In 2012, the first paper in the series Analytical Methods in Quality Control of Scientific Publications was published in the American Journal of Analytical Chemistry, Vol. 3, No. 6, 2012, pp. 443-447. This paper was m...In 2012, the first paper in the series Analytical Methods in Quality Control of Scientific Publications was published in the American Journal of Analytical Chemistry, Vol. 3, No. 6, 2012, pp. 443-447. This paper was mainly based on evidence presented in the 2011 in book Historical Overview of Chromatography and Related Techniques in Analysis of Antimalarial Drug Primaquine (editor Ilia Brondz, Nova Science Publishers, Inc., ISSN 978-1-61761-944-1). The first paper in this series di- scussed issues of obvious falsification and plagiarism contained in paper published by Dongre et al., Applications of GC-EI-MS for the Identification and Investigation of Positional Isomer in Primaquine, an Antimalarial Drug. Journal of Pharmaceutical and Biomedical Analysis, Vol. 39, No. 1-2, 2005, pp. 111-116. Dongre et al. copied their publication from an original research manuscript submitted for consideration by other authors. This paper was published in the Asian Journal of Chemistry, Vol. 17, No. 3, 2005, pp. 1678-1688. Conclusive arguments against the publication of Dongre et al. were presented in the American Journal of Analytical Chemistry, Vol. 3, No. 6, 2012, pp. 443-447. Further cases of general plagiarism and incompetence relating to authors, reviewers, editors, and publishers were presented in Part II in Analytical Methods in Quality Control of Scientific Publications Part II: The Authors’, Reviewers’, Editors’ Responsibility and the Publishers’ Authority in the International Journal of Analytical Mass Spectrometry and Chromatography, Vol. 1, No. 2, 2013, pp. 81-89. The present paper will discuss the following issues: the obvious neglect of the rights of authors by some publishers and editors;how original research manuscripts are exposed to mediocre researchers, and possibly sold, by editors to these “scientists” to boost the image of these particular “scientists”;how the order of authors’ names in published articles are changed to satisfy the commercial interests of companies;and how copyright is breached in an appalling way by well-established publishers. The documents presented here concern research publications in the fields of chromatography, chromatography-mass spectrometry, and mass spectrometry.展开更多
[Objectives]To analyze the clinical characteristics,distribution of traditional Chinese medicine(TCM)syndrome types,spectrum of comorbidities,and complications among inpatients with gout.[Methods]Data from 592 gout pa...[Objectives]To analyze the clinical characteristics,distribution of traditional Chinese medicine(TCM)syndrome types,spectrum of comorbidities,and complications among inpatients with gout.[Methods]Data from 592 gout patients admitted in the Department of Rheumatology at Wuxi Traditional Chinese Medicine Hospital between January 2018 and December 2024 were retrospectively collected.The data collected encompassed patient gender,age,TCM syndrome types,underlying comorbidities,infection status,and major complications,including renal insufficiency,interstitial lung disease,and osteoporosis.Descriptive statistical analyses were subsequently performed.[Results]Among the 592 inpatients,80.75%were male and 19.25%were female.A total of 94.76%patients had at least one underlying condition,with hypertension(80.74%),cerebral infarction(29.59%),heart disease(24.24%),and diabetes(21.56%)being the most prevalent.The primary TCM syndrome types identified were damp-heat obstruction syndrome(63.51%)and phlegm-stasis obstruction syndrome(21.11%).During hospitalization,20.94%of patients experienced concurrent infections,predominantly pulmonary infections(38.10%).The principal complications observed included renal insufficiency(32.09%),interstitial lung disease(18.75%),and osteoporosis(9.29%).[Conclusions]Inpatients diagnosed with gout often present with complex conditions and a high burden of comorbidities,predominantly cardiovascular and cerebrovascular diseases,as well as metabolic disorders.Additionally,there is a high incidence of infections and renal insufficiency within this population.TCM syndrome types in these patients are primarily characterized by damp-heat obstruction.In clinical practice,a comprehensive management approach that incorporates multidisciplinary collaboration is recommended.Alongside the control of uric acid levels and joint inflammation,proactive screening and management of comorbidities and related complications are essential.展开更多
BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently estab...BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently established technique for treating AIS.It provides the benefits of being a relatively simple and safe procedure,capable of partially enhancing a patient’s condition.However,some patients may experience endothelial damage and recurrent thrombosis,with clinical outcomes that are not always satisfactory.Hence,the efficacy of this method remains unclear.AIM To survey the association of stent thrombectomy vs standard treatment with neurological function protection,complications,and short-term prognosis in patients diagnosed with AIS.METHODS This study assigned 90 patients with AIS to the observation and control groups(n=45 patients)from December 2020 to December 2022.Stent thrombectomy was conducted in the observation group,whereas routine treatment was provided to the control group.The study assessed the therapeutic outcomes of two groups,including a comparison of their neurological function,living ability,anxiety and depression status,plaque area,serum inflammatory factors,serum Smur100βprotein,neuron-specific enolase(NSE),homocysteine(Hcy),and vascular endo-thelial function.Additionally,the incidence of complications was calculated and analyzed for each group.RESULTS The total effective rate of treatment was 77.78%and 95.56%in the control and observation groups,respectively.After 8 weeks of treatment,the scores on the National Institutes of Health Stroke Scale,Hamilton Anxiety Scale,and Hamilton Depression Scale decreased remarkably;the Barthel index increased remarkably,with better improvement effects of the scores in the observation group(P<0.05);total cholesterol,triglyceride,C-reactive protein,and plaque area lessened remarkably,with fewer patients in the observation group(P<0.05);S-100βprotein,NSE,and Hcy levels lessened remarkably,with fewer patients in the observation group(P<0.05);serum vascular endothelial growth factor and nitric oxide synthase levels increased remarkably,whereas the endothelin-1 level decreased,with better improvement effect in the observation group(P<0.05).Complications occurred in 8.88%of patients in the observation group compared with 33.33%in the control group.CONCLUSION Stent thrombectomy appeared to provide more remarkable neuroprotective effects in patients with AIS compared to the intravenous thrombolysis regimen.Additionally,it has effectively improved the neurological function,daily activities,and vascular endothelial function of patients,while reducing the incidence of complications and improving short-term prognosis.展开更多
BACKGROUND Single-balloon enteroscopy(SBE)is an established procedure for evaluating small bowel lesions.While its efficacy is well recognized,the incidence of major complications and their associated risk factors in ...BACKGROUND Single-balloon enteroscopy(SBE)is an established procedure for evaluating small bowel lesions.While its efficacy is well recognized,the incidence of major complications and their associated risk factors in a large population remain unclear.AIM To investigate the complications and risk factors associated with diagnostic SBE.METHODS This multicenter retrospective study included consecutive patients who underwent diagnostic SBE at three tertiary care hospitals between January 2016 and September 2024.Data on baseline characteristics,procedural parameters,indications,findings,and major complications were collected and analyzed.RESULTS A total of 2865 SBE procedures were performed in 1840 patients.The mean age was 51±18 years,and 64.5%were male.The most common indication was obscure gastrointestinal bleeding(57.1%),followed by abdominal pain(30.5%).The major complication rate was 0.4%(7/1840),all of which involved acute intestinal perforation identified during the procedure.Among the perforation cases,6 occurred in patients undergoing SBE for abdominal pain and 1 for obscure gastrointestinal bleeding.The perforation sites included the ileum(6/7)and duodenum(1/7).All cases were successfully managed surgically.Previous abdominal surgery and the use of abdominal compression were significantly associated with an increased risk of perforation(P value<0.001 for both).In subgroup analysis,perforation rates were 2.1%(6/288)in patients with prior abdominal surgery and 1.6%(7/428)with abdominal compression.CONCLUSION Acute intestinal perforation is a rare but serious complication.Prior abdominal surgery and abdominal compression are important risk factors,and careful patient selection is recommended to minimize complications.展开更多
The traditional view of the decompensated stage as a point of no return in the natural history of liver cirrhosis(LC)is currently being questioned.This is due to the appearance of data indicating the possibility of re...The traditional view of the decompensated stage as a point of no return in the natural history of liver cirrhosis(LC)is currently being questioned.This is due to the appearance of data indicating the possibility of restoring the structure and function of the liver,reducing the portal pressure with a positive effect on complications associated with portal hypertension and decreasing the risk of developing hepatocellular carcinoma after elimination of the etiological factor.To create a unified understanding the recompensation of decompensated LC,at the Baveno VII consensus workshop were developed criteria confirming it.At the moment,the efficacy of etiological therapy in achieving established criteria for recompensation has been evaluated only in patients with alcohol-related,as well as hepatitis B virus-related and hepatitis C virus-related decompensated LC.The purpose of the review is to provide up–to-date information on the role of etiological therapy in achieving recompensation of decompensated LC according to Baveno VII criteria.So far,only the first steps have been taken in studying this problem.To further understand it,research is needed to identify pathophysiological mechanisms,modifying factors,predictors,and potential noninvasive biomarkers of recompensation of decompensated LC.展开更多
BACKGROUND The use of biomarkers,such as the neutrophil-to-lymphocyte ratio(NLR)and the neutrophil-to-platelet ratio(NPR),has shown promise in evaluating early outcomes after medical,interventional,and surgical treatm...BACKGROUND The use of biomarkers,such as the neutrophil-to-lymphocyte ratio(NLR)and the neutrophil-to-platelet ratio(NPR),has shown promise in evaluating early outcomes after medical,interventional,and surgical treatments.NLR has emer-ged as an indicator of systemic inflammation and physiological stress.NPR has emerged as a potential indicator of inflammation and thrombotic risk in the context of surgical and radiological procedures.AIM To analyze the correlation of NLR and NPR with the development of post-liver transplantation(LT)early complications after stratification for hepatocellular carcinoma diagnosis.METHODS Consecutive patients undergone LT between January 2019 and December 2023 were enrolled.Data regarding the concentration of hemoglobin and the differ-ential leukocyte count on postoperative days(POD)0,1,3,and 5 were collected.RESULTS The dataset included 161 consecutive patients undergone LT.Clavien-Dindo IV-V complications had a good correlation with NLR POD 1(P=0.05),NLR POD 3(P<0.001),NLR POD 7(P<0.001),NPR POD 3(P<0.001).In addition,the NPR ratio on POD 3 correlated with the onset of 30-day hemorrhage(P=0.009).Finally,30-day mortality had a significant association with the NLR POD 1(P=0.03)and with NLR POD 7(P=0.004),while NPR had a significant correlation with 30-day mortality in NPR POD 7(P=0.004).CONCLUSION The analysis of NLR and NPR are strictly correlated with Clavien-Dindo IV-V complications and 30-day post-LT death.展开更多
BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are e...BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.展开更多
BACKGROUND Corneal ulcers are a major cause of visual impairment in developing countries.In Indonesia,severe infective ulcers often require keratoplasty(KP)to preserve ocular integrity and improve outcomes.AIM To dete...BACKGROUND Corneal ulcers are a major cause of visual impairment in developing countries.In Indonesia,severe infective ulcers often require keratoplasty(KP)to preserve ocular integrity and improve outcomes.AIM To determine demographic,clinical and microbiological characteristics,complications,and KP outcomes in patients with moderate to severe infective corneal ulcers.METHODS A retrospective review was conducted on patients with moderate to severe infective corneal ulcers who underwent KP between January 1,2018 and December 31,2020,with a minimum follow-up period of 3 weeks at the Ocular Infection and Immunology clinic of a tertiary referral hospital in Jakarta.Data were extracted from medical records.RESULTS A total of 99 eyes from 99 patients with a mean age of 41.7±16.2 years were included.Eight-nine eyes of corneal cases were located at the central cornea with>6 mm lesion size(forty-one eyes).The culture positivity rate was 33%,primarily composed of Staphylococcus epidermidis.Eyeball integrity was maintained in all patients.Mean uncorrected visual acuity(VA)before KP was 2.50 and improved to 2.04 after 3 months of follow-up.Twenty patients with a cornea that was kept transparent achieved a VA of 0.40.Complications after KP appeared in 60 eyes,while secondary glaucoma was the most common complication(28 eyes),followed by graft failure(24 eyes)and graft rejection(14 eyes).CONCLUSION Corneal ulcers are a common problem in Indonesia following eye trauma.Therapeutic and tectonic KP can preserve the integrity of the eyeball in moderate to severe cases,although complications are common.展开更多
BACKGROUND Gastric cancer is a malignancy with high morbidity and mortality rates.Surgical intervention,particularly gastrectomy,is essential for curative treatment but carries a substantial risk of complications.Iden...BACKGROUND Gastric cancer is a malignancy with high morbidity and mortality rates.Surgical intervention,particularly gastrectomy,is essential for curative treatment but carries a substantial risk of complications.Identifying key risk factors and understanding complication profiles are crucial for improving outcomes and guiding perioperative management.AIM To analyze the incidence of postoperative complications in patients with gastric cancer and identify potential risk factors.METHODS We conducted a retrospective analysis of 500 patients who underwent gastrectomy between January 2018 and December 2022.Postoperative complications were classified using the Clavien-Dindo system.RESULTS The overall complication rate was 28.4%(142/500),with 15.2%(76/500)experiencing major complications(Clavien-Dindo grade≥III).Pulmonary complications were the most frequent(10.8%),followed by surgical site infections(8.6%),and anastomotic leakage(4.2%).Age 70 years or more,body mass index of 25 kg/m²or more,advanced tumor stage,total gastrectomy,and operative time 240 min or more emerged as independent risk factors.CONCLUSION Focused preoperative risk assessment,targeted interventions,and reduced operative time for older or obese patients requiring total gastrectomy or presenting with advanced disease are important to improve surgical outcomes.展开更多
AIM:To evaluate the visual outcomes of implantable collamer lenses(ICLs)and identify the possible risk factors for ICL axis misalignment,and consequently,repositioning,explanting,or exchanging at a specialized eye hos...AIM:To evaluate the visual outcomes of implantable collamer lenses(ICLs)and identify the possible risk factors for ICL axis misalignment,and consequently,repositioning,explanting,or exchanging at a specialized eye hospital in Saudi Arabia.METHODS:The medical records of 813 eyes with different refractive errors corrected with ICL implantation were identified and included in this single-arm retrospective cohort study.The following data were collected:demographic characteristics,primary diagnosis,preoperative refraction,anterior chamber depth(ACD),white-to-white(WTW)measurement,endothelial cell density(ECD),and axial length.Patients’satisfaction and complaints,and their postoperative refraction,vault depth,and axis alignment with the preoperative target,were reviewed during the postoperative period.Collectively,these data were correlated with symptomatic axis rotation and the need for repositioning,explantation,or exchange due to high or low ICL vaults.RESULTS:Of 813 eyes,27(3.32%),13(1.59%),and 11(1.35%)required ICL repositioning,ICL explantation only without exchange,and ICL explantation with the placement of a new ICL,respectively.The mean follow-up period was 37.5mo.The main cause of explanation or exchange was incorrect WTW measurement in seven(29.17%)eyes,followed by high vault in four(16.56%)eyes.ICL repositioning was required in 27(3.32%)eyes with considerable rotation.Only 2(0.24%)eyes developed cataracts that required ICL removal,and retinal complications were reported in 7(0.86%)eyes.Long-term glaucoma and corneal decompensation were not observed in this cohort.CONCLUSION:With a high safety profile and reversibility,ICL implantation is a good alternative to corneal-based refractive surgery in eyes unsuitable for laser vision correction.The rate of secondary procedures in our study was 6.26%.Old age is a risk factor for secondary surgical interventions in the repositioning group,whereas abnormal vault and toric ICL rotation in the explantation group necessitated subsequent surgical procedures.Overall,ICL implantation demonstrates a good efficacy index and safety profile in patients with diverse refractive errors.展开更多
BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp ex...BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp exhibit characteristic signs and symptoms;hence,negative AAp and complicated AAp are the primary concerns in research on AAp.In other terms,further investigations and algorithms are required for at least one third of patients to predict the clinical condition and distinguish them from uncomplicated patients with AAp.AIM To use a Stochastic Gradient Boosting(SGB)-based machine learning(ML)algorithm to tell the difference between AAp patients who are complicated and those who are not,and to find some important biomarkers for both types of AAp by using modeling to get variable importance values.METHODS This study analyzed an open access data set containing 140 people,including 41 healthy controls,65 individuals with uncomplicated AAp,and 34 individuals with complicated AAp.We analyzed some demographic data(age,sex)of the patients and the following biochemical blood parameters:White blood cell(WBC)count,neutrophils,lymphocytes,monocytes,platelet count,neutrophil-tolymphocyte ratio,lymphocyte-to-monocyte ratio,mean platelet volume,neutrophil-to-immature granulocyte ratio,ferritin,total bilirubin,immature granulocyte count,immature granulocyte percent,and neutrophil-to-immature granulocyte ratio.We tested the SGB model using n-fold cross-validation.It was implemented with an 80-20 training-test split.We used variable importance values to identify the variables that were most effective on the target.RESULTS The SGB model demonstrated excellent performance in distinguishing AAp from control patients with an accuracy of 96.3%,a micro aera under the curve(AUC)of 94.7%,a sensitivity of 94.7%,and a specificity of 100%.In distinguishing complicated AAp patients from uncomplicated ones,the model achieved an accuracy of 78.9%,a micro AUC of 79%,a sensitivity of 83.3%,and a specificity of 76.9%.The most useful biomarkers for confirming the AA diagnosis were WBC(100%),neutrophils(95.14%),and the lymphocyte-monocyte ratio(76.05%).On the other hand,the most useful biomarkers for accurate diagnosis of complicated AAp were total bilirubin(100%),WBC(96.90%),and the neutrophil-immature granulocytes ratio(64.05%).CONCLUSION The SGB model achieved high accuracy rates in identifying AAp patients while it showed moderate performance in distinguishing complicated AAp patients from uncomplicated AAp patients.Although the model's accuracy in the classification of complicated AAp is moderate,the high variable importance obtained is clinically significant.We need further prospective validation studies,but the integration of such ML algorithms into clinical practice may improve diagnostic processes.展开更多
BACKGROUND The incidence and mortality of colorectal cancer continue to rise.For early-stage colorectal cancer,endoscopic resection has become a preferred or important treatment option due to its significant advantage...BACKGROUND The incidence and mortality of colorectal cancer continue to rise.For early-stage colorectal cancer,endoscopic resection has become a preferred or important treatment option due to its significant advantages in operative time,extent of trauma,and medical costs.However,increasing lesion diameter significantly elevates the technical difficulty of endoscopic resection.Currently,robust evidence-based evidence regarding the upper size limit for safely and effectively resecting lesions endoscopically remains lacking.AIM To evaluate the efficacy and safety of endoscopic resection for colorectal lesions≥30 mm in diameter.METHODS This retrospective study reviewed data from 102 patients who underwent endoscopic resection for colorectal lesions measuring≥30 mm in diameter at General Hospital of Northern Theater Command between January 2023 and July 2024.RESULTS Among 102 patients who underwent endoscopic resection,99 received endoscopic submucosal dissection and 3 underwent endoscopic full-thickness resection.Four patients(3.9%)required conversion to surgical radical resection postoperatively.All patients exhibited favorable wound healing at the resection sites,and no long-term complications were observed during the 3-month postoperative colonoscopy follow-up.The primary perioperative complication was post-endoscopic submucosal dissection electrocoagulation syndrome(PEECS)(24/102,23.5%).Multivariate analysis identified lesion location in the transverse colon as an independent risk factor for PEECS occurrence(odds ratio=6.734,95%confidence interval:1.623-27.945,P=0.009).CONCLUSION Large colorectal lesion diameter does not constitute an absolute contraindication to endoscopic resection.Experienced endoscopic centers can achieve complete resection with a favorable efficacy and safety profile.Notably,lesion location in the transverse colon is identified as an independent risk factor for PEECS.展开更多
BACKGROUND The burden of cannabis use disorder(CUD)in the context of its prevalence and subsequent cardiopulmonary outcomes among cancer patients with severe sepsis is unclear.AIM To address this knowledge gap,especia...BACKGROUND The burden of cannabis use disorder(CUD)in the context of its prevalence and subsequent cardiopulmonary outcomes among cancer patients with severe sepsis is unclear.AIM To address this knowledge gap,especially due to rising patterns of cannabis use and its emerging pharmacological role in cancer.METHODS By applying relevant International Classification of Diseases,Ninth and Tenth Revision,Clinical Modification codes to the National Inpatient Sample database between 2016-2020,we identified CUD(+)and CUD(-)arms among adult cancer admissions with severe sepsis.Comparing the two cohorts,we examined baseline demographic characteristics,epidemiological trends,major adverse cardiac and cerebrovascular events,respiratory failure,hospital cost,and length of stay.We used the Pearsonχ^(2) d test for categorical variables and the Mann-Whitney U test for continuous,non-normally distributed variables.Multivariable regression analysis was used to control for potential confounders.A P value≤0.05 was considered for statistical significance.RESULTS We identified a total of 743520 cancer patients admitted with severe sepsis,of which 4945 had CUD.Demographically,the CUD(+)cohort was more likely to be younger(median age=58 vs 69,P<0.001),male(67.9%vs 57.2%,P<0.001),black(23.7%vs 14.4%,P<0.001),Medicaid enrollees(35.2%vs 10.7%,P<0.001),in whom higher rates of substance use and depression were observed.CUD(+)patients also exhibited a higher prevalence of chronic pulmonary disease but lower rates of cardiovascular comorbidities.There was no significant difference in major adverse cardiac and cerebrovascular events between CUD(+)and CUD(-)cohorts on multivariable regression analysis.However,the CUD(+)cohort had lower all-cause mortality(adjusted odds ratio=0.83,95%confidence interval:0.7-0.97,P<0.001)and respiratory failure(adjusted odds ratio=0.8,95%confidence interval:0.69-0.92,P=0.002).Both groups had similar median length of stay,though CUD(+)patients were more likely to have higher hospital cost compared to CUD(-)patients(median=94574 dollars vs 86615 dollars,P<0.001).CONCLUSION CUD(+)cancer patients with severe sepsis,who tended to be younger,black,males with higher rates of substance use and depression had paradoxically significantly lower odds of all-cause in-hospital mortality and respiratory failure.Future research should aim to better elucidate the underlying mechanisms for these observations.展开更多
ACKGROUND The hemoglobin glycation index(HGI)represents the discrepancy between the glucose management indicator(GMI)based on mean blood glucose levels and laboratory values of glycated hemoglobin(HbA1c).The HGI is a ...ACKGROUND The hemoglobin glycation index(HGI)represents the discrepancy between the glucose management indicator(GMI)based on mean blood glucose levels and laboratory values of glycated hemoglobin(HbA1c).The HGI is a promising indicator for identifying individuals with excessive glycosylation,facilitating personalized evaluation and prediction of diabetic complications.However,the factors influencing the HGI in patients with type 1 diabetes(T1D)remain unclear.Autoimmune destruction of pancreaticβcells is central in T1D pathogenesis,yet insulin resistance can also be a feature of patients with T1D and their coexistence is called“double diabetes”(DD).However,knowledge regarding the relationship between DD features and the HGI in T1D is limited.AIM To assess the association between the HGI and DD features in adults with T1D.METHODS A total of 83 patients with T1D were recruited for this cross-sectional study.Laboratory HbA1c and GMI from continuous glucose monitoring data were collected to calculate the HGI.DD features included a family history of type 2 diabetes,overweight/obesity/central adiposity,hypertension,atherogenic dyslipidemia,an abnormal percentage of body fat(PBF)and/or visceral fat area(VFA)and decreased estimated insulin sensitivity.Skin autofluorescence of advanced glycation end products(SAF-AGEs),diabetic complications,and DD features were assessed,and their association with the HGI was analyzed.RESULTS A discrepancy was observed between HbA1c and GMI among patients with T1D and DD.A higher HGI was associated with an increased number of SAF-AGEs and a higher prevalence of diabetic microangiopathy(P=0.030),particularly retinopathy(P=0.031).Patients with three or more DD features exhibited an eight-fold increased risk of having a high HGI,compared with those without DD features(adjusted odds ratio=8.12;95%confidence interval:1.52-43.47).Specifically,an elevated PBF and/or VFA and decreased estimated insulin sensitivity were associated with high HGI.Regression analysis identified estimated insulin sensitivity and VFA as factors independently associated with HGI.CONCLUSION In patients with T1D,DD features are associated with a higher HGI,which represents a trend toward excessive glycosylation and is associated with a higher prevalence of chronic diabetic complications.展开更多
BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modifie...BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.展开更多
BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopi...BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopic pancreatoduodenectomy(LPD).METHODS A total of 804 consecutive patients who underwent LPD at our hospital between March 2017 and November 2021 were retrospectively analyzed.Correlations between pretreatment RDW and clinicopathological characteristics and short-term outcomes were investigated.RESULTS Patients with higher pretreatment RDW were older,had higher Eastern Cooperative Oncology Group scores and were associated with poorer short-term outcomes than those with normal RDW.High pretreatment RDW was an independent risk factor for postoperative complications(POCs)(hazard ratio=2.973,95%confidence interval:2.032-4.350,P<0.001)and severe POCs of grade IIIa or higher(hazard ratio=3.138,95%confidence interval:2.042-4.824,P<0.001)based on the Clavien-Dino classification system.Subgroup analysis showed that high pretreatment RDW was an independent risk factor for Clavien-Dino classi-fication grade IIIb or higher POCs,a comprehensive complication index score≥26.2,severe postoperative pancreatic fistula,severe bile leakage and severe hemorrhage.High pretreatment RDW was positively associated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and was negatively associated with albumin and the prognostic nutritional index.CONCLUSION Pretreatment RDW was a special parameter for patients who underwent LPD.It was associated with malnutrition,severe inflammatory status and poorer short-term outcomes.RDW could be a surrogate marker for nutritional and inflammatory status in identifying patients who were at high risk of developing POCs after LPD.展开更多
BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgica...BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgical intervention but has not been determined as a postoperative complication following surgery for lumbar spine disease.CASE SUMMARY To report the case of a 54-year-old male patient who had CES following spinal surgery,with no obvious compression lesions found during re-exploration,suggesting that vascular insufficiency may have contributed to the condition.Furthermore,a series of urodynamic studies on bladder recovery patterns in such complications have also been investigated.CONCLUSION Postoperative CES requires urgent imaging and exploration to rule out compression;noncompressive cases,including vascular insufficiency may performed conservative management.展开更多
BACKGROUND Complicated crown–root fracture (CRF) involves severe injury to the crown, root,and pulp, and may be accompanied by multiple root fractures. The loss of a toothhas lifelong consequences for children and te...BACKGROUND Complicated crown–root fracture (CRF) involves severe injury to the crown, root,and pulp, and may be accompanied by multiple root fractures. The loss of a toothhas lifelong consequences for children and teenagers, but the maintenance of pulphealth and the calcific healing of multiple root fractures are rarely reported in theliterature.CASE SUMMARY This case reports healing of a permanent tooth with complicated crown–root andadditional root fractures, in which pulp health was maintained. A 10-year-old girlfell and fractured the root of her maxillary left central incisor at the cervical level.After the coronal fragment was repositioned, the tooth was splinted until thetooth was no longer mobile, 2 years later. Eight years after treatment, the toothhas remained asymptomatic with vital pulp and localized gingival overgrowth.Cone-beam computed tomography revealed not only calcified healing of the CRFbut also spontaneous healing in an additional undiagnosed root fracture. Thefracture line on the enamel could not be healed by hard tissue and formed agroove in the cervical crown. It was speculated that the groove was related to thelocalized gingival overgrowth.CONCLUSION This case provides a clinical perspective of the treatment of a tooth with acomplicated CRF and an additional root fracture.展开更多
Pancreatic cancer is usually associated with a poor prognosis.Surgery is the main curative treatment but pancreatic operations are aggressive and new tools that help clinicians to predict surgical and prognostic outco...Pancreatic cancer is usually associated with a poor prognosis.Surgery is the main curative treatment but pancreatic operations are aggressive and new tools that help clinicians to predict surgical and prognostic outcomes are necessary.Lu et al recently published a retrospective,single centre cohort study evaluating the impact of seven nutritional and inflammatory markers in pancreatic cancer surgical patients:The albumin-to-globulin ratio,prognostic nutritional index(PNI),systemic immune-inflammation index(SII),neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),nutritional risk index,and the geriatric nutritional risk index.A significant correlation was found between the PNI,SII,NLR,and PLR and a hospital discharge of less than 15 days.In a univariable analysis,PNI,SII,NLR and PLR were significantly related to recurrence-free survival and,in a multivariable analysis PNI was associated with overall survival.Various meta-analyses corroborate the results in terms of prognosis but individual studies are discordant on their usefulness.Besides,the cut-off values for these markers vary significantly between studies and there are no clinical trials comparing them to identify the most relevant ones.These are limitations when implementing nutritional and inflammatory biomarkers into clinical practice and further studies are needed in order to answer these questions.展开更多
文摘In 2012, the first paper in the series Analytical Methods in Quality Control of Scientific Publications was published in the American Journal of Analytical Chemistry, Vol. 3, No. 6, 2012, pp. 443-447. This paper was mainly based on evidence presented in the 2011 in book Historical Overview of Chromatography and Related Techniques in Analysis of Antimalarial Drug Primaquine (editor Ilia Brondz, Nova Science Publishers, Inc., ISSN 978-1-61761-944-1). The first paper in this series di- scussed issues of obvious falsification and plagiarism contained in paper published by Dongre et al., Applications of GC-EI-MS for the Identification and Investigation of Positional Isomer in Primaquine, an Antimalarial Drug. Journal of Pharmaceutical and Biomedical Analysis, Vol. 39, No. 1-2, 2005, pp. 111-116. Dongre et al. copied their publication from an original research manuscript submitted for consideration by other authors. This paper was published in the Asian Journal of Chemistry, Vol. 17, No. 3, 2005, pp. 1678-1688. Conclusive arguments against the publication of Dongre et al. were presented in the American Journal of Analytical Chemistry, Vol. 3, No. 6, 2012, pp. 443-447. Further cases of general plagiarism and incompetence relating to authors, reviewers, editors, and publishers were presented in Part II in Analytical Methods in Quality Control of Scientific Publications Part II: The Authors’, Reviewers’, Editors’ Responsibility and the Publishers’ Authority in the International Journal of Analytical Mass Spectrometry and Chromatography, Vol. 1, No. 2, 2013, pp. 81-89. The present paper will discuss the following issues: the obvious neglect of the rights of authors by some publishers and editors;how original research manuscripts are exposed to mediocre researchers, and possibly sold, by editors to these “scientists” to boost the image of these particular “scientists”;how the order of authors’ names in published articles are changed to satisfy the commercial interests of companies;and how copyright is breached in an appalling way by well-established publishers. The documents presented here concern research publications in the fields of chromatography, chromatography-mass spectrometry, and mass spectrometry.
基金Supported by Wuxi Taihu Talent Program(202101)Project of Wu Jieping Medical Foundation(320.6750.2023-03-33).
文摘[Objectives]To analyze the clinical characteristics,distribution of traditional Chinese medicine(TCM)syndrome types,spectrum of comorbidities,and complications among inpatients with gout.[Methods]Data from 592 gout patients admitted in the Department of Rheumatology at Wuxi Traditional Chinese Medicine Hospital between January 2018 and December 2024 were retrospectively collected.The data collected encompassed patient gender,age,TCM syndrome types,underlying comorbidities,infection status,and major complications,including renal insufficiency,interstitial lung disease,and osteoporosis.Descriptive statistical analyses were subsequently performed.[Results]Among the 592 inpatients,80.75%were male and 19.25%were female.A total of 94.76%patients had at least one underlying condition,with hypertension(80.74%),cerebral infarction(29.59%),heart disease(24.24%),and diabetes(21.56%)being the most prevalent.The primary TCM syndrome types identified were damp-heat obstruction syndrome(63.51%)and phlegm-stasis obstruction syndrome(21.11%).During hospitalization,20.94%of patients experienced concurrent infections,predominantly pulmonary infections(38.10%).The principal complications observed included renal insufficiency(32.09%),interstitial lung disease(18.75%),and osteoporosis(9.29%).[Conclusions]Inpatients diagnosed with gout often present with complex conditions and a high burden of comorbidities,predominantly cardiovascular and cerebrovascular diseases,as well as metabolic disorders.Additionally,there is a high incidence of infections and renal insufficiency within this population.TCM syndrome types in these patients are primarily characterized by damp-heat obstruction.In clinical practice,a comprehensive management approach that incorporates multidisciplinary collaboration is recommended.Alongside the control of uric acid levels and joint inflammation,proactive screening and management of comorbidities and related complications are essential.
文摘BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently established technique for treating AIS.It provides the benefits of being a relatively simple and safe procedure,capable of partially enhancing a patient’s condition.However,some patients may experience endothelial damage and recurrent thrombosis,with clinical outcomes that are not always satisfactory.Hence,the efficacy of this method remains unclear.AIM To survey the association of stent thrombectomy vs standard treatment with neurological function protection,complications,and short-term prognosis in patients diagnosed with AIS.METHODS This study assigned 90 patients with AIS to the observation and control groups(n=45 patients)from December 2020 to December 2022.Stent thrombectomy was conducted in the observation group,whereas routine treatment was provided to the control group.The study assessed the therapeutic outcomes of two groups,including a comparison of their neurological function,living ability,anxiety and depression status,plaque area,serum inflammatory factors,serum Smur100βprotein,neuron-specific enolase(NSE),homocysteine(Hcy),and vascular endo-thelial function.Additionally,the incidence of complications was calculated and analyzed for each group.RESULTS The total effective rate of treatment was 77.78%and 95.56%in the control and observation groups,respectively.After 8 weeks of treatment,the scores on the National Institutes of Health Stroke Scale,Hamilton Anxiety Scale,and Hamilton Depression Scale decreased remarkably;the Barthel index increased remarkably,with better improvement effects of the scores in the observation group(P<0.05);total cholesterol,triglyceride,C-reactive protein,and plaque area lessened remarkably,with fewer patients in the observation group(P<0.05);S-100βprotein,NSE,and Hcy levels lessened remarkably,with fewer patients in the observation group(P<0.05);serum vascular endothelial growth factor and nitric oxide synthase levels increased remarkably,whereas the endothelin-1 level decreased,with better improvement effect in the observation group(P<0.05).Complications occurred in 8.88%of patients in the observation group compared with 33.33%in the control group.CONCLUSION Stent thrombectomy appeared to provide more remarkable neuroprotective effects in patients with AIS compared to the intravenous thrombolysis regimen.Additionally,it has effectively improved the neurological function,daily activities,and vascular endothelial function of patients,while reducing the incidence of complications and improving short-term prognosis.
文摘BACKGROUND Single-balloon enteroscopy(SBE)is an established procedure for evaluating small bowel lesions.While its efficacy is well recognized,the incidence of major complications and their associated risk factors in a large population remain unclear.AIM To investigate the complications and risk factors associated with diagnostic SBE.METHODS This multicenter retrospective study included consecutive patients who underwent diagnostic SBE at three tertiary care hospitals between January 2016 and September 2024.Data on baseline characteristics,procedural parameters,indications,findings,and major complications were collected and analyzed.RESULTS A total of 2865 SBE procedures were performed in 1840 patients.The mean age was 51±18 years,and 64.5%were male.The most common indication was obscure gastrointestinal bleeding(57.1%),followed by abdominal pain(30.5%).The major complication rate was 0.4%(7/1840),all of which involved acute intestinal perforation identified during the procedure.Among the perforation cases,6 occurred in patients undergoing SBE for abdominal pain and 1 for obscure gastrointestinal bleeding.The perforation sites included the ileum(6/7)and duodenum(1/7).All cases were successfully managed surgically.Previous abdominal surgery and the use of abdominal compression were significantly associated with an increased risk of perforation(P value<0.001 for both).In subgroup analysis,perforation rates were 2.1%(6/288)in patients with prior abdominal surgery and 1.6%(7/428)with abdominal compression.CONCLUSION Acute intestinal perforation is a rare but serious complication.Prior abdominal surgery and abdominal compression are important risk factors,and careful patient selection is recommended to minimize complications.
文摘The traditional view of the decompensated stage as a point of no return in the natural history of liver cirrhosis(LC)is currently being questioned.This is due to the appearance of data indicating the possibility of restoring the structure and function of the liver,reducing the portal pressure with a positive effect on complications associated with portal hypertension and decreasing the risk of developing hepatocellular carcinoma after elimination of the etiological factor.To create a unified understanding the recompensation of decompensated LC,at the Baveno VII consensus workshop were developed criteria confirming it.At the moment,the efficacy of etiological therapy in achieving established criteria for recompensation has been evaluated only in patients with alcohol-related,as well as hepatitis B virus-related and hepatitis C virus-related decompensated LC.The purpose of the review is to provide up–to-date information on the role of etiological therapy in achieving recompensation of decompensated LC according to Baveno VII criteria.So far,only the first steps have been taken in studying this problem.To further understand it,research is needed to identify pathophysiological mechanisms,modifying factors,predictors,and potential noninvasive biomarkers of recompensation of decompensated LC.
文摘BACKGROUND The use of biomarkers,such as the neutrophil-to-lymphocyte ratio(NLR)and the neutrophil-to-platelet ratio(NPR),has shown promise in evaluating early outcomes after medical,interventional,and surgical treatments.NLR has emer-ged as an indicator of systemic inflammation and physiological stress.NPR has emerged as a potential indicator of inflammation and thrombotic risk in the context of surgical and radiological procedures.AIM To analyze the correlation of NLR and NPR with the development of post-liver transplantation(LT)early complications after stratification for hepatocellular carcinoma diagnosis.METHODS Consecutive patients undergone LT between January 2019 and December 2023 were enrolled.Data regarding the concentration of hemoglobin and the differ-ential leukocyte count on postoperative days(POD)0,1,3,and 5 were collected.RESULTS The dataset included 161 consecutive patients undergone LT.Clavien-Dindo IV-V complications had a good correlation with NLR POD 1(P=0.05),NLR POD 3(P<0.001),NLR POD 7(P<0.001),NPR POD 3(P<0.001).In addition,the NPR ratio on POD 3 correlated with the onset of 30-day hemorrhage(P=0.009).Finally,30-day mortality had a significant association with the NLR POD 1(P=0.03)and with NLR POD 7(P=0.004),while NPR had a significant correlation with 30-day mortality in NPR POD 7(P=0.004).CONCLUSION The analysis of NLR and NPR are strictly correlated with Clavien-Dindo IV-V complications and 30-day post-LT death.
文摘BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.
文摘BACKGROUND Corneal ulcers are a major cause of visual impairment in developing countries.In Indonesia,severe infective ulcers often require keratoplasty(KP)to preserve ocular integrity and improve outcomes.AIM To determine demographic,clinical and microbiological characteristics,complications,and KP outcomes in patients with moderate to severe infective corneal ulcers.METHODS A retrospective review was conducted on patients with moderate to severe infective corneal ulcers who underwent KP between January 1,2018 and December 31,2020,with a minimum follow-up period of 3 weeks at the Ocular Infection and Immunology clinic of a tertiary referral hospital in Jakarta.Data were extracted from medical records.RESULTS A total of 99 eyes from 99 patients with a mean age of 41.7±16.2 years were included.Eight-nine eyes of corneal cases were located at the central cornea with>6 mm lesion size(forty-one eyes).The culture positivity rate was 33%,primarily composed of Staphylococcus epidermidis.Eyeball integrity was maintained in all patients.Mean uncorrected visual acuity(VA)before KP was 2.50 and improved to 2.04 after 3 months of follow-up.Twenty patients with a cornea that was kept transparent achieved a VA of 0.40.Complications after KP appeared in 60 eyes,while secondary glaucoma was the most common complication(28 eyes),followed by graft failure(24 eyes)and graft rejection(14 eyes).CONCLUSION Corneal ulcers are a common problem in Indonesia following eye trauma.Therapeutic and tectonic KP can preserve the integrity of the eyeball in moderate to severe cases,although complications are common.
基金Supported by the Chongqing Natural Science Foundation,No.cstc2020jcyj-msxmX0288the Chongqing Medical University Program for Youth Innovation in Future Medicine,No.W0190.
文摘BACKGROUND Gastric cancer is a malignancy with high morbidity and mortality rates.Surgical intervention,particularly gastrectomy,is essential for curative treatment but carries a substantial risk of complications.Identifying key risk factors and understanding complication profiles are crucial for improving outcomes and guiding perioperative management.AIM To analyze the incidence of postoperative complications in patients with gastric cancer and identify potential risk factors.METHODS We conducted a retrospective analysis of 500 patients who underwent gastrectomy between January 2018 and December 2022.Postoperative complications were classified using the Clavien-Dindo system.RESULTS The overall complication rate was 28.4%(142/500),with 15.2%(76/500)experiencing major complications(Clavien-Dindo grade≥III).Pulmonary complications were the most frequent(10.8%),followed by surgical site infections(8.6%),and anastomotic leakage(4.2%).Age 70 years or more,body mass index of 25 kg/m²or more,advanced tumor stage,total gastrectomy,and operative time 240 min or more emerged as independent risk factors.CONCLUSION Focused preoperative risk assessment,targeted interventions,and reduced operative time for older or obese patients requiring total gastrectomy or presenting with advanced disease are important to improve surgical outcomes.
文摘AIM:To evaluate the visual outcomes of implantable collamer lenses(ICLs)and identify the possible risk factors for ICL axis misalignment,and consequently,repositioning,explanting,or exchanging at a specialized eye hospital in Saudi Arabia.METHODS:The medical records of 813 eyes with different refractive errors corrected with ICL implantation were identified and included in this single-arm retrospective cohort study.The following data were collected:demographic characteristics,primary diagnosis,preoperative refraction,anterior chamber depth(ACD),white-to-white(WTW)measurement,endothelial cell density(ECD),and axial length.Patients’satisfaction and complaints,and their postoperative refraction,vault depth,and axis alignment with the preoperative target,were reviewed during the postoperative period.Collectively,these data were correlated with symptomatic axis rotation and the need for repositioning,explantation,or exchange due to high or low ICL vaults.RESULTS:Of 813 eyes,27(3.32%),13(1.59%),and 11(1.35%)required ICL repositioning,ICL explantation only without exchange,and ICL explantation with the placement of a new ICL,respectively.The mean follow-up period was 37.5mo.The main cause of explanation or exchange was incorrect WTW measurement in seven(29.17%)eyes,followed by high vault in four(16.56%)eyes.ICL repositioning was required in 27(3.32%)eyes with considerable rotation.Only 2(0.24%)eyes developed cataracts that required ICL removal,and retinal complications were reported in 7(0.86%)eyes.Long-term glaucoma and corneal decompensation were not observed in this cohort.CONCLUSION:With a high safety profile and reversibility,ICL implantation is a good alternative to corneal-based refractive surgery in eyes unsuitable for laser vision correction.The rate of secondary procedures in our study was 6.26%.Old age is a risk factor for secondary surgical interventions in the repositioning group,whereas abnormal vault and toric ICL rotation in the explantation group necessitated subsequent surgical procedures.Overall,ICL implantation demonstrates a good efficacy index and safety profile in patients with diverse refractive errors.
文摘BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp exhibit characteristic signs and symptoms;hence,negative AAp and complicated AAp are the primary concerns in research on AAp.In other terms,further investigations and algorithms are required for at least one third of patients to predict the clinical condition and distinguish them from uncomplicated patients with AAp.AIM To use a Stochastic Gradient Boosting(SGB)-based machine learning(ML)algorithm to tell the difference between AAp patients who are complicated and those who are not,and to find some important biomarkers for both types of AAp by using modeling to get variable importance values.METHODS This study analyzed an open access data set containing 140 people,including 41 healthy controls,65 individuals with uncomplicated AAp,and 34 individuals with complicated AAp.We analyzed some demographic data(age,sex)of the patients and the following biochemical blood parameters:White blood cell(WBC)count,neutrophils,lymphocytes,monocytes,platelet count,neutrophil-tolymphocyte ratio,lymphocyte-to-monocyte ratio,mean platelet volume,neutrophil-to-immature granulocyte ratio,ferritin,total bilirubin,immature granulocyte count,immature granulocyte percent,and neutrophil-to-immature granulocyte ratio.We tested the SGB model using n-fold cross-validation.It was implemented with an 80-20 training-test split.We used variable importance values to identify the variables that were most effective on the target.RESULTS The SGB model demonstrated excellent performance in distinguishing AAp from control patients with an accuracy of 96.3%,a micro aera under the curve(AUC)of 94.7%,a sensitivity of 94.7%,and a specificity of 100%.In distinguishing complicated AAp patients from uncomplicated ones,the model achieved an accuracy of 78.9%,a micro AUC of 79%,a sensitivity of 83.3%,and a specificity of 76.9%.The most useful biomarkers for confirming the AA diagnosis were WBC(100%),neutrophils(95.14%),and the lymphocyte-monocyte ratio(76.05%).On the other hand,the most useful biomarkers for accurate diagnosis of complicated AAp were total bilirubin(100%),WBC(96.90%),and the neutrophil-immature granulocytes ratio(64.05%).CONCLUSION The SGB model achieved high accuracy rates in identifying AAp patients while it showed moderate performance in distinguishing complicated AAp patients from uncomplicated AAp patients.Although the model's accuracy in the classification of complicated AAp is moderate,the high variable importance obtained is clinically significant.We need further prospective validation studies,but the integration of such ML algorithms into clinical practice may improve diagnostic processes.
基金Supported by the Shenyang Science and Technology of Liaoning Province,No.22-321-32-15.
文摘BACKGROUND The incidence and mortality of colorectal cancer continue to rise.For early-stage colorectal cancer,endoscopic resection has become a preferred or important treatment option due to its significant advantages in operative time,extent of trauma,and medical costs.However,increasing lesion diameter significantly elevates the technical difficulty of endoscopic resection.Currently,robust evidence-based evidence regarding the upper size limit for safely and effectively resecting lesions endoscopically remains lacking.AIM To evaluate the efficacy and safety of endoscopic resection for colorectal lesions≥30 mm in diameter.METHODS This retrospective study reviewed data from 102 patients who underwent endoscopic resection for colorectal lesions measuring≥30 mm in diameter at General Hospital of Northern Theater Command between January 2023 and July 2024.RESULTS Among 102 patients who underwent endoscopic resection,99 received endoscopic submucosal dissection and 3 underwent endoscopic full-thickness resection.Four patients(3.9%)required conversion to surgical radical resection postoperatively.All patients exhibited favorable wound healing at the resection sites,and no long-term complications were observed during the 3-month postoperative colonoscopy follow-up.The primary perioperative complication was post-endoscopic submucosal dissection electrocoagulation syndrome(PEECS)(24/102,23.5%).Multivariate analysis identified lesion location in the transverse colon as an independent risk factor for PEECS occurrence(odds ratio=6.734,95%confidence interval:1.623-27.945,P=0.009).CONCLUSION Large colorectal lesion diameter does not constitute an absolute contraindication to endoscopic resection.Experienced endoscopic centers can achieve complete resection with a favorable efficacy and safety profile.Notably,lesion location in the transverse colon is identified as an independent risk factor for PEECS.
文摘BACKGROUND The burden of cannabis use disorder(CUD)in the context of its prevalence and subsequent cardiopulmonary outcomes among cancer patients with severe sepsis is unclear.AIM To address this knowledge gap,especially due to rising patterns of cannabis use and its emerging pharmacological role in cancer.METHODS By applying relevant International Classification of Diseases,Ninth and Tenth Revision,Clinical Modification codes to the National Inpatient Sample database between 2016-2020,we identified CUD(+)and CUD(-)arms among adult cancer admissions with severe sepsis.Comparing the two cohorts,we examined baseline demographic characteristics,epidemiological trends,major adverse cardiac and cerebrovascular events,respiratory failure,hospital cost,and length of stay.We used the Pearsonχ^(2) d test for categorical variables and the Mann-Whitney U test for continuous,non-normally distributed variables.Multivariable regression analysis was used to control for potential confounders.A P value≤0.05 was considered for statistical significance.RESULTS We identified a total of 743520 cancer patients admitted with severe sepsis,of which 4945 had CUD.Demographically,the CUD(+)cohort was more likely to be younger(median age=58 vs 69,P<0.001),male(67.9%vs 57.2%,P<0.001),black(23.7%vs 14.4%,P<0.001),Medicaid enrollees(35.2%vs 10.7%,P<0.001),in whom higher rates of substance use and depression were observed.CUD(+)patients also exhibited a higher prevalence of chronic pulmonary disease but lower rates of cardiovascular comorbidities.There was no significant difference in major adverse cardiac and cerebrovascular events between CUD(+)and CUD(-)cohorts on multivariable regression analysis.However,the CUD(+)cohort had lower all-cause mortality(adjusted odds ratio=0.83,95%confidence interval:0.7-0.97,P<0.001)and respiratory failure(adjusted odds ratio=0.8,95%confidence interval:0.69-0.92,P=0.002).Both groups had similar median length of stay,though CUD(+)patients were more likely to have higher hospital cost compared to CUD(-)patients(median=94574 dollars vs 86615 dollars,P<0.001).CONCLUSION CUD(+)cancer patients with severe sepsis,who tended to be younger,black,males with higher rates of substance use and depression had paradoxically significantly lower odds of all-cause in-hospital mortality and respiratory failure.Future research should aim to better elucidate the underlying mechanisms for these observations.
基金Supported by the National Key R D Program of China,No.2022YFC2010102Natural Science Foundation of Hunan Province,No.2021JC0003+1 种基金National Natural Science Foundation of China,No.82070812the Sinocare Diabetes Foundation,No.LYF2022039.
文摘ACKGROUND The hemoglobin glycation index(HGI)represents the discrepancy between the glucose management indicator(GMI)based on mean blood glucose levels and laboratory values of glycated hemoglobin(HbA1c).The HGI is a promising indicator for identifying individuals with excessive glycosylation,facilitating personalized evaluation and prediction of diabetic complications.However,the factors influencing the HGI in patients with type 1 diabetes(T1D)remain unclear.Autoimmune destruction of pancreaticβcells is central in T1D pathogenesis,yet insulin resistance can also be a feature of patients with T1D and their coexistence is called“double diabetes”(DD).However,knowledge regarding the relationship between DD features and the HGI in T1D is limited.AIM To assess the association between the HGI and DD features in adults with T1D.METHODS A total of 83 patients with T1D were recruited for this cross-sectional study.Laboratory HbA1c and GMI from continuous glucose monitoring data were collected to calculate the HGI.DD features included a family history of type 2 diabetes,overweight/obesity/central adiposity,hypertension,atherogenic dyslipidemia,an abnormal percentage of body fat(PBF)and/or visceral fat area(VFA)and decreased estimated insulin sensitivity.Skin autofluorescence of advanced glycation end products(SAF-AGEs),diabetic complications,and DD features were assessed,and their association with the HGI was analyzed.RESULTS A discrepancy was observed between HbA1c and GMI among patients with T1D and DD.A higher HGI was associated with an increased number of SAF-AGEs and a higher prevalence of diabetic microangiopathy(P=0.030),particularly retinopathy(P=0.031).Patients with three or more DD features exhibited an eight-fold increased risk of having a high HGI,compared with those without DD features(adjusted odds ratio=8.12;95%confidence interval:1.52-43.47).Specifically,an elevated PBF and/or VFA and decreased estimated insulin sensitivity were associated with high HGI.Regression analysis identified estimated insulin sensitivity and VFA as factors independently associated with HGI.CONCLUSION In patients with T1D,DD features are associated with a higher HGI,which represents a trend toward excessive glycosylation and is associated with a higher prevalence of chronic diabetic complications.
文摘BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.
基金Supported by the National Natural Science Foundation of China,No.81302124.
文摘BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopic pancreatoduodenectomy(LPD).METHODS A total of 804 consecutive patients who underwent LPD at our hospital between March 2017 and November 2021 were retrospectively analyzed.Correlations between pretreatment RDW and clinicopathological characteristics and short-term outcomes were investigated.RESULTS Patients with higher pretreatment RDW were older,had higher Eastern Cooperative Oncology Group scores and were associated with poorer short-term outcomes than those with normal RDW.High pretreatment RDW was an independent risk factor for postoperative complications(POCs)(hazard ratio=2.973,95%confidence interval:2.032-4.350,P<0.001)and severe POCs of grade IIIa or higher(hazard ratio=3.138,95%confidence interval:2.042-4.824,P<0.001)based on the Clavien-Dino classification system.Subgroup analysis showed that high pretreatment RDW was an independent risk factor for Clavien-Dino classi-fication grade IIIb or higher POCs,a comprehensive complication index score≥26.2,severe postoperative pancreatic fistula,severe bile leakage and severe hemorrhage.High pretreatment RDW was positively associated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and was negatively associated with albumin and the prognostic nutritional index.CONCLUSION Pretreatment RDW was a special parameter for patients who underwent LPD.It was associated with malnutrition,severe inflammatory status and poorer short-term outcomes.RDW could be a surrogate marker for nutritional and inflammatory status in identifying patients who were at high risk of developing POCs after LPD.
文摘BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgical intervention but has not been determined as a postoperative complication following surgery for lumbar spine disease.CASE SUMMARY To report the case of a 54-year-old male patient who had CES following spinal surgery,with no obvious compression lesions found during re-exploration,suggesting that vascular insufficiency may have contributed to the condition.Furthermore,a series of urodynamic studies on bladder recovery patterns in such complications have also been investigated.CONCLUSION Postoperative CES requires urgent imaging and exploration to rule out compression;noncompressive cases,including vascular insufficiency may performed conservative management.
基金Supported by 2021 Disciplinary Construction Project in School of Dentistry,Anhui Medical University,No.2021kqxkFY05.
文摘BACKGROUND Complicated crown–root fracture (CRF) involves severe injury to the crown, root,and pulp, and may be accompanied by multiple root fractures. The loss of a toothhas lifelong consequences for children and teenagers, but the maintenance of pulphealth and the calcific healing of multiple root fractures are rarely reported in theliterature.CASE SUMMARY This case reports healing of a permanent tooth with complicated crown–root andadditional root fractures, in which pulp health was maintained. A 10-year-old girlfell and fractured the root of her maxillary left central incisor at the cervical level.After the coronal fragment was repositioned, the tooth was splinted until thetooth was no longer mobile, 2 years later. Eight years after treatment, the toothhas remained asymptomatic with vital pulp and localized gingival overgrowth.Cone-beam computed tomography revealed not only calcified healing of the CRFbut also spontaneous healing in an additional undiagnosed root fracture. Thefracture line on the enamel could not be healed by hard tissue and formed agroove in the cervical crown. It was speculated that the groove was related to thelocalized gingival overgrowth.CONCLUSION This case provides a clinical perspective of the treatment of a tooth with acomplicated CRF and an additional root fracture.
文摘Pancreatic cancer is usually associated with a poor prognosis.Surgery is the main curative treatment but pancreatic operations are aggressive and new tools that help clinicians to predict surgical and prognostic outcomes are necessary.Lu et al recently published a retrospective,single centre cohort study evaluating the impact of seven nutritional and inflammatory markers in pancreatic cancer surgical patients:The albumin-to-globulin ratio,prognostic nutritional index(PNI),systemic immune-inflammation index(SII),neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),nutritional risk index,and the geriatric nutritional risk index.A significant correlation was found between the PNI,SII,NLR,and PLR and a hospital discharge of less than 15 days.In a univariable analysis,PNI,SII,NLR and PLR were significantly related to recurrence-free survival and,in a multivariable analysis PNI was associated with overall survival.Various meta-analyses corroborate the results in terms of prognosis but individual studies are discordant on their usefulness.Besides,the cut-off values for these markers vary significantly between studies and there are no clinical trials comparing them to identify the most relevant ones.These are limitations when implementing nutritional and inflammatory biomarkers into clinical practice and further studies are needed in order to answer these questions.
