BACKGROUND Anxiety,depression,and other negative emotions are common among patients with chronic renal failure(CRF).Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.AIM ...BACKGROUND Anxiety,depression,and other negative emotions are common among patients with chronic renal failure(CRF).Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.AIM To explore the correlations among life satisfaction,pleasure levels,and negative emotions in patients with CRF.METHODS One hundred patients with CRF who received therapy at the First Affiliated Hospital of Jinzhou Medical University between December 2022 and February 2025 were included.The Depression,Anxiety,and Stress Scale(DASS-21),Satisfaction with Life Scale(SWLS),and Temporal Experience of Pleasure Scale(TEPS)were used to evaluate negative emotions,life satisfaction,and pleasure level,respectively.Pearson’s correlation coefficient analyzed the correlation between life satisfaction,pleasure level,and negative emotions.Linear regression analysis identified the factors affecting negative emotions.RESULTS The average DASS-21 score among patients with CRF was 51.90±2.30,with subscale scores of 17.90±1.50 for depression,18.53±1.18 for anxiety,and 15.47±2.36 for stress,all significantly higher than the domestic norm(P<0.05).The average SWLS score was 22.17±4.90.Correlation analysis revealed a negative correlation between the SWLS and total DASS-21 scores(P<0.05),but not with the individual depression,anxiety,or stress dimensions.The average TEPS score was 67.80±8.34.TEPS scores were negatively correlated with the DASS-21 score and the stress dimension(P<0.05),but not with depression or anxiety.Linear regression analysis showed that TEPS scores significantly influenced DASS-21 scores(P<0.05).CONCLUSION Patients with CRF experience high levels of negative emotions,which are negatively correlated with life satisfaction and pleasure.Furthermore,pleasure level had an impact on negative emotions.展开更多
BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis ...BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.展开更多
Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend ...Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend against illness,and maintain homeostasis)syndrome is considered a critical syndrome in traditional Chinese medicine(TCM)and is associated with poor prognosis in heart failure(HF).This study investigates the clinical,metabolic,and transcriptomic differences between heart failure patients with and without Qi deficiency syndrome.Methods:56 heart failure patients were evaluated using a Qi deficiency syndrome scale and divided into Qi deficiency syndrome(QD)and non-Qi deficiency(non-QD)groups based on the median score.Clinical characteristics,including baseline N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),total diuretic use during hospitalization,and 90-day rehospitalization rates,were compared between the groups.Differentially expressed genes(DEGs)and differential metabolites were identified,followed by enrichment analyses and validation using qPCR and Western blot in AC16 cardiomyocytes.Results:QD patients exhibited significantly higher NT-proBNP levels,lower LVEF,and increased 90-day rehospitalization rates.Metabolomic profiling revealed lipid metabolism disruptions,notably in linoleic acid and phospholipid pathways.Transcriptomic analysis highlighted 17 DEGs,including CISD2,a critical mitochondrial regulator,which was downregulated in QD patients.Correlation analysis identified significant associations between DEGs(e.g.,CISD2,BPGM)and lipid metabolites such as PC(16:0/P-16:0).Functional knockdown of CISD2 in AC16 cells led to upregulation of lipid oxidation enzymes ALOX15 and CYP1A2,linking CISD2 dysfunction to lipid metabolic dysregulation.Conclusion:Qi deficiency is associated with more severe heart failure symptoms,worse prognosis,and distinct metabolic and transcriptomic profiles,particularly in lipid metabolism.CISD2 emerges as a potential therapeutic target,offering new avenues for integrating molecular insights with TCM approaches to optimize HF management.展开更多
BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extraco...BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.展开更多
BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains u...BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains undefined.AIM To assess the correlation between ascites characteristics and clinical prognosis in AP patients by comparing color depth and turbidity of early ascites.METHODS This study included 667 AP patients with ascites,categorized by color and turbidity into yellow clear(n=54),yellow turbid(n=293),red brown(n=320).The trendχ2 test was employed to analyze the incidence of organ failure(OF),infected pancreatic necrosis(IPN),and mortality across groups.Receiver operating charac teristic(ROC)curves were used to evaluate the predictive value of ascites cell count,amylase,protein,and lactate dehydrogenase(LDH)for abdominal compartment syndrome(ACS)and intra-abdominal hemorrhage.RESULTS AP patients with ascites exhibited higher scores of scoring systems(such as Bedside index for severity in AP,Acute Physiology and Chronic Health Examination II,etc.)and increased complications and mortality rates(all P<0.05)compared to those without ascites.A linear association was observed between ascites color depth and turbidity and the incidence of OF,pancreatic necrosis,IPN,and mortality(P<0.05).LDH in ascites demonstrated high accuracy in predicting ACS and intra-abdominal hemorrhage,with areas under the ROC curve of 0.77 and 0.79,respectively.CONCLUSION Early in AP,ascites correlates with OF,IPN,and mortality,showing linear associations with color depth and turbidity.Ascitic LDH reliably predicts ACS and intra-abdominal hemorrhage in AP patients.展开更多
Lingguizhugan Decoction(LGZG)demonstrates significant efficacy in treating various cardiovascular diseases clinically,yet its precise mechanism of action remains elusive.This study aimed to elucidate the potential mec...Lingguizhugan Decoction(LGZG)demonstrates significant efficacy in treating various cardiovascular diseases clinically,yet its precise mechanism of action remains elusive.This study aimed to elucidate the potential mechanisms and effects of LGZG on isoproterenol(ISO)continuous stimulation-induced chronic heart failure(CHF)in mice,providing direct experimental evidence for further clinical applications.In vivo,continuous ISO infusion was administered to mice,and ventricular myocytes were utilized to explore LGZG's potential mechanism of action on theβ1-adrenergic receptor(β1-AR)/Gs/G protein-coupled receptor kinases(GRKs)/β-arrestin signaling deflection system in the heart.The findings reveal that LGZG significantly reduced the messenger ribonucleic acid(mRNA)expression of hypertrophy-related biomarkers[atrial natriuretic peptide(ANP)and B-type natriuretic peptide(BNP)]and improved cardiac remodeling and left ventricular diastolic function in mice with ISO-induced CHF.Furthermore,LGZG inhibited the overactivation of Gs/cyclic adenosine monophosphate(c AMP)/protein kinase A(PKA)signaling and downregulated the downstream transcriptional activity of c AMP-response element binding protein(CREB)and the expression of the coactivator CBP/P300.Notably,LGZG downregulated the expression ofβ-arrestin1 and GRK 2/3/5 while upregulating the expression ofβ1-AR andβ-arrestin2.These results suggest that LGZG inhibits Gs/c AMP/PKA signaling andβ-arrestin/GRK-mediated desensitization and internalization ofβ1-AR,potentially exerting cardioprotective effects through the synergistic regulation of theβ1-AR/Gs/GRKs/β-arrestin signaling deflection system via multiple pathways.展开更多
INTRODUCTION.On May 1st,2024,around 2:10 a.m.,a catastrophic collapse occurred along the Meilong Expressway near Meizhou City,Guangdong Province,China,at coordinates 24°29′24″N and 116°40′25″E.This colla...INTRODUCTION.On May 1st,2024,around 2:10 a.m.,a catastrophic collapse occurred along the Meilong Expressway near Meizhou City,Guangdong Province,China,at coordinates 24°29′24″N and 116°40′25″E.This collapse resulted in a pavement failure of approximately 17.9 m in length and covering an area of about 184.3 m^(2)(Chinanews,2024).展开更多
BACKGROUND Acute liver failure(ALF)is a life-threatening multisystemic condition with high short-term mortality.With the growing prevalence of obesity and metabolic syndrome,it is important to investigate the clinical...BACKGROUND Acute liver failure(ALF)is a life-threatening multisystemic condition with high short-term mortality.With the growing prevalence of obesity and metabolic syndrome,it is important to investigate the clinical implications of high body mass index(BMI)on survival outcomes in ALF.AIM To explore the impact of overweight and obesity on the clinical outcomes of patients with ALF.METHODS A retrospective observational cohort study was conducted involving patients with ALF admitted to the Johns Hopkins Health System between January 1,2000 and May 1,2020.We performed Cox proportional hazards regression to identify outcomes,including the need for liver transplantation(LT)or all-cause mortality.RESULTS A total of 196 patients were included,the median age was 43.5 years,63.3%were female,and 59.7%were of Caucasian ethnicity.Acetaminophen-induced ALF was the most common etiology(45%).The mean BMI was significantly greater among patients who underwent LT or died(29.64 kg/m^(2)vs 26.59 kg/m^(2),P=0.008)than among survivors.Patients with overweight and obesity had a higher risk of all-cause mortality or need for LT by 2.22-fold(95%CI:1.30-3.78)and 2.04-fold(95%CI:1.29-3.39),respectively.Elevated BMI was associated with renal failure and higher grades of hepatic encephalopathy.Derangements in serologic markers,including alanine transaminase,lactate,and ammonia,were associated with a mortality risk or need for LT.CONCLUSION In this large,retrospective study,with a diverse cohort of United States patients,Overweight and obese were independently associated with an increased risk of all-cause mortality or need for LT.This work highlights the importance of closely monitoring ALF patients who are overweight or obese for adverse complications and measures to improve outcomes in this vulnerable patient population.展开更多
Link failure is a critical issue in large networks and must be effectively addressed.In software-defined networks(SDN),link failure recovery schemes can be categorized into proactive and reactive approaches.Reactive s...Link failure is a critical issue in large networks and must be effectively addressed.In software-defined networks(SDN),link failure recovery schemes can be categorized into proactive and reactive approaches.Reactive schemes have longer recovery times while proactive schemes provide faster recovery but overwhelm the memory of switches by flow entries.As SDN adoption grows,ensuring efficient recovery from link failures in the data plane becomes crucial.In particular,data center networks(DCNs)demand rapid recovery times and efficient resource utilization to meet carrier-grade requirements.This paper proposes an efficient Decentralized Failure Recovery(DFR)model for SDNs,meeting recovery time requirements and optimizing switch memory resource consumption.The DFR model enables switches to autonomously reroute traffic upon link failures without involving the controller,achieving fast recovery times while minimizing memory usage.DFR employs the Fast Failover Group in the OpenFlow standard for local recovery without requiring controller communication and utilizes the k-shortest path algorithm to proactively install backup paths,allowing immediate local recovery without controller intervention and enhancing overall network stability and scalability.DFR employs flow entry aggregation techniques to reduce switch memory usage.Instead of matching flow entries to the destination host’s MAC address,DFR matches packets to the destination switch’s MAC address.This reduces the switches’Ternary Content-Addressable Memory(TCAM)consumption.Additionally,DFR modifies Address Resolution Protocol(ARP)replies to provide source hosts with the destination switch’s MAC address,facilitating flow entry aggregation without affecting normal network operations.The performance of DFR is evaluated through the network emulator Mininet 2.3.1 and Ryu 3.1 as SDN controller.For different number of active flows,number of hosts per edge switch,and different network sizes,the proposed model outperformed various failure recovery models:restoration-based,protection by flow entries,protection by group entries and protection by Vlan-tagging model in terms of recovery time,switch memory consumption and controller overhead which represented the number of flow entry updates to recover from the failure.Experimental results demonstrate that DFR achieves recovery times under 20 milliseconds,satisfying carrier-grade requirements for rapid failure recovery.Additionally,DFR reduces switch memory usage by up to 95%compared to traditional protection methods and minimizes controller load by eliminating the need for controller intervention during failure recovery.Theresults underscore the efficiency and scalability of the DFR model,making it a practical solution for enhancing network resilience in SDN environments.展开更多
Software-defined networking(SDN)is an innovative paradigm that separates the control and data planes,introducing centralized network control.SDN is increasingly being adopted by Carrier Grade networks,offering enhance...Software-defined networking(SDN)is an innovative paradigm that separates the control and data planes,introducing centralized network control.SDN is increasingly being adopted by Carrier Grade networks,offering enhanced networkmanagement capabilities than those of traditional networks.However,because SDN is designed to ensure high-level service availability,it faces additional challenges.One of themost critical challenges is ensuring efficient detection and recovery from link failures in the data plane.Such failures can significantly impact network performance and lead to service outages,making resiliency a key concern for the effective adoption of SDN.Since the recovery process is intrinsically dependent on timely failure detection,this research surveys and analyzes the current literature on both failure detection and recovery approaches in SDN.The survey provides a critical comparison of existing failure detection techniques,highlighting their advantages and disadvantages.Additionally,it examines the current failure recovery methods,categorized as either restoration-based or protection-based,and offers a comprehensive comparison of their strengths and limitations.Lastly,future research challenges and directions are discussed to address the shortcomings of existing failure recovery methods.展开更多
According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(C...According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(CHF)is also increasing.[1–3]Reports have shown that the presence of cognitive impairment(CI)in patients with CHF is associated with poor prognosis,[4–6]and the degree of CI is related to CHF severity.展开更多
Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,...Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,emerging evidence suggests that serum chloride may provide even better prognostic information in similar situations.Hypochloremia,characterised by low serum chloride levels,has been linked to increased mortality,exacerbated organ dysfunction,and higher requirements for renal replacement therapy and vasopressors in various critical conditions,including advanced liver diseases.The pathophysiological mecha-nisms underlying the association between low serum chloride levels and poor outcomes in liver disease appear to involve complex interactions among electro-lyte imbalances,renal function,and systemic hemodynamics.Chloride dysregu-lation can influence renal salt-sensing mechanisms,disrupt acid-base homeostasis,and exacerbate complications such as hepatic encephalopathy and hepatorenal syndrome.This article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease.By reviewing recent literature and analysing clinical data,we seek to establish serum chloride as an underutilised but valuable prognostic marker.Understanding the role of serum chloride in liver disease could enhance prognostic accuracy,refine treatment strategies,and ultimately improve patient outcomes.展开更多
BACKGROUND Anxiety and depression are prevalent among patients with chronic heart failure(CHF)and can adversely contribute to treatment adherence and clinical outcomes.Poor fluid restriction adherence is a widespread ...BACKGROUND Anxiety and depression are prevalent among patients with chronic heart failure(CHF)and can adversely contribute to treatment adherence and clinical outcomes.Poor fluid restriction adherence is a widespread challenge in the management of CHF.To effectively manage disease progression and alleviate symptoms,it is crucial to identify key influencing factors to facilitate the implementation of targeted interventions.AIM To investigate the status of anxiety and depression among patients with CHF and determine the factors contributing to poor fluid restriction adherence.METHODS Three hundred CHF patients seeking medical treatment at The First Hospital of Hunan University of Traditional Chinese Medicine between June 2021 and June 2023 were included in the study.Questionnaires,including the Psychosomatic Symptom Scale,Self-Rating Anxiety Scale,Self-Rating Depression Scale,and Fluid Restriction Adherence Questionnaire were administered to patients.Based on their anxiety and depression scores,patients were categorized into anxiety/depression and non-anxiety/depression groups,as well as fluid restriction adherence and fluid restriction non-adherence groups.General patient data were collected,and univariate and logistic regression analyses were conducted to determine the occurrence of depression and anxiety.Logistic regression analysis was used to identify independent factors influencing fluid restriction adherence.RESULTS Statistically significant differences in age,New York Heart Association(NYHA)grading,marital status,educational attainment,and family support were observed between depressed and non-depressed CHF patients(P<0.05).Age,NYHA grading,marital status,educational attainment,and family support were identified as factors influencing the development of depression.The anxiety and non-anxiety groups differed statistically in terms of gender,age,NYHA grading,smoking history,alcohol consumption history,monthly income,educational attainment,and family support(P<0.05).Gender,smoking,alcohol consumption,monthly income,and educational attainment affected anxiety in these patients.The fluid restriction adherence rate was 28.0%,and thirst sensation,anxiety,and depression were identified as independent influencing factors.CONCLUSION CHF patients are susceptible to anxiety and depression,with multiple associated influencing factors.Moreover,anxiety and depression are independent factors that can influence fluid restriction adherence in these patients.展开更多
BACKGROUND Acute-on-chronic liver failure(ACLF)is a liver disease based on chronic liver disease,which is significantly influenced by clinical treatment regimen and disease status,and despite the existence of multiple...BACKGROUND Acute-on-chronic liver failure(ACLF)is a liver disease based on chronic liver disease,which is significantly influenced by clinical treatment regimen and disease status,and despite the existence of multiple prognostic assessment indicators for ACLF,the overall sensitivity and accuracy are relatively low.AIM To investigate the prognostic value of the combined detection of alpha-fetoprotein(AFP),plasma prothrombin activity(PTA),and serum prealbumin(PA)in ACLF.METHODS This retrospective study included 87 patients with ACLF admitted from February 2021 to February 2023 and categorized them into the survival(n=47)and death(n=40)groups according to their clinical outcomes 3 months posttreatment.All the participants underwent AFP,PTA,and PA level measurements upon admission.Baseline data,as well as AFP,PTA,and PA levels,were comparatively analyzed.Pearson correlation coefficients were utilized to analyze the correlations of AFP,PTA,and PA with different survival outcomes in patients with ACLF.Receiver operating characteristic(ROC)curves and areas under the curves were used to evaluate the predictive value of AFP,PTA,and PA for ACLF prognosis.RESULTS AFP,PTA,and PA levels were markedly decreased in the death group than in the survival group(P<0.05).Pearson analysis indicated a positive association of the AFP,PTA,and PA levels with the survival of patients with ACLF(P<0.05).ROC curve analysis determined the sensitivity and specificity of the combined diagnosis at 91.24%and 100.00%,respectively,both of which were notably increased compared to the single-index diagnosis.The ROC of their combined diagnosis was 0.989,significantly surpassing 0.907,0.849,and 0.853 of AFP,PTA,and PA,respectively.No statistically significant variance was determined in the sensitivity and specificity of the combined diagnosis vs the single detection(P>0.05).CONCLUSION The combined detection of AFP,PTA,and PA levels demonstrates favorable diagnostic value for the short-term prognosis of patients with ACLF,featuring high sensitivity and specificity.展开更多
BACKGROUND Research examining the relationships among anxiety,depression,self-perceived burden(SPB),and psychological resilience(PR),along with the determinants of PR,in patients with chronic renal failure(CRF)receivi...BACKGROUND Research examining the relationships among anxiety,depression,self-perceived burden(SPB),and psychological resilience(PR),along with the determinants of PR,in patients with chronic renal failure(CRF)receiving maintenance hemodia-lysis(MHD)is limited.AIM To investigate the correlation between anxiety,depression,SPB,and PR in pati-ents with CRF on MHD.METHODS This study included 225 patients with CRF on MHD who were admitted between June 2021 and June 2024.The anxiety level was evaluated using the Self-Rating Anxiety Scale(SAS);the depression status was assessed using the Self-Rating Depression Scale(SDS);the SPB was measured using the SPB Scale(SPBS);and the PR was determined using the Connor–Davidson Resilience Scale(CD-RISC).The correlations among the SAS,SDS,SPB,and CD-RISC were analyzed using Pearson’s correlation coefficients.Univariate and multivariate analyses were performed to identify the factors that influence the PR of patients with CRF on MHD.RESULTS The SAS,SDS,SPB,and CD-RISC scores of the 225 patients were 45.25±15.36,54.81±14.68,32.31±11.52,and 66.48±9.18,respectively.Significant negative correlations were observed between SAS,SDS,SPB,and CD-RISC.Furthermore,longer dialysis vintage(P=0.015),the absence of religious beliefs(P=0.020),lower monthly income(P=0.008),higher SAS score(P=0.013),and higher SDS score(P=0.006)were all independent factors that adversely affected the PR of patients with CRF on MHD.CONCLUSION Patients with CRF on MHD present with varying degrees of anxiety,depression,and SPB,all of which exhibit a significant negative correlation with their PR.Moreover,longer dialysis vintage,the absence of religious beliefs,lower monthly income,higher SAS score,and higher SDS score were factors that negatively affected the PR of patients with CRF on MHD.展开更多
BACKGROUND Patients with acute-on-chronic liver failure(ACLF)have a high mortality rate,poor prognosis,and often experience concurrent thrombocytopenia and bleeding events.AIM To evaluate the efficacy and safety of re...BACKGROUND Patients with acute-on-chronic liver failure(ACLF)have a high mortality rate,poor prognosis,and often experience concurrent thrombocytopenia and bleeding events.AIM To evaluate the efficacy and safety of recombinant human thrombopoietin(rhTPO)in patients with ACLF with concomitant severe thrombocytopenia.METHODS This was a prospective,open-label study.We assigned 70 ACLF patients with severe thrombocytopenia into the rhTPO group and control group,with 35 patients in each group.Patients in the rhTPO group received subcutaneous injections of rhTPO at a dose of 15000 IU/day for 7 consecutive days,while patients in the control group did not receive rhTPO treatment.The primary endpoint was the proportion of patients with platelet count>50×10^(9)/L on day 14.RESULTS The proportion of patients with platelet count>50×10^(9)/L on day 14 was 60.7%in the rhTPO group,which was significantly higher than that(12.0%)in the control group(P<0.001).The platelet count in the rhTPO group on day 14 was 64×10^(9)/L,exceeding the baseline of 28×10^(9)/L.Compared to the control group,the rhTPO group exhibited a significant increase in platelet count from baseline(P<0.05).Model for end-stage liver disease score,albumin level and international normalized ratio improved significantly from baseline on day 14 after rhTPO injection.The concentrations of serum thrombopoietin and hepatocyte growth factor in the rhTPO group after 7 days were 143.7 and 195.4 pg/mL,respectively,showing a significant increase from baseline(P<0.05).Eight(22.9%)patients had bleeding events in the control group compared with four(11.4%)in the rhTPO group.The incidence of 90-day mortality was also higher in the control group(6,17.1%)than that in the rhTPO group(3,8.6%).CONCLUSION rhTPO significantly increased the platelet count in ACLF patients with thrombocytopenia and reduce the occurrence of bleeding events,with a good safety profile.展开更多
Objective:To analyze the burden of caregivers of CHF patients in the current environment,to explore the related burden and influencing factors of caring for patients with chronic heart failure,and to explore the impac...Objective:To analyze the burden of caregivers of CHF patients in the current environment,to explore the related burden and influencing factors of caring for patients with chronic heart failure,and to explore the impact of filial piety values on the burden of caring for patients.Methods:192 caregivers of CHF patients in the hospital were selected as the main objects of this study.The main method was convenient sampling.Through a questionnaire survey of 192 CHF patients'caregivers,a unified investigation was conducted from the aspects of patient"'s general condition,objective burden,anxiety and depression degree and relationship quality,etc.The structural equation model was constructed and adjusted by analyzing data entry and variable correlation.Finally,path analysis was used to conduct inferential research on the direct and indirect influencing factors of control burden.Results:More than half of the patients'caregivers had a caregiving burden,and the practical caregiving dimension had the highest score.The total effect values of patient-related factors,including anxiety degree,number of concomitant diseases and half-year readmission rate,were 0.36,0.31 and 0.20,respectively(P<0.05).The total effect values of filial piety,anxiety degree,average care time and understanding degree of disease directly derived from the caregivers themselves were-0.38,0.29,0.29 and-0.23,respectively(P<0.05).In addition,the influence of filial piety values on the caregiver burden was more obvious,and the direct effect value of the value was-0.41(P<0.001).Conclusion:Most caregivers of CHF patients have a certain objective burden of care,and there are many factors that affect it,among which the degree of filial piety value is the most important.This finding provides a clear goal for caregivers to develop measures to improve the caregiver burden.展开更多
During extensive gully land consolidation projects on China's Loess Plateau,many loess-bedrock fill slopes were formed,which frequently experience shallow landslides induced by rainfall.However,studies on loess-be...During extensive gully land consolidation projects on China's Loess Plateau,many loess-bedrock fill slopes were formed,which frequently experience shallow landslides induced by rainfall.However,studies on loess-bedrock slope failure triggered by continuous heavy rainfall are limited,and the role of the soilerock interface between the original bedrock slope and fill slope in the hydrological and failure process of the slope remains unclear.In this study,we conducted a continuous rainfall model test on a loess-bedrock fill slope.During the test,the responses of volume water content,pore pressure,micro deformation,and movement of the infiltration front were observed.The hydrological process and failure mechanism were then analysed.The findings suggest that the soilerock interface is a predominant infiltration surface within the slope.Rainfall infiltration rates at the interface reach 1.24-2.80 times those of the fill slope,with peak interfacial pore water pressure exceeding that of the loess fill.Furthermore,the infiltration front moves rapidly along the interface toward the bottom of the slope,reducing interfacial cohesion between bedrock and loess.The slope failure modes are summarised into three phases:local failure→flow slide and crack penetration→multistage block retrogressive slides.The cracks generated at the slope surface serve as key determinants of the geometry and scale of shallow landslides.Therefore,we recommend targeted engineering interventions to mitigate the instability and erosion of loessebedrock fill slopes.展开更多
With the change of the main influencing factors such as structural configuration and impact conditions,reinforced concrete slabs exhibit different mechanical behaviors with different failure patterns,and the failure m...With the change of the main influencing factors such as structural configuration and impact conditions,reinforced concrete slabs exhibit different mechanical behaviors with different failure patterns,and the failure modes are transformed.In order to reveal the failure mode and transformation rule of reinforced concrete slabs under impact loads,a dynamic impact response test was carried out using a drop hammer test device.The dynamic data pertaining to the impact force,support reaction force,structural displacement,and reinforcement strain were obtained through the use of digital image correlation technology(DIC),impact force measurement,and strain measurement.The analysis of the ultimate damage state of the reinforced concrete slab identified four distinct types of impact failure modes:local failure by stamping,overall failure by stamping,local-overall coupling failure,and local failure by punching.Additionally,the influence laws of hammerhead shape,hammer height,and reinforcement ratio on the dynamic response and failure mode transformation of the slab were revealed.The results indicate that:(1)The local damage to the slab by the plane hammer is readily apparent,while the overall damage by the spherical hammer is more pronounced.(2)In comparison to the high reinforcement ratio slabs,the overall bending resistance of the low reinforcement ratio slabs is significantly inferior,and the slab back exhibits further cracks.(3)As the hammer height increases,the slab failure mode undergoes a transformation,shifting from local failure by stamping and overall failure by stamping to local-overall coupling failure and local failure by punching.(4)Three failure mode thresholds have been established,and by comparing the peak impact force with the failure thresholds,the failure mode of the slab can be effectively determined.展开更多
This article discusses the study by GrubićRotkvićet al on the mechanisms of action of sodium-glucose cotransporter 2 inhibitors(SGLT2i)in patients with type 2 diabetes mellitus(T2DM)and heart failure(HF).T2DM and HF a...This article discusses the study by GrubićRotkvićet al on the mechanisms of action of sodium-glucose cotransporter 2 inhibitors(SGLT2i)in patients with type 2 diabetes mellitus(T2DM)and heart failure(HF).T2DM and HF are highly comorbid,with a significantly increased prevalence of HF in patients with T2DM.SGLT2i exhibit potential in reducing hospitalization rates for HF and cardiovascular mortality through multiple mechanisms,including improving blood glucose control,promoting urinary sodium excretion,reducing sympathetic nervous system activity,lowering both preload and afterload on the heart,alleviating inflammation and oxidative stress,enhancing endothelial function,improving myocardial energy metabolism,and stabilizing cardiac ion homeostasis.Further research and clinical practice will help optimize the use of SGLT2i in HF patients.展开更多
文摘BACKGROUND Anxiety,depression,and other negative emotions are common among patients with chronic renal failure(CRF).Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.AIM To explore the correlations among life satisfaction,pleasure levels,and negative emotions in patients with CRF.METHODS One hundred patients with CRF who received therapy at the First Affiliated Hospital of Jinzhou Medical University between December 2022 and February 2025 were included.The Depression,Anxiety,and Stress Scale(DASS-21),Satisfaction with Life Scale(SWLS),and Temporal Experience of Pleasure Scale(TEPS)were used to evaluate negative emotions,life satisfaction,and pleasure level,respectively.Pearson’s correlation coefficient analyzed the correlation between life satisfaction,pleasure level,and negative emotions.Linear regression analysis identified the factors affecting negative emotions.RESULTS The average DASS-21 score among patients with CRF was 51.90±2.30,with subscale scores of 17.90±1.50 for depression,18.53±1.18 for anxiety,and 15.47±2.36 for stress,all significantly higher than the domestic norm(P<0.05).The average SWLS score was 22.17±4.90.Correlation analysis revealed a negative correlation between the SWLS and total DASS-21 scores(P<0.05),but not with the individual depression,anxiety,or stress dimensions.The average TEPS score was 67.80±8.34.TEPS scores were negatively correlated with the DASS-21 score and the stress dimension(P<0.05),but not with depression or anxiety.Linear regression analysis showed that TEPS scores significantly influenced DASS-21 scores(P<0.05).CONCLUSION Patients with CRF experience high levels of negative emotions,which are negatively correlated with life satisfaction and pleasure.Furthermore,pleasure level had an impact on negative emotions.
文摘BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.
基金supported by the Sanming Project of Medicine in Shenzhen[SZZYSM202206001]National Natural Science Foundation of China[82004320 and 82374383]+3 种基金Natural Science Foundation of Guangdong Province of China[2022A1515011710 and 2022A1515010679]Shenzhen Science and Technology Innovation Committee[JCYJ20220530141407017 and JCYJ20240813153619026]2024 High-quality Development Research Project of Shenzhen Bao’an Public Hospital[YNXM2024078]and Shenzhen Bao’an Chinese Medicine Hospital Research Program[BAZYY20220702].
文摘Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend against illness,and maintain homeostasis)syndrome is considered a critical syndrome in traditional Chinese medicine(TCM)and is associated with poor prognosis in heart failure(HF).This study investigates the clinical,metabolic,and transcriptomic differences between heart failure patients with and without Qi deficiency syndrome.Methods:56 heart failure patients were evaluated using a Qi deficiency syndrome scale and divided into Qi deficiency syndrome(QD)and non-Qi deficiency(non-QD)groups based on the median score.Clinical characteristics,including baseline N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),total diuretic use during hospitalization,and 90-day rehospitalization rates,were compared between the groups.Differentially expressed genes(DEGs)and differential metabolites were identified,followed by enrichment analyses and validation using qPCR and Western blot in AC16 cardiomyocytes.Results:QD patients exhibited significantly higher NT-proBNP levels,lower LVEF,and increased 90-day rehospitalization rates.Metabolomic profiling revealed lipid metabolism disruptions,notably in linoleic acid and phospholipid pathways.Transcriptomic analysis highlighted 17 DEGs,including CISD2,a critical mitochondrial regulator,which was downregulated in QD patients.Correlation analysis identified significant associations between DEGs(e.g.,CISD2,BPGM)and lipid metabolites such as PC(16:0/P-16:0).Functional knockdown of CISD2 in AC16 cells led to upregulation of lipid oxidation enzymes ALOX15 and CYP1A2,linking CISD2 dysfunction to lipid metabolic dysregulation.Conclusion:Qi deficiency is associated with more severe heart failure symptoms,worse prognosis,and distinct metabolic and transcriptomic profiles,particularly in lipid metabolism.CISD2 emerges as a potential therapeutic target,offering new avenues for integrating molecular insights with TCM approaches to optimize HF management.
文摘BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.
基金Supported by National Natural Science Foundation of China,No.82360136Jiangxi Clinical Research Center for Gastroenterology,No.20223BCG74011.
文摘BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains undefined.AIM To assess the correlation between ascites characteristics and clinical prognosis in AP patients by comparing color depth and turbidity of early ascites.METHODS This study included 667 AP patients with ascites,categorized by color and turbidity into yellow clear(n=54),yellow turbid(n=293),red brown(n=320).The trendχ2 test was employed to analyze the incidence of organ failure(OF),infected pancreatic necrosis(IPN),and mortality across groups.Receiver operating charac teristic(ROC)curves were used to evaluate the predictive value of ascites cell count,amylase,protein,and lactate dehydrogenase(LDH)for abdominal compartment syndrome(ACS)and intra-abdominal hemorrhage.RESULTS AP patients with ascites exhibited higher scores of scoring systems(such as Bedside index for severity in AP,Acute Physiology and Chronic Health Examination II,etc.)and increased complications and mortality rates(all P<0.05)compared to those without ascites.A linear association was observed between ascites color depth and turbidity and the incidence of OF,pancreatic necrosis,IPN,and mortality(P<0.05).LDH in ascites demonstrated high accuracy in predicting ACS and intra-abdominal hemorrhage,with areas under the ROC curve of 0.77 and 0.79,respectively.CONCLUSION Early in AP,ascites correlates with OF,IPN,and mortality,showing linear associations with color depth and turbidity.Ascitic LDH reliably predicts ACS and intra-abdominal hemorrhage in AP patients.
基金supported by the National Natural Science Foundation of China(No.82074054)Shanghai Municipal Commission of Health and Family Planning(No.ZY(2021-2023)-0208)+2 种基金Youth Program of the National Natural Science Foundation of China(No.81903831)Shanghai Municipality:Shanghai Chenguang Program(No.19CG48)Natural Science Foundation of Shanghai(No.24ZR1465900)。
文摘Lingguizhugan Decoction(LGZG)demonstrates significant efficacy in treating various cardiovascular diseases clinically,yet its precise mechanism of action remains elusive.This study aimed to elucidate the potential mechanisms and effects of LGZG on isoproterenol(ISO)continuous stimulation-induced chronic heart failure(CHF)in mice,providing direct experimental evidence for further clinical applications.In vivo,continuous ISO infusion was administered to mice,and ventricular myocytes were utilized to explore LGZG's potential mechanism of action on theβ1-adrenergic receptor(β1-AR)/Gs/G protein-coupled receptor kinases(GRKs)/β-arrestin signaling deflection system in the heart.The findings reveal that LGZG significantly reduced the messenger ribonucleic acid(mRNA)expression of hypertrophy-related biomarkers[atrial natriuretic peptide(ANP)and B-type natriuretic peptide(BNP)]and improved cardiac remodeling and left ventricular diastolic function in mice with ISO-induced CHF.Furthermore,LGZG inhibited the overactivation of Gs/cyclic adenosine monophosphate(c AMP)/protein kinase A(PKA)signaling and downregulated the downstream transcriptional activity of c AMP-response element binding protein(CREB)and the expression of the coactivator CBP/P300.Notably,LGZG downregulated the expression ofβ-arrestin1 and GRK 2/3/5 while upregulating the expression ofβ1-AR andβ-arrestin2.These results suggest that LGZG inhibits Gs/c AMP/PKA signaling andβ-arrestin/GRK-mediated desensitization and internalization ofβ1-AR,potentially exerting cardioprotective effects through the synergistic regulation of theβ1-AR/Gs/GRKs/β-arrestin signaling deflection system via multiple pathways.
基金supported by the National Natural Science Foundation of China(Nos.42371094,41907253)partially supported by the Interdisciplinary Cultivation Program of Xidian University(No.21103240005)the Postdoctoral Fellowship Program of CPSF(No.GZB20240589)。
文摘INTRODUCTION.On May 1st,2024,around 2:10 a.m.,a catastrophic collapse occurred along the Meilong Expressway near Meizhou City,Guangdong Province,China,at coordinates 24°29′24″N and 116°40′25″E.This collapse resulted in a pavement failure of approximately 17.9 m in length and covering an area of about 184.3 m^(2)(Chinanews,2024).
文摘BACKGROUND Acute liver failure(ALF)is a life-threatening multisystemic condition with high short-term mortality.With the growing prevalence of obesity and metabolic syndrome,it is important to investigate the clinical implications of high body mass index(BMI)on survival outcomes in ALF.AIM To explore the impact of overweight and obesity on the clinical outcomes of patients with ALF.METHODS A retrospective observational cohort study was conducted involving patients with ALF admitted to the Johns Hopkins Health System between January 1,2000 and May 1,2020.We performed Cox proportional hazards regression to identify outcomes,including the need for liver transplantation(LT)or all-cause mortality.RESULTS A total of 196 patients were included,the median age was 43.5 years,63.3%were female,and 59.7%were of Caucasian ethnicity.Acetaminophen-induced ALF was the most common etiology(45%).The mean BMI was significantly greater among patients who underwent LT or died(29.64 kg/m^(2)vs 26.59 kg/m^(2),P=0.008)than among survivors.Patients with overweight and obesity had a higher risk of all-cause mortality or need for LT by 2.22-fold(95%CI:1.30-3.78)and 2.04-fold(95%CI:1.29-3.39),respectively.Elevated BMI was associated with renal failure and higher grades of hepatic encephalopathy.Derangements in serologic markers,including alanine transaminase,lactate,and ammonia,were associated with a mortality risk or need for LT.CONCLUSION In this large,retrospective study,with a diverse cohort of United States patients,Overweight and obese were independently associated with an increased risk of all-cause mortality or need for LT.This work highlights the importance of closely monitoring ALF patients who are overweight or obese for adverse complications and measures to improve outcomes in this vulnerable patient population.
文摘Link failure is a critical issue in large networks and must be effectively addressed.In software-defined networks(SDN),link failure recovery schemes can be categorized into proactive and reactive approaches.Reactive schemes have longer recovery times while proactive schemes provide faster recovery but overwhelm the memory of switches by flow entries.As SDN adoption grows,ensuring efficient recovery from link failures in the data plane becomes crucial.In particular,data center networks(DCNs)demand rapid recovery times and efficient resource utilization to meet carrier-grade requirements.This paper proposes an efficient Decentralized Failure Recovery(DFR)model for SDNs,meeting recovery time requirements and optimizing switch memory resource consumption.The DFR model enables switches to autonomously reroute traffic upon link failures without involving the controller,achieving fast recovery times while minimizing memory usage.DFR employs the Fast Failover Group in the OpenFlow standard for local recovery without requiring controller communication and utilizes the k-shortest path algorithm to proactively install backup paths,allowing immediate local recovery without controller intervention and enhancing overall network stability and scalability.DFR employs flow entry aggregation techniques to reduce switch memory usage.Instead of matching flow entries to the destination host’s MAC address,DFR matches packets to the destination switch’s MAC address.This reduces the switches’Ternary Content-Addressable Memory(TCAM)consumption.Additionally,DFR modifies Address Resolution Protocol(ARP)replies to provide source hosts with the destination switch’s MAC address,facilitating flow entry aggregation without affecting normal network operations.The performance of DFR is evaluated through the network emulator Mininet 2.3.1 and Ryu 3.1 as SDN controller.For different number of active flows,number of hosts per edge switch,and different network sizes,the proposed model outperformed various failure recovery models:restoration-based,protection by flow entries,protection by group entries and protection by Vlan-tagging model in terms of recovery time,switch memory consumption and controller overhead which represented the number of flow entry updates to recover from the failure.Experimental results demonstrate that DFR achieves recovery times under 20 milliseconds,satisfying carrier-grade requirements for rapid failure recovery.Additionally,DFR reduces switch memory usage by up to 95%compared to traditional protection methods and minimizes controller load by eliminating the need for controller intervention during failure recovery.Theresults underscore the efficiency and scalability of the DFR model,making it a practical solution for enhancing network resilience in SDN environments.
文摘Software-defined networking(SDN)is an innovative paradigm that separates the control and data planes,introducing centralized network control.SDN is increasingly being adopted by Carrier Grade networks,offering enhanced networkmanagement capabilities than those of traditional networks.However,because SDN is designed to ensure high-level service availability,it faces additional challenges.One of themost critical challenges is ensuring efficient detection and recovery from link failures in the data plane.Such failures can significantly impact network performance and lead to service outages,making resiliency a key concern for the effective adoption of SDN.Since the recovery process is intrinsically dependent on timely failure detection,this research surveys and analyzes the current literature on both failure detection and recovery approaches in SDN.The survey provides a critical comparison of existing failure detection techniques,highlighting their advantages and disadvantages.Additionally,it examines the current failure recovery methods,categorized as either restoration-based or protection-based,and offers a comprehensive comparison of their strengths and limitations.Lastly,future research challenges and directions are discussed to address the shortcomings of existing failure recovery methods.
文摘According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(CHF)is also increasing.[1–3]Reports have shown that the presence of cognitive impairment(CI)in patients with CHF is associated with poor prognosis,[4–6]and the degree of CI is related to CHF severity.
文摘Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,emerging evidence suggests that serum chloride may provide even better prognostic information in similar situations.Hypochloremia,characterised by low serum chloride levels,has been linked to increased mortality,exacerbated organ dysfunction,and higher requirements for renal replacement therapy and vasopressors in various critical conditions,including advanced liver diseases.The pathophysiological mecha-nisms underlying the association between low serum chloride levels and poor outcomes in liver disease appear to involve complex interactions among electro-lyte imbalances,renal function,and systemic hemodynamics.Chloride dysregu-lation can influence renal salt-sensing mechanisms,disrupt acid-base homeostasis,and exacerbate complications such as hepatic encephalopathy and hepatorenal syndrome.This article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease.By reviewing recent literature and analysing clinical data,we seek to establish serum chloride as an underutilised but valuable prognostic marker.Understanding the role of serum chloride in liver disease could enhance prognostic accuracy,refine treatment strategies,and ultimately improve patient outcomes.
基金Huxiang TCM Physique Intervention Clinical Research Center,No.2023SK4061Traditional Chinese Medicine Research Project of Hunan Province,No.B2023065+4 种基金Hunan Province"14th Five-Year Plan"key specialty of TCM,No.[2023]4Hunan University of Chinese Medicine and Hospital Joint Foundation,No.2023XYLH019 and 2024XYLH365R&D Plan for Key Areas of Hunan Provincial Department of Science and Technology,No.2019SK2321Excellent Youth Program of Hunan Education Department,No.24B0346Hunan Provincial Natural Science Foundation for Young Scientists,No.2025JJ60626.
文摘BACKGROUND Anxiety and depression are prevalent among patients with chronic heart failure(CHF)and can adversely contribute to treatment adherence and clinical outcomes.Poor fluid restriction adherence is a widespread challenge in the management of CHF.To effectively manage disease progression and alleviate symptoms,it is crucial to identify key influencing factors to facilitate the implementation of targeted interventions.AIM To investigate the status of anxiety and depression among patients with CHF and determine the factors contributing to poor fluid restriction adherence.METHODS Three hundred CHF patients seeking medical treatment at The First Hospital of Hunan University of Traditional Chinese Medicine between June 2021 and June 2023 were included in the study.Questionnaires,including the Psychosomatic Symptom Scale,Self-Rating Anxiety Scale,Self-Rating Depression Scale,and Fluid Restriction Adherence Questionnaire were administered to patients.Based on their anxiety and depression scores,patients were categorized into anxiety/depression and non-anxiety/depression groups,as well as fluid restriction adherence and fluid restriction non-adherence groups.General patient data were collected,and univariate and logistic regression analyses were conducted to determine the occurrence of depression and anxiety.Logistic regression analysis was used to identify independent factors influencing fluid restriction adherence.RESULTS Statistically significant differences in age,New York Heart Association(NYHA)grading,marital status,educational attainment,and family support were observed between depressed and non-depressed CHF patients(P<0.05).Age,NYHA grading,marital status,educational attainment,and family support were identified as factors influencing the development of depression.The anxiety and non-anxiety groups differed statistically in terms of gender,age,NYHA grading,smoking history,alcohol consumption history,monthly income,educational attainment,and family support(P<0.05).Gender,smoking,alcohol consumption,monthly income,and educational attainment affected anxiety in these patients.The fluid restriction adherence rate was 28.0%,and thirst sensation,anxiety,and depression were identified as independent influencing factors.CONCLUSION CHF patients are susceptible to anxiety and depression,with multiple associated influencing factors.Moreover,anxiety and depression are independent factors that can influence fluid restriction adherence in these patients.
文摘BACKGROUND Acute-on-chronic liver failure(ACLF)is a liver disease based on chronic liver disease,which is significantly influenced by clinical treatment regimen and disease status,and despite the existence of multiple prognostic assessment indicators for ACLF,the overall sensitivity and accuracy are relatively low.AIM To investigate the prognostic value of the combined detection of alpha-fetoprotein(AFP),plasma prothrombin activity(PTA),and serum prealbumin(PA)in ACLF.METHODS This retrospective study included 87 patients with ACLF admitted from February 2021 to February 2023 and categorized them into the survival(n=47)and death(n=40)groups according to their clinical outcomes 3 months posttreatment.All the participants underwent AFP,PTA,and PA level measurements upon admission.Baseline data,as well as AFP,PTA,and PA levels,were comparatively analyzed.Pearson correlation coefficients were utilized to analyze the correlations of AFP,PTA,and PA with different survival outcomes in patients with ACLF.Receiver operating characteristic(ROC)curves and areas under the curves were used to evaluate the predictive value of AFP,PTA,and PA for ACLF prognosis.RESULTS AFP,PTA,and PA levels were markedly decreased in the death group than in the survival group(P<0.05).Pearson analysis indicated a positive association of the AFP,PTA,and PA levels with the survival of patients with ACLF(P<0.05).ROC curve analysis determined the sensitivity and specificity of the combined diagnosis at 91.24%and 100.00%,respectively,both of which were notably increased compared to the single-index diagnosis.The ROC of their combined diagnosis was 0.989,significantly surpassing 0.907,0.849,and 0.853 of AFP,PTA,and PA,respectively.No statistically significant variance was determined in the sensitivity and specificity of the combined diagnosis vs the single detection(P>0.05).CONCLUSION The combined detection of AFP,PTA,and PA levels demonstrates favorable diagnostic value for the short-term prognosis of patients with ACLF,featuring high sensitivity and specificity.
基金Supported by Key Research Fund of Wannan Medical College,No.WK2021ZF15Research Foundation for Advanced Talents of Wannan Medical College,No.YR202213+3 种基金Foundation of Anhui Educational Committee,No.2023AH051759Excellent Youth Research Project of Anhui UniversitiesNo.2023AH030107Horizontal Project of Wannan Medical College,No.622202504003 and No.662202404013.
文摘BACKGROUND Research examining the relationships among anxiety,depression,self-perceived burden(SPB),and psychological resilience(PR),along with the determinants of PR,in patients with chronic renal failure(CRF)receiving maintenance hemodia-lysis(MHD)is limited.AIM To investigate the correlation between anxiety,depression,SPB,and PR in pati-ents with CRF on MHD.METHODS This study included 225 patients with CRF on MHD who were admitted between June 2021 and June 2024.The anxiety level was evaluated using the Self-Rating Anxiety Scale(SAS);the depression status was assessed using the Self-Rating Depression Scale(SDS);the SPB was measured using the SPB Scale(SPBS);and the PR was determined using the Connor–Davidson Resilience Scale(CD-RISC).The correlations among the SAS,SDS,SPB,and CD-RISC were analyzed using Pearson’s correlation coefficients.Univariate and multivariate analyses were performed to identify the factors that influence the PR of patients with CRF on MHD.RESULTS The SAS,SDS,SPB,and CD-RISC scores of the 225 patients were 45.25±15.36,54.81±14.68,32.31±11.52,and 66.48±9.18,respectively.Significant negative correlations were observed between SAS,SDS,SPB,and CD-RISC.Furthermore,longer dialysis vintage(P=0.015),the absence of religious beliefs(P=0.020),lower monthly income(P=0.008),higher SAS score(P=0.013),and higher SDS score(P=0.006)were all independent factors that adversely affected the PR of patients with CRF on MHD.CONCLUSION Patients with CRF on MHD present with varying degrees of anxiety,depression,and SPB,all of which exhibit a significant negative correlation with their PR.Moreover,longer dialysis vintage,the absence of religious beliefs,lower monthly income,higher SAS score,and higher SDS score were factors that negatively affected the PR of patients with CRF on MHD.
基金Supported by Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-034A.
文摘BACKGROUND Patients with acute-on-chronic liver failure(ACLF)have a high mortality rate,poor prognosis,and often experience concurrent thrombocytopenia and bleeding events.AIM To evaluate the efficacy and safety of recombinant human thrombopoietin(rhTPO)in patients with ACLF with concomitant severe thrombocytopenia.METHODS This was a prospective,open-label study.We assigned 70 ACLF patients with severe thrombocytopenia into the rhTPO group and control group,with 35 patients in each group.Patients in the rhTPO group received subcutaneous injections of rhTPO at a dose of 15000 IU/day for 7 consecutive days,while patients in the control group did not receive rhTPO treatment.The primary endpoint was the proportion of patients with platelet count>50×10^(9)/L on day 14.RESULTS The proportion of patients with platelet count>50×10^(9)/L on day 14 was 60.7%in the rhTPO group,which was significantly higher than that(12.0%)in the control group(P<0.001).The platelet count in the rhTPO group on day 14 was 64×10^(9)/L,exceeding the baseline of 28×10^(9)/L.Compared to the control group,the rhTPO group exhibited a significant increase in platelet count from baseline(P<0.05).Model for end-stage liver disease score,albumin level and international normalized ratio improved significantly from baseline on day 14 after rhTPO injection.The concentrations of serum thrombopoietin and hepatocyte growth factor in the rhTPO group after 7 days were 143.7 and 195.4 pg/mL,respectively,showing a significant increase from baseline(P<0.05).Eight(22.9%)patients had bleeding events in the control group compared with four(11.4%)in the rhTPO group.The incidence of 90-day mortality was also higher in the control group(6,17.1%)than that in the rhTPO group(3,8.6%).CONCLUSION rhTPO significantly increased the platelet count in ACLF patients with thrombocytopenia and reduce the occurrence of bleeding events,with a good safety profile.
文摘Objective:To analyze the burden of caregivers of CHF patients in the current environment,to explore the related burden and influencing factors of caring for patients with chronic heart failure,and to explore the impact of filial piety values on the burden of caring for patients.Methods:192 caregivers of CHF patients in the hospital were selected as the main objects of this study.The main method was convenient sampling.Through a questionnaire survey of 192 CHF patients'caregivers,a unified investigation was conducted from the aspects of patient"'s general condition,objective burden,anxiety and depression degree and relationship quality,etc.The structural equation model was constructed and adjusted by analyzing data entry and variable correlation.Finally,path analysis was used to conduct inferential research on the direct and indirect influencing factors of control burden.Results:More than half of the patients'caregivers had a caregiving burden,and the practical caregiving dimension had the highest score.The total effect values of patient-related factors,including anxiety degree,number of concomitant diseases and half-year readmission rate,were 0.36,0.31 and 0.20,respectively(P<0.05).The total effect values of filial piety,anxiety degree,average care time and understanding degree of disease directly derived from the caregivers themselves were-0.38,0.29,0.29 and-0.23,respectively(P<0.05).In addition,the influence of filial piety values on the caregiver burden was more obvious,and the direct effect value of the value was-0.41(P<0.001).Conclusion:Most caregivers of CHF patients have a certain objective burden of care,and there are many factors that affect it,among which the degree of filial piety value is the most important.This finding provides a clear goal for caregivers to develop measures to improve the caregiver burden.
基金supported by the National Key R&D Program of China(Grant No.2023YFC3008404)the National Key Research and Development Program,China(Grant No.2017YFD0800501)the National Natural Science Foundation of China(No.41790443).
文摘During extensive gully land consolidation projects on China's Loess Plateau,many loess-bedrock fill slopes were formed,which frequently experience shallow landslides induced by rainfall.However,studies on loess-bedrock slope failure triggered by continuous heavy rainfall are limited,and the role of the soilerock interface between the original bedrock slope and fill slope in the hydrological and failure process of the slope remains unclear.In this study,we conducted a continuous rainfall model test on a loess-bedrock fill slope.During the test,the responses of volume water content,pore pressure,micro deformation,and movement of the infiltration front were observed.The hydrological process and failure mechanism were then analysed.The findings suggest that the soilerock interface is a predominant infiltration surface within the slope.Rainfall infiltration rates at the interface reach 1.24-2.80 times those of the fill slope,with peak interfacial pore water pressure exceeding that of the loess fill.Furthermore,the infiltration front moves rapidly along the interface toward the bottom of the slope,reducing interfacial cohesion between bedrock and loess.The slope failure modes are summarised into three phases:local failure→flow slide and crack penetration→multistage block retrogressive slides.The cracks generated at the slope surface serve as key determinants of the geometry and scale of shallow landslides.Therefore,we recommend targeted engineering interventions to mitigate the instability and erosion of loessebedrock fill slopes.
基金Supported by the National Natural Science Foundation of China(Grant No.52078283)Shandong Provincial Natural Science Foundation(Project No.ZR2024MA094)。
文摘With the change of the main influencing factors such as structural configuration and impact conditions,reinforced concrete slabs exhibit different mechanical behaviors with different failure patterns,and the failure modes are transformed.In order to reveal the failure mode and transformation rule of reinforced concrete slabs under impact loads,a dynamic impact response test was carried out using a drop hammer test device.The dynamic data pertaining to the impact force,support reaction force,structural displacement,and reinforcement strain were obtained through the use of digital image correlation technology(DIC),impact force measurement,and strain measurement.The analysis of the ultimate damage state of the reinforced concrete slab identified four distinct types of impact failure modes:local failure by stamping,overall failure by stamping,local-overall coupling failure,and local failure by punching.Additionally,the influence laws of hammerhead shape,hammer height,and reinforcement ratio on the dynamic response and failure mode transformation of the slab were revealed.The results indicate that:(1)The local damage to the slab by the plane hammer is readily apparent,while the overall damage by the spherical hammer is more pronounced.(2)In comparison to the high reinforcement ratio slabs,the overall bending resistance of the low reinforcement ratio slabs is significantly inferior,and the slab back exhibits further cracks.(3)As the hammer height increases,the slab failure mode undergoes a transformation,shifting from local failure by stamping and overall failure by stamping to local-overall coupling failure and local failure by punching.(4)Three failure mode thresholds have been established,and by comparing the peak impact force with the failure thresholds,the failure mode of the slab can be effectively determined.
文摘This article discusses the study by GrubićRotkvićet al on the mechanisms of action of sodium-glucose cotransporter 2 inhibitors(SGLT2i)in patients with type 2 diabetes mellitus(T2DM)and heart failure(HF).T2DM and HF are highly comorbid,with a significantly increased prevalence of HF in patients with T2DM.SGLT2i exhibit potential in reducing hospitalization rates for HF and cardiovascular mortality through multiple mechanisms,including improving blood glucose control,promoting urinary sodium excretion,reducing sympathetic nervous system activity,lowering both preload and afterload on the heart,alleviating inflammation and oxidative stress,enhancing endothelial function,improving myocardial energy metabolism,and stabilizing cardiac ion homeostasis.Further research and clinical practice will help optimize the use of SGLT2i in HF patients.
