Traditional psychiatric diagnosis relies on subjective symptom assessment,lacking objective biomarkers that hinder early detection and personalized treatment.Plasma proteins and polygenic risk score(PRS),as potential ...Traditional psychiatric diagnosis relies on subjective symptom assessment,lacking objective biomarkers that hinder early detection and personalized treatment.Plasma proteins and polygenic risk score(PRS),as potential predictive tools,hold promise for advancing early diagnosis of mental disorders.This study aims to evaluate the predictive potential of proteomic features and PRS in multiple mental illnesses(depression,schizophrenia,and post-traumatic stress disorder(PTSD)).Using participant data from the UK Biobank-Pharma Proteomics Project,we screen protein associations with mental disorders through least absolute shrinkage and selection operator(LASSO)analysis and construct a Cox regression risk prediction model by integrating the PRS.Additionally,we evaluate predictive performance using 6 machine learning methods and Kaplan-Meier survival curves.Our findings reveal distinct predictive patterns across dis-orders.For depression,integrating plasma proteins with PRS significantly improves prediction beyond the clinical model(C-index=0.6322).For schizophrenia,adding plasma proteins enhances predictive performance,whereas PRS provides no significant improvement.For PTSD,neither plasma proteins nor PRS add substantial predictive value beyond clinical variables.Risk stratification analysis demonstrat that all three mental disorders models can clearly distinguish high-risk from low-risk groups(depression:HR=2.34,P<0.001;schizophrenia:HR=5.47,P<0.001;PTSD:HR=3.02,P<0.001).Al-though it shows good performance in short-term prediction,its long-term prediction ability has decreased,and it needs to be further optimized in the future.This study underscores the differential utility of biomarkers across mental disorders and provides a rationale for disorder-specific predictive modeling in precision psychiatry.展开更多
BACKGROUND Emphysematous pyelonephritis(EPN)is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection,predominantly affecting diabetic and immunocomp...BACKGROUND Emphysematous pyelonephritis(EPN)is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection,predominantly affecting diabetic and immunocompromised patients.It carries high morbidity and mortality,requiring early diagnosis and timely intervention.Various prognostic scoring systems help in triaging critically ill patients.The National Early Warning Score 2(NEWS 2)scoring system is a widely used physiological assessment tool that evaluates clinical deterioration based on vital parameters,but its standard form lacks specificity for risk stratification in EPN,necessitating modifications to improve treatment decisionmaking and prognostic accuracy in this critical condition.AIM To highlight the need to modify the NEWS 2 score to enable more intense monitoring and better treatment outcomes.METHODS This prospective study was done on all EPN patients admitted to our hospital over the past 12 years.A weighted average risk-stratification index was calculated for each of the three groups,mortality risk was calculated for each of the NEWS 2 scores,and the need for intervention for each of the three groups was calculated.The NEWS 2 score was subsequently modified with 0-6,7-14 and 15-20 scores included in groups 1,2 and 3,respectively.RESULTS A total of 171 patients with EPN were included in the study,with a predominant association with diabetes(90.6%)and a female-to-male ratio of 1.5:1.The combined prognostic scoring of the three groups was 10.7,13.0,and 21.9,respectively(P<0.01).All patients managed conservatively belonged to group 1(P<0.01).Eight patients underwent early nephrectomy,with six from group 3(P<0.01).Overall mortality was 8(4.7%),with seven from group 3(87.5%).The cutoff NEWS 2 score for mortality was identified to be 15,with a sensitivity of 87.5%,specificity of 96.9%,and an overall accuracy rate of 96.5%.The area under the curve to predict mortality based on the NEWS 2 score was 0.98,with a confidence interval of(0.97,1.0)and P<0.001.CONCLUSION Modified NEWS 2(mNEWS 2)score dramatically aids in the appropriate assessment of treatment-related outcomes.MNEWS 2 scores should become the practice standard to reduce the morbidity and mortality associated with this dreaded illness.展开更多
Objective We aimed to investigate the patterns of fasting blood glucose(FBG)trajectories and analyze the relationship between various occupational hazard factors and FBG trajectories in male steelworkers.Methods The s...Objective We aimed to investigate the patterns of fasting blood glucose(FBG)trajectories and analyze the relationship between various occupational hazard factors and FBG trajectories in male steelworkers.Methods The study cohort included 3,728 workers who met the selection criteria for the Tanggang Occupational Cohort(TGOC)between 2017 and 2022.A group-based trajectory model was used to identify the FBG trajectories.Environmental risk scores(ERS)were constructed using regression coefficients from the occupational hazard model as weights.Univariate and multivariate logistic regression analyses were performed to explore the effects of occupational hazard factors using the ERS on FBG trajectories.Results FBG trajectories were categorized into three groups.An association was observed between high temperature,noise exposure,and FBG trajectory(P<0.05).Using the first quartile group of ERS1 as a reference,the fourth quartile group of ERS1 had an increased risk of medium and high FBG by 1.90and 2.21 times,respectively(odds ratio[OR]=1.90,95%confidence interval[CI]:1.17–3.10;OR=2.21,95%CI:1.09–4.45).Conclusion An association was observed between occupational hazards based on ERS and FBG trajectories.The risk of FBG trajectory levels increase with an increase in ERS.展开更多
BACKGROUND Chronic liver disease is a growing global health problem,leading to hepatic decompensation characterized by an array of clinical and biochemical complic-ations.Several scoring systems have been introduced i...BACKGROUND Chronic liver disease is a growing global health problem,leading to hepatic decompensation characterized by an array of clinical and biochemical complic-ations.Several scoring systems have been introduced in assessing the severity of hepatic decompensation with the most frequent ones are Child-Pugh score,model of end-stage liver disease(MELD)score,and MELD-Na score.Anemia is frequently observed in cirrhotic patients and is linked to worsened clinical outcomes.Although studies have explored anemia in liver disease,few have investigated the correlation of hemoglobin level with the severity of hepatic decompensation.AIM To determine the relationship between hemoglobin levels and the severity of decompensated liver disease and comparing the strength of this correlation using the Child-Pugh,MELD,and MELD-Na scores.METHODS This cross-sectional study was conducted at a tertiary care hospital with 652 decompensated liver disease patients enrolled in the study.Data was collected on demographics,clinical history,and laboratory findings,including hemoglobin levels,bilirubin,albumin,prothrombin time(international normalized ratio),sodium,and creatinine.The Child-Pugh,MELD,and MELD-Na scores were calculated.Statistical analysis was performed using Statistical Package for the Social Sciences version 26,and correlations between hemoglobin levels and severity scores were assessed using Spearman's correlation coefficient.RESULTS The study included 405 males(62.1%)and 247 females(37.9%)with an average age of 58.8 years.Significant inverse correlations were found between hemoglobin levels and Child-Pugh,MELD,and MELD-Na scores(P<0.01),with the MELD scoring system being the strongest correlator among all.One-way analysis of variance revealed significant differences in hemoglobin levels across the severity groups of each scoring system(P=0.001).Tukey's post hoc analysis confirmed significant internal differences among each severity group.CONCLUSION Understanding the correlation between hemoglobin and liver disease severity can improve patient management by offering insights into prognosis and guiding treatment decisions.展开更多
Background Biomarkers-based prediction of long-term risk of acute coronary syndrome(ACS)is scarce.We aim to develop a risk score integrating clinical routine information(C)and plasma biomarkers(B)for predicting long-t...Background Biomarkers-based prediction of long-term risk of acute coronary syndrome(ACS)is scarce.We aim to develop a risk score integrating clinical routine information(C)and plasma biomarkers(B)for predicting long-term risk of ACS patients.Methods We included 2729 ACS patients from the OCEA(Observation of cardiovascular events in ACS patients).The earlier admitted 1910 patients were enrolled as development cohort;and the subsequently admitted 819 subjects were treated as valida-tion cohort.We investigated 10-year risk of cardiovascular(CV)death,myocardial infarction(MI)and all cause death in these pa-tients.Potential variables contributing to risk of clinical events were assessed using Cox regression models and a score was de-rived using main part of these variables.Results During 16,110 person-years of follow-up,there were 238 CV death/MI in the development cohort.The 7 most import-ant predictors including in the final model were NT-proBNP,D-dimer,GDF-15,peripheral artery disease(PAD),Fibrinogen,ST-segment elevated MI(STEMI),left ventricular ejection fraction(LVEF),termed as CB-ACS score.C-index of the score for predica-tion of cardiovascular events was 0.79(95%CI:0.76-0.82)in development cohort and 0.77(95%CI:0.76-0.78)in the validation co-hort(5832 person-years of follow-up),which outperformed GRACE 2.0 and ABC-ACS risk score.The CB-ACS score was also well calibrated in development and validation cohort(Greenwood-Nam-D’Agostino:P=0.70 and P=0.07,respectively).Conclusions CB-ACS risk score provides a useful tool for long-term prediction of CV events in patients with ACS.This model outperforms GRACE 2.0 and ABC-ACS ischemic risk score.展开更多
Objective:Neuroblastoma is the most common extracranial solid tumor in children and has complex genetic underpinnings.Previous genome-wide association studies(GWASs)have identified many loci associated with neuroblast...Objective:Neuroblastoma is the most common extracranial solid tumor in children and has complex genetic underpinnings.Previous genome-wide association studies(GWASs)have identified many loci associated with neuroblastoma susceptibility;however,their application in risk prediction for Chinese children has not been systematically explored.This study seeks to enhance neuroblastoma risk prediction by validating these loci and evaluating their performance in polygenic risk models.Methods:We validated 35 GWAS-identified neuroblastoma susceptibility loci in a cohort of Chinese children,consisting of 402 neuroblastoma patients and 473 healthy controls.Genotyping these polymorphisms was conducted via the TaqMan method.Univariable and multivariable logistic regression analyses revealed the genetic loci significantly associated with neuroblastoma risk.We constructed polygenic risk models by combining these loci and assessed their predictive performance via area under the curve(AUC)analysis.We also established a polygenic risk scoring(PRS)model for risk prediction by adopting the PLINK method.Results:Fourteen loci,including ten protective polymorphisms from CASC15,BARD1,LMO1,HSD17B12,and HACE1,and four risk variants from BARD1,RSRC1,CPZ and MMP20 were significantly associated with neuroblastoma risk.Compared with single-gene model,the 8-gene model(AUC=0.72)and 13-gene model(AUC=0.73)demonstrated superior predictive performance.Additionally,a PRS incorporating six significant loci achieved an AUC of 0.66,effectively stratifying individuals into distinct risk categories regarding neuroblastoma susceptibility.A higher PRS was significantly associated with advanced International Neuroblastoma Staging System(INSS)stages,suggesting its potential for clinical risk stratification.Conclusions:Our findings validate multiple loci as neuroblastoma risk factors in Chinese children and demonstrate the utility of polygenic risk models,particularly the PRS,in improving risk prediction.These results suggest that integrating multiple genetic variants into a PRS can enhance neuroblastoma risk stratification and potentially improve early diagnosis by guiding targeted screening programs for high-risk children.展开更多
BACKGROUND Inflammation is closely related to survival and disease progression in patients with cancer.However,the predictive value of inflammation-based scores for survival in patients with hepatocellular carcinoma(H...BACKGROUND Inflammation is closely related to survival and disease progression in patients with cancer.However,the predictive value of inflammation-based scores for survival in patients with hepatocellular carcinoma(HCC)treated with Lenvatinib has not been fully elucidated.AIM To compare different inflammation scores'prognostic values,and establish novel nomogram for predicting overall survival(OS)in HCC patients on Lenvatinib.METHODS In total,144 patients with HCC treated with Lenvatinib were enrolled in this study.The prognostic value of pre-treatment inflammation-based scores was retrospectively analyzed,including the platelet-to-lymphocyte ratio,neutrophil-to-lymphocyte ratio,lymphocyteto-C-reactive protein ratio,lymphocyte-to-monocyte ratio,systemic immune-inflammation index,C-reactive protein-to-albumin ratio,and prognostic nutritional index(PNI).Kaplan-Meier survival curves and time-dependent receiver operating characteristic analysis were used to assess predictive accuracy.Univariate and multivariate Cox regression analyses were conducted to identify prognostic factors predicting OS and construct a prognostic nomogram.RESULTS All the inflammation-based scores demonstrated good discrimination in terms of OS(all P<0.05),and the PNI emerged as an independent predictor of OS in multivariate analysis(hazard ratio=4.097;95%confidence interval:1.405-11.944;P=0.01).We selected three independent prognostic factors(macrovascular invasion,metastasis,and PNI)to generate a nomogram for OS.CONCLUSION The PNI is a prognostic indicator for assessing OS in patients with HCC treated with Lenvatinib and is superior to other inflammation-based scores in predicting OS.展开更多
Background:Acute cholangitis is an infection due to the bile duct obstruction.Despite progress in treat-ment,acute cholangitis remains potentially fatal.Early diagnosis and treatment improve the patient out-comes.The ...Background:Acute cholangitis is an infection due to the bile duct obstruction.Despite progress in treat-ment,acute cholangitis remains potentially fatal.Early diagnosis and treatment improve the patient out-comes.The present study aimed to identify clinical and biological factors at admission associated with 30-day mortality in acute cholangitis,to build an efficient prognostic score based on these parameters and to study the performances of this new score.Methods:We enrolled all adult patients consecutively hospitalized for acute cholangitis between January 2017 and December 2021.We developed a score system named ProChol using variables significantly asso-ciated with 30-day mortality in multivariate logistic analysis and simplified this system(named sProChol)based on a simple points-based approach.Results:In total,528 patients were included,with an average age of 77±13 years,a male predominance(54.2%)and a majority of lithiasis etiology(66.5%).Mortality in 30 days was 11.9%.In multivariate logis-tic analysis,tumor etiology[adjusted odds ratio(aOR)=15.43,95%confidence interval(CI):5.90-40.40],stent obstruction(aOR=5.12,95%CI:2.02-12.99),hypoalbuminemia(aOR=3.50,95%CI:1.25-9.81),renal failure(aOR=6.51,95%CI:2.62-16.18),oxygen therapy(aOR=4.63,95%CI:1.02-20.92)and cu-rative anticoagulation(aOR=2.60,95%CI:1.23-5.52)were independently associated with the 30-day mortality while fever was a protective factor(aOR=0.37,95%CI:0.16-0.84).ProChol score using these 7 parameters and sProChol using the 3 robust factors(etiology,renal failure and anticoagulation)presented respectively an area under receiver operating characteristic(ROC)curves(AUC)of 0.81 and 0.77,higher than Tokyo(AUC=0.72)and Gravito-Soares et al.score(AUC=0.71).Patients with sProChol≥4 had a significantly higher risk of transfer to intensive care unit(13.3%vs.5.1%;P<0.001)and longer length of stay(P=0.0006).Conclusions:ProChol and sProChol constructed from simple clinico-biological parameters at admission,present interesting performances in predicting the 30-day mortality in acute cholangitis.展开更多
Background:The survival benefits of pulmonary metastasectomy(PM)in colorectal cancer(CRC)patients with pulmonary metastasis remain controversial.This study aimed to assess the survival effect of PM on CRC patients wit...Background:The survival benefits of pulmonary metastasectomy(PM)in colorectal cancer(CRC)patients with pulmonary metastasis remain controversial.This study aimed to assess the survival effect of PM on CRC patients with pulmonary metastasis.Methods:Data from CRC patients with pulmonary metastasis were collected from the Surveillance,Epidemiology,and End Results database between 2010 and 2020.A 1:1 propensity score matching(PSM)analysis was employed to minimize heterogeneity between the groups.Kaplan-Meier analysis was performed to evaluate the overall survival(OS)of CRC patients with pulmonary metastasis who underwent PM.Results:A total of 1,399 CRC patients with pulmonary metastasis were included;140 patients and 1,259 patients underwent PM and did not,respectively.After PSM,there were 140 patients in each group.Patients who underwent PM demonstrated a longer median OS than those who did not,in both the overall cohort and the PSM cohort.In the PSM cohort,the median OS was 51 months(95%confidence interval[CI],45-64 months)for CRC patients with pulmonary metastasis who underwent PM and 36 months(95%CI,31-42 months)for those who did not undergo PM.Additionally,Cox proportional hazard models indicated that PM was a significant protective factor for OS in CRC patients with pulmonary metastasis(hazard ratio:0.57;95%CI,0.41-0.80,P<0.01).Conclusion:PM prolongs the survival of CRC patients with pulmonary metastasis.展开更多
Background Renal and liver dysfunction,which are common complications in infectious diseases,are associated with poor clinical outcomes.This study aimed to evaluate the prognostic value of the Model for End-Stage Live...Background Renal and liver dysfunction,which are common complications in infectious diseases,are associated with poor clinical outcomes.This study aimed to evaluate the prognostic value of the Model for End-Stage Liver Disease Excluding International Normalized Ratio(MELD-XI)score for predicting short-term mortality in patients with infective endocarditis(IE)complicated by sepsis.Methods A total of 496 consecutive IE patients complicated with sepsis at Guangdong Provincial People's Hospital were enrolled and divided into three groups according to the tertiles of MELD-XI score:<7.9(n=164),7.9-14.6(n=168),and>14.6(n=164).Major adverse clinical events(MACE)were composite endpoints that included acute heart failure,renal dialysis,stroke,and death during hospitalization.Multivariate analysis was used to explore the prognostic value of MELD-XI score.Results In-hospital and 6-month mortality were 14.3%and 21.5%,respectively.In-hospital mortality and the incidence of MACE rose significantly with higher MELD-XI scores(mortality:8.5%vs.12.5%vs.14.3%,P=0.002;Incidence of MACE:24.4%vs.31%vs.51.2%,P<0.001).Receiver operating characteristic(ROC)curve analysis showed that the optimal cutoff value of MELD-XI score was 15.7[area under the curve(AUC):0.648,95%CI:0.578-0.718,P<0.001].Multivariate regression analysis revealed that MELD-XI score>15.7 was a significantly independent risk factor for both in-hospital[adjusted odds ratio(OR):2.27,95%CI:1.28-4.05,P=0.005]and 6-month mortality[adjusted hazard ratio(HR):1.69,95%CI:1.13-2.53,P=0.011].Conclusions MELD-XI score>15.7 was independently associated with short-term mortality in IE patients complicated with sepsis,suggesting its potential value as a prognostic biomarker for risk stratification in this population.展开更多
In this article,we discussed the article by Zeng et al,published in a recent issue of the World Journal of Gastroenterology.The publication represents a significant advancement in the prognostic evaluation of rectal n...In this article,we discussed the article by Zeng et al,published in a recent issue of the World Journal of Gastroenterology.The publication represents a significant advancement in the prognostic evaluation of rectal neuroendocrine neoplasms.The GATIS score is a single nomogram model that incorporates five key progno-stic factors:Tumor grade;T stage;tumor size;age;and the prognostic nutritional index.This innovation optimizes the prognostic process,delivering more accurate predictions of overall survival and progression-free survival compared to tradi-tional TNM staging and World Health Organization classification systems.The findings of the study were based on a retrospective analysis spanning 12 years and involving 1408 patients from 17 reference centers in China.In this editorial,we specifically examined the strengths and limitations of the study,the clinical implications of the GATIS score,and the questions arising from its conclusions.展开更多
Objective:To investigate the value of dynamic monitoring of serum interleukin(IL)-33 and tumor necrosis factor(TNF)-αlevels in the early diagnosis,severity assessment and prognosis of acute pancreatitis(AP)combined w...Objective:To investigate the value of dynamic monitoring of serum interleukin(IL)-33 and tumor necrosis factor(TNF)-αlevels in the early diagnosis,severity assessment and prognosis of acute pancreatitis(AP)combined with abdominal CT radiomics and intestinal microbiota data.Methods:A total of 170 AP patients were admitted immediately after the onset of the disease and divided into MAP group(85 cases)and SAP group(85 cases).The levels of serum IL-33,TNF-α,IL-6,and HMGB1,as well as the expression of miRNA-155 in extracellular vesicles(EVs),were dynamically monitored at multiple time points(0 h,6 h,12 h,24 h,3 d,5 d,7 d,14 d)after admission.Abdominal CT radiomics analyzed the texture characteristics of pancreatic necrosis,and stool samples collected at admission were metagenomic sequencing of the gut microbiome.The Acute Pancreatitis Severity Bedside Index(BISAP)score is calculated within 48 hours of admission.Multivariate regression analysis assessed the independent effects of various factors on the prognosis of mortality groups.Results:Serum IL-33 and TNF-αlevels in SAP patients were significantly higher than those in MAP patients(p<0.05)at all time points,peaked on day 3,and decreased with treatment.The levels of these cytokines in patients with SIRS were also higher than in patients without SIRS(p<0.05).The serum IL-33,TNF-αlevels and BISAP scores in the mortality group were higher than those in the survival group(p<0.05).Multivariate regression analysis showed that serum IL-33(OR=3.21,95%CI:1.12–9.23,p=0.03),TNF-α(OR=4.05,95%CI:1.37–11.96,p=0.01),and BISAP score(OR=5.67,95%CI:1.83–17.54,p<0.01)were independent prognostic risk factors.Spearman correlation analysis showed that serum IL-33 and TNF-αlevels were positively correlated with BISAP scores(r=0.68,p<0.01;r=0.73,p<0.01).Conclusion:Dynamic monitoring of serum IL-33 and TNF-αlevels combined with BISAP score has important clinical value for early diagnosis,severity assessment,treatment guidance and prognosis evaluation of AP,and provides a basis for accurate diagnosis and treatment.展开更多
AIM:To compare analysis of the impact of high altitude on corneal endothelial cells,and the prognosis in patients with cataract surgeries.METHODS:Totally 265 plateau patients with cataract surgeries performed between ...AIM:To compare analysis of the impact of high altitude on corneal endothelial cells,and the prognosis in patients with cataract surgeries.METHODS:Totally 265 plateau patients with cataract surgeries performed between January 2019 and July 2022(average altitude=3000 m),and 524 plain patients with cataract surgeries performed between January 2020 and July 2022 were included.The propensity score matching(PSM)method was applied to match the basic information of patients in both regions on a 1:1 basis.Corneal endothelial cell density(ECD),coefficient of variation(CV),hexagonal cell ratio(HEX),duration of surgery,and pre-and postoperative visual acuity(VA)were compared retrospectively,and correlation tests were done.RESULTS:Totally 223 pairs have been matched successfully.The HEX in the plateau group was higher than that in the plain group(61.95%±6.191%vs 44.91%±6.829%,P<0.001).For ECD and CV,no significant differences were observed between both groups(P>0.1).The pre-and postoperative VA of patients with cataract surgeries in the plateau group were lower(1.40±0.610 vs 0.71±0.514,P<0.001&0.68±0.479 vs 0.18±0.259,P<0.001),and the duration of surgery was longer than those in the plain group(27.06±14.900 min vs 16.03±8.033 min,P<0.001).No significant associations were found between the post-operative VA and the corneal endothelial parameters(P>0.05),while the post-operative VA was significantly related to the pre-operative VA and the duration of surgery(P<0.05).CONCLUSION:The relative hypoxic environment of the plateau does not promote the apoptosis of corneal endothelial cells,but may lead to the compensatory increase of their functions.In plateau patients,no significant associations are found between the poor VA and the corneal endothelial functions early after cataract surgeries.展开更多
Background:The oxidative balance score(OBS)is a comprehensive scoring mechanism for evaluating oxidative stress.Previous studies have not yet clarified the correlations between OBS and mortality risk due to the divers...Background:The oxidative balance score(OBS)is a comprehensive scoring mechanism for evaluating oxidative stress.Previous studies have not yet clarified the correlations between OBS and mortality risk due to the diversity of antioxidant and pro-oxidant constituents.This research investigates the relationship between OBS,which is composed of 20 prespecified oxidative stressrelated factors,and the overall and specific-cause mortality.Methods:This study analyzed 24,299 adults aged older than or equal to 18 years from the National Health and Nutrition Examination Survey(NHANES)1999–2018,followed for survival until December 31,2019.Cox proportional hazards regression was used to evaluate the links between the OBS and mortality from all causes,cardiovascular disease(CVD),and cancer,adjusted for several relevant demographic and comorbidity factors.Results:During a median follow-up of 9.6 years,there were 3,003 deaths,including 740 from CVD,746 from cancer.The Kaplan-Meier curves showed a reduced risk of mortality for the subjects with a higher OBS relative to their counterparts in the lowest quartile.The highest OBS quartile was inversely associated with a decreased risk of mortality(all-cause HR:0.68,95%CI:0.60–0.77;CVD HR:0.58,95%CI:0.45–0.74;cancer HR:0.61,95%CI:0.48–0.78)after covariate correction.In addition,a significant link between dietary patterns,lifestyle components,and a significant association with mortality was observed,demonstrating consistency across subgroup analyses.Conclusions:An inverse correlation exists between OBS and mortality from all-cause,CVD,and cancer.These results suggest that diet and lifestyle modifications can substantially impact health outcomes by modulating oxidative balance.展开更多
Objective: To explore the application effect of nursing interventions based on APACHE II scores in patients with severe pancreatitis and its impact on the recovery time of the gastrointestinal function. Methods: A tot...Objective: To explore the application effect of nursing interventions based on APACHE II scores in patients with severe pancreatitis and its impact on the recovery time of the gastrointestinal function. Methods: A total of 86 patients with severe pancreatitis treated in our hospital from March 2023 to March 2024 were selected. Using a random number table method, the patients were divided into a control group receiving conventional nursing care and a study group receiving nursing interventions based on APACHE II scores, with 43 patients in each group. The intervention effects of the two groups were compared. Results: The recovery time of gastrointestinal function in the study group was significantly shorter than that in the control group (P < 0.05). After the intervention, the quality of life scores in the study group was significantly higher than those in the control group (P < 0.05). The incidence of complications in the study group was significantly lower than in the control group (P < 0.05). Conclusion: Nursing interventions based on APACHE II scores can shorten gastrointestinal recovery time and reduce complications in patients with severe pancreatitis, contributing to improved quality of life.展开更多
BACKGROUND Peritoneal metastasis occurs in about 20%of patients with colorectal cancer(CRC)and is associated with a 5-year survival rate of only 6%.Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy ...BACKGROUND Peritoneal metastasis occurs in about 20%of patients with colorectal cancer(CRC)and is associated with a 5-year survival rate of only 6%.Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy reportedly improves survival in selected patients.Achieving complete cytoreduction,indicated by a low completeness of cytoreduction(CCR)score,is a key factor in extending survival.Here,we present a case in which multimodal therapy yielded long-term survival in a patient,even though she had a CCR score of 3.CASE SUMMARY A 61-year-old female with CRC and extensive peritoneal metastases presented with abdominal distention.Cytoreductive surgery was not completed due to the extent of the disease(CCR score:3).The patient underwent palliative omen-tectomy,followed by hyperthermic intraperitoneal chemotherapy with mitomycin C,and early postoperative intraperitoneal chemotherapy.She subsequently received systemic chemotherapy,which was terminated after 19 cycles and two dose reductions due to side effects.She was in good health without distant metastases or peritoneal recurrence at the 6-year follow-up.CONCLUSION Aggressive multimodal treatment may yield long-term survival and quality of life improvement in patients with advanced disease,even with high CCR scores.展开更多
BACKGROUND The prevalence of coronary heart disease(CHD)is higher in patients with depression than in the general population.Recently,multiple novel biomarkers have been proposed to predict CHD risk,and these factors ...BACKGROUND The prevalence of coronary heart disease(CHD)is higher in patients with depression than in the general population.Recently,multiple novel biomarkers have been proposed to predict CHD risk,and these factors have been reported to be altered in patients with depression.AIM To explore whether these new biomarkers are associated with an increased risk of CHD in patients with depression.METHODS We recruited 279 healthy controls and 164 sex-and age-matched patients with depression and collected their clinical characteristics and laboratory values of novel cardiovascular biomarkers.The Framingham CHD risk score was used to assess the CHD risk of all individuals,and the cardiovascular markers related to the CHD risk in patients with depression were analyzed.RESULTS Patients with depression had an increased CHD risk of 5.3%(95%confidence interval:4.470-6.103)and altered novel cardiovascular biomarkers compared to healthy controls,which included lower levels of thyroid stimulating hormone,albumin,total bilirubin,total cholesterol,high-density lipoprotein cholesterol,and higher levels of triglyceride(TG)and uric acid.Further regression analysis showed that illness duration,family history of depression,serum TG,and urea acid levels were significantly correlated with the Framingham risk score in patients with depression.CONCLUSION Patients with depression had a higher CHD risk and that their illness duration,family history of depression,serum TG,and uric acid levels could play important roles in predicting CHD risk.Moreover,elevated CHD risk in patients with depression was not only related to physiological changes caused by depression but also to their genetic susceptibility.展开更多
Emphysematous pyelonephritis(EPN)is a severe,a lethal necrotizing upper urinary tract infection,characterized by gas production within the renal pa-renchyma,collecting system,or perinephric tissue.EPN is emerging as a...Emphysematous pyelonephritis(EPN)is a severe,a lethal necrotizing upper urinary tract infection,characterized by gas production within the renal pa-renchyma,collecting system,or perinephric tissue.EPN is emerging as a sig-nificant concern,necessitating early diagnosis,severity assessment,and timely intervention to improve outcomes.This study proposes a modified National Early Warning Score 2(mNEWS 2)to enhance risk stratification and predictive accuracy in EPN management.The mNEWS 2 refines the original NEWS 2 system,which aggregates 6 physiological indicators(body temperature,systolic blood pressure,pulse rate,oxygen saturation,breathing rate,and degree of consciousness),by incorporating weighted risk stratification indices and specific cutoff values derived from clinical observations,statistical modeling,and predictive per-formance analysis.A pilot study identified optimal thresholds,with a score of 15 maximizing predictive performance for mortality risk and intervention needs,validated through receiver operating characteristic curve analysis.So,the mNEWS 2 score represents a significant advancement in EPN management,offering improved risk stratification and treatment outcomes.展开更多
Background:Transcatheter arterial chemoembolization(TACE)combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,prolonged time intervals can lead to...Background:Transcatheter arterial chemoembolization(TACE)combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,prolonged time intervals can lead to recanalization and neoangiogenesis,which may interfere with the synergistic effects of combination therapy.This study aimed to investigate whether TACE simultaneously combined with microwave ablation(MWA)is more effective than sequential therapy in patients with HCC.Methods:A total of 129 HCC patients who underwent TACE combined with MWA were included in this study.Based on the time interval between the first combination therapy of TACE and MWA,patients were divided into the simultaneous and sequential groups.Propensity score matching(PSM)was performed to reduce bias between the groups.Overall survival(OS),time-to-progression(TTP),tumor response,and liver function were compared.Results:Before PSM,the simultaneous group had a higher tumor load.Following PSM,36 and 40 patients remained in the simultaneous and sequential groups,respectively.The median TTP and OS were 12.9 vs.10.6 months(P=0.262)and 44.0 vs.26.5 months(P=0.313)for the simultaneous and sequential groups,respectively.After 4–8 weeks,there were 16 complete responders and 17 partial responders in the simultaneous group and 15 and 22 patients in the sequential group,respectively(P=0.504).The median complete response duration was 11.3 and 9.2 months for the simultaneous and sequential groups,respectively(P=0.882).These results did not differ in BCLC stratified subgroups.Patients with small tumor sizes(≤5 cm),tumor nodules≤3,well-defined boundaries,and early-stage tumors were more likely to achieve complete response(all P<0.05).After 4–8 weeks,the liver function was significantly improved compared to that before or one day after treatment.Conclusions:TACE simultaneously combined with MWA is safe and effective but not superior to sequential therapy.展开更多
Metabolic-associated steatotic liver disease(MASLD)has become the leading cause of chronic liver disease worldwide,yet reliable tools for prognostication remain limited.Fibrosis-based indices such as the fibrosis-4 an...Metabolic-associated steatotic liver disease(MASLD)has become the leading cause of chronic liver disease worldwide,yet reliable tools for prognostication remain limited.Fibrosis-based indices such as the fibrosis-4 and nonalcoholic fatty liver disease fibrosis score are widely used but primarily reflect structural damage rather than functional decline.The albumin-bilirubin(ALBI)score,originally established to assess hepatic reserve in patients with hepatocellular carcinoma,provides a simple and objective measure of liver function derived from routine laboratory parameters.Recent validation and meta-analytic studies have shown that ALBI predicts liver-related outcomes and all-cause mortality across diverse chronic liver disease populations,including MASLD,and offers complementary prognostic information beyond fibrosis-based models.Its simplicity,cost-effectiveness,and compatibility with automated reporting systems make it feasible for integration into clinical workflows and population-level risk stratification.However,interpretation of ALBI should consider potential confounders such as renal dysfunction,inflammation,and Gilbert syndrome,and threshold calibration across ethnic groups remains necessary.The ALBI score represents a promising functional biomarker that could enhance risk prediction and care pathways in MASLD,although prospective,multiethnic,and longitudinal studies remain needed to confirm its prognostic value and define clinically meaningful cut-offs.展开更多
基金The National Natural Science Foundation of China-Regional Science“Identification of novel drug targets for lung cancer via Mendelian randomization analysis based on blood proteomics”(62362062)The 2025 Xinjiang University Excellent Graduate Innovation Project“Research on identification of therapeutic targets and predictive factors for mental disorders based on proteomics”(XJDX2025YJS151)。
文摘Traditional psychiatric diagnosis relies on subjective symptom assessment,lacking objective biomarkers that hinder early detection and personalized treatment.Plasma proteins and polygenic risk score(PRS),as potential predictive tools,hold promise for advancing early diagnosis of mental disorders.This study aims to evaluate the predictive potential of proteomic features and PRS in multiple mental illnesses(depression,schizophrenia,and post-traumatic stress disorder(PTSD)).Using participant data from the UK Biobank-Pharma Proteomics Project,we screen protein associations with mental disorders through least absolute shrinkage and selection operator(LASSO)analysis and construct a Cox regression risk prediction model by integrating the PRS.Additionally,we evaluate predictive performance using 6 machine learning methods and Kaplan-Meier survival curves.Our findings reveal distinct predictive patterns across dis-orders.For depression,integrating plasma proteins with PRS significantly improves prediction beyond the clinical model(C-index=0.6322).For schizophrenia,adding plasma proteins enhances predictive performance,whereas PRS provides no significant improvement.For PTSD,neither plasma proteins nor PRS add substantial predictive value beyond clinical variables.Risk stratification analysis demonstrat that all three mental disorders models can clearly distinguish high-risk from low-risk groups(depression:HR=2.34,P<0.001;schizophrenia:HR=5.47,P<0.001;PTSD:HR=3.02,P<0.001).Al-though it shows good performance in short-term prediction,its long-term prediction ability has decreased,and it needs to be further optimized in the future.This study underscores the differential utility of biomarkers across mental disorders and provides a rationale for disorder-specific predictive modeling in precision psychiatry.
文摘BACKGROUND Emphysematous pyelonephritis(EPN)is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection,predominantly affecting diabetic and immunocompromised patients.It carries high morbidity and mortality,requiring early diagnosis and timely intervention.Various prognostic scoring systems help in triaging critically ill patients.The National Early Warning Score 2(NEWS 2)scoring system is a widely used physiological assessment tool that evaluates clinical deterioration based on vital parameters,but its standard form lacks specificity for risk stratification in EPN,necessitating modifications to improve treatment decisionmaking and prognostic accuracy in this critical condition.AIM To highlight the need to modify the NEWS 2 score to enable more intense monitoring and better treatment outcomes.METHODS This prospective study was done on all EPN patients admitted to our hospital over the past 12 years.A weighted average risk-stratification index was calculated for each of the three groups,mortality risk was calculated for each of the NEWS 2 scores,and the need for intervention for each of the three groups was calculated.The NEWS 2 score was subsequently modified with 0-6,7-14 and 15-20 scores included in groups 1,2 and 3,respectively.RESULTS A total of 171 patients with EPN were included in the study,with a predominant association with diabetes(90.6%)and a female-to-male ratio of 1.5:1.The combined prognostic scoring of the three groups was 10.7,13.0,and 21.9,respectively(P<0.01).All patients managed conservatively belonged to group 1(P<0.01).Eight patients underwent early nephrectomy,with six from group 3(P<0.01).Overall mortality was 8(4.7%),with seven from group 3(87.5%).The cutoff NEWS 2 score for mortality was identified to be 15,with a sensitivity of 87.5%,specificity of 96.9%,and an overall accuracy rate of 96.5%.The area under the curve to predict mortality based on the NEWS 2 score was 0.98,with a confidence interval of(0.97,1.0)and P<0.001.CONCLUSION Modified NEWS 2(mNEWS 2)score dramatically aids in the appropriate assessment of treatment-related outcomes.MNEWS 2 scores should become the practice standard to reduce the morbidity and mortality associated with this dreaded illness.
基金supported by the Key Research and Development Program of the Ministry of Science and Technology of China(grant number:2016YF0900605)the Key Research and Development Program of Hebei Province(grant number:192777129D)+1 种基金the Joint Fund for Iron and Steel of the Natural Science Foundation of Hebei Province(grant number:H2016209058)the National Natural Science Foundation for Regional Joint Fund of China(grant number:U22A20364)。
文摘Objective We aimed to investigate the patterns of fasting blood glucose(FBG)trajectories and analyze the relationship between various occupational hazard factors and FBG trajectories in male steelworkers.Methods The study cohort included 3,728 workers who met the selection criteria for the Tanggang Occupational Cohort(TGOC)between 2017 and 2022.A group-based trajectory model was used to identify the FBG trajectories.Environmental risk scores(ERS)were constructed using regression coefficients from the occupational hazard model as weights.Univariate and multivariate logistic regression analyses were performed to explore the effects of occupational hazard factors using the ERS on FBG trajectories.Results FBG trajectories were categorized into three groups.An association was observed between high temperature,noise exposure,and FBG trajectory(P<0.05).Using the first quartile group of ERS1 as a reference,the fourth quartile group of ERS1 had an increased risk of medium and high FBG by 1.90and 2.21 times,respectively(odds ratio[OR]=1.90,95%confidence interval[CI]:1.17–3.10;OR=2.21,95%CI:1.09–4.45).Conclusion An association was observed between occupational hazards based on ERS and FBG trajectories.The risk of FBG trajectory levels increase with an increase in ERS.
文摘BACKGROUND Chronic liver disease is a growing global health problem,leading to hepatic decompensation characterized by an array of clinical and biochemical complic-ations.Several scoring systems have been introduced in assessing the severity of hepatic decompensation with the most frequent ones are Child-Pugh score,model of end-stage liver disease(MELD)score,and MELD-Na score.Anemia is frequently observed in cirrhotic patients and is linked to worsened clinical outcomes.Although studies have explored anemia in liver disease,few have investigated the correlation of hemoglobin level with the severity of hepatic decompensation.AIM To determine the relationship between hemoglobin levels and the severity of decompensated liver disease and comparing the strength of this correlation using the Child-Pugh,MELD,and MELD-Na scores.METHODS This cross-sectional study was conducted at a tertiary care hospital with 652 decompensated liver disease patients enrolled in the study.Data was collected on demographics,clinical history,and laboratory findings,including hemoglobin levels,bilirubin,albumin,prothrombin time(international normalized ratio),sodium,and creatinine.The Child-Pugh,MELD,and MELD-Na scores were calculated.Statistical analysis was performed using Statistical Package for the Social Sciences version 26,and correlations between hemoglobin levels and severity scores were assessed using Spearman's correlation coefficient.RESULTS The study included 405 males(62.1%)and 247 females(37.9%)with an average age of 58.8 years.Significant inverse correlations were found between hemoglobin levels and Child-Pugh,MELD,and MELD-Na scores(P<0.01),with the MELD scoring system being the strongest correlator among all.One-way analysis of variance revealed significant differences in hemoglobin levels across the severity groups of each scoring system(P=0.001).Tukey's post hoc analysis confirmed significant internal differences among each severity group.CONCLUSION Understanding the correlation between hemoglobin and liver disease severity can improve patient management by offering insights into prognosis and guiding treatment decisions.
基金funded,in part,by the National Natural Science Fund (NSFC,China) under award number 81900382supported,in part,by the Yang talents Program of Beijing (QML20200302)Beijing Municipal Natural Science Foundation (7222072).
文摘Background Biomarkers-based prediction of long-term risk of acute coronary syndrome(ACS)is scarce.We aim to develop a risk score integrating clinical routine information(C)and plasma biomarkers(B)for predicting long-term risk of ACS patients.Methods We included 2729 ACS patients from the OCEA(Observation of cardiovascular events in ACS patients).The earlier admitted 1910 patients were enrolled as development cohort;and the subsequently admitted 819 subjects were treated as valida-tion cohort.We investigated 10-year risk of cardiovascular(CV)death,myocardial infarction(MI)and all cause death in these pa-tients.Potential variables contributing to risk of clinical events were assessed using Cox regression models and a score was de-rived using main part of these variables.Results During 16,110 person-years of follow-up,there were 238 CV death/MI in the development cohort.The 7 most import-ant predictors including in the final model were NT-proBNP,D-dimer,GDF-15,peripheral artery disease(PAD),Fibrinogen,ST-segment elevated MI(STEMI),left ventricular ejection fraction(LVEF),termed as CB-ACS score.C-index of the score for predica-tion of cardiovascular events was 0.79(95%CI:0.76-0.82)in development cohort and 0.77(95%CI:0.76-0.78)in the validation co-hort(5832 person-years of follow-up),which outperformed GRACE 2.0 and ABC-ACS risk score.The CB-ACS score was also well calibrated in development and validation cohort(Greenwood-Nam-D’Agostino:P=0.70 and P=0.07,respectively).Conclusions CB-ACS risk score provides a useful tool for long-term prediction of CV events in patients with ACS.This model outperforms GRACE 2.0 and ABC-ACS ischemic risk score.
基金supported by grants from the National Natural Science Foundation of China(No.82173593,32300473)Guangzhou Science and Technology Project(No.2025A04J4537,2025A04J4696)+1 种基金Guangdong Basic and Applied Basic Research Foundation(No.2023A1515220053)Postdoctoral Science Foundation of Jiangsu Province(No.2021K524C).
文摘Objective:Neuroblastoma is the most common extracranial solid tumor in children and has complex genetic underpinnings.Previous genome-wide association studies(GWASs)have identified many loci associated with neuroblastoma susceptibility;however,their application in risk prediction for Chinese children has not been systematically explored.This study seeks to enhance neuroblastoma risk prediction by validating these loci and evaluating their performance in polygenic risk models.Methods:We validated 35 GWAS-identified neuroblastoma susceptibility loci in a cohort of Chinese children,consisting of 402 neuroblastoma patients and 473 healthy controls.Genotyping these polymorphisms was conducted via the TaqMan method.Univariable and multivariable logistic regression analyses revealed the genetic loci significantly associated with neuroblastoma risk.We constructed polygenic risk models by combining these loci and assessed their predictive performance via area under the curve(AUC)analysis.We also established a polygenic risk scoring(PRS)model for risk prediction by adopting the PLINK method.Results:Fourteen loci,including ten protective polymorphisms from CASC15,BARD1,LMO1,HSD17B12,and HACE1,and four risk variants from BARD1,RSRC1,CPZ and MMP20 were significantly associated with neuroblastoma risk.Compared with single-gene model,the 8-gene model(AUC=0.72)and 13-gene model(AUC=0.73)demonstrated superior predictive performance.Additionally,a PRS incorporating six significant loci achieved an AUC of 0.66,effectively stratifying individuals into distinct risk categories regarding neuroblastoma susceptibility.A higher PRS was significantly associated with advanced International Neuroblastoma Staging System(INSS)stages,suggesting its potential for clinical risk stratification.Conclusions:Our findings validate multiple loci as neuroblastoma risk factors in Chinese children and demonstrate the utility of polygenic risk models,particularly the PRS,in improving risk prediction.These results suggest that integrating multiple genetic variants into a PRS can enhance neuroblastoma risk stratification and potentially improve early diagnosis by guiding targeted screening programs for high-risk children.
基金Supported by Natural Science Foundation of China,No.82103566。
文摘BACKGROUND Inflammation is closely related to survival and disease progression in patients with cancer.However,the predictive value of inflammation-based scores for survival in patients with hepatocellular carcinoma(HCC)treated with Lenvatinib has not been fully elucidated.AIM To compare different inflammation scores'prognostic values,and establish novel nomogram for predicting overall survival(OS)in HCC patients on Lenvatinib.METHODS In total,144 patients with HCC treated with Lenvatinib were enrolled in this study.The prognostic value of pre-treatment inflammation-based scores was retrospectively analyzed,including the platelet-to-lymphocyte ratio,neutrophil-to-lymphocyte ratio,lymphocyteto-C-reactive protein ratio,lymphocyte-to-monocyte ratio,systemic immune-inflammation index,C-reactive protein-to-albumin ratio,and prognostic nutritional index(PNI).Kaplan-Meier survival curves and time-dependent receiver operating characteristic analysis were used to assess predictive accuracy.Univariate and multivariate Cox regression analyses were conducted to identify prognostic factors predicting OS and construct a prognostic nomogram.RESULTS All the inflammation-based scores demonstrated good discrimination in terms of OS(all P<0.05),and the PNI emerged as an independent predictor of OS in multivariate analysis(hazard ratio=4.097;95%confidence interval:1.405-11.944;P=0.01).We selected three independent prognostic factors(macrovascular invasion,metastasis,and PNI)to generate a nomogram for OS.CONCLUSION The PNI is a prognostic indicator for assessing OS in patients with HCC treated with Lenvatinib and is superior to other inflammation-based scores in predicting OS.
文摘Background:Acute cholangitis is an infection due to the bile duct obstruction.Despite progress in treat-ment,acute cholangitis remains potentially fatal.Early diagnosis and treatment improve the patient out-comes.The present study aimed to identify clinical and biological factors at admission associated with 30-day mortality in acute cholangitis,to build an efficient prognostic score based on these parameters and to study the performances of this new score.Methods:We enrolled all adult patients consecutively hospitalized for acute cholangitis between January 2017 and December 2021.We developed a score system named ProChol using variables significantly asso-ciated with 30-day mortality in multivariate logistic analysis and simplified this system(named sProChol)based on a simple points-based approach.Results:In total,528 patients were included,with an average age of 77±13 years,a male predominance(54.2%)and a majority of lithiasis etiology(66.5%).Mortality in 30 days was 11.9%.In multivariate logis-tic analysis,tumor etiology[adjusted odds ratio(aOR)=15.43,95%confidence interval(CI):5.90-40.40],stent obstruction(aOR=5.12,95%CI:2.02-12.99),hypoalbuminemia(aOR=3.50,95%CI:1.25-9.81),renal failure(aOR=6.51,95%CI:2.62-16.18),oxygen therapy(aOR=4.63,95%CI:1.02-20.92)and cu-rative anticoagulation(aOR=2.60,95%CI:1.23-5.52)were independently associated with the 30-day mortality while fever was a protective factor(aOR=0.37,95%CI:0.16-0.84).ProChol score using these 7 parameters and sProChol using the 3 robust factors(etiology,renal failure and anticoagulation)presented respectively an area under receiver operating characteristic(ROC)curves(AUC)of 0.81 and 0.77,higher than Tokyo(AUC=0.72)and Gravito-Soares et al.score(AUC=0.71).Patients with sProChol≥4 had a significantly higher risk of transfer to intensive care unit(13.3%vs.5.1%;P<0.001)and longer length of stay(P=0.0006).Conclusions:ProChol and sProChol constructed from simple clinico-biological parameters at admission,present interesting performances in predicting the 30-day mortality in acute cholangitis.
基金supported by National Key Clinical Discipline and the National Natural Science Foundation of China[grant number 82102955]the Guangzhou Basic Research Project[grant number 202201011326]the GuangDong Basic and Applied Basic Research Foundation[grant number 2024A1515220062]。
文摘Background:The survival benefits of pulmonary metastasectomy(PM)in colorectal cancer(CRC)patients with pulmonary metastasis remain controversial.This study aimed to assess the survival effect of PM on CRC patients with pulmonary metastasis.Methods:Data from CRC patients with pulmonary metastasis were collected from the Surveillance,Epidemiology,and End Results database between 2010 and 2020.A 1:1 propensity score matching(PSM)analysis was employed to minimize heterogeneity between the groups.Kaplan-Meier analysis was performed to evaluate the overall survival(OS)of CRC patients with pulmonary metastasis who underwent PM.Results:A total of 1,399 CRC patients with pulmonary metastasis were included;140 patients and 1,259 patients underwent PM and did not,respectively.After PSM,there were 140 patients in each group.Patients who underwent PM demonstrated a longer median OS than those who did not,in both the overall cohort and the PSM cohort.In the PSM cohort,the median OS was 51 months(95%confidence interval[CI],45-64 months)for CRC patients with pulmonary metastasis who underwent PM and 36 months(95%CI,31-42 months)for those who did not undergo PM.Additionally,Cox proportional hazard models indicated that PM was a significant protective factor for OS in CRC patients with pulmonary metastasis(hazard ratio:0.57;95%CI,0.41-0.80,P<0.01).Conclusion:PM prolongs the survival of CRC patients with pulmonary metastasis.
文摘Background Renal and liver dysfunction,which are common complications in infectious diseases,are associated with poor clinical outcomes.This study aimed to evaluate the prognostic value of the Model for End-Stage Liver Disease Excluding International Normalized Ratio(MELD-XI)score for predicting short-term mortality in patients with infective endocarditis(IE)complicated by sepsis.Methods A total of 496 consecutive IE patients complicated with sepsis at Guangdong Provincial People's Hospital were enrolled and divided into three groups according to the tertiles of MELD-XI score:<7.9(n=164),7.9-14.6(n=168),and>14.6(n=164).Major adverse clinical events(MACE)were composite endpoints that included acute heart failure,renal dialysis,stroke,and death during hospitalization.Multivariate analysis was used to explore the prognostic value of MELD-XI score.Results In-hospital and 6-month mortality were 14.3%and 21.5%,respectively.In-hospital mortality and the incidence of MACE rose significantly with higher MELD-XI scores(mortality:8.5%vs.12.5%vs.14.3%,P=0.002;Incidence of MACE:24.4%vs.31%vs.51.2%,P<0.001).Receiver operating characteristic(ROC)curve analysis showed that the optimal cutoff value of MELD-XI score was 15.7[area under the curve(AUC):0.648,95%CI:0.578-0.718,P<0.001].Multivariate regression analysis revealed that MELD-XI score>15.7 was a significantly independent risk factor for both in-hospital[adjusted odds ratio(OR):2.27,95%CI:1.28-4.05,P=0.005]and 6-month mortality[adjusted hazard ratio(HR):1.69,95%CI:1.13-2.53,P=0.011].Conclusions MELD-XI score>15.7 was independently associated with short-term mortality in IE patients complicated with sepsis,suggesting its potential value as a prognostic biomarker for risk stratification in this population.
文摘In this article,we discussed the article by Zeng et al,published in a recent issue of the World Journal of Gastroenterology.The publication represents a significant advancement in the prognostic evaluation of rectal neuroendocrine neoplasms.The GATIS score is a single nomogram model that incorporates five key progno-stic factors:Tumor grade;T stage;tumor size;age;and the prognostic nutritional index.This innovation optimizes the prognostic process,delivering more accurate predictions of overall survival and progression-free survival compared to tradi-tional TNM staging and World Health Organization classification systems.The findings of the study were based on a retrospective analysis spanning 12 years and involving 1408 patients from 17 reference centers in China.In this editorial,we specifically examined the strengths and limitations of the study,the clinical implications of the GATIS score,and the questions arising from its conclusions.
文摘Objective:To investigate the value of dynamic monitoring of serum interleukin(IL)-33 and tumor necrosis factor(TNF)-αlevels in the early diagnosis,severity assessment and prognosis of acute pancreatitis(AP)combined with abdominal CT radiomics and intestinal microbiota data.Methods:A total of 170 AP patients were admitted immediately after the onset of the disease and divided into MAP group(85 cases)and SAP group(85 cases).The levels of serum IL-33,TNF-α,IL-6,and HMGB1,as well as the expression of miRNA-155 in extracellular vesicles(EVs),were dynamically monitored at multiple time points(0 h,6 h,12 h,24 h,3 d,5 d,7 d,14 d)after admission.Abdominal CT radiomics analyzed the texture characteristics of pancreatic necrosis,and stool samples collected at admission were metagenomic sequencing of the gut microbiome.The Acute Pancreatitis Severity Bedside Index(BISAP)score is calculated within 48 hours of admission.Multivariate regression analysis assessed the independent effects of various factors on the prognosis of mortality groups.Results:Serum IL-33 and TNF-αlevels in SAP patients were significantly higher than those in MAP patients(p<0.05)at all time points,peaked on day 3,and decreased with treatment.The levels of these cytokines in patients with SIRS were also higher than in patients without SIRS(p<0.05).The serum IL-33,TNF-αlevels and BISAP scores in the mortality group were higher than those in the survival group(p<0.05).Multivariate regression analysis showed that serum IL-33(OR=3.21,95%CI:1.12–9.23,p=0.03),TNF-α(OR=4.05,95%CI:1.37–11.96,p=0.01),and BISAP score(OR=5.67,95%CI:1.83–17.54,p<0.01)were independent prognostic risk factors.Spearman correlation analysis showed that serum IL-33 and TNF-αlevels were positively correlated with BISAP scores(r=0.68,p<0.01;r=0.73,p<0.01).Conclusion:Dynamic monitoring of serum IL-33 and TNF-αlevels combined with BISAP score has important clinical value for early diagnosis,severity assessment,treatment guidance and prognosis evaluation of AP,and provides a basis for accurate diagnosis and treatment.
文摘AIM:To compare analysis of the impact of high altitude on corneal endothelial cells,and the prognosis in patients with cataract surgeries.METHODS:Totally 265 plateau patients with cataract surgeries performed between January 2019 and July 2022(average altitude=3000 m),and 524 plain patients with cataract surgeries performed between January 2020 and July 2022 were included.The propensity score matching(PSM)method was applied to match the basic information of patients in both regions on a 1:1 basis.Corneal endothelial cell density(ECD),coefficient of variation(CV),hexagonal cell ratio(HEX),duration of surgery,and pre-and postoperative visual acuity(VA)were compared retrospectively,and correlation tests were done.RESULTS:Totally 223 pairs have been matched successfully.The HEX in the plateau group was higher than that in the plain group(61.95%±6.191%vs 44.91%±6.829%,P<0.001).For ECD and CV,no significant differences were observed between both groups(P>0.1).The pre-and postoperative VA of patients with cataract surgeries in the plateau group were lower(1.40±0.610 vs 0.71±0.514,P<0.001&0.68±0.479 vs 0.18±0.259,P<0.001),and the duration of surgery was longer than those in the plain group(27.06±14.900 min vs 16.03±8.033 min,P<0.001).No significant associations were found between the post-operative VA and the corneal endothelial parameters(P>0.05),while the post-operative VA was significantly related to the pre-operative VA and the duration of surgery(P<0.05).CONCLUSION:The relative hypoxic environment of the plateau does not promote the apoptosis of corneal endothelial cells,but may lead to the compensatory increase of their functions.In plateau patients,no significant associations are found between the poor VA and the corneal endothelial functions early after cataract surgeries.
基金supported by the Young Talent Development Plan of ChangZhou Health Commission(No.CZQM2021023)Youth Foundation of ChangZhou Health Commission(No.QN202379)+1 种基金Foundation of Jiangsu University(No.JDYY2023156)Changzhou Municipal 14th Five-Year Plan for High-level Health Care Talent Training Program(No.CJ20242001).
文摘Background:The oxidative balance score(OBS)is a comprehensive scoring mechanism for evaluating oxidative stress.Previous studies have not yet clarified the correlations between OBS and mortality risk due to the diversity of antioxidant and pro-oxidant constituents.This research investigates the relationship between OBS,which is composed of 20 prespecified oxidative stressrelated factors,and the overall and specific-cause mortality.Methods:This study analyzed 24,299 adults aged older than or equal to 18 years from the National Health and Nutrition Examination Survey(NHANES)1999–2018,followed for survival until December 31,2019.Cox proportional hazards regression was used to evaluate the links between the OBS and mortality from all causes,cardiovascular disease(CVD),and cancer,adjusted for several relevant demographic and comorbidity factors.Results:During a median follow-up of 9.6 years,there were 3,003 deaths,including 740 from CVD,746 from cancer.The Kaplan-Meier curves showed a reduced risk of mortality for the subjects with a higher OBS relative to their counterparts in the lowest quartile.The highest OBS quartile was inversely associated with a decreased risk of mortality(all-cause HR:0.68,95%CI:0.60–0.77;CVD HR:0.58,95%CI:0.45–0.74;cancer HR:0.61,95%CI:0.48–0.78)after covariate correction.In addition,a significant link between dietary patterns,lifestyle components,and a significant association with mortality was observed,demonstrating consistency across subgroup analyses.Conclusions:An inverse correlation exists between OBS and mortality from all-cause,CVD,and cancer.These results suggest that diet and lifestyle modifications can substantially impact health outcomes by modulating oxidative balance.
文摘Objective: To explore the application effect of nursing interventions based on APACHE II scores in patients with severe pancreatitis and its impact on the recovery time of the gastrointestinal function. Methods: A total of 86 patients with severe pancreatitis treated in our hospital from March 2023 to March 2024 were selected. Using a random number table method, the patients were divided into a control group receiving conventional nursing care and a study group receiving nursing interventions based on APACHE II scores, with 43 patients in each group. The intervention effects of the two groups were compared. Results: The recovery time of gastrointestinal function in the study group was significantly shorter than that in the control group (P < 0.05). After the intervention, the quality of life scores in the study group was significantly higher than those in the control group (P < 0.05). The incidence of complications in the study group was significantly lower than in the control group (P < 0.05). Conclusion: Nursing interventions based on APACHE II scores can shorten gastrointestinal recovery time and reduce complications in patients with severe pancreatitis, contributing to improved quality of life.
基金Supported by a Research Fund from Dankook University in 2024,No.R202400759.
文摘BACKGROUND Peritoneal metastasis occurs in about 20%of patients with colorectal cancer(CRC)and is associated with a 5-year survival rate of only 6%.Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy reportedly improves survival in selected patients.Achieving complete cytoreduction,indicated by a low completeness of cytoreduction(CCR)score,is a key factor in extending survival.Here,we present a case in which multimodal therapy yielded long-term survival in a patient,even though she had a CCR score of 3.CASE SUMMARY A 61-year-old female with CRC and extensive peritoneal metastases presented with abdominal distention.Cytoreductive surgery was not completed due to the extent of the disease(CCR score:3).The patient underwent palliative omen-tectomy,followed by hyperthermic intraperitoneal chemotherapy with mitomycin C,and early postoperative intraperitoneal chemotherapy.She subsequently received systemic chemotherapy,which was terminated after 19 cycles and two dose reductions due to side effects.She was in good health without distant metastases or peritoneal recurrence at the 6-year follow-up.CONCLUSION Aggressive multimodal treatment may yield long-term survival and quality of life improvement in patients with advanced disease,even with high CCR scores.
基金Supported by the National Natural Science Foundation of China,No.82301737.
文摘BACKGROUND The prevalence of coronary heart disease(CHD)is higher in patients with depression than in the general population.Recently,multiple novel biomarkers have been proposed to predict CHD risk,and these factors have been reported to be altered in patients with depression.AIM To explore whether these new biomarkers are associated with an increased risk of CHD in patients with depression.METHODS We recruited 279 healthy controls and 164 sex-and age-matched patients with depression and collected their clinical characteristics and laboratory values of novel cardiovascular biomarkers.The Framingham CHD risk score was used to assess the CHD risk of all individuals,and the cardiovascular markers related to the CHD risk in patients with depression were analyzed.RESULTS Patients with depression had an increased CHD risk of 5.3%(95%confidence interval:4.470-6.103)and altered novel cardiovascular biomarkers compared to healthy controls,which included lower levels of thyroid stimulating hormone,albumin,total bilirubin,total cholesterol,high-density lipoprotein cholesterol,and higher levels of triglyceride(TG)and uric acid.Further regression analysis showed that illness duration,family history of depression,serum TG,and urea acid levels were significantly correlated with the Framingham risk score in patients with depression.CONCLUSION Patients with depression had a higher CHD risk and that their illness duration,family history of depression,serum TG,and uric acid levels could play important roles in predicting CHD risk.Moreover,elevated CHD risk in patients with depression was not only related to physiological changes caused by depression but also to their genetic susceptibility.
文摘Emphysematous pyelonephritis(EPN)is a severe,a lethal necrotizing upper urinary tract infection,characterized by gas production within the renal pa-renchyma,collecting system,or perinephric tissue.EPN is emerging as a sig-nificant concern,necessitating early diagnosis,severity assessment,and timely intervention to improve outcomes.This study proposes a modified National Early Warning Score 2(mNEWS 2)to enhance risk stratification and predictive accuracy in EPN management.The mNEWS 2 refines the original NEWS 2 system,which aggregates 6 physiological indicators(body temperature,systolic blood pressure,pulse rate,oxygen saturation,breathing rate,and degree of consciousness),by incorporating weighted risk stratification indices and specific cutoff values derived from clinical observations,statistical modeling,and predictive per-formance analysis.A pilot study identified optimal thresholds,with a score of 15 maximizing predictive performance for mortality risk and intervention needs,validated through receiver operating characteristic curve analysis.So,the mNEWS 2 score represents a significant advancement in EPN management,offering improved risk stratification and treatment outcomes.
基金supported by grants from Guangzhou Sci-ence and Technology Bureau City-University(College)Joint Fund-ing Project(2023A03J0224)2024 Guangzhou Basic and Applied Basic Research Scheme(Project for Maiden Voyage)(SL2023A04J00258)。
文摘Background:Transcatheter arterial chemoembolization(TACE)combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,prolonged time intervals can lead to recanalization and neoangiogenesis,which may interfere with the synergistic effects of combination therapy.This study aimed to investigate whether TACE simultaneously combined with microwave ablation(MWA)is more effective than sequential therapy in patients with HCC.Methods:A total of 129 HCC patients who underwent TACE combined with MWA were included in this study.Based on the time interval between the first combination therapy of TACE and MWA,patients were divided into the simultaneous and sequential groups.Propensity score matching(PSM)was performed to reduce bias between the groups.Overall survival(OS),time-to-progression(TTP),tumor response,and liver function were compared.Results:Before PSM,the simultaneous group had a higher tumor load.Following PSM,36 and 40 patients remained in the simultaneous and sequential groups,respectively.The median TTP and OS were 12.9 vs.10.6 months(P=0.262)and 44.0 vs.26.5 months(P=0.313)for the simultaneous and sequential groups,respectively.After 4–8 weeks,there were 16 complete responders and 17 partial responders in the simultaneous group and 15 and 22 patients in the sequential group,respectively(P=0.504).The median complete response duration was 11.3 and 9.2 months for the simultaneous and sequential groups,respectively(P=0.882).These results did not differ in BCLC stratified subgroups.Patients with small tumor sizes(≤5 cm),tumor nodules≤3,well-defined boundaries,and early-stage tumors were more likely to achieve complete response(all P<0.05).After 4–8 weeks,the liver function was significantly improved compared to that before or one day after treatment.Conclusions:TACE simultaneously combined with MWA is safe and effective but not superior to sequential therapy.
文摘Metabolic-associated steatotic liver disease(MASLD)has become the leading cause of chronic liver disease worldwide,yet reliable tools for prognostication remain limited.Fibrosis-based indices such as the fibrosis-4 and nonalcoholic fatty liver disease fibrosis score are widely used but primarily reflect structural damage rather than functional decline.The albumin-bilirubin(ALBI)score,originally established to assess hepatic reserve in patients with hepatocellular carcinoma,provides a simple and objective measure of liver function derived from routine laboratory parameters.Recent validation and meta-analytic studies have shown that ALBI predicts liver-related outcomes and all-cause mortality across diverse chronic liver disease populations,including MASLD,and offers complementary prognostic information beyond fibrosis-based models.Its simplicity,cost-effectiveness,and compatibility with automated reporting systems make it feasible for integration into clinical workflows and population-level risk stratification.However,interpretation of ALBI should consider potential confounders such as renal dysfunction,inflammation,and Gilbert syndrome,and threshold calibration across ethnic groups remains necessary.The ALBI score represents a promising functional biomarker that could enhance risk prediction and care pathways in MASLD,although prospective,multiethnic,and longitudinal studies remain needed to confirm its prognostic value and define clinically meaningful cut-offs.
