BACKGROUND Meniscal tears are one of the most common knee injuries.After the diagnosis of a meniscal tear has been made,there are several factors physicians use to guide clinical decision-making.The influence of time ...BACKGROUND Meniscal tears are one of the most common knee injuries.After the diagnosis of a meniscal tear has been made,there are several factors physicians use to guide clinical decision-making.The influence of time between injury and isolated meniscus repair on patient outcomes is not well described.Assessing this relationship is important as it may influence clinical decision-making and can add to the preoperative patient education process.We hypothesized that increasing the time from injury to meniscus surgery would worsen postoperative outcomes.AIM To investigate the current literature for data on the relationship between time between meniscus injury and repair on patient outcomes.METHODS PubMed,Academic Search Complete,MEDLINE,CINAHL,and SPORTDiscus were searched for studies published between January 1,1995 and July 13,2023 on isolated meniscus repair.Exclusion criteria included concomitant ligament surgery,incomplete outcomes or time to surgery data,and meniscectomies.Patient demographics,time to injury,and postoperative outcomes from each study were abstracted and analyzed.RESULTS Five studies met all inclusion and exclusion criteria.There were 204(121 male,83 female)patients included.Three of five(60%)studies determined that time between injury and surgery was not statistically significant for postoperative Lysholm scores(P=0.62),Tegner scores(P=0.46),failure rate(P=0.45,P=0.86),and International Knee Documentation Committee scores(P=0.65).Two of five(40%)studies found a statistically significant increase in Lysholm scores with shorter time to surgery(P=0.03)and a statistically significant association between progression of medial meniscus extrusion ratio(P=0.01)and increasing time to surgery.CONCLUSION Our results do not support the hypothesis that increased time from injury to isolated meniscus surgery worsens postoperative outcomes.Decision-making primarily based on injury interval is thus not recommended.展开更多
Introduction: The Coronavirus pandemic was responsible for an unprecedented health crisis that shook the world with its high contagiousness and lethality. Its impact on maternal and fetal health places pregnant women ...Introduction: The Coronavirus pandemic was responsible for an unprecedented health crisis that shook the world with its high contagiousness and lethality. Its impact on maternal and fetal health places pregnant women at high risk. The aim of our study was to determine the factors associated with the occurrence of COVID-19 in pregnant women, and the maternal and perinatal outcomes of infected patients. Methodology: This was a case-control study involving 42 cases matched to 42 controls recruited from two public and tertiary hospitals in the cities of Yaoundé and Douala over a period from November 31 to May 31, 2024. Cases were defined as deliveries or records of COVID-19 deliveries confirmed positive by reverse transcription polymerase chain reaction (RT-PCR) or by a COVID-19 rapid diagnostic test (Covid-RDT). Controls were defined as deliveries or records of deliveries negative to the same test. They were matched by the hospital. Non-consenting births and unusable records were excluded. The data collected were recorded on a pre-established, pretexted data sheet examining sociodemographic, clinical characteristics and maternal and perinatal outcomes which were then analyzed using SPSS version 23.0 software. Results: After multivariate analysis, the independent sociodemographic factors were: belonging to the [30 - 40] age group (OR: 4.4;P = 0.010), being married (OR: 8.1;P = 0.030);being unemployed (OR: 3;P = 0.040). Independent clinical factors were: being in the third trimester of pregnancy (OR: 1.1;P = 0.017), being diabetic (OR: 5;P = 0.033) and being obese (OR: 11.5;P = 0.043). Independent factors associated with maternal outcome were: caesarean section (OR: 10;P = 0.001);admission to intensive care (OR: 30.7;P = 0.013);SO2 ≤ 94% (OR: 11.7;P = 0.033);HR > 100 (OR: 15.5;P = 0.001). Independent factors associated with perinatal outcome were: weight Conclusion: The factors associated with the occurrence of COVID-19 in pregnant women are multiple, and maternal outcome depends on its condition on admission, and has a significant impact on perinatal health, including mode of delivery. Emphasis must be placed on prevention and optimal management of these associated factors.展开更多
Objective: To examine the effects of comprehensive nursing interventions on maternal and infant outcomes in pregnant women diagnosed with gestational diabetes mellitus (GDM). Methods: A quasi-experimental design was e...Objective: To examine the effects of comprehensive nursing interventions on maternal and infant outcomes in pregnant women diagnosed with gestational diabetes mellitus (GDM). Methods: A quasi-experimental design was employed, involving 60 pregnant women with GDM who were purposively selected and randomly allocated into experimental and control groups, each comprising 30 participants. The experimental group received comprehensive nursing interventions and pregnancy monitoring, while the control group received standard nursing care. Data collection was conducted using demographic questionnaires, pregnancy indicators, and maternal-infant outcome measurement tools. The collected data were analyzed using Microsoft Excel and the Statistical Package for Social Sciences (SPSS). Results: The findings indicated significant improvements in fasting blood glucose, postprandial blood glucose, amniotic fluid index, and neonatal birth weight in the experimental group compared to the control group. However, no statistically significant differences were observed in body mass index (BMI) or pregnancy weight gain. Comprehensive nursing interventions were associated with a significant reduction in maternal complications, including polyhydramnios, postpartum hemorrhage, and preeclampsia, as well as neonatal complications such as neonatal pneumonia, macrosomia, and hypoglycemia. Conclusion: Comprehensive nursing interventions have a positive impact on maternal and neonatal outcomes in pregnant women with GDM.展开更多
Objective:Endometrial tuberculosis,which commonly affects women of reproductive age,is a significant cause of intrauterine adhesions(IUA),potentially leading to hypomenorrhea,amenorrhea,and infertility.Hysteroscopic a...Objective:Endometrial tuberculosis,which commonly affects women of reproductive age,is a significant cause of intrauterine adhesions(IUA),potentially leading to hypomenorrhea,amenorrhea,and infertility.Hysteroscopic adhesiolysis is the primary treatment for IUA;however,studies specifically addressing its efficacy in tuberculosisinduced IUA remain scarce.This study aims to evaluate the therapeutic outcomes of hysteroscopic adhesiolysis for IUA caused by endometrial tuberculosis.Methods:This retrospective cohort study included patients diagnosed with tuberculosisinduced IUA who underwent hysteroscopic adhesiolysis at the Third Xiangya Hospital of Central South University between May 2014 and October 2022.Clinical data including age,medical history,adhesion severity,surgical treatment,and reproductive outcomes were analyzed.Results:Among 39 patients identified,2 were lost to follow-up.A total of 37 patients were included,with a follow-up duration ranging from 6 months to 9 years.Hypomenorrhea was reported in 24(64.9%)patients,secondary amenorrhea in 10(27.0%)patients,and normal menstruation in 3(8.1%)patients.Most patients presented with primary infertility(59.5%),and only 2(5.4%)had secondary infertility.The median American Fertility Society(AFS)score at initial assessment was 10(range,8−12);8(21.6%)patients had moderate IUA,and 29(78.4%)had severe IUA.A total of 86 surgical procedures were performed across 37 patients,with 27 patients undergoing 2 or more surgeries.Postoperatively,25(67.6%)patients achieved normalization of the uterine cavity,while 12(32.4%)still had a reduced cavity.Only 7(18.9%)patients had a grossly normal endometrium at the final surgery,all of whom had moderate adhesions at the initial procedure.Menstrual flow returned to normal in 12(32.4%)patients,while 25(67.6%)continued to experience hypomenorrhea.Of 29 patients who attempted in vitro fertilization and embryo transfer(IVF-ET),only 6(20.7%)conceived.Among these,4(13.8%)delivered at term via cesarean section;one case was complicated by postpartum hemorrhage due to uterine atony and another by placental adhesion.Conclusion:Endometrial tuberculosis can lead to severe IUA.Hysteroscopic adhesiolysis facilitates cavity restoration and improvement of menstrual conditions,but the overall reproductive outcomes remain suboptimal.展开更多
BACKGROUND There are few clinicopathologic characteristics and clinical results for oesophageal gastrointestinal stromal tumours(GISTs).Thus,the objective of this study was to identify the clinicopathologic characteri...BACKGROUND There are few clinicopathologic characteristics and clinical results for oesophageal gastrointestinal stromal tumours(GISTs).Thus,the objective of this study was to identify the clinicopathologic characteristics and clinical results of oesophageal GISTs.AIM To investigate endoscopic treatment effective of oesophageal GISTs.METHODS It was retrospective research that collected 32 patients with oesophageal GISTs treated by endoscopic resection(ER)between January 2012 and January 2023 in two Hospital.Clinicopathologic,endoscopic records,and follow-up data were collected and analysed.RESULTS Thirty-one patients underwent en bloc resection and 24(75.0%)lesions underwent R0 resection.The size of GISTs was 2.12±1.88 cm.The overall complication rate was 25.0%,including hydrothorax and post-endoscopic submucosal dissection electrocoagulation syndrome.The mean mitotic index was 3.34±5.04(median,1.50;range,1.00-4.00).Eighteen(56.3%),6(18.8%),2(6.3%),and 6(18.8%)patients were identified as very low,low,intermediate,and high risk,respectively.Three patients developed recurrence after a median follow-up of 64.69±33.13 months.The 5-year overall survival rate was 100%,and the disease-free survival rate was 90.6%.CONCLUSION ER is safe and effective for patients with low-risk oesophageal GISTs.Early detection of oesophageal GISTs is essential to achieve a favourable prognosis.展开更多
The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a pati...The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.展开更多
In the practice of healthcare,patient-reported outcomes(PROs)and PRO measures(PROMs)are used as an attempt to observe the changes in complex clinical situations.They guide us in making decisions based on the evidence ...In the practice of healthcare,patient-reported outcomes(PROs)and PRO measures(PROMs)are used as an attempt to observe the changes in complex clinical situations.They guide us in making decisions based on the evidence regarding patient care by recording the change in outcomes for a particular treatment to a given condition and finally to understand whether a patient will benefit from a particular treatment and to quantify the treatment effect.For any PROM to be usable in health care,we need it to be reliable,encapsulating the points of interest with the potential to detect any real change.Using structured outcome measures routinely in clinical practice helps the physician to understand the functional limitation of a patient that would otherwise not be clear in an office interview,and this allows the physician and patient to have a meaningful conver-sation as well as a customized plan for each patient.Having mentioned the rationale and the benefits of PROMs,understanding the quantification process is crucial before embarking on management decisions.A better interpretation of change needs to identify the treatment effect based on clinical relevance for a given condition.There are a multiple set of measurement indices to serve this effect and most of them are used interchangeably without clear demarcation on their differences.This article details the various quantification metrics used to evaluate the treatment effect using PROMs,their limitations and the scope of usage and implementation in clinical practice.展开更多
BACKGROUND To investigate the preoperative factors influencing textbook outcomes(TO)in Intrahepatic cholangiocarcinoma(ICC)patients and evaluate the feasibility of an interpretable machine learning model for preoperat...BACKGROUND To investigate the preoperative factors influencing textbook outcomes(TO)in Intrahepatic cholangiocarcinoma(ICC)patients and evaluate the feasibility of an interpretable machine learning model for preoperative prediction of TO,we developed a machine learning model for preoperative prediction of TO and used the SHapley Additive exPlanations(SHAP)technique to illustrate the prediction process.AIM To analyze the factors influencing textbook outcomes before surgery and to establish interpretable machine learning models for preoperative prediction.METHODS A total of 376 patients diagnosed with ICC were retrospectively collected from four major medical institutions in China,covering the period from 2011 to 2017.Logistic regression analysis was conducted to identify preoperative variables associated with achieving TO.Based on these variables,an EXtreme Gradient Boosting(XGBoost)machine learning prediction model was constructed using the XGBoost package.The SHAP(package:Shapviz)algorithm was employed to visualize each variable's contribution to the model's predictions.Kaplan-Meier survival analysis was performed to compare the prognostic differences between the TO-achieving and non-TO-achieving groups.RESULTS Among 376 patients,287 were included in the training group and 89 in the validation group.Logistic regression identified the following preoperative variables influencing TO:Child-Pugh classification,Eastern Cooperative Oncology Group(ECOG)score,hepatitis B,and tumor size.The XGBoost prediction model demonstrated high accuracy in internal validation(AUC=0.8825)and external validation(AUC=0.8346).Survival analysis revealed that the disease-free survival rates for patients achieving TO at 1,2,and 3 years were 64.2%,56.8%,and 43.4%,respectively.CONCLUSION Child-Pugh classification,ECOG score,hepatitis B,and tumor size are preoperative predictors of TO.In both the training group and the validation group,the machine learning model had certain effectiveness in predicting TO before surgery.The SHAP algorithm provided intuitive visualization of the machine learning prediction process,enhancing its interpretability.展开更多
BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with si...BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with significant long-term morbidity,and histological abnormalities such as crescentic glomerulonephritis are infrequently reported.PSAGN has also been linked to late-onset chronic kidney disease in some populations due to high levels of proteinuria.METHODS This prospective observational study was conducted at Lady Ridgeway Hospital(Colombo,Sri Lanka)over 15 months.Children with PSAGN were enrolled based on clinical and laboratory criteria.Persistent proteinuria≥2+for 2 weeks and serum creatinine>100μmol/L warranted renal biopsy,assessed via light microscopy and immunofluorescence.Normalization of complement 3(C3)within 6 to 8 weeks was required for inclusion.Data on clinical features,urine protein levels,and renal function were collected from patient records,and potential associations were analysed using Statistical Package for the Social Sciences and R language for statistical computing.Ethical approval was obtained from the Ethical Review Committee,Lady Ridgeway Hospital for Children(Ref No:LRH/ERC/2021/60).RESULTS Forty-four patients were recruited.There were 27(61.4%)male patients and 17(38.6%)female patients.Thirty-seven(84%)of them were above 5 years of age.Twenty(45%)patients had a history of skin sepsis,and eighteen(41%)had a history of throat infection.Among patients with proteinuria≥2+,53%had serum creatinine>100µmol/L,while among those with proteinuria<2+,7%had serum creatinine>100µmol/L.The association of high-degree proteinuria with elevated serum creatinine was significant(χ²=7.8,P=0.005)in PSAGN.The odds ratio of the logistic regression model was 1.049(95%confidence interval:1.003-1.098),indicating a positive direction with statistically significant association(P=0.037).There was no significant association between proteinuria and the degree of hypertension or estimated creatinine clearance.Ten children underwent renal biopsy.Crescents(less than 50%)were demonstrated in five children,while three children had typical diffuse proliferative glomer-ulonephritis.One child had severe acute tubular necrosis,and another had crescentic glomerulonephritis(crescents>50%).The immunofluorescence studies revealed deposition of immunoglobulin G and C3 in all biopsy specimens.CONCLUSION High-degree proteinuria was significantly associated with elevated serum creatinine(>100μmol/L)in children with PSAGN.The majority of children with persistent proteinuria≥2+for more than 2 weeks and the highest recorded serum creatinine>100μmol/L had atypical renal histological findings.展开更多
Gestational diabetes mellitus(GDM)is a metabolic disorder,recognised during 24-28 weeks of pregnancy.GDM is linked with adverse newborn outcomes such as macrosomia,premature delivery,metabolic disorder,cardiovascular,...Gestational diabetes mellitus(GDM)is a metabolic disorder,recognised during 24-28 weeks of pregnancy.GDM is linked with adverse newborn outcomes such as macrosomia,premature delivery,metabolic disorder,cardiovascular,and neurological disorders.Recent investigations have focused on the correlation of genetic factors such asβ-cell function and insulin secretary genes(transcription factor 7 like 2,potassium voltage-gated channel subfamily q member 1,adipo-nectin etc.)on maternal metabolism during gestation leading to GDM.Epigenetic alterations like DNA methylation,histone modification,and miRNA expression can influence gene expression and play a dominant role in feto-maternal meta-bolic pathways.Interactions between genes and environment,resulting in differ-ential gene expression patterns may lead to GDM.Researchers suggested that GDM women are more susceptible to insulin resistance,which alters intrauterine surroundings,resulting hyperglycemia and hyperinsulinemia.Epigenetic modi-fications in genes affecting neuroendocrine activities,and metabolism,increase the risk of obesity and type 2 diabetes in offspring.There is currently no treatment or effective preventive method for GDM,since the molecular processes of insulin resistance are not well understood.The present review was undertaken to un-derstand the pathophysiology of GDM and its effects on adverse neonatal out-comes.In addition,the study of genetic and epigenetic alterations will provide lead to researchers in the search for predictive molecular biomarkers.展开更多
This editorial offers insights from a minireview by Venkatesh et al,who explored pharmacological adjuvants for diabetic vitrectomy.Specifically,they synthesized current knowledge and evaluated the efficacy of various ...This editorial offers insights from a minireview by Venkatesh et al,who explored pharmacological adjuvants for diabetic vitrectomy.Specifically,they synthesized current knowledge and evaluated the efficacy of various adjunctive therapies in improving the outcomes of diabetic retinopathy and managing associated complications.Herein,we highlight the key roles of pharmacological adjuvants in optimizing surgical techniques,minimizing intraoperative challenges,and enhancing postoperative recovery.We further discuss the potential implications of this approach for clinical practice and future research directions in this evolving field.Overall,this editorial underscores the importance of incorporating pharmacological adjuvants into standard diabetic vitrectomy care to improve surgical outcomes and thus patients’quality of life.展开更多
BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated ...BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated with PH-PVT.METHODS Medical records of patients who underwent hepatic resection for various diseases between February 2014 and December 2023 at Beijing Tsinghua Changgung Hospital affiliated with Tsinghua University(Beijing,China)were retrospectively reviewed.The patients were divided into a PH-PVT group and a non-PH-PVT group.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PH-PVT.RESULTS A total of 1064 patients were included in the study cohort,and the incidence and mortality rates of PH-PVT were 3.9%and 35.7%,respectively.The median time from hepatectomy to the diagnosis of PH-PVT was 6 days.Multivariate analysis revealed that hepatectomy combined with pancreaticoduodenectomy(HPD)[odds ratio(OR)=7.627(1.390-41.842),P=0.019],portal vein reconstruction[OR=6.119(2.636-14.203),P<0.001]and a postoperative portal vein angle<100°[OR=2.457(1.131-5.348),P=0.023]were independent risk factors for PH-PVT.Age≥60 years[OR=8.688(1.774-42.539),P=0.008]and portal vein reconstruction[OR=6.182(1.246-30.687),P=0.026]were independent risk factors for mortality in PH-PVT patients.CONCLUSION Portal vein reconstruction,a postoperative portal vein angle<100°and HPD were independent risk factors for PHPVT.Age≥60 years and portal vein reconstruction were independent risk factors for mortality in PH-PVT patients.展开更多
Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data dat...Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data databases were searched to include clinical studies on the effect of EP on pregnancy outcomes in patients with EMs,published before August 31,2020.A meta-analysis was performed using Rev Man 5.3 software after two investigators independently screened the literature,extracted information,and evaluated the risk of bias of the included studies.Results The meta-analysis included ten studies(651 and 1,040 in the combined EP and uncomplicated EP groups,respectively).The spontaneous pregnancy rate,clinical pregnancy rate,and live birth rate were significantly lower in the group with combined EPs than in the group without combined EPs[Odd’s ratio(OR)=0.63,95%confidence interval(CI):0.50–0.80,P=0.0001;OR=0.63,95%CI:0.48–0.84,P=0.001;OR=0.63,95%CI:0.42–0.96,P=0.03],and the rate of embryonic abortion was significantly higher than that in the uncomplicated EP group[OR=3.10,95%CI:1.52–6.32,P=0.002].Conclusion EP may adversely affect pregnancy outcomes in patients with infertility and EMs.Even after surgical treatment,EP can still reduce natural pregnancy,clinical pregnancy,and live birth rates in infertile women with EMs and increase the risk of embryo arrest in these women.展开更多
In recent years,the obstetrics department has advocated vaginal delivery to reduce the rate of cesarean sections.However,in clinical practice,pregnant women are prone to anxiety before childbirth,making it difficult t...In recent years,the obstetrics department has advocated vaginal delivery to reduce the rate of cesarean sections.However,in clinical practice,pregnant women are prone to anxiety before childbirth,making it difficult to perform a vaginal trial delivery smoothly.The combined approach of ADIET communication and delivery rehearsal for vaginal trial delivery can provide a reference for reducing prenatal anxiety,shortening labor duration,facilitating a smooth delivery,and ensuring the safety of both mothers and babies.AIM To analyze the effect of AIDET communication combined with labor rehearsal on vaginal trial delivery.METHODS A study conducted between January 2023 and December 2023 included 200 vaginal trials.Women were randomly assigned to an observation group(100 women),which received ADIET communication plus delivery intervention,and a control group(100 women),which received routine communication plus delivery intervention.This study aimed to compare antenatal anxiety status as measured using the Maternal Anxiety Scale,labor duration,delivery efficacy as assessed using the simplified Chinese version of the Childbirth Self-Efficacy Inventory,and delivery outcomes.RESULTS After the intervention,the observation group had a lower Maternal Anxiety Scale score and higher Childbirth Self-Efficacy Inventory score(P<0.05)than the control group(P<0.05),whereas the observation group had higher natural delivery,cesarean delivery,vaginal delivery,and neonatal asphyxia rates(P<0.05).CONCLUSION For women undergoing vaginal trial delivery,a combination of AIDET communication and delivery rehearsal can relieve prenatal anxiety,enhance delivery efficiency,shorten labor duration,and somewhat improve delivery outcomes.展开更多
Hepatitis B virus(HBV)is one of the major micro-pathogens in the progression of chronic liver infections worldwide.Despite a vaccine and anti-virus drugs used in the management of HBV infection,the prognosis and outco...Hepatitis B virus(HBV)is one of the major micro-pathogens in the progression of chronic liver infections worldwide.Despite a vaccine and anti-virus drugs used in the management of HBV infection,the prognosis and outcomes of this chronic infection remain complex and the infection can easily recur.Several parameters such as host age,viral mutations and genotypes,regional distributions,etc.have an effect on the outcome of hepatitis B infection following preventive measures and therapy around viral life cycle in the clinic.In addition,the economic status in different regions and groups of patients also affect disease progression.A costeffectiveness analysis is considered to play a critical role in the management of chronic HBV infection.This mini-review investigates the above-mentioned aspects and provides a perspective viewpoint for the management of HBV infection in the future.展开更多
BACKGROUND Difficult total hip replacements(THRs)are hip arthroplasties performed on patients with compromised or severely altered bone or soft tissue.Difficult THR indications are common in low-income countries,where...BACKGROUND Difficult total hip replacements(THRs)are hip arthroplasties performed on patients with compromised or severely altered bone or soft tissue.Difficult THR indications are common in low-income countries,where access to care is often delayed.In these contexts,patients generally consult us with severe impairments that require significant technical adaptations,as well as adaptation to available resources and local conditions.AIM To describe the results and difficulties encountered following difficult THR in the study center.METHODS This bi-centric retrospective study was conducted over a 10-year period(2013-2023)and included 50 patients operated on for difficult THR.The mean age of the patients was 37.8 years.Surgical difficulties were recorded from operative reports,and the strategies employed to overcome these difficulties were analyzed,taking into account the types of implants used.RESULTS At last follow-up,functional results were considered good to excellent according to the Postel-Merle d'Aubignéscore,with significant improvement after surgery(P<0.005).Mean operative time was 177 minutes(range:90-290 minutes),with a mean blood loss of 568 mL(range:200-900 mL).The short-term and medium-term post-operative complication rate was 6%.CONCLUSION Even in difficult conditions,THR can produce favorable results through careful planning,adaptation of techniques and targeted approaches to overcoming challenges.展开更多
Background:Totally thoracoscopic surgery(TTS)and right lateral thoracotomy(RLT)are both extensively utilized in the surgical repair for atrial septal defect(ASD).However,RLT is generally considered in low-weight pedia...Background:Totally thoracoscopic surgery(TTS)and right lateral thoracotomy(RLT)are both extensively utilized in the surgical repair for atrial septal defect(ASD).However,RLT is generally considered in low-weight pediatric patients as a result of restricted surgical exposure.This study aims to introduce an RLT approach for ASD repair in adults and compare its clinical outcomes with TTS.Methods:We conducted a retrospective analysis of the clinical data of 23 adult patients who underwent ASD repair at Guangdong Provincial People’s Hospital between June and October 2024.Patients were divided into two groups based on the surgical approach they adopted:group totally thoracoscopic surgery(TTS,n=12)and group right lateral thoracotomy(RLT,n=11).All individuals finished a follow-up three months after surgery.Operative parameters,postoperative courses,echocardiographic measurements and laboratory investigations were compared between the two groups.Results:The total surgical duration was significantly longer in group RLT compared with group TTS[(234.00±47.93)min vs.(175.17±52.36)min,p=0.011].Group RLT exhibited a significantly higher respiratory index(RI)at<6 h postoperatively(1.00±0.58 vs.0.30±0.37,p=0.01)and significantly lower levels of soluble suppression of tumorigenicity 2(sST2)[(136.61±43.12)ng/mL vs.(199.08±33.56)ng/mL,p=0.037]and cardiac troponin(cTnT)[(277.04±89.85)pg/mL vs.(343.30±482.40)pg/mL,p=0.047]at 12-24 h postoperatively.Echocardiographic measurements showed no significant differences between two groups,except for a more pronounced reduction in left atrial(LA)size at discharge in group TTS[(5.00±3.64)mm vs.(0.09±4.44)mm,p=0.008].Conversely,group RLT demonstrated a less significant decrease in glutamyl transpeptidase(GGT)[(1.00±6.00)U/L vs.(5.25±3.86)U/L,p=0.026]but a more significant decrease in blood urea nitrogen(BUN)[(1.81±1.10)mg/dL vs.(0.81±1.07)mg/dL,p=0.038].Conclusions:RLT for ASD repair in adults demonstrated comparable clinical outcomes to TTS in terms of postoperative recovery and cardiac function and also produced fewer scars than TTS.Our study proved the feasibility,safety and cosmetic effects of uniport RLT for ASD repair in adults when compared with TTS.展开更多
This letter addresses the study by Jayabalan et al,which underscores the liver outcome score(LOS)and hemoglobin(Hb)as key prognostic markers for patients with autoimmune liver disease overlap syndromes(AILDOS),with pa...This letter addresses the study by Jayabalan et al,which underscores the liver outcome score(LOS)and hemoglobin(Hb)as key prognostic markers for patients with autoimmune liver disease overlap syndromes(AILDOS),with particular relevance to the autoimmune hepatitis-primary biliary cholangitis(AIH-PBC)subgroup.The findings indicate that an LOS threshold of 6 achieves high sensitivity and specificity in predicting liver-related mortality among AIH-PBC patients.Moreover,low Hb levels emerge as a significant mortality predictor across all AILDOS cases.These results contribute valuable perspectives on risk stratification in AILDOS,highlighting the promise of non-invasive prognostic tools.Future studies with larger cohorts are needed to substantiate LOS and Hb as robust markers for clinical application.展开更多
To investigate the risk and influencing factors of long-term liver adverse events in chronic hepatitis B patients achieving hepatitis B surface antigen(HBsAg)clearance after pegylated interferonα(Peg-IFNα)treatment,...To investigate the risk and influencing factors of long-term liver adverse events in chronic hepatitis B patients achieving hepatitis B surface antigen(HBsAg)clearance after pegylated interferonα(Peg-IFNα)treatment,a retrospective analysis was conducted on 456 patients at Beijing Ditan Hospital from 2008 to 2023 who achieved HBsAg clearance and discontinued Peg-IFNαtreatment.The baseline was defined as the time of HBsAg clearance and treatment cessation.The endpoint was the first occurrence of liver adverse events(hepatocellular carcinoma or ascites)or last follow-up.Subsequently,we evaluated the incidence and risk factors of liver adverse events,along with changes in liver fibrosis,cirrhosis,and liver function indicators.During a median follow-up of 70 months,the incidence of liver adverse events was 2.30%,hepatocellular carcinoma 1.76%,and ascites 0.55%.Older age and cirrhosis were significant risk factors(HR 1.075 and 41.393,both P<0.01).The APRI score significantly improved at follow-up compared to baseline(0.53 vs.0.25,P<0.001),and cirrhosis prevalence decreased from 5.70%to 0.88%(P<0.001).In conclusion,patients who achieved HBsAg clearance and discontinued Peg-IFNαtreatment have a low risk of liver adverse events,while advanced age and cirrhosis remain major risk factors.展开更多
In recent years,artificial intelligence(AI)has been increasingly integrated into educational settings worldwide.This study aims to explore the effectiveness of AI classroom teaching for Chinese undergraduate students,...In recent years,artificial intelligence(AI)has been increasingly integrated into educational settings worldwide.This study aims to explore the effectiveness of AI classroom teaching for Chinese undergraduate students,focusing on its influence on learning outcomes and student engagement.The research uses a quantitative approach,utilizing surveys and academic performance data to evaluate two main objectives:(1)the impact of AI teaching methods on academic performance compared to traditional instruction;(2)the level of student engagement and satisfaction with AI-based learning tools.The study sample includes undergraduate students from multiple universities in China,allowing for a diverse representation of various disciplines.Data will be collected through standardized tests,questionnaires,and academic records,ensuring the reliability and validity of the results.The findings will provide insights into the potential advantages and challenges of AI integration in higher education and inform future strategies for adopting AI in Chinese classrooms.By exploring both the academic and practical aspects of AI-driven education,this research aims to contribute valuable knowledge to the growing field of AI in education,particularly in the context of Chinese higher education.The results are expected to have implications for educators,policymakers,and AI developers interested in enhancing the effectiveness of educational technologies.展开更多
文摘BACKGROUND Meniscal tears are one of the most common knee injuries.After the diagnosis of a meniscal tear has been made,there are several factors physicians use to guide clinical decision-making.The influence of time between injury and isolated meniscus repair on patient outcomes is not well described.Assessing this relationship is important as it may influence clinical decision-making and can add to the preoperative patient education process.We hypothesized that increasing the time from injury to meniscus surgery would worsen postoperative outcomes.AIM To investigate the current literature for data on the relationship between time between meniscus injury and repair on patient outcomes.METHODS PubMed,Academic Search Complete,MEDLINE,CINAHL,and SPORTDiscus were searched for studies published between January 1,1995 and July 13,2023 on isolated meniscus repair.Exclusion criteria included concomitant ligament surgery,incomplete outcomes or time to surgery data,and meniscectomies.Patient demographics,time to injury,and postoperative outcomes from each study were abstracted and analyzed.RESULTS Five studies met all inclusion and exclusion criteria.There were 204(121 male,83 female)patients included.Three of five(60%)studies determined that time between injury and surgery was not statistically significant for postoperative Lysholm scores(P=0.62),Tegner scores(P=0.46),failure rate(P=0.45,P=0.86),and International Knee Documentation Committee scores(P=0.65).Two of five(40%)studies found a statistically significant increase in Lysholm scores with shorter time to surgery(P=0.03)and a statistically significant association between progression of medial meniscus extrusion ratio(P=0.01)and increasing time to surgery.CONCLUSION Our results do not support the hypothesis that increased time from injury to isolated meniscus surgery worsens postoperative outcomes.Decision-making primarily based on injury interval is thus not recommended.
文摘Introduction: The Coronavirus pandemic was responsible for an unprecedented health crisis that shook the world with its high contagiousness and lethality. Its impact on maternal and fetal health places pregnant women at high risk. The aim of our study was to determine the factors associated with the occurrence of COVID-19 in pregnant women, and the maternal and perinatal outcomes of infected patients. Methodology: This was a case-control study involving 42 cases matched to 42 controls recruited from two public and tertiary hospitals in the cities of Yaoundé and Douala over a period from November 31 to May 31, 2024. Cases were defined as deliveries or records of COVID-19 deliveries confirmed positive by reverse transcription polymerase chain reaction (RT-PCR) or by a COVID-19 rapid diagnostic test (Covid-RDT). Controls were defined as deliveries or records of deliveries negative to the same test. They were matched by the hospital. Non-consenting births and unusable records were excluded. The data collected were recorded on a pre-established, pretexted data sheet examining sociodemographic, clinical characteristics and maternal and perinatal outcomes which were then analyzed using SPSS version 23.0 software. Results: After multivariate analysis, the independent sociodemographic factors were: belonging to the [30 - 40] age group (OR: 4.4;P = 0.010), being married (OR: 8.1;P = 0.030);being unemployed (OR: 3;P = 0.040). Independent clinical factors were: being in the third trimester of pregnancy (OR: 1.1;P = 0.017), being diabetic (OR: 5;P = 0.033) and being obese (OR: 11.5;P = 0.043). Independent factors associated with maternal outcome were: caesarean section (OR: 10;P = 0.001);admission to intensive care (OR: 30.7;P = 0.013);SO2 ≤ 94% (OR: 11.7;P = 0.033);HR > 100 (OR: 15.5;P = 0.001). Independent factors associated with perinatal outcome were: weight Conclusion: The factors associated with the occurrence of COVID-19 in pregnant women are multiple, and maternal outcome depends on its condition on admission, and has a significant impact on perinatal health, including mode of delivery. Emphasis must be placed on prevention and optimal management of these associated factors.
文摘Objective: To examine the effects of comprehensive nursing interventions on maternal and infant outcomes in pregnant women diagnosed with gestational diabetes mellitus (GDM). Methods: A quasi-experimental design was employed, involving 60 pregnant women with GDM who were purposively selected and randomly allocated into experimental and control groups, each comprising 30 participants. The experimental group received comprehensive nursing interventions and pregnancy monitoring, while the control group received standard nursing care. Data collection was conducted using demographic questionnaires, pregnancy indicators, and maternal-infant outcome measurement tools. The collected data were analyzed using Microsoft Excel and the Statistical Package for Social Sciences (SPSS). Results: The findings indicated significant improvements in fasting blood glucose, postprandial blood glucose, amniotic fluid index, and neonatal birth weight in the experimental group compared to the control group. However, no statistically significant differences were observed in body mass index (BMI) or pregnancy weight gain. Comprehensive nursing interventions were associated with a significant reduction in maternal complications, including polyhydramnios, postpartum hemorrhage, and preeclampsia, as well as neonatal complications such as neonatal pneumonia, macrosomia, and hypoglycemia. Conclusion: Comprehensive nursing interventions have a positive impact on maternal and neonatal outcomes in pregnant women with GDM.
基金supported by the Wisdom Accumulation and Talent Cultivation Project of Third Xiangya Hosipital of Central South University,China(YX202112).
文摘Objective:Endometrial tuberculosis,which commonly affects women of reproductive age,is a significant cause of intrauterine adhesions(IUA),potentially leading to hypomenorrhea,amenorrhea,and infertility.Hysteroscopic adhesiolysis is the primary treatment for IUA;however,studies specifically addressing its efficacy in tuberculosisinduced IUA remain scarce.This study aims to evaluate the therapeutic outcomes of hysteroscopic adhesiolysis for IUA caused by endometrial tuberculosis.Methods:This retrospective cohort study included patients diagnosed with tuberculosisinduced IUA who underwent hysteroscopic adhesiolysis at the Third Xiangya Hospital of Central South University between May 2014 and October 2022.Clinical data including age,medical history,adhesion severity,surgical treatment,and reproductive outcomes were analyzed.Results:Among 39 patients identified,2 were lost to follow-up.A total of 37 patients were included,with a follow-up duration ranging from 6 months to 9 years.Hypomenorrhea was reported in 24(64.9%)patients,secondary amenorrhea in 10(27.0%)patients,and normal menstruation in 3(8.1%)patients.Most patients presented with primary infertility(59.5%),and only 2(5.4%)had secondary infertility.The median American Fertility Society(AFS)score at initial assessment was 10(range,8−12);8(21.6%)patients had moderate IUA,and 29(78.4%)had severe IUA.A total of 86 surgical procedures were performed across 37 patients,with 27 patients undergoing 2 or more surgeries.Postoperatively,25(67.6%)patients achieved normalization of the uterine cavity,while 12(32.4%)still had a reduced cavity.Only 7(18.9%)patients had a grossly normal endometrium at the final surgery,all of whom had moderate adhesions at the initial procedure.Menstrual flow returned to normal in 12(32.4%)patients,while 25(67.6%)continued to experience hypomenorrhea.Of 29 patients who attempted in vitro fertilization and embryo transfer(IVF-ET),only 6(20.7%)conceived.Among these,4(13.8%)delivered at term via cesarean section;one case was complicated by postpartum hemorrhage due to uterine atony and another by placental adhesion.Conclusion:Endometrial tuberculosis can lead to severe IUA.Hysteroscopic adhesiolysis facilitates cavity restoration and improvement of menstrual conditions,but the overall reproductive outcomes remain suboptimal.
基金Supported by National Natural Science Foundation of China,No.82002515,No.82273025 and No.82203460China Postdoctoral Science Foundation,No.2022TQ0070 and No.2022M710759Shanghai Municipal Commission of Science and Technology,No.22JC1403003,No.22XD1402200,No.19140901902 and No.22S31903800.
文摘BACKGROUND There are few clinicopathologic characteristics and clinical results for oesophageal gastrointestinal stromal tumours(GISTs).Thus,the objective of this study was to identify the clinicopathologic characteristics and clinical results of oesophageal GISTs.AIM To investigate endoscopic treatment effective of oesophageal GISTs.METHODS It was retrospective research that collected 32 patients with oesophageal GISTs treated by endoscopic resection(ER)between January 2012 and January 2023 in two Hospital.Clinicopathologic,endoscopic records,and follow-up data were collected and analysed.RESULTS Thirty-one patients underwent en bloc resection and 24(75.0%)lesions underwent R0 resection.The size of GISTs was 2.12±1.88 cm.The overall complication rate was 25.0%,including hydrothorax and post-endoscopic submucosal dissection electrocoagulation syndrome.The mean mitotic index was 3.34±5.04(median,1.50;range,1.00-4.00).Eighteen(56.3%),6(18.8%),2(6.3%),and 6(18.8%)patients were identified as very low,low,intermediate,and high risk,respectively.Three patients developed recurrence after a median follow-up of 64.69±33.13 months.The 5-year overall survival rate was 100%,and the disease-free survival rate was 90.6%.CONCLUSION ER is safe and effective for patients with low-risk oesophageal GISTs.Early detection of oesophageal GISTs is essential to achieve a favourable prognosis.
文摘The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.
文摘In the practice of healthcare,patient-reported outcomes(PROs)and PRO measures(PROMs)are used as an attempt to observe the changes in complex clinical situations.They guide us in making decisions based on the evidence regarding patient care by recording the change in outcomes for a particular treatment to a given condition and finally to understand whether a patient will benefit from a particular treatment and to quantify the treatment effect.For any PROM to be usable in health care,we need it to be reliable,encapsulating the points of interest with the potential to detect any real change.Using structured outcome measures routinely in clinical practice helps the physician to understand the functional limitation of a patient that would otherwise not be clear in an office interview,and this allows the physician and patient to have a meaningful conver-sation as well as a customized plan for each patient.Having mentioned the rationale and the benefits of PROMs,understanding the quantification process is crucial before embarking on management decisions.A better interpretation of change needs to identify the treatment effect based on clinical relevance for a given condition.There are a multiple set of measurement indices to serve this effect and most of them are used interchangeably without clear demarcation on their differences.This article details the various quantification metrics used to evaluate the treatment effect using PROMs,their limitations and the scope of usage and implementation in clinical practice.
基金Supported by National Key Research and Development Program,No.2022YFC2407304Major Research Project for Middle-Aged and Young Scientists of Fujian Provincial Health Commission,No.2021ZQNZD013+2 种基金The National Natural Science Foundation of China,No.62275050Fujian Province Science and Technology Innovation Joint Fund Project,No.2019Y9108Major Science and Technology Projects of Fujian Province,No.2021YZ036017.
文摘BACKGROUND To investigate the preoperative factors influencing textbook outcomes(TO)in Intrahepatic cholangiocarcinoma(ICC)patients and evaluate the feasibility of an interpretable machine learning model for preoperative prediction of TO,we developed a machine learning model for preoperative prediction of TO and used the SHapley Additive exPlanations(SHAP)technique to illustrate the prediction process.AIM To analyze the factors influencing textbook outcomes before surgery and to establish interpretable machine learning models for preoperative prediction.METHODS A total of 376 patients diagnosed with ICC were retrospectively collected from four major medical institutions in China,covering the period from 2011 to 2017.Logistic regression analysis was conducted to identify preoperative variables associated with achieving TO.Based on these variables,an EXtreme Gradient Boosting(XGBoost)machine learning prediction model was constructed using the XGBoost package.The SHAP(package:Shapviz)algorithm was employed to visualize each variable's contribution to the model's predictions.Kaplan-Meier survival analysis was performed to compare the prognostic differences between the TO-achieving and non-TO-achieving groups.RESULTS Among 376 patients,287 were included in the training group and 89 in the validation group.Logistic regression identified the following preoperative variables influencing TO:Child-Pugh classification,Eastern Cooperative Oncology Group(ECOG)score,hepatitis B,and tumor size.The XGBoost prediction model demonstrated high accuracy in internal validation(AUC=0.8825)and external validation(AUC=0.8346).Survival analysis revealed that the disease-free survival rates for patients achieving TO at 1,2,and 3 years were 64.2%,56.8%,and 43.4%,respectively.CONCLUSION Child-Pugh classification,ECOG score,hepatitis B,and tumor size are preoperative predictors of TO.In both the training group and the validation group,the machine learning model had certain effectiveness in predicting TO before surgery.The SHAP algorithm provided intuitive visualization of the machine learning prediction process,enhancing its interpretability.
文摘BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with significant long-term morbidity,and histological abnormalities such as crescentic glomerulonephritis are infrequently reported.PSAGN has also been linked to late-onset chronic kidney disease in some populations due to high levels of proteinuria.METHODS This prospective observational study was conducted at Lady Ridgeway Hospital(Colombo,Sri Lanka)over 15 months.Children with PSAGN were enrolled based on clinical and laboratory criteria.Persistent proteinuria≥2+for 2 weeks and serum creatinine>100μmol/L warranted renal biopsy,assessed via light microscopy and immunofluorescence.Normalization of complement 3(C3)within 6 to 8 weeks was required for inclusion.Data on clinical features,urine protein levels,and renal function were collected from patient records,and potential associations were analysed using Statistical Package for the Social Sciences and R language for statistical computing.Ethical approval was obtained from the Ethical Review Committee,Lady Ridgeway Hospital for Children(Ref No:LRH/ERC/2021/60).RESULTS Forty-four patients were recruited.There were 27(61.4%)male patients and 17(38.6%)female patients.Thirty-seven(84%)of them were above 5 years of age.Twenty(45%)patients had a history of skin sepsis,and eighteen(41%)had a history of throat infection.Among patients with proteinuria≥2+,53%had serum creatinine>100µmol/L,while among those with proteinuria<2+,7%had serum creatinine>100µmol/L.The association of high-degree proteinuria with elevated serum creatinine was significant(χ²=7.8,P=0.005)in PSAGN.The odds ratio of the logistic regression model was 1.049(95%confidence interval:1.003-1.098),indicating a positive direction with statistically significant association(P=0.037).There was no significant association between proteinuria and the degree of hypertension or estimated creatinine clearance.Ten children underwent renal biopsy.Crescents(less than 50%)were demonstrated in five children,while three children had typical diffuse proliferative glomer-ulonephritis.One child had severe acute tubular necrosis,and another had crescentic glomerulonephritis(crescents>50%).The immunofluorescence studies revealed deposition of immunoglobulin G and C3 in all biopsy specimens.CONCLUSION High-degree proteinuria was significantly associated with elevated serum creatinine(>100μmol/L)in children with PSAGN.The majority of children with persistent proteinuria≥2+for more than 2 weeks and the highest recorded serum creatinine>100μmol/L had atypical renal histological findings.
基金Supported by Maulana Azad National Fellowship,University Grants Commission,New Delhi,and Department of Biotechnology,New Delhi,No.AS[82-27/2019(SA III)]DBT-BUILDER-University of Lucknow Interdisciplinary Life Science Programme for Advance Research and Education(Level II),No.TG(BT/INF/22/SP47623/2022).
文摘Gestational diabetes mellitus(GDM)is a metabolic disorder,recognised during 24-28 weeks of pregnancy.GDM is linked with adverse newborn outcomes such as macrosomia,premature delivery,metabolic disorder,cardiovascular,and neurological disorders.Recent investigations have focused on the correlation of genetic factors such asβ-cell function and insulin secretary genes(transcription factor 7 like 2,potassium voltage-gated channel subfamily q member 1,adipo-nectin etc.)on maternal metabolism during gestation leading to GDM.Epigenetic alterations like DNA methylation,histone modification,and miRNA expression can influence gene expression and play a dominant role in feto-maternal meta-bolic pathways.Interactions between genes and environment,resulting in differ-ential gene expression patterns may lead to GDM.Researchers suggested that GDM women are more susceptible to insulin resistance,which alters intrauterine surroundings,resulting hyperglycemia and hyperinsulinemia.Epigenetic modi-fications in genes affecting neuroendocrine activities,and metabolism,increase the risk of obesity and type 2 diabetes in offspring.There is currently no treatment or effective preventive method for GDM,since the molecular processes of insulin resistance are not well understood.The present review was undertaken to un-derstand the pathophysiology of GDM and its effects on adverse neonatal out-comes.In addition,the study of genetic and epigenetic alterations will provide lead to researchers in the search for predictive molecular biomarkers.
文摘This editorial offers insights from a minireview by Venkatesh et al,who explored pharmacological adjuvants for diabetic vitrectomy.Specifically,they synthesized current knowledge and evaluated the efficacy of various adjunctive therapies in improving the outcomes of diabetic retinopathy and managing associated complications.Herein,we highlight the key roles of pharmacological adjuvants in optimizing surgical techniques,minimizing intraoperative challenges,and enhancing postoperative recovery.We further discuss the potential implications of this approach for clinical practice and future research directions in this evolving field.Overall,this editorial underscores the importance of incorporating pharmacological adjuvants into standard diabetic vitrectomy care to improve surgical outcomes and thus patients’quality of life.
文摘BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated with PH-PVT.METHODS Medical records of patients who underwent hepatic resection for various diseases between February 2014 and December 2023 at Beijing Tsinghua Changgung Hospital affiliated with Tsinghua University(Beijing,China)were retrospectively reviewed.The patients were divided into a PH-PVT group and a non-PH-PVT group.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PH-PVT.RESULTS A total of 1064 patients were included in the study cohort,and the incidence and mortality rates of PH-PVT were 3.9%and 35.7%,respectively.The median time from hepatectomy to the diagnosis of PH-PVT was 6 days.Multivariate analysis revealed that hepatectomy combined with pancreaticoduodenectomy(HPD)[odds ratio(OR)=7.627(1.390-41.842),P=0.019],portal vein reconstruction[OR=6.119(2.636-14.203),P<0.001]and a postoperative portal vein angle<100°[OR=2.457(1.131-5.348),P=0.023]were independent risk factors for PH-PVT.Age≥60 years[OR=8.688(1.774-42.539),P=0.008]and portal vein reconstruction[OR=6.182(1.246-30.687),P=0.026]were independent risk factors for mortality in PH-PVT patients.CONCLUSION Portal vein reconstruction,a postoperative portal vein angle<100°and HPD were independent risk factors for PHPVT.Age≥60 years and portal vein reconstruction were independent risk factors for mortality in PH-PVT patients.
文摘Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data databases were searched to include clinical studies on the effect of EP on pregnancy outcomes in patients with EMs,published before August 31,2020.A meta-analysis was performed using Rev Man 5.3 software after two investigators independently screened the literature,extracted information,and evaluated the risk of bias of the included studies.Results The meta-analysis included ten studies(651 and 1,040 in the combined EP and uncomplicated EP groups,respectively).The spontaneous pregnancy rate,clinical pregnancy rate,and live birth rate were significantly lower in the group with combined EPs than in the group without combined EPs[Odd’s ratio(OR)=0.63,95%confidence interval(CI):0.50–0.80,P=0.0001;OR=0.63,95%CI:0.48–0.84,P=0.001;OR=0.63,95%CI:0.42–0.96,P=0.03],and the rate of embryonic abortion was significantly higher than that in the uncomplicated EP group[OR=3.10,95%CI:1.52–6.32,P=0.002].Conclusion EP may adversely affect pregnancy outcomes in patients with infertility and EMs.Even after surgical treatment,EP can still reduce natural pregnancy,clinical pregnancy,and live birth rates in infertile women with EMs and increase the risk of embryo arrest in these women.
文摘In recent years,the obstetrics department has advocated vaginal delivery to reduce the rate of cesarean sections.However,in clinical practice,pregnant women are prone to anxiety before childbirth,making it difficult to perform a vaginal trial delivery smoothly.The combined approach of ADIET communication and delivery rehearsal for vaginal trial delivery can provide a reference for reducing prenatal anxiety,shortening labor duration,facilitating a smooth delivery,and ensuring the safety of both mothers and babies.AIM To analyze the effect of AIDET communication combined with labor rehearsal on vaginal trial delivery.METHODS A study conducted between January 2023 and December 2023 included 200 vaginal trials.Women were randomly assigned to an observation group(100 women),which received ADIET communication plus delivery intervention,and a control group(100 women),which received routine communication plus delivery intervention.This study aimed to compare antenatal anxiety status as measured using the Maternal Anxiety Scale,labor duration,delivery efficacy as assessed using the simplified Chinese version of the Childbirth Self-Efficacy Inventory,and delivery outcomes.RESULTS After the intervention,the observation group had a lower Maternal Anxiety Scale score and higher Childbirth Self-Efficacy Inventory score(P<0.05)than the control group(P<0.05),whereas the observation group had higher natural delivery,cesarean delivery,vaginal delivery,and neonatal asphyxia rates(P<0.05).CONCLUSION For women undergoing vaginal trial delivery,a combination of AIDET communication and delivery rehearsal can relieve prenatal anxiety,enhance delivery efficiency,shorten labor duration,and somewhat improve delivery outcomes.
基金Supported by Natural Science Foundation of Shanghai,No.17ZR1431400.
文摘Hepatitis B virus(HBV)is one of the major micro-pathogens in the progression of chronic liver infections worldwide.Despite a vaccine and anti-virus drugs used in the management of HBV infection,the prognosis and outcomes of this chronic infection remain complex and the infection can easily recur.Several parameters such as host age,viral mutations and genotypes,regional distributions,etc.have an effect on the outcome of hepatitis B infection following preventive measures and therapy around viral life cycle in the clinic.In addition,the economic status in different regions and groups of patients also affect disease progression.A costeffectiveness analysis is considered to play a critical role in the management of chronic HBV infection.This mini-review investigates the above-mentioned aspects and provides a perspective viewpoint for the management of HBV infection in the future.
文摘BACKGROUND Difficult total hip replacements(THRs)are hip arthroplasties performed on patients with compromised or severely altered bone or soft tissue.Difficult THR indications are common in low-income countries,where access to care is often delayed.In these contexts,patients generally consult us with severe impairments that require significant technical adaptations,as well as adaptation to available resources and local conditions.AIM To describe the results and difficulties encountered following difficult THR in the study center.METHODS This bi-centric retrospective study was conducted over a 10-year period(2013-2023)and included 50 patients operated on for difficult THR.The mean age of the patients was 37.8 years.Surgical difficulties were recorded from operative reports,and the strategies employed to overcome these difficulties were analyzed,taking into account the types of implants used.RESULTS At last follow-up,functional results were considered good to excellent according to the Postel-Merle d'Aubignéscore,with significant improvement after surgery(P<0.005).Mean operative time was 177 minutes(range:90-290 minutes),with a mean blood loss of 568 mL(range:200-900 mL).The short-term and medium-term post-operative complication rate was 6%.CONCLUSION Even in difficult conditions,THR can produce favorable results through careful planning,adaptation of techniques and targeted approaches to overcoming challenges.
基金This research was funded by the Natural Science Foundation of Guangdong Province(2023A1515012501)Guangzhou Municipal Science and Technology Planning Project(2023B03J1254)Congenital Heart Disease Medical Talent Cultivation and Education Fund(2023QT0009).
文摘Background:Totally thoracoscopic surgery(TTS)and right lateral thoracotomy(RLT)are both extensively utilized in the surgical repair for atrial septal defect(ASD).However,RLT is generally considered in low-weight pediatric patients as a result of restricted surgical exposure.This study aims to introduce an RLT approach for ASD repair in adults and compare its clinical outcomes with TTS.Methods:We conducted a retrospective analysis of the clinical data of 23 adult patients who underwent ASD repair at Guangdong Provincial People’s Hospital between June and October 2024.Patients were divided into two groups based on the surgical approach they adopted:group totally thoracoscopic surgery(TTS,n=12)and group right lateral thoracotomy(RLT,n=11).All individuals finished a follow-up three months after surgery.Operative parameters,postoperative courses,echocardiographic measurements and laboratory investigations were compared between the two groups.Results:The total surgical duration was significantly longer in group RLT compared with group TTS[(234.00±47.93)min vs.(175.17±52.36)min,p=0.011].Group RLT exhibited a significantly higher respiratory index(RI)at<6 h postoperatively(1.00±0.58 vs.0.30±0.37,p=0.01)and significantly lower levels of soluble suppression of tumorigenicity 2(sST2)[(136.61±43.12)ng/mL vs.(199.08±33.56)ng/mL,p=0.037]and cardiac troponin(cTnT)[(277.04±89.85)pg/mL vs.(343.30±482.40)pg/mL,p=0.047]at 12-24 h postoperatively.Echocardiographic measurements showed no significant differences between two groups,except for a more pronounced reduction in left atrial(LA)size at discharge in group TTS[(5.00±3.64)mm vs.(0.09±4.44)mm,p=0.008].Conversely,group RLT demonstrated a less significant decrease in glutamyl transpeptidase(GGT)[(1.00±6.00)U/L vs.(5.25±3.86)U/L,p=0.026]but a more significant decrease in blood urea nitrogen(BUN)[(1.81±1.10)mg/dL vs.(0.81±1.07)mg/dL,p=0.038].Conclusions:RLT for ASD repair in adults demonstrated comparable clinical outcomes to TTS in terms of postoperative recovery and cardiac function and also produced fewer scars than TTS.Our study proved the feasibility,safety and cosmetic effects of uniport RLT for ASD repair in adults when compared with TTS.
文摘This letter addresses the study by Jayabalan et al,which underscores the liver outcome score(LOS)and hemoglobin(Hb)as key prognostic markers for patients with autoimmune liver disease overlap syndromes(AILDOS),with particular relevance to the autoimmune hepatitis-primary biliary cholangitis(AIH-PBC)subgroup.The findings indicate that an LOS threshold of 6 achieves high sensitivity and specificity in predicting liver-related mortality among AIH-PBC patients.Moreover,low Hb levels emerge as a significant mortality predictor across all AILDOS cases.These results contribute valuable perspectives on risk stratification in AILDOS,highlighting the promise of non-invasive prognostic tools.Future studies with larger cohorts are needed to substantiate LOS and Hb as robust markers for clinical application.
基金funded by the Beijing Research Ward Ecxellence Program,BRWEP(BRWEP2024W102170101)the capital health research and development of special public health project(2022-1-2172)+3 种基金the National Key Research and Development Program(2022YFC2603500,2022YFC2603505,2023YFC2306901,2023YFC2308105,2023YFC2308105)the Beijing Municipal Health Commission high-level public health technical personnel construction project,discipline leader-03-26Beijing Hospitals Authority"peak"talent training program(DFL20241803)the Beijing Hospitals Authority Clinical medicine Development of special funding support(ZLRK202301).
文摘To investigate the risk and influencing factors of long-term liver adverse events in chronic hepatitis B patients achieving hepatitis B surface antigen(HBsAg)clearance after pegylated interferonα(Peg-IFNα)treatment,a retrospective analysis was conducted on 456 patients at Beijing Ditan Hospital from 2008 to 2023 who achieved HBsAg clearance and discontinued Peg-IFNαtreatment.The baseline was defined as the time of HBsAg clearance and treatment cessation.The endpoint was the first occurrence of liver adverse events(hepatocellular carcinoma or ascites)or last follow-up.Subsequently,we evaluated the incidence and risk factors of liver adverse events,along with changes in liver fibrosis,cirrhosis,and liver function indicators.During a median follow-up of 70 months,the incidence of liver adverse events was 2.30%,hepatocellular carcinoma 1.76%,and ascites 0.55%.Older age and cirrhosis were significant risk factors(HR 1.075 and 41.393,both P<0.01).The APRI score significantly improved at follow-up compared to baseline(0.53 vs.0.25,P<0.001),and cirrhosis prevalence decreased from 5.70%to 0.88%(P<0.001).In conclusion,patients who achieved HBsAg clearance and discontinued Peg-IFNαtreatment have a low risk of liver adverse events,while advanced age and cirrhosis remain major risk factors.
文摘In recent years,artificial intelligence(AI)has been increasingly integrated into educational settings worldwide.This study aims to explore the effectiveness of AI classroom teaching for Chinese undergraduate students,focusing on its influence on learning outcomes and student engagement.The research uses a quantitative approach,utilizing surveys and academic performance data to evaluate two main objectives:(1)the impact of AI teaching methods on academic performance compared to traditional instruction;(2)the level of student engagement and satisfaction with AI-based learning tools.The study sample includes undergraduate students from multiple universities in China,allowing for a diverse representation of various disciplines.Data will be collected through standardized tests,questionnaires,and academic records,ensuring the reliability and validity of the results.The findings will provide insights into the potential advantages and challenges of AI integration in higher education and inform future strategies for adopting AI in Chinese classrooms.By exploring both the academic and practical aspects of AI-driven education,this research aims to contribute valuable knowledge to the growing field of AI in education,particularly in the context of Chinese higher education.The results are expected to have implications for educators,policymakers,and AI developers interested in enhancing the effectiveness of educational technologies.
