Frailty has emerged as a pivotal determinant of post-liver transplant(LT)outcomes,yet its integration into clinical practice remains inconsistent.Defined by functional impairments and reduced physiologic reserve,frail...Frailty has emerged as a pivotal determinant of post-liver transplant(LT)outcomes,yet its integration into clinical practice remains inconsistent.Defined by functional impairments and reduced physiologic reserve,frailty transcends traditional metrics like the model for end-stage liver disease(MELD)score,demonstrating increasing predictive value for mortality beyond the immediate postoperative period.Recent findings suggest that frail recipients experience significantly higher mortality within the first 12 months following transplantation—a period when traditional monitoring often wanes.This raises critical questions about the adequacy of current assessment and follow-up protocols.The observed dissociation between MELD scores and long-term survival underscores the limitations of existing selection criteria.Frailty,as a dynamic and modifiable condition,represents an opportunity for targeted intervention.Prehabilitation programs focusing on nutritional optimization,physical rehabilitation,and psychosocial support could enhance resilience in transplant candidates,reducing their risk profile and improving post-transplant outcomes.Furthermore,these findings call for an expanded approach to post-transplant monitoring.Extending surveillance for frail recipients beyond standard timelines may facilitate early detection of complications,mitigating their impact on survival.Incorporating frailty into both pre-and post-transplant protocols could redefine how transplant centers evaluate and manage risk.This editorial advocates for a paradigm shift:Frailty must no longer be viewed as a secondary consideration but as a core element in LT care.By addressing frailty comprehensively,we can move toward more personalized,effective strategies that improve survival and quality of life for LT recipients.展开更多
Objective:While albumin and the weight-standardized hand grip strength(HGS/W)serve as valuable prognostic indicators for cancer patients,their correlation with the prognosis in frail cancer patients remains inadequate...Objective:While albumin and the weight-standardized hand grip strength(HGS/W)serve as valuable prognostic indicators for cancer patients,their correlation with the prognosis in frail cancer patients remains inadequately explored.This study aimed to investigate the prognostic importance of the albumin level and HGS/W in cancer patients with frailty and to further investigate their combined prognostic value.Moreover,this comprehensive evaluation aimed to facilitate timely intervention and treatment for frail patients.Methods:The research enrolled 5,794 cancer patients identified with frailty from a multicenter research database.The diagnosis of frailty was based on the FRAIL scale.An Albumin-HGS/W score was constructed by combining the albumin and HGS/W values.Cox proportional hazard regression was utilized to examine the association between the albumin level and HGS/W and patient outcomes.Results:Among these patients,2,543 were females and 3,251 were males,with a median age of 60.0 years.Optimal stratification based on patient survival revealed the ideal threshold for HGS/W to be 0.48 for males and 0.39 for females,and for albumin to be 38 for both sexes.The fully adjusted model revealed that higher Albumin-HGS/W scores were correlated with a poorer patient prognosis.Notably,an Albumin-HGS/W score of 2 was associated with a higher risk of mortality compared with a score of 0 in the total population(HR:1.813,95%CI:1.580-2.080,P<0.001).Conclusions:Low albumin or HGS/W values are associated with low survival in cancer patients with frailty.Elevated Albumin-HGS/W scores were linked to decreased survival rates in cancer patients with frailty.展开更多
BACKGROUND Morphomics,a computed tomography-based body composition assessment,helps predicting esophageal cancer outcomes,but its link to bioelectrical impedance analysis(BIA)and functional assessments such as hand gr...BACKGROUND Morphomics,a computed tomography-based body composition assessment,helps predicting esophageal cancer outcomes,but its link to bioelectrical impedance analysis(BIA)and functional assessments such as hand grip strength(HGS)and cardiopulmonary exercise testing(CPET)remains unclear.AIM To investigate correlations between morphomics and BIA,HGS,CPET,and assess its ability to predict low cardiorespiratory fitness(CRF).METHODS Fifty esophageal cancer patients underwent multi-level morphomics,BIA,HGS,and CPET.Correlations were analyzed using heatmaps and scatter plots,and logistic regression assessed morphomic predictive value for low CRF.RESULTS T11 is the only level with complete morphomic data,making it the most applicable.To ensure reliability,T11 and its adjacent levels,T10-12,were included in the subsequent analysis.Dorsal muscle group volume from T10-12 morphomics all correlated positively with BIA muscle components(r=0.56-0.68,all P<0.001),HGS(r=0.4-0.48,all P<0.001),and CPET variables(r=0.43-0.51,all P<0.001).Subcutaneous fat area and visceral fat area from morphomics correlated with body fat percentage(r=0.58-0.67,all P<0.001)and negatively with CPET parameters(r=-0.33 to-0.52,all P<0.05).Morphomics also showed potential in identifying low CRF,with an area under the receiver operating characteristic curve of 0.778.CONCLUSION T11 morphomics shows strong correlation with BIA,HGS,and CPET,and may serve as a practical tool for preoperative risk assessment in esophageal cancer patients.展开更多
Inguinal hernia is a prevalent global surgical condition,accounting for millions of repairs annually.Tension-free mesh repair has become the gold standard for both open approaches(e.g.,Lichtenstein repair)and laparosc...Inguinal hernia is a prevalent global surgical condition,accounting for millions of repairs annually.Tension-free mesh repair has become the gold standard for both open approaches(e.g.,Lichtenstein repair)and laparoscopic techniques(e.g.,transabdominal preperitoneal and totally extraperitoneal[TEP]repairs).1,2,3 Guidelines updated in 2018 and 2023 emphasize mesh-based repairs,providing recommendations to optimize outcomes and minimize complications.1,2 Laparoscopic hernia repair,particularly TEP,offers several advantages,such as reduced pain,quicker recovery,and improved cosmetic outcomes.展开更多
In 2019,China had over 13.14 million dementia cases,with incidence rates of(56.47–207.08)/100,000[1].Early cognitive impairment—a key dementia symptom—reduces quality of life,increases care dependence,and lowers su...In 2019,China had over 13.14 million dementia cases,with incidence rates of(56.47–207.08)/100,000[1].Early cognitive impairment—a key dementia symptom—reduces quality of life,increases care dependence,and lowers survival in older adults[2].A decline in physical function can also be observed in older adults with increasing age.Grip strength has been shown to be a marker of overall physiological function in older adults.展开更多
文摘Frailty has emerged as a pivotal determinant of post-liver transplant(LT)outcomes,yet its integration into clinical practice remains inconsistent.Defined by functional impairments and reduced physiologic reserve,frailty transcends traditional metrics like the model for end-stage liver disease(MELD)score,demonstrating increasing predictive value for mortality beyond the immediate postoperative period.Recent findings suggest that frail recipients experience significantly higher mortality within the first 12 months following transplantation—a period when traditional monitoring often wanes.This raises critical questions about the adequacy of current assessment and follow-up protocols.The observed dissociation between MELD scores and long-term survival underscores the limitations of existing selection criteria.Frailty,as a dynamic and modifiable condition,represents an opportunity for targeted intervention.Prehabilitation programs focusing on nutritional optimization,physical rehabilitation,and psychosocial support could enhance resilience in transplant candidates,reducing their risk profile and improving post-transplant outcomes.Furthermore,these findings call for an expanded approach to post-transplant monitoring.Extending surveillance for frail recipients beyond standard timelines may facilitate early detection of complications,mitigating their impact on survival.Incorporating frailty into both pre-and post-transplant protocols could redefine how transplant centers evaluate and manage risk.This editorial advocates for a paradigm shift:Frailty must no longer be viewed as a secondary consideration but as a core element in LT care.By addressing frailty comprehensively,we can move toward more personalized,effective strategies that improve survival and quality of life for LT recipients.
基金supported by a Henan Province Science and Technology Research Project(No.252102311033)the National Key Research and Development Program(No.2022YFC2009600 and No.2022YFC2009601).
文摘Objective:While albumin and the weight-standardized hand grip strength(HGS/W)serve as valuable prognostic indicators for cancer patients,their correlation with the prognosis in frail cancer patients remains inadequately explored.This study aimed to investigate the prognostic importance of the albumin level and HGS/W in cancer patients with frailty and to further investigate their combined prognostic value.Moreover,this comprehensive evaluation aimed to facilitate timely intervention and treatment for frail patients.Methods:The research enrolled 5,794 cancer patients identified with frailty from a multicenter research database.The diagnosis of frailty was based on the FRAIL scale.An Albumin-HGS/W score was constructed by combining the albumin and HGS/W values.Cox proportional hazard regression was utilized to examine the association between the albumin level and HGS/W and patient outcomes.Results:Among these patients,2,543 were females and 3,251 were males,with a median age of 60.0 years.Optimal stratification based on patient survival revealed the ideal threshold for HGS/W to be 0.48 for males and 0.39 for females,and for albumin to be 38 for both sexes.The fully adjusted model revealed that higher Albumin-HGS/W scores were correlated with a poorer patient prognosis.Notably,an Albumin-HGS/W score of 2 was associated with a higher risk of mortality compared with a score of 0 in the total population(HR:1.813,95%CI:1.580-2.080,P<0.001).Conclusions:Low albumin or HGS/W values are associated with low survival in cancer patients with frailty.Elevated Albumin-HGS/W scores were linked to decreased survival rates in cancer patients with frailty.
基金Supported by Chang Gung Memorial Hospital,Taiwan,No.CMRPG3N1171,No.CMRPG3N1172,No.CORPVVN0071,No.CMRPVVK0111-3 and No.CMRPVVL0121-3National Science and Technology Council,Taiwan,No.MOST 114-2314-B-182A-066-.
文摘BACKGROUND Morphomics,a computed tomography-based body composition assessment,helps predicting esophageal cancer outcomes,but its link to bioelectrical impedance analysis(BIA)and functional assessments such as hand grip strength(HGS)and cardiopulmonary exercise testing(CPET)remains unclear.AIM To investigate correlations between morphomics and BIA,HGS,CPET,and assess its ability to predict low cardiorespiratory fitness(CRF).METHODS Fifty esophageal cancer patients underwent multi-level morphomics,BIA,HGS,and CPET.Correlations were analyzed using heatmaps and scatter plots,and logistic regression assessed morphomic predictive value for low CRF.RESULTS T11 is the only level with complete morphomic data,making it the most applicable.To ensure reliability,T11 and its adjacent levels,T10-12,were included in the subsequent analysis.Dorsal muscle group volume from T10-12 morphomics all correlated positively with BIA muscle components(r=0.56-0.68,all P<0.001),HGS(r=0.4-0.48,all P<0.001),and CPET variables(r=0.43-0.51,all P<0.001).Subcutaneous fat area and visceral fat area from morphomics correlated with body fat percentage(r=0.58-0.67,all P<0.001)and negatively with CPET parameters(r=-0.33 to-0.52,all P<0.05).Morphomics also showed potential in identifying low CRF,with an area under the receiver operating characteristic curve of 0.778.CONCLUSION T11 morphomics shows strong correlation with BIA,HGS,and CPET,and may serve as a practical tool for preoperative risk assessment in esophageal cancer patients.
文摘Inguinal hernia is a prevalent global surgical condition,accounting for millions of repairs annually.Tension-free mesh repair has become the gold standard for both open approaches(e.g.,Lichtenstein repair)and laparoscopic techniques(e.g.,transabdominal preperitoneal and totally extraperitoneal[TEP]repairs).1,2,3 Guidelines updated in 2018 and 2023 emphasize mesh-based repairs,providing recommendations to optimize outcomes and minimize complications.1,2 Laparoscopic hernia repair,particularly TEP,offers several advantages,such as reduced pain,quicker recovery,and improved cosmetic outcomes.
基金supported by the Shanghai New Three-year Action Plan for Public Health(Grant No.GWV-10.1-XK16)the US National Institute on Aging(RO1-AGO34479).
文摘In 2019,China had over 13.14 million dementia cases,with incidence rates of(56.47–207.08)/100,000[1].Early cognitive impairment—a key dementia symptom—reduces quality of life,increases care dependence,and lowers survival in older adults[2].A decline in physical function can also be observed in older adults with increasing age.Grip strength has been shown to be a marker of overall physiological function in older adults.
