Objectives This study aimed to analyze the prevalence of long-term central line-associated bloodstream infections(CLABSI)among hospitalized adults with cancer in Italy and compare the characteristics of patients who r...Objectives This study aimed to analyze the prevalence of long-term central line-associated bloodstream infections(CLABSI)among hospitalized adults with cancer in Italy and compare the characteristics of patients who required long-term central venous access device(LCVAD)substitution due to prior CLABSI with those who had never experienced CLABSI.Methods The study was conducted in hospitals across northern and central Italy using a multicenter,observational,cross-sectional design from March to September 2021.A total of 174 adults with cancer were included.Data were collected through electronic case report forms,including demographic,clinical,treatment-related,and catheter-related variables.Propensity score matching(PSM)was used to compare the characteristics of patients who underwent LCVAD substitution due to previous CLABSI with those who never experienced CLABSI.Multiple correspondence analysis(MCA)was conducted to explore the patterns within matched subgroups.Results The prevalence of CLABSI was 3%,and 5.2%of patients required LCVAD substitution due to prior CLABSI.After applying PSM,the groups were successfully balanced for sex,age,presence of metastases,comorbidities,BMI,received treatments,corticosteroid therapy,ongoing antibiotics,hormone therapy,type of LCVAD,lumens,and utilization frequency.Hematologic cancer was more frequent in the CLABSI group(44.4%)compared to the non-infective group(0),with a statistically significant difference(P=0.045).MCA revealed potential patterns among matched subgroups but did not identify statistically significant associations:patients with previous LCVAD substitution were more frequently associated with a history of prior infections,ongoing antibiotic therapy,and unspecified primary lesion locations;conversely,patients who never experienced CLABSI tended to cluster around characteristics such as hormone therapy and corticosteroid therapy.Conclusions These findings emphasize the importance of continuous monitoring,individualized infection prevention strategies in oncology nursing practice.Future research with larger datasets is needed to validate these findings and develop tailored interventions to reduce CLABSI risks.展开更多
BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in...BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in patients with hepatocellular carcinoma(HCC)who underwent laparoscopic hepatectomy during and after surgery.METHODS We retrospectively collected the clinicopathological data of 107 patients who successfully underwent laparoscopic hepatectomy at Zhongshan Hospital(Xiamen),Fudan University from June 2022 to June 2023.Whether using the ICG fluorescence imaging technique,we divided them into the ICG and non-ICG groups.To eliminate statistical bias,a 1:1 propensity score matching analysis was conducted.The comparison of perioperative outcomes,including inflammationrelated markers and progression-free survival,was analyzed statistically.RESULTS Intraoperatively,the ICG group exhibited lower blood loss,a shorter surgical time,lower hepatic inflow occlusion(HIO)frequency,and a shorter total HIO time.Postoperatively,the participation of ICG resulted in a shorter duration of hospitalization(6.5 vs 7.6 days,P=0.03)and postoperative inflammatory response attenuation(lower neutrophil-lymphocyte ratio on the first day after surgery and platelet-lymphocyte ratio on the third day,P<0.05).Although the differences were not significant,the levels of all inflammation-related markers were lower in the ICG group.The rates of postoperative complications and the survival analyses,including progression-free and overall survivals showed no significant difference between the groups.CONCLUSION The involvement of ICG fluorescence imaging may lead to improved perioperative outcomes,especially postoperative inflammatory response attenuation,and ultimately improve HCC patients’recovery after surgery.展开更多
BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences b...BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences between CSP and traditional endoscopic mucosal resection(EMR)for the treatment of intestinal polyps.AIM To compare the efficacy-cost of EMR and CSP in the treatment of intestinal polyps.METHODS A total of 100 patients with intestinal polyps were included in the retrospective data of our hospital from April 2022 to May 2023.According to the treatment methods,they were divided into EMR(n=46)group and CSP(n=54)group.The baseline data of the two groups were balanced by 1:1 propensity score matching(PSM),and the cost-effectiveness analysis was performed on the two groups after matching.The recurrence rate of the two groups of patients was followed up for 1 year,and they were divided into recurrence group and non-recurrence group according to whether they recurred.Multivariate logistic regression analysis was used to screen out the influencing factors affecting the recurrence of intestinal polyps after endoscopic resection.RESULTS Significant disparities were observed in the number of polyps and smoking background between the two groups before PSM(P<0.05).Following PSM,the number of polyps and smoking history were well balanced between the EMR and CSP groups.The direct cost incurred by the CSP group was markedly higher than that incurred by the EMR group.Concurrently,the cost-effectiveness ratio in the CSP group was substantially reduced when juxtaposed with that in the EMR group(P<0.05).Upon completion of the 1-year follow-up,the rate of recurrence after endoscopic intestinal polypectomy was 38.00%.Multivariate methods revealed that age≥60 years,male sex,number of polyps≥3,and pathological type of adenoma were risk factors for recurrence after endoscopic intestinal polypectomy(all P<0.05).CONCLUSION CSP was more cost-effective for the treatment of intestinal polyps.An age≥60 years,male sex,having a number of polyps≥3,and pathological type of adenoma are independent influencing factors for recurrence.展开更多
AIM: To compare the prognoses of hepatocellular carcinoma (HCC) patients that underwent anatomic liver resection (AR) or non-anatomic liver resection (NAR) using propensity score-matched populations.
Objective：Prognosis of patients with locally advanced rectal cancer（LARC）but achieving yp T1–2N0 stage after neoadjuvant concurrent chemo-radiotherapy（CRT）has been shown to be favorable.This study aims to determ...Objective：Prognosis of patients with locally advanced rectal cancer（LARC）but achieving yp T1–2N0 stage after neoadjuvant concurrent chemo-radiotherapy（CRT）has been shown to be favorable.This study aims to determine whether the long-term outcome of yp T1–2N0 cases can be comparable to that of p T1–2N0 cohort that received definitive surgery for early disease.Method：From January 2008 to December 2013,449 consecutive patients with rectal cancer were treated and their outcome maintained in a database.Patients with LARC underwent total mesorectal excision（TME）surgery at4–8 weeks after completion of CRT,and those achieving stage yp I were identified as a group.As a comparison,stage p I group pertains to patients whose initially limited disease was not upstaged after TME surgery alone.After propensity score matching（PSM）,comparisons of local regional control（LC）,distant metastasis-free survival（DMFS）,disease-free survival（DFS）and overall survival（OS）were performed using Kaplan-Meier analysis and log-rank test between yp I and p I groups.Down-staging depth score（DDS）,a novel method of evaluating CRT response,was used for subset analysis.Results：Of the 449 patients,168 matched cases were generated for analysis.Five-year LC,DMFS,DFS and OS for stage p I vs.yp I groups were 96.7%vs.96.4%（P=0.796）,92.7%vs.73.6%（P=0.025）,91.2%vs.73.6%（P=0.080）and 93.1%vs.72.3%（P=0.040）,respectively.In the DDS-favorable subset of the yp I group,LC,DMFS,DFS and OS resulted in no significant differences in comparison with the p I group（P=0.384,0.368,0.277 and0.458,respectively）.Conclusions：LC was comparable in both groups;however,distant metastasis developed more frequently in down-staged LARC than de novo early stage cases,reflecting the need to improve the efficacy of systemic treatment despite excellent pathologic response.DDS can be an indicator to identify a subset of the yp I group whose longterm oncologic outcomes are as good as those of stage p I cohort.展开更多
Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.T...Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.Methods:This study retrospectively compared short-term(28/56 days)survival rates of two different nationwide cohorts(cohort I:2008-2011 and cohort II:2012-2015).Eligible HBV-ACLF patients were enrolled retrospectively.Patients in the cohorts I and II were assigned either to the standard medical therapy(SMT)group(cohort I-SMT,cohort II-SMT)or artificial liver support system(ALSS)group(cohort IALSS,cohort II-ALSS).Propensity score matching analysis was conducted to eliminate baseline differences,and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.Results:Short-term(28/56 days)survival rates were significantly higher in the ALSS group than those in the SMT group(P<0.05)and were higher in the cohort II than those in the cohort I(P<0.001).After propensity score matching,short-term(28/56 days)survival rates were higher in the cohort II than those in the cohort I for both SMT(60.7%vs.53.0%,50.0%vs.39.8%,P<0.05)and ALSS(66.1%vs.56.5%,53.0%vs.44.4%,P<0.05)treatments.The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments(P=0.046).Multivariate logistic regression analysis revealed that ALSS(OR=0.962,95%CI:0.951-0.973,P=0.038),nucleos(t)ide analogs(OR=0.927,95%CI:0.871-0.983,P=0.046),old age(OR=1.028,95%CI:1.015-1.041,P<0.001),total bilirubin(OR=1.002,95%CI:1.001-1.003,P=0.004),INR(OR=1.569,95%CI:1.044-2.358,P<0.001),COSSH-ACLF grade(OR=2.683,95%CI:1.792-4.017,P<0.001),and albumin(OR=0.952,95%CI:0.924-0.982,P=0.002)were independent factors for 28-day mortality.Conclusions:The treatment for patients with HBV-ACLF has improved in the past decade.展开更多
Background: Significant portal hypertension(SPH) is a relative contraindication for patients with resectable hepatocellular carcinoma(HCC). However, increasing evidence indicates that liver resection is feasible for H...Background: Significant portal hypertension(SPH) is a relative contraindication for patients with resectable hepatocellular carcinoma(HCC). However, increasing evidence indicates that liver resection is feasible for HCC patients with SPH. Methods: HCC patients with cirrhosis who underwent laparoscopic liver resection(LLR) in two centers from January 2013 to April 2018 were included. Surgical and survival outcomes were analyzed to explore potential prognostic factors. Propensity score matching(PSM) analysis was performed to minimize bias. Results: A total of 165 patients were divided into two groups based on the presence(SPH, n = 76) or absence(non-SPH, n = 89) of SPH. Patients in the SPH group had longer operative time, more blood loss, and more advanced TNM stage than patients in the non-SPH group( P < 0.05). However, there were no significant differences in the postoperative 90-day mortality rate( n = 0), overall postoperative complications(47.4% vs. 41.6%, P = 0.455), Clavien-Dindo classification( P = 0.347), conversion to open surgery(9.2% vs. 6.7%, P = 0.557), or length of hospitalization(16 vs. 15 days, P = 0.203) between the SPH and non-SPH groups before PSM. Similar results were obtained after PSM. The 1-, 3-, and 5-year overall survival(OS) and recurrence-free survival rates in the SPH group were not significantly different from those in the non-SPH group both before and after PSM(log-rank P > 0.05). After PSM, alpha-fetoprotein(AFP) ≥ 400 μg/L [hazard ratio(HR) = 4.71, 95% confidence interval(CI): 2.69-8.25], ascites(HR = 2.18, 95% CI: 1.30-3.66), American Society of Anesthesiologists(ASA) classification(Ⅲ vs. Ⅱ)(HR = 2.13, 95% CI: 1.11-4.07) and tumor diameter > 5 cm(HR = 3.91, 95% CI: 2.02-7.56) independently predicted worse OS. Conclusions: LLR for patients with HCC complicated with SPH appears feasible at the price of increasing operative time and blood loss. AFP, ascites, ASA classification and tumor diameter may predict the prognosis of HCC complicated with SPH after LLR.展开更多
Objective To define risk stratification and guide optimal surgical timing of perioperative viral respiratory infection(VRI)in children with cardiac surgery.Methods Retrospective study with propensity score-matched ana...Objective To define risk stratification and guide optimal surgical timing of perioperative viral respiratory infection(VRI)in children with cardiac surgery.Methods Retrospective study with propensity score-matched analysis.A total of 2,831 patients had performed RespPCR testing,and finally there were 2,740 negative RespPCR patients and 91 positive RespPCR patients.展开更多
Background Prior randomized trials have shown reduced bleeding with bivalirudin compared with unfractionated heparin （UFH） in patients undergoing percutaneous coronary intervention （PCI）. However, it is not known ...Background Prior randomized trials have shown reduced bleeding with bivalirudin compared with unfractionated heparin （UFH） in patients undergoing percutaneous coronary intervention （PCI）. However, it is not known if this benefit is also present when UFH doses are more tightly controlled （as measured by activated clotting time, ACT）.展开更多
BACKGROUND Patients with inflammatory bowel disease(IBD)are at an increased risk of bacterial pneumonia,contributing to significant morbidity and mortality.While previous studies have identified various risk factors,i...BACKGROUND Patients with inflammatory bowel disease(IBD)are at an increased risk of bacterial pneumonia,contributing to significant morbidity and mortality.While previous studies have identified various risk factors,including medications and comorbidities,the independent contribution of IBD to pneumonia risk remains unclear.We hypothesized that the increased pneumonia risk is primarily driven by factors other than IBD itself.AIM To investigate the relative contributions of IBD,comorbidities,and medications to pneumonia risk in patients with IBD.METHODS We conducted a retrospective cohort study using the All of Us Research Program database(2010-2022).We matched 2810 participants with IBD 1:1 with controls using four propensity score models:(1)Demographics/Lifestyle only;(2)Plus comorbidities;(3)Plus medications;and(4)All factors combined.Then we used Cox proportional hazards models to assess pneumonia risk and logistic regression to evaluate risk factors.RESULTS In the primary analysis of 5620 matched participants,IBD was not independently associated with increased pneumonia risk[hazard ratio(HR)=1.07,95%CI:0.84-1.35]when matched for all factors.However,participants with IBD had significantly higher risk(HR=2.08,95%CI:1.56-2.78)when matched only for demographics and lifestyle factors.Within the IBD cohort,a high comorbidity burden(Charlson Comorbidity Index≥10)[odds ratio(OR)=12.20,95%CI:6.69-23.00]and systemic steroid use(OR=2.26,95%CI:1.21-4.64)were independently associated with increased pneumonia risk.CONCLUSION Comorbidities and systemic steroids,rather than IBD itself,drive pneumonia risk.Management should focus on these factors and prioritize vaccination in high-risk patients.展开更多
According to the data in China Statistical Yearbook from 1992 to 2008,by using regression model,we adopt least square method and generalized least square method to conduct empirical analysis on the relationship betwee...According to the data in China Statistical Yearbook from 1992 to 2008,by using regression model,we adopt least square method and generalized least square method to conduct empirical analysis on the relationship between urban-rural residents'income and consumption in China's east,northeast,central region and west.The results show that the urban-rural residents'propensity to consume in China's four regions has prominent characteristics.In terms of region,urban residents'marginal propensity to consume takes on irregular fluctuation,while the rural residents'propensity to consume conforms to law of diminishing of marginal propensity to consume;in terms of time sequence,the rural residents'marginal propensity to consume in China's four regions takes on"multi-U-form"fluctuation trend,and the rural residents'marginal propensity to consume in different regions has certain difference,while the urban residents'marginal propensity to consume takes on low-frequency broad width fluctuation trend;the urban-rural residents'average marginal propensity to consume in China's four regions conforms to the law of diminishing.In order to increase consumption and promote the balanced rapid development of regional economy,in light of the urban-rural difference and characteristics of different regions,we should propound effective measures to promote urban-rural residents'propensity to consume,and formulate and implement regional policy in order to stimulate consumption.展开更多
Objective:To clarify the oncological benefit of zoledronic acid for hormone-naive metastatic prostate cancer,patient outcome of androgen deprivation therapy with zoledronic acid(ADT+Z)and androgen deprivation therapy ...Objective:To clarify the oncological benefit of zoledronic acid for hormone-naive metastatic prostate cancer,patient outcome of androgen deprivation therapy with zoledronic acid(ADT+Z)and androgen deprivation therapy alone(ADT)was compared.Methods:Fifty-two patients with pathologically confirmed metastatic prostate cancer were prospectively enrolled and treated with combined androgen blockade(goserelin and bicalutamide)with zoledronic acid(4 mg every 4 weeks for 24 months).A propensity score-match with logistic regression analysis was applied to select 50 pair-matched cohorts(both from ADT+Z and from historical control cohorts who had undergone ADT alone),and patient outcomes were compared.Results:Patients with ADT+Z had significantly longer time to progression(TTP)than those with ADT(median TTP;24.2 vs.14.0 months,p=0.0092),while no significant difference of overall survival between two groups(p=0.1502).Multivariate analysis for biochemical recurrence revealed treatment with ADT was the sole independent prognostic factor(HR:1.724,95%CI:1.06-2.86,p=0.0297).Conclusion:Combination of zoledronic acid with ADT may prolong time to castration resistant prostate cancer.展开更多
This study empirically examines the influence of decision makers＇ （DMs） characteristics on risk analysis in strategic investment decisions （SIDs） of companies operating automotive industry in India. This study ha...This study empirically examines the influence of decision makers＇ （DMs） characteristics on risk analysis in strategic investment decisions （SIDs） of companies operating automotive industry in India. This study has developed and tested a structural model that linking select demographics, risk propensity and risk analysis in SIDs. The primary data were collected from Senior Finance Professionals （CFOs, GMs, VPs and so on） representing 36 listed automotive companies operating in India. Based on the responses collected from a single cross-sectional mailed survey, this study finds that risk propensity has a significant positive influence on the extent of usage of risk analysis in SIDs.展开更多
Background:The optimal regimen of infliximab salvage in acute severe ulcerative colitis(ASUC)patients remains controversial.This study aimed to compare accelerated and standard infliximab induction in Chinese ASUC pat...Background:The optimal regimen of infliximab salvage in acute severe ulcerative colitis(ASUC)patients remains controversial.This study aimed to compare accelerated and standard infliximab induction in Chinese ASUC patients,and to explore risk factors and concrete accelerated regimens for them.Methods:Data were retrospectively collected from steroid-refractory ASUC patients receiving infliximab as rescue therapy at seven tertiary centers across China.Outcomes including colectomy and clinical remission(Mayo score≤2 and every subscore≤1 at Day 14)rates were compared between patients receiving accelerated and standard infliximab induction using propensity score adjust-ment for potential confounders.The dose-response relationship was explored by plotting restricted cubic splines.Logistic regression and Cox proportional hazards regression analyses were performed to determine risk factors for adverse outcomes.A systematic re-view and meta-analysis was also performed.Results:A total of 76 patients were analysed:29 received standard and 47 received accelerated induction.The accelerated group had a higher 90-day colectomy rate(17.8%vs 0%,P=0.019)and lower clinical remission rate(27.7%vs 65.5%,P=0.001).After adjust-ing for propensity score and institution,there was no significant difference in colectomy or clinical remission rates(both P>0.05).Dose-effect curves showed decreased colectomy hazard with higher cumulative infliximab dosage within 5 days,with no improve-ment observed for increasing cumulative infliximab dosage within 28 days.Multivariate logistic regression analyses revealed C-reac-tive protein of>10 mg/L at infliximab initiation(odds ratio?5.00,95%confidence interval:1.27-24.34)as an independent risk factor for no clinical remission.Meta-analysis also revealed no significant difference in colectomy rates at 3 months(P=0.54).Conclusions:After adjusting for confounders,there were no significant differences in colectomy or clinical remission rates between accelerated and standard infliximab induction among ASUC patients.Early administration of an intensified dosage within 5 days may be beneficial.Elevated C-reactive protein at infliximab initiation indicated need for intensive treatment.展开更多
Aim:To elucidate the role and efficacy of laparoscopic liver resection for elderly patients with hepatocellular carcinoma(HCC).Methods:A retrospective comparative analysis was performed between laparoscopic and open l...Aim:To elucidate the role and efficacy of laparoscopic liver resection for elderly patients with hepatocellular carcinoma(HCC).Methods:A retrospective comparative analysis was performed between laparoscopic and open liver resection operated from year 2008 to 2018.Consecutive HCC patients aged 65 or above at the time of operation were recruited.Patients with recurrent HCC and/or alternative pathology were excluded.Short-term and long-term outcomes between the laparoscopic and the open group were compared.Propensity score matching of patients in a ratio of 1:2 was conducted before comparison.Results:A total of 911 patients underwent hepatectomy for primary HCC from 2008 to 2018.Among them,320 elderly patients aged over 65 years old were eligible for analysis.Heterogeneities between laparoscopic and open groups were identified namely pre-operative albumin level,aspartate transaminase,and magnitude of hepatectomy(major vs.minor).After propensity score matching of 1:2,46 patients in the laparoscopic group and 92 patients in the open group were included for comparison.The laparoscopic group had less blood loss(326 mL vs.735 mL;P<0.001),shorter operative time(223 min vs.324 min;P<0.001),and shorter hospital stay(6.3 days vs.10.5 days;P<0.001).No significant differences in postoperative morbidity and hospital mortality were noted between the groups.For oncological outcome,the laparoscopic group had a superior disease-free survival(59.7%vs.44.5%;P=0.041),and a trend towards better overall survival compared with the open group.(78.4%vs.64.8%;P=0.110).Conclusion:Laparoscopic liver resection is a safe approach for elderly patients with HCC with benefits from faster recovery and better oncological outcomes.展开更多
目的探讨脑卒中后不同血压水平与患者远期死亡风险的关系,为卒中后血压管理提供参考依据。方法利用美国国家健康与营养调查(NHANES)2005—2018年共7个周期的横断面数据,结合国家死亡指数(NDI)获取生存结局。共纳入39573例受试者,其中卒...目的探讨脑卒中后不同血压水平与患者远期死亡风险的关系,为卒中后血压管理提供参考依据。方法利用美国国家健康与营养调查(NHANES)2005—2018年共7个周期的横断面数据,结合国家死亡指数(NDI)获取生存结局。共纳入39573例受试者,其中卒中组1589例,非卒中组37984例;按照随访结局将卒中组划分为死亡亚组(n=612)和存活亚组(n=977)。收集收缩压(SBP)、舒张压(DBP)及平均动脉压(MAP)等体格检查数据,采用基于广义倾向得分加权的Cox比例风险回归模型分析血压与死亡风险的非线性关系。结果血压与死亡风险呈非线性关系。SBP在111~121 mm Hg时死亡风险未见显著变化(HR=1.145,95%CI:0.902~1.388);121~133 mm Hg时风险上升(HR=1.901,95%CI:1.679~2.122);>133 mm Hg时死亡风险进一步增加(HR=3.583,95%CI:3.377~3.789)。DBP在62.7~70.7 mm Hg(HR=0.570,95%CI:0.399~0.741)、70.7~77.3 mm Hg(HR=0.446,95%CI:0.240~0.652)及>77.3 mm Hg(HR=0.480,95%CI:0.286~0.674)时均与较低死亡风险相关。MAP在80.2~87.1 mm Hg(HR=0.628,95%CI:0.330~0.926)和87.1~94.7 mm Hg(HR=0.629,95%CI:0.360~0.898)时死亡风险较低,>94.7 mm Hg时差异无统计学意义(HR=1.036,95%CI:0.797~1.275)。结论脑卒中后血压水平与患者远期死亡风险密切相关,控制SBP并维持相对较高的DBP水平可能有助于改善患者的长期预后。展开更多
基金part of a project that has received funding from the 5x1000 Humanitas funds。
文摘Objectives This study aimed to analyze the prevalence of long-term central line-associated bloodstream infections(CLABSI)among hospitalized adults with cancer in Italy and compare the characteristics of patients who required long-term central venous access device(LCVAD)substitution due to prior CLABSI with those who had never experienced CLABSI.Methods The study was conducted in hospitals across northern and central Italy using a multicenter,observational,cross-sectional design from March to September 2021.A total of 174 adults with cancer were included.Data were collected through electronic case report forms,including demographic,clinical,treatment-related,and catheter-related variables.Propensity score matching(PSM)was used to compare the characteristics of patients who underwent LCVAD substitution due to previous CLABSI with those who never experienced CLABSI.Multiple correspondence analysis(MCA)was conducted to explore the patterns within matched subgroups.Results The prevalence of CLABSI was 3%,and 5.2%of patients required LCVAD substitution due to prior CLABSI.After applying PSM,the groups were successfully balanced for sex,age,presence of metastases,comorbidities,BMI,received treatments,corticosteroid therapy,ongoing antibiotics,hormone therapy,type of LCVAD,lumens,and utilization frequency.Hematologic cancer was more frequent in the CLABSI group(44.4%)compared to the non-infective group(0),with a statistically significant difference(P=0.045).MCA revealed potential patterns among matched subgroups but did not identify statistically significant associations:patients with previous LCVAD substitution were more frequently associated with a history of prior infections,ongoing antibiotic therapy,and unspecified primary lesion locations;conversely,patients who never experienced CLABSI tended to cluster around characteristics such as hormone therapy and corticosteroid therapy.Conclusions These findings emphasize the importance of continuous monitoring,individualized infection prevention strategies in oncology nursing practice.Future research with larger datasets is needed to validate these findings and develop tailored interventions to reduce CLABSI risks.
基金Supported by the Incubation Project of Zhongshan Hospital(Xiamen),Fudan University,No.2019ZSXMYS15the Clinical Research Center for Precision Medicine of Abdominal Tumor of Fujian Province+1 种基金the Key Clinical Specialty Discipline Construction Program of Fujian ProvinceXiamen Medical and Health Guidance Project,No.3502Z20244ZD1103.
文摘BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in patients with hepatocellular carcinoma(HCC)who underwent laparoscopic hepatectomy during and after surgery.METHODS We retrospectively collected the clinicopathological data of 107 patients who successfully underwent laparoscopic hepatectomy at Zhongshan Hospital(Xiamen),Fudan University from June 2022 to June 2023.Whether using the ICG fluorescence imaging technique,we divided them into the ICG and non-ICG groups.To eliminate statistical bias,a 1:1 propensity score matching analysis was conducted.The comparison of perioperative outcomes,including inflammationrelated markers and progression-free survival,was analyzed statistically.RESULTS Intraoperatively,the ICG group exhibited lower blood loss,a shorter surgical time,lower hepatic inflow occlusion(HIO)frequency,and a shorter total HIO time.Postoperatively,the participation of ICG resulted in a shorter duration of hospitalization(6.5 vs 7.6 days,P=0.03)and postoperative inflammatory response attenuation(lower neutrophil-lymphocyte ratio on the first day after surgery and platelet-lymphocyte ratio on the third day,P<0.05).Although the differences were not significant,the levels of all inflammation-related markers were lower in the ICG group.The rates of postoperative complications and the survival analyses,including progression-free and overall survivals showed no significant difference between the groups.CONCLUSION The involvement of ICG fluorescence imaging may lead to improved perioperative outcomes,especially postoperative inflammatory response attenuation,and ultimately improve HCC patients’recovery after surgery.
文摘BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences between CSP and traditional endoscopic mucosal resection(EMR)for the treatment of intestinal polyps.AIM To compare the efficacy-cost of EMR and CSP in the treatment of intestinal polyps.METHODS A total of 100 patients with intestinal polyps were included in the retrospective data of our hospital from April 2022 to May 2023.According to the treatment methods,they were divided into EMR(n=46)group and CSP(n=54)group.The baseline data of the two groups were balanced by 1:1 propensity score matching(PSM),and the cost-effectiveness analysis was performed on the two groups after matching.The recurrence rate of the two groups of patients was followed up for 1 year,and they were divided into recurrence group and non-recurrence group according to whether they recurred.Multivariate logistic regression analysis was used to screen out the influencing factors affecting the recurrence of intestinal polyps after endoscopic resection.RESULTS Significant disparities were observed in the number of polyps and smoking background between the two groups before PSM(P<0.05).Following PSM,the number of polyps and smoking history were well balanced between the EMR and CSP groups.The direct cost incurred by the CSP group was markedly higher than that incurred by the EMR group.Concurrently,the cost-effectiveness ratio in the CSP group was substantially reduced when juxtaposed with that in the EMR group(P<0.05).Upon completion of the 1-year follow-up,the rate of recurrence after endoscopic intestinal polypectomy was 38.00%.Multivariate methods revealed that age≥60 years,male sex,number of polyps≥3,and pathological type of adenoma were risk factors for recurrence after endoscopic intestinal polypectomy(all P<0.05).CONCLUSION CSP was more cost-effective for the treatment of intestinal polyps.An age≥60 years,male sex,having a number of polyps≥3,and pathological type of adenoma are independent influencing factors for recurrence.
基金Supported by A Grant-in-Aid for Scientific Research from the Ministry of Education,Culture,Sports,Science,and Technology,No.23591993a Grant from the Yuasa Memorial Foundation
文摘AIM: To compare the prognoses of hepatocellular carcinoma (HCC) patients that underwent anatomic liver resection (AR) or non-anatomic liver resection (NAR) using propensity score-matched populations.
基金supported by Natural Science Foundation of China (No.81773241)Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (No.2017I2M-1-006)
文摘Objective：Prognosis of patients with locally advanced rectal cancer（LARC）but achieving yp T1–2N0 stage after neoadjuvant concurrent chemo-radiotherapy（CRT）has been shown to be favorable.This study aims to determine whether the long-term outcome of yp T1–2N0 cases can be comparable to that of p T1–2N0 cohort that received definitive surgery for early disease.Method：From January 2008 to December 2013,449 consecutive patients with rectal cancer were treated and their outcome maintained in a database.Patients with LARC underwent total mesorectal excision（TME）surgery at4–8 weeks after completion of CRT,and those achieving stage yp I were identified as a group.As a comparison,stage p I group pertains to patients whose initially limited disease was not upstaged after TME surgery alone.After propensity score matching（PSM）,comparisons of local regional control（LC）,distant metastasis-free survival（DMFS）,disease-free survival（DFS）and overall survival（OS）were performed using Kaplan-Meier analysis and log-rank test between yp I and p I groups.Down-staging depth score（DDS）,a novel method of evaluating CRT response,was used for subset analysis.Results：Of the 449 patients,168 matched cases were generated for analysis.Five-year LC,DMFS,DFS and OS for stage p I vs.yp I groups were 96.7%vs.96.4%（P=0.796）,92.7%vs.73.6%（P=0.025）,91.2%vs.73.6%（P=0.080）and 93.1%vs.72.3%（P=0.040）,respectively.In the DDS-favorable subset of the yp I group,LC,DMFS,DFS and OS resulted in no significant differences in comparison with the p I group（P=0.384,0.368,0.277 and0.458,respectively）.Conclusions：LC was comparable in both groups;however,distant metastasis developed more frequently in down-staged LARC than de novo early stage cases,reflecting the need to improve the efficacy of systemic treatment despite excellent pathologic response.DDS can be an indicator to identify a subset of the yp I group whose longterm oncologic outcomes are as good as those of stage p I cohort.
基金supported by grants from the Science&Technology Key Program of Zhejiang China(2017C03051)the National Science&Technology Major Project of China(2017ZX10203201)。
文摘Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.Methods:This study retrospectively compared short-term(28/56 days)survival rates of two different nationwide cohorts(cohort I:2008-2011 and cohort II:2012-2015).Eligible HBV-ACLF patients were enrolled retrospectively.Patients in the cohorts I and II were assigned either to the standard medical therapy(SMT)group(cohort I-SMT,cohort II-SMT)or artificial liver support system(ALSS)group(cohort IALSS,cohort II-ALSS).Propensity score matching analysis was conducted to eliminate baseline differences,and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.Results:Short-term(28/56 days)survival rates were significantly higher in the ALSS group than those in the SMT group(P<0.05)and were higher in the cohort II than those in the cohort I(P<0.001).After propensity score matching,short-term(28/56 days)survival rates were higher in the cohort II than those in the cohort I for both SMT(60.7%vs.53.0%,50.0%vs.39.8%,P<0.05)and ALSS(66.1%vs.56.5%,53.0%vs.44.4%,P<0.05)treatments.The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments(P=0.046).Multivariate logistic regression analysis revealed that ALSS(OR=0.962,95%CI:0.951-0.973,P=0.038),nucleos(t)ide analogs(OR=0.927,95%CI:0.871-0.983,P=0.046),old age(OR=1.028,95%CI:1.015-1.041,P<0.001),total bilirubin(OR=1.002,95%CI:1.001-1.003,P=0.004),INR(OR=1.569,95%CI:1.044-2.358,P<0.001),COSSH-ACLF grade(OR=2.683,95%CI:1.792-4.017,P<0.001),and albumin(OR=0.952,95%CI:0.924-0.982,P=0.002)were independent factors for 28-day mortality.Conclusions:The treatment for patients with HBV-ACLF has improved in the past decade.
基金supported by grants from the National Natu-ral Science Foundation of China(81701950 and 82172135)Medi-cal Research Projects of Chongqing for staffagainst the epidemic(2020FYYX248)the Kuanren Talents Program of the Second Affiliated Hospital,Chongqing Medical University(KY2019Y002).
文摘Background: Significant portal hypertension(SPH) is a relative contraindication for patients with resectable hepatocellular carcinoma(HCC). However, increasing evidence indicates that liver resection is feasible for HCC patients with SPH. Methods: HCC patients with cirrhosis who underwent laparoscopic liver resection(LLR) in two centers from January 2013 to April 2018 were included. Surgical and survival outcomes were analyzed to explore potential prognostic factors. Propensity score matching(PSM) analysis was performed to minimize bias. Results: A total of 165 patients were divided into two groups based on the presence(SPH, n = 76) or absence(non-SPH, n = 89) of SPH. Patients in the SPH group had longer operative time, more blood loss, and more advanced TNM stage than patients in the non-SPH group( P < 0.05). However, there were no significant differences in the postoperative 90-day mortality rate( n = 0), overall postoperative complications(47.4% vs. 41.6%, P = 0.455), Clavien-Dindo classification( P = 0.347), conversion to open surgery(9.2% vs. 6.7%, P = 0.557), or length of hospitalization(16 vs. 15 days, P = 0.203) between the SPH and non-SPH groups before PSM. Similar results were obtained after PSM. The 1-, 3-, and 5-year overall survival(OS) and recurrence-free survival rates in the SPH group were not significantly different from those in the non-SPH group both before and after PSM(log-rank P > 0.05). After PSM, alpha-fetoprotein(AFP) ≥ 400 μg/L [hazard ratio(HR) = 4.71, 95% confidence interval(CI): 2.69-8.25], ascites(HR = 2.18, 95% CI: 1.30-3.66), American Society of Anesthesiologists(ASA) classification(Ⅲ vs. Ⅱ)(HR = 2.13, 95% CI: 1.11-4.07) and tumor diameter > 5 cm(HR = 3.91, 95% CI: 2.02-7.56) independently predicted worse OS. Conclusions: LLR for patients with HCC complicated with SPH appears feasible at the price of increasing operative time and blood loss. AFP, ascites, ASA classification and tumor diameter may predict the prognosis of HCC complicated with SPH after LLR.
文摘Objective To define risk stratification and guide optimal surgical timing of perioperative viral respiratory infection(VRI)in children with cardiac surgery.Methods Retrospective study with propensity score-matched analysis.A total of 2,831 patients had performed RespPCR testing,and finally there were 2,740 negative RespPCR patients and 91 positive RespPCR patients.
文摘Background Prior randomized trials have shown reduced bleeding with bivalirudin compared with unfractionated heparin （UFH） in patients undergoing percutaneous coronary intervention （PCI）. However, it is not known if this benefit is also present when UFH doses are more tightly controlled （as measured by activated clotting time, ACT）.
基金Supported by The Interdisciplinary Guided Network for Investigation,Translation and Equity for the All of Us Research Program,No.OT2 OD031915.
文摘BACKGROUND Patients with inflammatory bowel disease(IBD)are at an increased risk of bacterial pneumonia,contributing to significant morbidity and mortality.While previous studies have identified various risk factors,including medications and comorbidities,the independent contribution of IBD to pneumonia risk remains unclear.We hypothesized that the increased pneumonia risk is primarily driven by factors other than IBD itself.AIM To investigate the relative contributions of IBD,comorbidities,and medications to pneumonia risk in patients with IBD.METHODS We conducted a retrospective cohort study using the All of Us Research Program database(2010-2022).We matched 2810 participants with IBD 1:1 with controls using four propensity score models:(1)Demographics/Lifestyle only;(2)Plus comorbidities;(3)Plus medications;and(4)All factors combined.Then we used Cox proportional hazards models to assess pneumonia risk and logistic regression to evaluate risk factors.RESULTS In the primary analysis of 5620 matched participants,IBD was not independently associated with increased pneumonia risk[hazard ratio(HR)=1.07,95%CI:0.84-1.35]when matched for all factors.However,participants with IBD had significantly higher risk(HR=2.08,95%CI:1.56-2.78)when matched only for demographics and lifestyle factors.Within the IBD cohort,a high comorbidity burden(Charlson Comorbidity Index≥10)[odds ratio(OR)=12.20,95%CI:6.69-23.00]and systemic steroid use(OR=2.26,95%CI:1.21-4.64)were independently associated with increased pneumonia risk.CONCLUSION Comorbidities and systemic steroids,rather than IBD itself,drive pneumonia risk.Management should focus on these factors and prioritize vaccination in high-risk patients.
文摘According to the data in China Statistical Yearbook from 1992 to 2008,by using regression model,we adopt least square method and generalized least square method to conduct empirical analysis on the relationship between urban-rural residents'income and consumption in China's east,northeast,central region and west.The results show that the urban-rural residents'propensity to consume in China's four regions has prominent characteristics.In terms of region,urban residents'marginal propensity to consume takes on irregular fluctuation,while the rural residents'propensity to consume conforms to law of diminishing of marginal propensity to consume;in terms of time sequence,the rural residents'marginal propensity to consume in China's four regions takes on"multi-U-form"fluctuation trend,and the rural residents'marginal propensity to consume in different regions has certain difference,while the urban residents'marginal propensity to consume takes on low-frequency broad width fluctuation trend;the urban-rural residents'average marginal propensity to consume in China's four regions conforms to the law of diminishing.In order to increase consumption and promote the balanced rapid development of regional economy,in light of the urban-rural difference and characteristics of different regions,we should propound effective measures to promote urban-rural residents'propensity to consume,and formulate and implement regional policy in order to stimulate consumption.
文摘Objective:To clarify the oncological benefit of zoledronic acid for hormone-naive metastatic prostate cancer,patient outcome of androgen deprivation therapy with zoledronic acid(ADT+Z)and androgen deprivation therapy alone(ADT)was compared.Methods:Fifty-two patients with pathologically confirmed metastatic prostate cancer were prospectively enrolled and treated with combined androgen blockade(goserelin and bicalutamide)with zoledronic acid(4 mg every 4 weeks for 24 months).A propensity score-match with logistic regression analysis was applied to select 50 pair-matched cohorts(both from ADT+Z and from historical control cohorts who had undergone ADT alone),and patient outcomes were compared.Results:Patients with ADT+Z had significantly longer time to progression(TTP)than those with ADT(median TTP;24.2 vs.14.0 months,p=0.0092),while no significant difference of overall survival between two groups(p=0.1502).Multivariate analysis for biochemical recurrence revealed treatment with ADT was the sole independent prognostic factor(HR:1.724,95%CI:1.06-2.86,p=0.0297).Conclusion:Combination of zoledronic acid with ADT may prolong time to castration resistant prostate cancer.
文摘This study empirically examines the influence of decision makers＇ （DMs） characteristics on risk analysis in strategic investment decisions （SIDs） of companies operating automotive industry in India. This study has developed and tested a structural model that linking select demographics, risk propensity and risk analysis in SIDs. The primary data were collected from Senior Finance Professionals （CFOs, GMs, VPs and so on） representing 36 listed automotive companies operating in India. Based on the responses collected from a single cross-sectional mailed survey, this study finds that risk propensity has a significant positive influence on the extent of usage of risk analysis in SIDs.
基金supported by National High Level Hospital Clinical Research Funding[grant number 2022-PUMCH-B-022]CAMS Innovation Fund for Medical Sciences(CIFMS)from Chinese Academy of Medical Sciences[grant number 2021-I2M-1-062].
文摘Background:The optimal regimen of infliximab salvage in acute severe ulcerative colitis(ASUC)patients remains controversial.This study aimed to compare accelerated and standard infliximab induction in Chinese ASUC patients,and to explore risk factors and concrete accelerated regimens for them.Methods:Data were retrospectively collected from steroid-refractory ASUC patients receiving infliximab as rescue therapy at seven tertiary centers across China.Outcomes including colectomy and clinical remission(Mayo score≤2 and every subscore≤1 at Day 14)rates were compared between patients receiving accelerated and standard infliximab induction using propensity score adjust-ment for potential confounders.The dose-response relationship was explored by plotting restricted cubic splines.Logistic regression and Cox proportional hazards regression analyses were performed to determine risk factors for adverse outcomes.A systematic re-view and meta-analysis was also performed.Results:A total of 76 patients were analysed:29 received standard and 47 received accelerated induction.The accelerated group had a higher 90-day colectomy rate(17.8%vs 0%,P=0.019)and lower clinical remission rate(27.7%vs 65.5%,P=0.001).After adjust-ing for propensity score and institution,there was no significant difference in colectomy or clinical remission rates(both P>0.05).Dose-effect curves showed decreased colectomy hazard with higher cumulative infliximab dosage within 5 days,with no improve-ment observed for increasing cumulative infliximab dosage within 28 days.Multivariate logistic regression analyses revealed C-reac-tive protein of>10 mg/L at infliximab initiation(odds ratio?5.00,95%confidence interval:1.27-24.34)as an independent risk factor for no clinical remission.Meta-analysis also revealed no significant difference in colectomy rates at 3 months(P=0.54).Conclusions:After adjusting for confounders,there were no significant differences in colectomy or clinical remission rates between accelerated and standard infliximab induction among ASUC patients.Early administration of an intensified dosage within 5 days may be beneficial.Elevated C-reactive protein at infliximab initiation indicated need for intensive treatment.
文摘Aim:To elucidate the role and efficacy of laparoscopic liver resection for elderly patients with hepatocellular carcinoma(HCC).Methods:A retrospective comparative analysis was performed between laparoscopic and open liver resection operated from year 2008 to 2018.Consecutive HCC patients aged 65 or above at the time of operation were recruited.Patients with recurrent HCC and/or alternative pathology were excluded.Short-term and long-term outcomes between the laparoscopic and the open group were compared.Propensity score matching of patients in a ratio of 1:2 was conducted before comparison.Results:A total of 911 patients underwent hepatectomy for primary HCC from 2008 to 2018.Among them,320 elderly patients aged over 65 years old were eligible for analysis.Heterogeneities between laparoscopic and open groups were identified namely pre-operative albumin level,aspartate transaminase,and magnitude of hepatectomy(major vs.minor).After propensity score matching of 1:2,46 patients in the laparoscopic group and 92 patients in the open group were included for comparison.The laparoscopic group had less blood loss(326 mL vs.735 mL;P<0.001),shorter operative time(223 min vs.324 min;P<0.001),and shorter hospital stay(6.3 days vs.10.5 days;P<0.001).No significant differences in postoperative morbidity and hospital mortality were noted between the groups.For oncological outcome,the laparoscopic group had a superior disease-free survival(59.7%vs.44.5%;P=0.041),and a trend towards better overall survival compared with the open group.(78.4%vs.64.8%;P=0.110).Conclusion:Laparoscopic liver resection is a safe approach for elderly patients with HCC with benefits from faster recovery and better oncological outcomes.
文摘目的探讨脑卒中后不同血压水平与患者远期死亡风险的关系,为卒中后血压管理提供参考依据。方法利用美国国家健康与营养调查(NHANES)2005—2018年共7个周期的横断面数据,结合国家死亡指数(NDI)获取生存结局。共纳入39573例受试者,其中卒中组1589例,非卒中组37984例;按照随访结局将卒中组划分为死亡亚组(n=612)和存活亚组(n=977)。收集收缩压(SBP)、舒张压(DBP)及平均动脉压(MAP)等体格检查数据,采用基于广义倾向得分加权的Cox比例风险回归模型分析血压与死亡风险的非线性关系。结果血压与死亡风险呈非线性关系。SBP在111~121 mm Hg时死亡风险未见显著变化(HR=1.145,95%CI:0.902~1.388);121~133 mm Hg时风险上升(HR=1.901,95%CI:1.679~2.122);>133 mm Hg时死亡风险进一步增加(HR=3.583,95%CI:3.377~3.789)。DBP在62.7~70.7 mm Hg(HR=0.570,95%CI:0.399~0.741)、70.7~77.3 mm Hg(HR=0.446,95%CI:0.240~0.652)及>77.3 mm Hg(HR=0.480,95%CI:0.286~0.674)时均与较低死亡风险相关。MAP在80.2~87.1 mm Hg(HR=0.628,95%CI:0.330~0.926)和87.1~94.7 mm Hg(HR=0.629,95%CI:0.360~0.898)时死亡风险较低,>94.7 mm Hg时差异无统计学意义(HR=1.036,95%CI:0.797~1.275)。结论脑卒中后血压水平与患者远期死亡风险密切相关,控制SBP并维持相对较高的DBP水平可能有助于改善患者的长期预后。
