Objective We aimed to investigate the patterns of fasting blood glucose(FBG)trajectories and analyze the relationship between various occupational hazard factors and FBG trajectories in male steelworkers.Methods The s...Objective We aimed to investigate the patterns of fasting blood glucose(FBG)trajectories and analyze the relationship between various occupational hazard factors and FBG trajectories in male steelworkers.Methods The study cohort included 3,728 workers who met the selection criteria for the Tanggang Occupational Cohort(TGOC)between 2017 and 2022.A group-based trajectory model was used to identify the FBG trajectories.Environmental risk scores(ERS)were constructed using regression coefficients from the occupational hazard model as weights.Univariate and multivariate logistic regression analyses were performed to explore the effects of occupational hazard factors using the ERS on FBG trajectories.Results FBG trajectories were categorized into three groups.An association was observed between high temperature,noise exposure,and FBG trajectory(P<0.05).Using the first quartile group of ERS1 as a reference,the fourth quartile group of ERS1 had an increased risk of medium and high FBG by 1.90and 2.21 times,respectively(odds ratio[OR]=1.90,95%confidence interval[CI]:1.17–3.10;OR=2.21,95%CI:1.09–4.45).Conclusion An association was observed between occupational hazards based on ERS and FBG trajectories.The risk of FBG trajectory levels increase with an increase in ERS.展开更多
BACKGROUND Clinical predictors of dengue fever are crucial for guiding timely management and avoiding life-threatening complications.While prognostic scores are available,a systematic evaluation of these tools is lack...BACKGROUND Clinical predictors of dengue fever are crucial for guiding timely management and avoiding life-threatening complications.While prognostic scores are available,a systematic evaluation of these tools is lacking.AIM To evaluate the performance and accuracy of various proposed dengue clinical prognostic scores.METHODS Three databases,PubMed,EMBASE and Cochrane,were searched for peer-reviewed studies published from inception to 4 September 2023.Studies either developing or validating a prognostic model relevant to dengue fever were included.A total of 29 studies(n=17910)were included.RESULTS Most commonly studied outcomes were severe dengue(15 models)and mortality(8 models).For the paediatric population,Bedside Dengue Severity Score by Gayathri et al(specificity=0.98)and the nomogram model by Nguyen et al(sensitivity=0.87)performed better.For the adult population,the most specific model was reported by Leo et al(specificity=0.98).The most sensitive score is shared between Warning Signs for Severe Dengue as reported by Leo et al and Model 2 by Lee et al(sensitivity=1.00).CONCLUSION While several models demonstrated precision and reliability in predicting severe dengue and mortality,broader application across diverse geographic settings is needed to assess their external validity.展开更多
BACKGROUND Chronic liver disease is a growing global health problem,leading to hepatic decompensation characterized by an array of clinical and biochemical complic-ations.Several scoring systems have been introduced i...BACKGROUND Chronic liver disease is a growing global health problem,leading to hepatic decompensation characterized by an array of clinical and biochemical complic-ations.Several scoring systems have been introduced in assessing the severity of hepatic decompensation with the most frequent ones are Child-Pugh score,model of end-stage liver disease(MELD)score,and MELD-Na score.Anemia is frequently observed in cirrhotic patients and is linked to worsened clinical outcomes.Although studies have explored anemia in liver disease,few have investigated the correlation of hemoglobin level with the severity of hepatic decompensation.AIM To determine the relationship between hemoglobin levels and the severity of decompensated liver disease and comparing the strength of this correlation using the Child-Pugh,MELD,and MELD-Na scores.METHODS This cross-sectional study was conducted at a tertiary care hospital with 652 decompensated liver disease patients enrolled in the study.Data was collected on demographics,clinical history,and laboratory findings,including hemoglobin levels,bilirubin,albumin,prothrombin time(international normalized ratio),sodium,and creatinine.The Child-Pugh,MELD,and MELD-Na scores were calculated.Statistical analysis was performed using Statistical Package for the Social Sciences version 26,and correlations between hemoglobin levels and severity scores were assessed using Spearman's correlation coefficient.RESULTS The study included 405 males(62.1%)and 247 females(37.9%)with an average age of 58.8 years.Significant inverse correlations were found between hemoglobin levels and Child-Pugh,MELD,and MELD-Na scores(P<0.01),with the MELD scoring system being the strongest correlator among all.One-way analysis of variance revealed significant differences in hemoglobin levels across the severity groups of each scoring system(P=0.001).Tukey's post hoc analysis confirmed significant internal differences among each severity group.CONCLUSION Understanding the correlation between hemoglobin and liver disease severity can improve patient management by offering insights into prognosis and guiding treatment decisions.展开更多
Objective:To evaluate the efficacy and symptom scores of early diabetic nephropathy(DKD)treated with modified Shenqi Dihuang Decoction.Methods:82 patients with early DKD who visited the hospital from February 2023 to ...Objective:To evaluate the efficacy and symptom scores of early diabetic nephropathy(DKD)treated with modified Shenqi Dihuang Decoction.Methods:82 patients with early DKD who visited the hospital from February 2023 to February 2025 were randomly divided into two groups by drawing.Group A received modified Shenqi Dihuang Decoction+SGLT2 inhibitor,while Group B received SGLT2 inhibitor only.The efficacy,symptom scores,blood glucose,and renal function were compared between the two groups.Results:The efficacy of Group A was higher than that of Group B in the treatment of early DKD(P<0.05).The DKD symptom scores of Group A were lower than those of Group B(P<0.05).The fasting blood glucose(FBG),2-hour postprandial blood glucose(PBG),and glycated hemoglobin(HbA1c)of Group A were better than those of Group B(P<0.05).The serum creatinine(SCr),blood urea nitrogen(BUN),and urinary albumin excretion rate(UAER)of Group A were also better than those of Group B.Conclusion:The combination of modified Shenqi Dihuang Decoction and SGLT2 inhibitor dapagliflozin has excellent efficacy in the treatment of early DKD,which can improve renal function,reduce DKD symptoms,and stabilize blood glucose levels.展开更多
Objective: To explore the application effect of nursing interventions based on APACHE II scores in patients with severe pancreatitis and its impact on the recovery time of the gastrointestinal function. Methods: A tot...Objective: To explore the application effect of nursing interventions based on APACHE II scores in patients with severe pancreatitis and its impact on the recovery time of the gastrointestinal function. Methods: A total of 86 patients with severe pancreatitis treated in our hospital from March 2023 to March 2024 were selected. Using a random number table method, the patients were divided into a control group receiving conventional nursing care and a study group receiving nursing interventions based on APACHE II scores, with 43 patients in each group. The intervention effects of the two groups were compared. Results: The recovery time of gastrointestinal function in the study group was significantly shorter than that in the control group (P < 0.05). After the intervention, the quality of life scores in the study group was significantly higher than those in the control group (P < 0.05). The incidence of complications in the study group was significantly lower than in the control group (P < 0.05). Conclusion: Nursing interventions based on APACHE II scores can shorten gastrointestinal recovery time and reduce complications in patients with severe pancreatitis, contributing to improved quality of life.展开更多
BACKGROUND Inflammation is closely related to survival and disease progression in patients with cancer.However,the predictive value of inflammation-based scores for survival in patients with hepatocellular carcinoma(H...BACKGROUND Inflammation is closely related to survival and disease progression in patients with cancer.However,the predictive value of inflammation-based scores for survival in patients with hepatocellular carcinoma(HCC)treated with Lenvatinib has not been fully elucidated.AIM To compare different inflammation scores'prognostic values,and establish novel nomogram for predicting overall survival(OS)in HCC patients on Lenvatinib.METHODS In total,144 patients with HCC treated with Lenvatinib were enrolled in this study.The prognostic value of pre-treatment inflammation-based scores was retrospectively analyzed,including the platelet-to-lymphocyte ratio,neutrophil-to-lymphocyte ratio,lymphocyteto-C-reactive protein ratio,lymphocyte-to-monocyte ratio,systemic immune-inflammation index,C-reactive protein-to-albumin ratio,and prognostic nutritional index(PNI).Kaplan-Meier survival curves and time-dependent receiver operating characteristic analysis were used to assess predictive accuracy.Univariate and multivariate Cox regression analyses were conducted to identify prognostic factors predicting OS and construct a prognostic nomogram.RESULTS All the inflammation-based scores demonstrated good discrimination in terms of OS(all P<0.05),and the PNI emerged as an independent predictor of OS in multivariate analysis(hazard ratio=4.097;95%confidence interval:1.405-11.944;P=0.01).We selected three independent prognostic factors(macrovascular invasion,metastasis,and PNI)to generate a nomogram for OS.CONCLUSION The PNI is a prognostic indicator for assessing OS in patients with HCC treated with Lenvatinib and is superior to other inflammation-based scores in predicting OS.展开更多
BACKGROUND Previous studies have reported the high predictive accuracy of 4C Mortality Score derived at hospital admission in coronavirus disease 2019(COVID-19)patients.Very few studies have assessed it at intensive c...BACKGROUND Previous studies have reported the high predictive accuracy of 4C Mortality Score derived at hospital admission in coronavirus disease 2019(COVID-19)patients.Very few studies have assessed it at intensive care unit(ICU)admission and compared it with the Acute Physiology and Chronic Health Evaluation(APACHE)II score.There are no studies comparing its accuracy with APACHE III score.AIM To describe the characteristics and outcomes of patients admitted to ICU with COVID-19 infection and to compare the accuracy of 4C score and APACHE score in predicting mortality in these patients.METHODS We conducted this retrospective cohort study using an electronic database in a tertiary ICU in Sydney.We included all adult patients(age>16 years)admitted to ICU with COVID-19 infection over a 5-month period(July 1,2021 to November 30,2021).We collected the data on demographics,clinical characteristics,interventions and outcomes for all patients.We calculated the 4C Mortality Score for each patient using eight variables as described previously.We compared the predictive accuracy of 4C Mortality Score at hospital and ICU admission and APACHE II and III scores by area under the receiver operating characteristic curve(AUROC).We determined the optimal cut-off value for each of these scores using the‘nearest’method and its 95%confidence interval by bootstrapping.RESULTS A total of 140 patients(62%males,mean age 56±17 years,mean APACHE II score 13±57)were included in the study.Nineteen(13.6%)of 140 patients died in the hospital.Compared to survivors,the non-survivors were older,males,had more comorbidities,higher rate of mechanical ventilation and vasopressor use.The AUROC for the 4C Mortality Score at hospital and ICU admission and APACHE II and II score was 0.75,0.80.0.75 and 0.79 respectively.The optimal cut-off value for these four scores was 9,10,14 and 56 respectively.The cut-point for all the scores had higher sensitivity than specificity.CONCLUSION The 4C score at ICU admission had a higher accuracy in predicting mortality than the 4C score at hospital admission.The predictive accuracy was similar to that for APACHE III score.The 4C score at ICU admission needs to be validated in future studies.展开更多
BACKGROUND:Extracorporeal membrane oxygenation(ECMO)is an effective measure for saving the lives of critically ill patients.Prompt identification of the risk factors for mortality among patients receiving ECMO and com...BACKGROUND:Extracorporeal membrane oxygenation(ECMO)is an effective measure for saving the lives of critically ill patients.Prompt identification of the risk factors for mortality among patients receiving ECMO and comprehensive analysis of the long-term prognosis of survivors are vital.This scoping review summarized the representative prognostic scoring systems,aiming to help clinicians in selecting an appropriate scoring system to avoid unnecessary medical resource consumption and reduce ECMO-associated mortality.METHODS:A comprehensive search of multiple databases,including PubMed,Embase,and the Cochrane Library,was conducted.After removing duplicate studies,a full-text review was performed,and all studies that reported score systems before and/or after ECMO support were included.This protocol adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews(PRISMA-ScR)and has been registered with the Open Science Framework(osf.io/zp4ge).RESULTS:Among the 114 studies included,we identified three scores for patients receiving veno-venous ECMO(VV-ECMO),five scores for patients receiving veno-arterial ECMO(VA-ECMO),and three critical illness scores,which apply to both VV-and VA-ECMO conditions.All characteristics of these scoring systems,their advantages,and their limitations were summarized.CONCLUSION:The implementation of an ECMO scoring system helps to assess the condition of critically ill patients,predict outcome,and provide objective indicators to determine the optimal timing for ECMO intervention.Due to the limitations of the currently available scores,further efforts in improving and validating the ECMO scoring system are needed to achieve the goals of minimizing unnecessary consumption of medical resources and reducing mortality rates.展开更多
Objective:To investigate the value of dynamic monitoring of serum interleukin(IL)-33 and tumor necrosis factor(TNF)-αlevels in the early diagnosis,severity assessment and prognosis of acute pancreatitis(AP)combined w...Objective:To investigate the value of dynamic monitoring of serum interleukin(IL)-33 and tumor necrosis factor(TNF)-αlevels in the early diagnosis,severity assessment and prognosis of acute pancreatitis(AP)combined with abdominal CT radiomics and intestinal microbiota data.Methods:A total of 170 AP patients were admitted immediately after the onset of the disease and divided into MAP group(85 cases)and SAP group(85 cases).The levels of serum IL-33,TNF-α,IL-6,and HMGB1,as well as the expression of miRNA-155 in extracellular vesicles(EVs),were dynamically monitored at multiple time points(0 h,6 h,12 h,24 h,3 d,5 d,7 d,14 d)after admission.Abdominal CT radiomics analyzed the texture characteristics of pancreatic necrosis,and stool samples collected at admission were metagenomic sequencing of the gut microbiome.The Acute Pancreatitis Severity Bedside Index(BISAP)score is calculated within 48 hours of admission.Multivariate regression analysis assessed the independent effects of various factors on the prognosis of mortality groups.Results:Serum IL-33 and TNF-αlevels in SAP patients were significantly higher than those in MAP patients(p<0.05)at all time points,peaked on day 3,and decreased with treatment.The levels of these cytokines in patients with SIRS were also higher than in patients without SIRS(p<0.05).The serum IL-33,TNF-αlevels and BISAP scores in the mortality group were higher than those in the survival group(p<0.05).Multivariate regression analysis showed that serum IL-33(OR=3.21,95%CI:1.12–9.23,p=0.03),TNF-α(OR=4.05,95%CI:1.37–11.96,p=0.01),and BISAP score(OR=5.67,95%CI:1.83–17.54,p<0.01)were independent prognostic risk factors.Spearman correlation analysis showed that serum IL-33 and TNF-αlevels were positively correlated with BISAP scores(r=0.68,p<0.01;r=0.73,p<0.01).Conclusion:Dynamic monitoring of serum IL-33 and TNF-αlevels combined with BISAP score has important clinical value for early diagnosis,severity assessment,treatment guidance and prognosis evaluation of AP,and provides a basis for accurate diagnosis and treatment.展开更多
Objective:To evaluate the therapeutic effect of Shenqi Dihuang Decoction combined with calcium dobesilate on patients with diabetic nephropathy(DKD).Methods:90 patients with DKD who visited the hospital from March 202...Objective:To evaluate the therapeutic effect of Shenqi Dihuang Decoction combined with calcium dobesilate on patients with diabetic nephropathy(DKD).Methods:90 patients with DKD who visited the hospital from March 2024 to March 2025 were selected as samples and randomly divided into two groups.Group A was treated with Shenqi Dihuang Decoction combined with calcium dobesilate,while Group B was treated with calcium dobesilate alone.The efficacy,syndrome scores,blood glucose levels,and renal function indicators were compared between the two groups.Results:The efficacy of DKD treatment in Group A was higher than that in Group B(P<0.05).The syndrome scores in Group A were lower than those in Group B(P<0.05).The 2-hour postprandial blood glucose(PBG),fasting blood glucose(FBG),and glycated hemoglobin(HbA1c)levels in Group A were lower than those in Group B(P<0.05).The serum creatinine(SCr),urinary microalbumin,urinary albumin excretion rate(UAER),and β2-microglobulin(β2-MG)levels in Group A were also lower than those in Group B(P<0.05).Conclusion:The treatment of DKD with Shenqi Dihuang Decoction combined with calcium dobesilate can stabilize blood glucose levels,improve renal function,and reduce syndrome scores,which is highly effective and feasible.展开更多
BACKGROUND In the field of anesthesia for procedure for prolapse and hemorrhoids(PPH)surgery,combined spinal-epidural(CSE)anesthesia has been a common approach.However,exploring new combinations to optimize patient ou...BACKGROUND In the field of anesthesia for procedure for prolapse and hemorrhoids(PPH)surgery,combined spinal-epidural(CSE)anesthesia has been a common approach.However,exploring new combinations to optimize patient outcomes remains crucial.Remimazolam,a short-acting benzodiazepine,shows potential for improving sedation and reducing patient anxiety.The effects of combining remimazolam with CSE anesthesia,compared to traditional CSE anesthesia alone,on patient anxiety,sedation depth,and hemodynamics during PPH surgery have not been fully elucidated.AIM To compare remimazolam-CSE vs CSE alone on State-Trait Anxiety Inventory-State scale(STAI-S)scores,sedation,and hemodynamics in PPH surgery.METHODS This study is a single-center,prospective,randomized controlled trial.Between November 23,2022,and August 6,2024,60 eligible patients were randomly assigned to the CSE anesthesia group or the remimazolam-combined CSE anesthesia group(30 patients each).STAI-S scores,Ramsay sedation scores,and hemodynamic parameters(systolic blood pressure,diastolic blood pressure,heart rate)were measured at multiple time points.Two-way mixed-effects ANOVA and posthoc analyses were performed.RESULTS The Combined group demonstrated significantly lower STAI-S scores before leaving the operating room[mean:28.80 vs 54.03,mean difference(95%CI):25.23(21.24-29.23),P<0.001]and 24 hours post-operation[mean:45.07 vs 54.53,mean difference(95%CI):9.47(6.29-12.64),P<0.001]than the CSE group.Moreover,the Combined group achieved a deeper sedation level during intraoperative maintenance[median:5.00(IQR:5.00-5.00)vs 2.00(IQR:2.00-2.00);median difference(95%CI):3.00(3.00-3.00),P<0.001].Regarding hemodynamics,a significant intergroup difference in systolic blood pressure was observed at the start of the surgery[mean:128.8 vs 114.7 for the Combined and CSE groups,mean difference(95%CI):14.17(0.77-27.57),adjusted P=0.033].CONCLUSION Remimazolam-combined anesthesia outperformed CSE anesthesia in reducing STAI-S scores,enhancing intraoperative sedation,and stabilizing systolic blood pressure at a critical stage,indicating its superiority in perioperative management.展开更多
This editorial narrative review discussed Budd-Chiari syndrome(BCS),which re-presents a rare but critical vascular liver disease resulting in an obstruction of he-patic venous outflow.Despite having a unifying mechani...This editorial narrative review discussed Budd-Chiari syndrome(BCS),which re-presents a rare but critical vascular liver disease resulting in an obstruction of he-patic venous outflow.Despite having a unifying mechanism,the syndrome shows a large heterogeneity across presentation,cause,and disease trajectory,compli-cating diagnosis and management.Based on established prognostic scoring systems,the New Clichy Score,the BCS-transjugular intrahepatic portosystemic shunt Index,the Zeitoun Score,and the Pediatric End-stage Liver Disease score were examined.These scoring systems are used for risk stratification and thera-peutic decision-making.Although these models deliver suitability information,their static parameters,narrow validation,and limited generalizability reduce their usefulness in diverse populations.Specific challenges are highlighted in pediatric patients,pregnant females,and individuals with myeloproliferative neoplasms for whom current tools often fall short.Moreover,there remains uncertainty regarding the durability of Pediatric End-stage Liver Disease score response and longer-term risks,such as hepatocellular carcinoma.There is a need to have a dynamic prognostic model that uses imaging and genetic factors in future studies.The article discussed enhancing recruitment to improve research.Overall,this article provided a contemporary,evidence-based approach for cli-nicians to aid in the evaluation and treatment of BCS.展开更多
基金supported by the Key Research and Development Program of the Ministry of Science and Technology of China(grant number:2016YF0900605)the Key Research and Development Program of Hebei Province(grant number:192777129D)+1 种基金the Joint Fund for Iron and Steel of the Natural Science Foundation of Hebei Province(grant number:H2016209058)the National Natural Science Foundation for Regional Joint Fund of China(grant number:U22A20364)。
文摘Objective We aimed to investigate the patterns of fasting blood glucose(FBG)trajectories and analyze the relationship between various occupational hazard factors and FBG trajectories in male steelworkers.Methods The study cohort included 3,728 workers who met the selection criteria for the Tanggang Occupational Cohort(TGOC)between 2017 and 2022.A group-based trajectory model was used to identify the FBG trajectories.Environmental risk scores(ERS)were constructed using regression coefficients from the occupational hazard model as weights.Univariate and multivariate logistic regression analyses were performed to explore the effects of occupational hazard factors using the ERS on FBG trajectories.Results FBG trajectories were categorized into three groups.An association was observed between high temperature,noise exposure,and FBG trajectory(P<0.05).Using the first quartile group of ERS1 as a reference,the fourth quartile group of ERS1 had an increased risk of medium and high FBG by 1.90and 2.21 times,respectively(odds ratio[OR]=1.90,95%confidence interval[CI]:1.17–3.10;OR=2.21,95%CI:1.09–4.45).Conclusion An association was observed between occupational hazards based on ERS and FBG trajectories.The risk of FBG trajectory levels increase with an increase in ERS.
文摘BACKGROUND Clinical predictors of dengue fever are crucial for guiding timely management and avoiding life-threatening complications.While prognostic scores are available,a systematic evaluation of these tools is lacking.AIM To evaluate the performance and accuracy of various proposed dengue clinical prognostic scores.METHODS Three databases,PubMed,EMBASE and Cochrane,were searched for peer-reviewed studies published from inception to 4 September 2023.Studies either developing or validating a prognostic model relevant to dengue fever were included.A total of 29 studies(n=17910)were included.RESULTS Most commonly studied outcomes were severe dengue(15 models)and mortality(8 models).For the paediatric population,Bedside Dengue Severity Score by Gayathri et al(specificity=0.98)and the nomogram model by Nguyen et al(sensitivity=0.87)performed better.For the adult population,the most specific model was reported by Leo et al(specificity=0.98).The most sensitive score is shared between Warning Signs for Severe Dengue as reported by Leo et al and Model 2 by Lee et al(sensitivity=1.00).CONCLUSION While several models demonstrated precision and reliability in predicting severe dengue and mortality,broader application across diverse geographic settings is needed to assess their external validity.
文摘BACKGROUND Chronic liver disease is a growing global health problem,leading to hepatic decompensation characterized by an array of clinical and biochemical complic-ations.Several scoring systems have been introduced in assessing the severity of hepatic decompensation with the most frequent ones are Child-Pugh score,model of end-stage liver disease(MELD)score,and MELD-Na score.Anemia is frequently observed in cirrhotic patients and is linked to worsened clinical outcomes.Although studies have explored anemia in liver disease,few have investigated the correlation of hemoglobin level with the severity of hepatic decompensation.AIM To determine the relationship between hemoglobin levels and the severity of decompensated liver disease and comparing the strength of this correlation using the Child-Pugh,MELD,and MELD-Na scores.METHODS This cross-sectional study was conducted at a tertiary care hospital with 652 decompensated liver disease patients enrolled in the study.Data was collected on demographics,clinical history,and laboratory findings,including hemoglobin levels,bilirubin,albumin,prothrombin time(international normalized ratio),sodium,and creatinine.The Child-Pugh,MELD,and MELD-Na scores were calculated.Statistical analysis was performed using Statistical Package for the Social Sciences version 26,and correlations between hemoglobin levels and severity scores were assessed using Spearman's correlation coefficient.RESULTS The study included 405 males(62.1%)and 247 females(37.9%)with an average age of 58.8 years.Significant inverse correlations were found between hemoglobin levels and Child-Pugh,MELD,and MELD-Na scores(P<0.01),with the MELD scoring system being the strongest correlator among all.One-way analysis of variance revealed significant differences in hemoglobin levels across the severity groups of each scoring system(P=0.001).Tukey's post hoc analysis confirmed significant internal differences among each severity group.CONCLUSION Understanding the correlation between hemoglobin and liver disease severity can improve patient management by offering insights into prognosis and guiding treatment decisions.
文摘Objective:To evaluate the efficacy and symptom scores of early diabetic nephropathy(DKD)treated with modified Shenqi Dihuang Decoction.Methods:82 patients with early DKD who visited the hospital from February 2023 to February 2025 were randomly divided into two groups by drawing.Group A received modified Shenqi Dihuang Decoction+SGLT2 inhibitor,while Group B received SGLT2 inhibitor only.The efficacy,symptom scores,blood glucose,and renal function were compared between the two groups.Results:The efficacy of Group A was higher than that of Group B in the treatment of early DKD(P<0.05).The DKD symptom scores of Group A were lower than those of Group B(P<0.05).The fasting blood glucose(FBG),2-hour postprandial blood glucose(PBG),and glycated hemoglobin(HbA1c)of Group A were better than those of Group B(P<0.05).The serum creatinine(SCr),blood urea nitrogen(BUN),and urinary albumin excretion rate(UAER)of Group A were also better than those of Group B.Conclusion:The combination of modified Shenqi Dihuang Decoction and SGLT2 inhibitor dapagliflozin has excellent efficacy in the treatment of early DKD,which can improve renal function,reduce DKD symptoms,and stabilize blood glucose levels.
文摘Objective: To explore the application effect of nursing interventions based on APACHE II scores in patients with severe pancreatitis and its impact on the recovery time of the gastrointestinal function. Methods: A total of 86 patients with severe pancreatitis treated in our hospital from March 2023 to March 2024 were selected. Using a random number table method, the patients were divided into a control group receiving conventional nursing care and a study group receiving nursing interventions based on APACHE II scores, with 43 patients in each group. The intervention effects of the two groups were compared. Results: The recovery time of gastrointestinal function in the study group was significantly shorter than that in the control group (P < 0.05). After the intervention, the quality of life scores in the study group was significantly higher than those in the control group (P < 0.05). The incidence of complications in the study group was significantly lower than in the control group (P < 0.05). Conclusion: Nursing interventions based on APACHE II scores can shorten gastrointestinal recovery time and reduce complications in patients with severe pancreatitis, contributing to improved quality of life.
基金Supported by Natural Science Foundation of China,No.82103566。
文摘BACKGROUND Inflammation is closely related to survival and disease progression in patients with cancer.However,the predictive value of inflammation-based scores for survival in patients with hepatocellular carcinoma(HCC)treated with Lenvatinib has not been fully elucidated.AIM To compare different inflammation scores'prognostic values,and establish novel nomogram for predicting overall survival(OS)in HCC patients on Lenvatinib.METHODS In total,144 patients with HCC treated with Lenvatinib were enrolled in this study.The prognostic value of pre-treatment inflammation-based scores was retrospectively analyzed,including the platelet-to-lymphocyte ratio,neutrophil-to-lymphocyte ratio,lymphocyteto-C-reactive protein ratio,lymphocyte-to-monocyte ratio,systemic immune-inflammation index,C-reactive protein-to-albumin ratio,and prognostic nutritional index(PNI).Kaplan-Meier survival curves and time-dependent receiver operating characteristic analysis were used to assess predictive accuracy.Univariate and multivariate Cox regression analyses were conducted to identify prognostic factors predicting OS and construct a prognostic nomogram.RESULTS All the inflammation-based scores demonstrated good discrimination in terms of OS(all P<0.05),and the PNI emerged as an independent predictor of OS in multivariate analysis(hazard ratio=4.097;95%confidence interval:1.405-11.944;P=0.01).We selected three independent prognostic factors(macrovascular invasion,metastasis,and PNI)to generate a nomogram for OS.CONCLUSION The PNI is a prognostic indicator for assessing OS in patients with HCC treated with Lenvatinib and is superior to other inflammation-based scores in predicting OS.
文摘BACKGROUND Previous studies have reported the high predictive accuracy of 4C Mortality Score derived at hospital admission in coronavirus disease 2019(COVID-19)patients.Very few studies have assessed it at intensive care unit(ICU)admission and compared it with the Acute Physiology and Chronic Health Evaluation(APACHE)II score.There are no studies comparing its accuracy with APACHE III score.AIM To describe the characteristics and outcomes of patients admitted to ICU with COVID-19 infection and to compare the accuracy of 4C score and APACHE score in predicting mortality in these patients.METHODS We conducted this retrospective cohort study using an electronic database in a tertiary ICU in Sydney.We included all adult patients(age>16 years)admitted to ICU with COVID-19 infection over a 5-month period(July 1,2021 to November 30,2021).We collected the data on demographics,clinical characteristics,interventions and outcomes for all patients.We calculated the 4C Mortality Score for each patient using eight variables as described previously.We compared the predictive accuracy of 4C Mortality Score at hospital and ICU admission and APACHE II and III scores by area under the receiver operating characteristic curve(AUROC).We determined the optimal cut-off value for each of these scores using the‘nearest’method and its 95%confidence interval by bootstrapping.RESULTS A total of 140 patients(62%males,mean age 56±17 years,mean APACHE II score 13±57)were included in the study.Nineteen(13.6%)of 140 patients died in the hospital.Compared to survivors,the non-survivors were older,males,had more comorbidities,higher rate of mechanical ventilation and vasopressor use.The AUROC for the 4C Mortality Score at hospital and ICU admission and APACHE II and II score was 0.75,0.80.0.75 and 0.79 respectively.The optimal cut-off value for these four scores was 9,10,14 and 56 respectively.The cut-point for all the scores had higher sensitivity than specificity.CONCLUSION The 4C score at ICU admission had a higher accuracy in predicting mortality than the 4C score at hospital admission.The predictive accuracy was similar to that for APACHE III score.The 4C score at ICU admission needs to be validated in future studies.
基金Natural Sciences Foundation of Gansu(No.23JRRA0972No.25RCKA013)+4 种基金Natural Sciences Foundation of Fujian(No.2022J05105)Science and Technology Planning Project of Chengguan District(No.2022RCCX0023)Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital(No.CY2022-MS-A03)Talent Introduction Plan of the Lanzhou University Second Hospital(No.YJRCKYQDJ-2021-02)Major Scientific Research Project on Health and Medical Science and Technology Innovation in Gansu Province(No.GSWSQNPY2024-13).
文摘BACKGROUND:Extracorporeal membrane oxygenation(ECMO)is an effective measure for saving the lives of critically ill patients.Prompt identification of the risk factors for mortality among patients receiving ECMO and comprehensive analysis of the long-term prognosis of survivors are vital.This scoping review summarized the representative prognostic scoring systems,aiming to help clinicians in selecting an appropriate scoring system to avoid unnecessary medical resource consumption and reduce ECMO-associated mortality.METHODS:A comprehensive search of multiple databases,including PubMed,Embase,and the Cochrane Library,was conducted.After removing duplicate studies,a full-text review was performed,and all studies that reported score systems before and/or after ECMO support were included.This protocol adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews(PRISMA-ScR)and has been registered with the Open Science Framework(osf.io/zp4ge).RESULTS:Among the 114 studies included,we identified three scores for patients receiving veno-venous ECMO(VV-ECMO),five scores for patients receiving veno-arterial ECMO(VA-ECMO),and three critical illness scores,which apply to both VV-and VA-ECMO conditions.All characteristics of these scoring systems,their advantages,and their limitations were summarized.CONCLUSION:The implementation of an ECMO scoring system helps to assess the condition of critically ill patients,predict outcome,and provide objective indicators to determine the optimal timing for ECMO intervention.Due to the limitations of the currently available scores,further efforts in improving and validating the ECMO scoring system are needed to achieve the goals of minimizing unnecessary consumption of medical resources and reducing mortality rates.
文摘Objective:To investigate the value of dynamic monitoring of serum interleukin(IL)-33 and tumor necrosis factor(TNF)-αlevels in the early diagnosis,severity assessment and prognosis of acute pancreatitis(AP)combined with abdominal CT radiomics and intestinal microbiota data.Methods:A total of 170 AP patients were admitted immediately after the onset of the disease and divided into MAP group(85 cases)and SAP group(85 cases).The levels of serum IL-33,TNF-α,IL-6,and HMGB1,as well as the expression of miRNA-155 in extracellular vesicles(EVs),were dynamically monitored at multiple time points(0 h,6 h,12 h,24 h,3 d,5 d,7 d,14 d)after admission.Abdominal CT radiomics analyzed the texture characteristics of pancreatic necrosis,and stool samples collected at admission were metagenomic sequencing of the gut microbiome.The Acute Pancreatitis Severity Bedside Index(BISAP)score is calculated within 48 hours of admission.Multivariate regression analysis assessed the independent effects of various factors on the prognosis of mortality groups.Results:Serum IL-33 and TNF-αlevels in SAP patients were significantly higher than those in MAP patients(p<0.05)at all time points,peaked on day 3,and decreased with treatment.The levels of these cytokines in patients with SIRS were also higher than in patients without SIRS(p<0.05).The serum IL-33,TNF-αlevels and BISAP scores in the mortality group were higher than those in the survival group(p<0.05).Multivariate regression analysis showed that serum IL-33(OR=3.21,95%CI:1.12–9.23,p=0.03),TNF-α(OR=4.05,95%CI:1.37–11.96,p=0.01),and BISAP score(OR=5.67,95%CI:1.83–17.54,p<0.01)were independent prognostic risk factors.Spearman correlation analysis showed that serum IL-33 and TNF-αlevels were positively correlated with BISAP scores(r=0.68,p<0.01;r=0.73,p<0.01).Conclusion:Dynamic monitoring of serum IL-33 and TNF-αlevels combined with BISAP score has important clinical value for early diagnosis,severity assessment,treatment guidance and prognosis evaluation of AP,and provides a basis for accurate diagnosis and treatment.
文摘Objective:To evaluate the therapeutic effect of Shenqi Dihuang Decoction combined with calcium dobesilate on patients with diabetic nephropathy(DKD).Methods:90 patients with DKD who visited the hospital from March 2024 to March 2025 were selected as samples and randomly divided into two groups.Group A was treated with Shenqi Dihuang Decoction combined with calcium dobesilate,while Group B was treated with calcium dobesilate alone.The efficacy,syndrome scores,blood glucose levels,and renal function indicators were compared between the two groups.Results:The efficacy of DKD treatment in Group A was higher than that in Group B(P<0.05).The syndrome scores in Group A were lower than those in Group B(P<0.05).The 2-hour postprandial blood glucose(PBG),fasting blood glucose(FBG),and glycated hemoglobin(HbA1c)levels in Group A were lower than those in Group B(P<0.05).The serum creatinine(SCr),urinary microalbumin,urinary albumin excretion rate(UAER),and β2-microglobulin(β2-MG)levels in Group A were also lower than those in Group B(P<0.05).Conclusion:The treatment of DKD with Shenqi Dihuang Decoction combined with calcium dobesilate can stabilize blood glucose levels,improve renal function,and reduce syndrome scores,which is highly effective and feasible.
基金Supported by the Health Commission of Hunan Province,No.202204115263the Fundamental Research Funds for the Central Universities of Central South University,No.2024XQLH027.
文摘BACKGROUND In the field of anesthesia for procedure for prolapse and hemorrhoids(PPH)surgery,combined spinal-epidural(CSE)anesthesia has been a common approach.However,exploring new combinations to optimize patient outcomes remains crucial.Remimazolam,a short-acting benzodiazepine,shows potential for improving sedation and reducing patient anxiety.The effects of combining remimazolam with CSE anesthesia,compared to traditional CSE anesthesia alone,on patient anxiety,sedation depth,and hemodynamics during PPH surgery have not been fully elucidated.AIM To compare remimazolam-CSE vs CSE alone on State-Trait Anxiety Inventory-State scale(STAI-S)scores,sedation,and hemodynamics in PPH surgery.METHODS This study is a single-center,prospective,randomized controlled trial.Between November 23,2022,and August 6,2024,60 eligible patients were randomly assigned to the CSE anesthesia group or the remimazolam-combined CSE anesthesia group(30 patients each).STAI-S scores,Ramsay sedation scores,and hemodynamic parameters(systolic blood pressure,diastolic blood pressure,heart rate)were measured at multiple time points.Two-way mixed-effects ANOVA and posthoc analyses were performed.RESULTS The Combined group demonstrated significantly lower STAI-S scores before leaving the operating room[mean:28.80 vs 54.03,mean difference(95%CI):25.23(21.24-29.23),P<0.001]and 24 hours post-operation[mean:45.07 vs 54.53,mean difference(95%CI):9.47(6.29-12.64),P<0.001]than the CSE group.Moreover,the Combined group achieved a deeper sedation level during intraoperative maintenance[median:5.00(IQR:5.00-5.00)vs 2.00(IQR:2.00-2.00);median difference(95%CI):3.00(3.00-3.00),P<0.001].Regarding hemodynamics,a significant intergroup difference in systolic blood pressure was observed at the start of the surgery[mean:128.8 vs 114.7 for the Combined and CSE groups,mean difference(95%CI):14.17(0.77-27.57),adjusted P=0.033].CONCLUSION Remimazolam-combined anesthesia outperformed CSE anesthesia in reducing STAI-S scores,enhancing intraoperative sedation,and stabilizing systolic blood pressure at a critical stage,indicating its superiority in perioperative management.
文摘This editorial narrative review discussed Budd-Chiari syndrome(BCS),which re-presents a rare but critical vascular liver disease resulting in an obstruction of he-patic venous outflow.Despite having a unifying mechanism,the syndrome shows a large heterogeneity across presentation,cause,and disease trajectory,compli-cating diagnosis and management.Based on established prognostic scoring systems,the New Clichy Score,the BCS-transjugular intrahepatic portosystemic shunt Index,the Zeitoun Score,and the Pediatric End-stage Liver Disease score were examined.These scoring systems are used for risk stratification and thera-peutic decision-making.Although these models deliver suitability information,their static parameters,narrow validation,and limited generalizability reduce their usefulness in diverse populations.Specific challenges are highlighted in pediatric patients,pregnant females,and individuals with myeloproliferative neoplasms for whom current tools often fall short.Moreover,there remains uncertainty regarding the durability of Pediatric End-stage Liver Disease score response and longer-term risks,such as hepatocellular carcinoma.There is a need to have a dynamic prognostic model that uses imaging and genetic factors in future studies.The article discussed enhancing recruitment to improve research.Overall,this article provided a contemporary,evidence-based approach for cli-nicians to aid in the evaluation and treatment of BCS.
