00.000+00:00Clinical challenges with hypervirulent (hvKP) in China<abstract><title style='display:none'>Abstract</title><p>Hypervirulent <italic>Klebsiella pneumoniae</italic> (hvKp) is an evolving pathotype with higher virulence than classical <italic>K. pneumoniae</italic> (cKp) and is characterized by community-acquired, multiple sites of infections and young and healthy hosts. hvKP infections were primarily found in East Asia and have been increasingly reported worldwide over the past few decades. To better understand the clinical challenges faced by China with hvKP, this review will provide a summary and discussion focused on recognizing hvKP strains and prevalence of antibiotic-resistant hypervirulent strains in China and the mechanisms of acquiring antimicrobial resistance. Compared with cKP, hvKP is likely to cause serious disseminated infections, leading to a higher mortality. However, sensitive and specific clinical microbiology laboratory tests are still not available. Given the limited published data due to the clinical difficulty in differentiating hvKP from cKP, extrapolation of the previous data may not be applicable for the management of hvKP. A consensus definition of hvKP is needed. Furthermore, an increasing number of reports have described hvKp strains with antimicrobial resistance acquisition, increasing the challenges for management of hvKP. China, as an epidemic country, is also facing these challenges. Quite a number of studies from China have reported antibiotic-resistant hvKP strains, including extended-spectrum β-lactamase (ESBL), and carbapenem-, tigecycline-, and colistin-resistant strains. hvKP infections, especially those of antimicrobial-resistant strains, pose to be a great threat for public health in China. Therefore, an immediate response to recognize the hypervirulent strains and provide optimal treatments, especially those with resistance determinants, is an urgent priority for China.</p></abstract>ARTICLE2021-01-05T00:00:00.000+00:00Predictive value of lymphocyte-to-monocyte ratio in patients with contrast-induced nephropathy after percutaneous coronary intervention for acute coronary syndrome<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Background and Objectives</title><p>Lymphocyte-to-monocyte ratio (LMR) has emerged as a new indirect marker of inflammation, which is associated with adverse outcomes in cardiovascular diseases. The aim of this study was to evaluate whether admission LMR is associated with contrast-induced nephropathy (CIN) in patients who underwent percutaneous coronary intervention for acute coronary syndrome (ACS).</p></sec><sec><title style='display:none'>Methods</title><p>A total of 873 patients were assessed. LMR was calculated via dividing lymphocyte count by monocyte count.</p></sec><sec><title style='display:none'>Results</title><p>LMR was significantly lower in the with-CIN group. ROC analysis showed that the LMR ratios &lt;2.52 predicted CIN development with sensitivity of 66.3% and specificity of 55.8%. Multivariate analysis showed that eGFR, admission glucose, and LMR were independent predictors of CIN in patients with ACS.</p></sec><sec><title style='display:none'>Conclusion</title><p>LMR is an easily accessible marker and could be used as a predictor of CIN in patients with ACS undergoing percutaneous coronary intervention.</p></sec></abstract>ARTICLE2021-07-09T00:00:00.000+00:00Current status and future direction of community-based management of hypertension in China