Genetic variations are risk factors for neonatal hyperbilirubinemia(NHB),a common cause of infant hospitalization in the first postnatal week,but their contribution and long-term impacts remain unclear.This population...Genetic variations are risk factors for neonatal hyperbilirubinemia(NHB),a common cause of infant hospitalization in the first postnatal week,but their contribution and long-term impacts remain unclear.This population-based multicenter study enrolls 1780 hospitalized NHB newborns and 38,158 genetically screened newborns across 20 hospitals(2019-2022).Excluding cases with clear clinical causes,977 NHB cases are categorized into genetic variation-positive and-negative groups.Results show significantly higher NHB-related gene variants(81.63%vs.65.62%)and positive variation rates(36.29%vs.9.4%)in NHB cases than in the general newborn population(all P<0.001).Among the 977 NHB cases,325(33.3%)have positive variants,with higher rates of severe hyperbilirubinemia(16.9%vs.9.7%,P=0.001),prolonged jaundice(36.3%vs.27.6%,P=0.005),and cholestasis/hypercholanaemia(23.7%vs.14.7%,P<0.001)in the positive group.Cumulative genetic variants in bilirubin metabolism pathways exhibit dosedependent associations with increased risks of complications.Long-term follow-up reveals that UGT1A1 variants prolong jaundice up to one month,while severe SLC10A1 variants cause persistent cholestasis/hypercholanaemia beyond nine months.This large-scale evidence highlights genetic factors as key NHB determinants,with implications for neonatal care protocols to integrate genetic testing and establish longterm surveillance for variant carriers.展开更多
The development of photocatalysts that combine high efficiency,durability,and visible-light responsiveness remains a central challenge for solar-to-hydrogen conversion.In a recent study,Cabrero-Antonino et al.report a...The development of photocatalysts that combine high efficiency,durability,and visible-light responsiveness remains a central challenge for solar-to-hydrogen conversion.In a recent study,Cabrero-Antonino et al.report a 2D/2D Schottky heterojunction constructed from ultrasmall Cu_(2)[CuTCPP]MOF nanosheets and conductive Ti_(3)C_(2)MXene.This hybrid interface generates a built-in interfacial electric field that promotes directional charge transfer,suppresses recombination,and significantly prolongs carrier lifetimes,as evidenced by femtosecond transient absorption spectroscopy.The MXene component not only functions as a hole acceptor to improve charge separation but also mitigates photooxidative degradation of the MOF,thereby enhancing long-term stability.The optimized heterojunction achieves a hydrogen evolution rate exceeding 5000μmol g^(-1)under visible light,nearly 20 times higher than that of pristine MOF,with notable operational durability.These findings demonstrate the critical role of interfacial engineering in achieving synergistic charge dynamics across hybrid architectures.The work provides a scalable,sustainable strategy for noble-metalfree photocatalysis,offering valuable insights for the rational design of next-generation systems for water splitting,CO_(2)reduction,and solar-driven chemical transformations.展开更多
BACKGROUND Fracture nonunion represents a challenging complication during fracture repair,often necessitating surgical intervention.Teriparatide,a recombinant human parathyroid hormone,has demonstrated promise in enha...BACKGROUND Fracture nonunion represents a challenging complication during fracture repair,often necessitating surgical intervention.Teriparatide,a recombinant human parathyroid hormone,has demonstrated promise in enhancing fracture healing,although its efficacy in treating established nonunion remains under investigation.CASE SUMMARY We report a case of a 27-year-old male who presented with a right humerus fracture following a traffic accident.Despite undergoing open reduction and internal fixation,the fracture resulted in a delayed union and subsequent nonunion.After 4 years of conservative management,teriparatide treatment was initiated due to persistent nonunion.Teriparatide injections were administered daily for 6 months,resulting in complete fracture healing and resolution of pain.CONCLUSION Our case demonstrates the successful use of teriparatide in treating a prolonged nonunion of a humerus fracture.Teriparatide may provide a valuable therapeutic option for established bone nonunion,even in cases that have not responded to conservative treatments.展开更多
Hepatitis A virus(HAV)infection remains a significant public health concern in many developing countries.The annual incidence of HAV infection is 1.5 million,though this figure may be underestimated owing to the infec...Hepatitis A virus(HAV)infection remains a significant public health concern in many developing countries.The annual incidence of HAV infection is 1.5 million,though this figure may be underestimated owing to the infection’s asymptomatic nature and the presence of milder disease variants.The clinical spectrum of HAV infection now ranges from asymptomatic infection to fulminant hepatitis.Despite the availability of safe and highly effective vaccines,HAV infections remain a major contributor to acute viral hepatitis worldwide.展开更多
There are many short-lived animals,but those displaying a lifecycle with more than one generation per year(multivoltine lifecycle)are rare amongterrestrial vertebrates.The multivoltine lifecycle requires rapid growth ...There are many short-lived animals,but those displaying a lifecycle with more than one generation per year(multivoltine lifecycle)are rare amongterrestrial vertebrates.The multivoltine lifecycle requires rapid growth and maturation and a long active season.Thus,small lizards in humidtropical or subtropical areas are candidates for multivoltine lifecycles.To test this prediction,we conducted a capture-mark-recapture study of asubtropical grass lizard,Takydromus toyamai,endemic to Miyako Islands,Japan.Juveniles grew very quickly,averaging 0.3 mm/day in the warmseason,and attained sexual maturity at 2.5 months post-hatching.The breeding season was very long,and hatchlings emerged from May toNovember.The prolonged breeding season and rapid growth to maturity allowed some individuals to produce a second generation in their frstyear.Estimates of hatching date from growth rates indicated that many females that hatched in May-June became gravid 76-120 days afterhatching and 122-165 days after oviposition of the eggs from which they hatched.Analyses of juvenile survivorship and month of hatching suggest that nearly half of breeding adults were members of multivoltine generations,although the 2 generations were not discrete.The species isshort-lived,with only 16% of individuals surviving beyond 12 months,and few individuals reproduced in a second year.We refer to this conditionas a“semi-multivoltine lifecycle.”Individuals that hatch late in the season defer reproduction until the following year and become founders ofthe next season’s cohort.This putative advantage of late-hatching individuals may have driven the evolution of this lifecycle.展开更多
The widespread popularization and application of laser technology have provided a powerful tool for a deeper understanding of the material world and given birth to several emerging research fields.This study mainly fo...The widespread popularization and application of laser technology have provided a powerful tool for a deeper understanding of the material world and given birth to several emerging research fields.This study mainly focuses on the following three key aspects.First,the classical ensemble method is adopted to conduct a comprehensive and in-depth analysis of two-dimensional(2D)matter–wave pulses in Bose–Fermi mixed gases(including linear and nonlinear pulses).Second,under the strict constraints of unitary systems,a coupled Kd V equation is successfully derived,and the prolongation structure theory is skillfully used to carry out detailed calculations and analyses on this equation.Thus,the prolongation algebra of this equation is accurately determined,and the corresponding Lax pair is rigorously derived.Finally,based on the carefully obtained Lax pair from the prolongation structure theory,the soliton solutions of this equation are further analyzed in depth,and intuitive images of each soliton solution are carefully drawn.This lays a solid foundation for subsequent detailed research on these soliton characteristics and provides great convenience.展开更多
BACKGROUND:This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit(ICU)stays.METHODS:Pediatric patients who underwent cardiac surgery were included,with data co...BACKGROUND:This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit(ICU)stays.METHODS:Pediatric patients who underwent cardiac surgery were included,with data collected from the pediatric intensive care database.The datasets were randomly divided into a training set(75%)and a testing set(25%).A nomogram model was developed to predict prolonged ICU stays in the training set and then validated in the testing set.RESULTS:A total of 795 patients and 266 patients were assigned to the training and testing sets,respectively,with consistent variables.The nomogram developed from the training set included eight characteristics:age,systolic blood pressure,respiratory rate,bicarbonate,direct bilirubin,high-sensitivity C-reactive protein,international normalized ratio,and operation time.The area under the curve values of the nomogram in the training and testing sets were 0.812 and 0.736,respectively.The nomogram demonstrated excellent discrimination and calibration.Decision curve analysis showed that the use of the nomogram resulted in more favorable outcomes compared with the strategies of treating all or none of the patients.CONCLUSION:This study presents a nomogram that may enable early identification of high-risk patients and facilitates tailored postoperative care and better outcomes after pediatric cardiac surgery.展开更多
Atrial fibrillation(AF)is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment opt...Atrial fibrillation(AF)is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment options include pharmacological and electrical cardioversion,each carrying specific risks.AF may resolve spontaneously,but often recurs,making a“watch-andwait”strategy a reasonable approach to avoid unnecessary antiarrhythmic therapy.展开更多
BACKGROUND Venlafaxine,a serotonin-norepinephrine reuptake inhibitor,is widely prescribed for the treatment of major depressive disorder.At therapeutic dose,it is generally safe,with a low incidence of adverse effects...BACKGROUND Venlafaxine,a serotonin-norepinephrine reuptake inhibitor,is widely prescribed for the treatment of major depressive disorder.At therapeutic dose,it is generally safe,with a low incidence of adverse effects.However,massive venlafaxine inge-stion can cause serious cardiotoxicity,leading to life-threatening arrhythmias.CASE SUMMARY A 31-year-old woman with a history of depression ingested 14.8 g of venlafaxine along with 6 mg of estazolam and 6 mg of flunitrazepam.On admission,2 hours post-ingestion,she presented only with mild QTc prolongation.At 4 hours post-ingestion,she developed a generalized tonic-clonic seizure.Following endo-tracheal intubation,intravenous midazolam infusion was initiated and 50 g of activated charcoal was administered via a nasogastric tube.At 15 hours post-ingestion,she developed ventricular tachycardia that rapidly progressed to refr-actory ventricular fibrillation,which was successfully treated with veno-arterial extracorporeal membrane oxygenation.Toxicological analysis revealed serum ve-nlafaxine and O-desmethylvenlafaxine concentrations 17µg/mL and 10µg/mL,respectively,at 15 hours post-ingestion.CONCLUSION In cases of massive venlafaxine ingestion,continuous intensive monitoring,particularly of QTc,is essential for at least 24 hours,even when initial clinical signs are mild.If refractory ventricular arrhythmias occur,prompt ini-tiation of veno-arterial extracorporeal membrane oxygenation should be considered.展开更多
Poyang Lake,China's largest freshwater lake,is a critical wintering ground for most of the global Siberian Grane(Grus leucogeranus)population.However,increasingly prolonged dry seasons have degraded the natural we...Poyang Lake,China's largest freshwater lake,is a critical wintering ground for most of the global Siberian Grane(Grus leucogeranus)population.However,increasingly prolonged dry seasons have degraded the natural wetlands of Poyang Lake,forcing Siberian Cranes to shift to artificial habitats.From 2015 to 2023,field surveys revealed a substantial increase in the number of Siberian Cranes in artificial habitats,with peak counts reaching 3000individuals,accounting for up to 53%of the species'global population.Satellite telemetry of 13 individuals further confirmed the spatial use of these habitats,highlighting their consistent reliance on artificial sites over multiple years.Seven high-use hotspots were identified outside of Poyang Lake,including two artificial provisioning sites that supported dense foraging flocks for extended periods.Satellite telemetry confirmed this trend,with artificial habitats making up to 64.2%of the occurrence sites in some years.This reliance on artificial habitats was closely linked to the reduced tuber biomass in natural wetlands and low winter water levels in Poyang Lake,which collectively explained 83%of the variance in crane abundance in artificial habitats.Artificial habitat use peaked in December and January,indicating marked seasonal variation.Siberian Cranes also exhibited a pronounced circadian rhythm,foraging in artificial habitats during the day and returning to natural wetlands to roost at night.Despite the shift toward artificial habitats,natural wetlands remain critical for nighttime refuge.The continued dependence on artificial habitats raises concerns about disease transmission owing to dense congregations.Conservation strategies should prioritize both the careful management of artificial provisioning sites and the restoration of natural wetlands to improve food and habitat availability within natural ecosystems,ultimately enabling the return of Siberian Cranes to their traditional natural habitats.展开更多
Glioblastoma(GBM)is a highly infiltrative brain tumor.The treatment of GBM is challenging due to the existence of blood brain barrier,its highly invasive nature,and its heterogeneity.Given the limitations of conventio...Glioblastoma(GBM)is a highly infiltrative brain tumor.The treatment of GBM is challenging due to the existence of blood brain barrier,its highly invasive nature,and its heterogeneity.Given the limitations of conventional therapies,this Perspective explores the development trajectory of implantable devices,highlighting the advantages of current models.With the progression in research,these implantable devices certainly hold promising potential for GBM therapy.展开更多
Prolonged grief disorder(PGD)is characterized by intense and persistent grief that significantly impairs daily functioning.For bereaved parents,the loss of a child represents an unparalleled emotional challenge,placin...Prolonged grief disorder(PGD)is characterized by intense and persistent grief that significantly impairs daily functioning.For bereaved parents,the loss of a child represents an unparalleled emotional challenge,placing them at heightened risk of developing PGD.This review traces the evolution of PGD from early con-ceptualization to current definitions in the International Classification of Diseases,11th revision,and Diagnostic and Statistical Manual of Mental Disorders,5th Edition,Text Revision.Building on this historical foundation,the analysis examined the prevalence,risk factors,and diagnostic criteria of PGD in bereaved parents,with particular attention to sex differences,the nature of the loss,and the time elapsed since the child’s death.Furthermore,this review examines the multidimensional consequences of PGD on parents,including its emotional,physiological,and functional effects.Evidence-based treatments for PGD,such as psychotherapeutic approaches and emerging interventions,are also discussed.By synthesizing existing research,this review provides a comprehensive under-standing of PGD among bereaved parents,highlights the unique challenges they face,and offers practical insights and recommendations for clinicians working with this population.展开更多
To evaluate the efficacy and safety of gemcitabine （GEM） at 30 min standard-dose infusion （30 min-SDI） compared with prolonged low-dose infusion （P-LDI） in patients with advanced non-small-cell lung cancer （NS...To evaluate the efficacy and safety of gemcitabine （GEM） at 30 min standard-dose infusion （30 min-SDI） compared with prolonged low-dose infusion （P-LDI） in patients with advanced non-small-cell lung cancer （NSCLC）. Electronic databases including Pubmed, EMbase, Cochrane Library, CNKI, CBM, and VIP were searched using keywords ＂GEM＂, ＂P-LDI＂, and ＂NSCLC＂. Review Manager 5.3 was used to perform the recta-analysis. Primary endpoints were overall response rate （ORR） and 1-year survival rate （1-year SR）. Secondary endpoints were grade 3/4 hematotoxicity and nausea/vomiting. Six randomized controlled trials （RCTs） with a total of 637 patients were included. The results showed that P-LDI was superior in ORR （OR = 1.50, 95% CI： 1.08-2.10, P = 0.02）, but had an equal 1-year SR （OR = 1.27, 95 % CI： 0.90-1.79, P = 0.18） as compared with 30 min-SDl. For grade 3/4 adverse events, there was no significant difference in anemia （OR = 1.84, 95% CI： 0.61-5.57, P = 0.28） and nausea/vomiting （OR = 1.15, 95% CI： 0.63-2.12, P = 0.64） between the two treatments. However, patients with P-LDI experienced less leukopenia （OR = 0.64, 95% CI： 0.43-0.97, P = 0.04） and thrombocytopenia （OR = 0.37, 95% CI： 0.17-0.80, P = 0.01）. P-LDI was superior in terms of ORR, experienced less grade 3/4 thrombocytopenia and leukopenia compared with 30 min-SDI, and could be a viable treatment option for advanced NSCLC.展开更多
This study examined regional prolonged low temperature （PLT） events in China from the observational station data for the period 1960–2008 using the new criteria. The new definition of a site PLT event is that the d...This study examined regional prolonged low temperature （PLT） events in China from the observational station data for the period 1960–2008 using the new criteria. The new definition of a site PLT event is that the daily minimum temperature does not exceed the 10th percentile threshold of the local daily minimum temperature climatology for at least 5 days at a station. The regional PLT event is defined as at least five adjacent stations exhibiting site PLT simultaneously for 5 d. Under the new definition, 552 regional PLT events were identified, and three indices： duration, extent, and intensity, as well as a comprehensive index （CI） were used to quantify the event severity. In addition, geographical patterns and temporal variations of regional PLT events were investigated using three event categories： strong, moderate, and weak. Spatially, strong events were mainly located in the north of Xinjiang and along the Yangtze River to the south of the Yangtze River; moderate events occurred in Xinjiang and south of the Yangtze River; and weak events occurred south of the Yellow River. The variation for the annual frequency of regional PLT events in China in the last 49 years showed a significant decreasing trend with a rate of-1.99 times per decade, and the significant transition decade was the 1980s.展开更多
BACKGROUND Prolonged postoperative ileus(PPOI)is one of the common complications in gastric cancer patients who underwent gastrectomy.Evidence on the predictors of PPOI after gastrectomy is limited and few prediction ...BACKGROUND Prolonged postoperative ileus(PPOI)is one of the common complications in gastric cancer patients who underwent gastrectomy.Evidence on the predictors of PPOI after gastrectomy is limited and few prediction models of nomogram are used to estimate the risk of PPOI.We hypothesized that a predictive nomogram can be used for clinical risk estimation of PPOI in gastric cancer patients.AIM To investigate the risk factors for PPOI and establish a nomogram for clinical risk estimation.METHODS Between June 2016 and March 2017,the data of 162 patients with gastrectomy were obtained from a prospective and observational registry database.Clinical data of patients who fulfilled the criteria were obtained.Univariate and multivariable logistic regression models were performed to detect the relationship between variables and PPOI.A nomogram for PPOI was developed and verified by bootstrap resampling.The calibration curve was employed to detect the concentricity between the model probability curve and ideal curve.The clinical usefulness of our model was evaluated using the net benefit curve.RESULTS This study analyzed 14 potential variables of PPOI in 162 gastric cancer patients who underwent gastrectomy.The incidence of PPOI was 19.75%in patients with gastrectomy.Age older than 60 years,open surgery,advanced stage(III–IV),and postoperative use of opioid analgesic were independent risk factors for PPOI.We developed a simple and easy-to-use prediction nomogram of PPOI after gastrectomy.This nomogram had an excellent diagnostic performance[area under the curve(AUC)=0.836,sensitivity=84.4%,and specificity=75.4%].This nomogram was further validated by bootstrapping for 500 repetitions.The AUC of the bootstrap model was 0.832(95%CI:0.741–0.924).This model showed a good fitting and calibration and positive net benefits in decision curve analysis.CONCLUSION We have developed a prediction nomogram of PPOI for gastric cancer.This novel nomogram might serve as an essential early warning sign of PPOI in gastric cancer patients.展开更多
Objective:To discuss the effect of prolonged second stage of labor on maternal and neonatal outcomes.Methods:A total of 101 primiparas with the length of second stage of labor longer than 2 h were selected and pregnan...Objective:To discuss the effect of prolonged second stage of labor on maternal and neonatal outcomes.Methods:A total of 101 primiparas with the length of second stage of labor longer than 2 h were selected and pregnant women with the length less than 2 h served as control.The maternal and neonatal outcomes of two groups were observed and compared.Results:A total of 62.1%(18/11) with the length of second stage of labor between 120 min and 180 min,46.7%(28/32) between 181 min and 240 min and 12 longer than 241 min underwent vaginal delivery.The longer the length of second stage of labor,the lower score of Apgar scale for infants in 1 min,and the higher the incidence of asphyxia.But there was no difference in scale in 5 min.As second stage of labor prolonged,the incidences of cesarean section and of postpartum hemorrhage increased. Conclusions:Almost half of puerperas with the length of second stage of labor longer than 2 h underwent vaginal delivery.The prolonged second stage of labor can decrease the score of Apgar scale in 1 min,increase the incidence of asphyxia,but has no effect on scale in 5 min.It still need more evidence from evidence medicine to definition of time and treatment of second stage of labor.展开更多
BACKGROUND Prolonged postoperative ileus(PPOI) is a prolonged state of "pathological"gastrointestinal(GI) tract dysmotility. There are relatively few studies examining the influence of preoperative nutrition...BACKGROUND Prolonged postoperative ileus(PPOI) is a prolonged state of "pathological"gastrointestinal(GI) tract dysmotility. There are relatively few studies examining the influence of preoperative nutritional status on the development of PPOI in patients who underwent GI surgery. The association between preoperative albumin and PPOI has not been fully studied. We hypothesized that preoperative albumin may be an independent indicator of PPOI.AIM To analyze the role of preoperative albumin in predicting PPOI and to establish a nomogram for clinical risk evaluation.METHODS Patients were drawn from a prospective hospital registry database of GI surgery.A total of 311 patients diagnosed with gastric or colorectal cancer between June 2016 and March 2017 were included. Potential predictors of PPOI were analyzed by univariate and multivariable logistic regression analyses, and a nomogram for quantifying the presence of PPOI was developed and internally validated.RESULTS The overall PPOI rate was 21.54%. Advanced tumor stage and postoperative opioid analgesic administration were associated with PPOI. Preoperative albumin was an independent predictor of PPOI, and an optimal cutoff value of 39.15 was statistically calculated. After adjusting multiple variables, per unit or per SD increase in albumin resulted in a significant decrease in the incidence of PPOI of 8%(OR = 0.92, 95%CI: 0.85-1.00, P = 0.046) or 27%(OR = 0.73, 95%CI:0.54-0.99, P = 0.046), respectively. Patients with a high level of preoperative albumin(≥ 39.15) tended to experience PPOI compared to those with low levels(< 39.15)(OR = 0.43, 95%CI: 0.24-0.78, P = 0.006). A nomogram for predicting PPOI was developed [area under the curve(AUC) = 0.741] and internally validated by bootstrap resampling(AUC = 0.725, 95%CI: 0.663-0.799).CONCLUSION Preoperative albumin is an independent predictive factor of PPOI in patients who underwent GI surgery. The nomogram provided a model to screen for early indications in the clinical setting.展开更多
We examined the possible multiple defects induced by acute and prolonged exposure to high levels of manganese（Mn） solution by monitoring the endpoints of lifespan,development,reproduction,and stress response.Our dat...We examined the possible multiple defects induced by acute and prolonged exposure to high levels of manganese（Mn） solution by monitoring the endpoints of lifespan,development,reproduction,and stress response.Our data suggest that acute exposure（6 h） to Mn did not cause severe defects of life span,development,and reproduction,similarly,no significant defect could be found in animals exposed to a low concentration of Mn（2.5 μmol/L） for 48 h.In contrast,prolonged exposure（48 h） to high Mn concentrations（75 and 200 μmol/L） resulted in significant defects of life span,development,and reproduction,as well as the increase of the percentage of population with hsp-16.2：：gfp expression indicating the obvious induction of stress responses in exposed animals.Moreover,prolonged exposure（48 h） to high concentrations（75 and 200 μmol/L） of Mn decreased the expression levels of antioxidant genes of sod-1,sod-2,sod-3,and sod-4 compared to control.Therefore,prolonged exposure to high concentrations of Mn will induce the severe defects of life span,development,and reproduction in nematodes possibly by affecting the stress response and expression of antioxidant genes in Caenorhabditis elegans.展开更多
AIM To investigate feasibility of combined assessment of biochemical and electrophysiological myocardial impairment markers risk-stratifying patients with chronic heart failure(CHF). METHODS Serum levels of heart-type...AIM To investigate feasibility of combined assessment of biochemical and electrophysiological myocardial impairment markers risk-stratifying patients with chronic heart failure(CHF). METHODS Serum levels of heart-type fatty acid binding protein(H-FABP) as a marker of ongoing myocardial damage and QRS duration on electrocardiogram were measured at admission in 322 consecutive patients with CHF. A prolonged QRS duration was defined as 120 ms or longer. The cut-off value for H-FABP level(4.5 ng/mL) was determined from a previous study. Patients were prospectively followed during a median follow up period of 534 d. The primary endpoint was cardiac deaths and rehospitalization for worsening CHF.RESULTS There were 117 primary events, including 27 cardiac deaths and 90 rehospitalizations. Patients were stratified into four groups according to H-FABP level and QRS duration(≥ 120 ms). Multivariate analysis demonstrated that high H-FABP levels [hazard ratio(HR) = 1.745, P = 0.021] and QRS prolongation(HR1.612, P = 0.0258) were independent predictors of cardiac events. Kaplan-Meier analysis demonstrated that the combination of high H-FABP levels and QRS prolongation could be used to reliably stratify patients at high risk for cardiac events(log rank test P < 0.0001).CONCLUSION Combined assessment of myocardial damage and electrical disturbance can be used to risk-stratify patients with CHF.展开更多
AIM To determine the prevalence of QT prolongation in a large series of end stage liver disease(ESLD)patients and its association to clinical variables and mortality.METHODS The QT interval was measured and corrected ...AIM To determine the prevalence of QT prolongation in a large series of end stage liver disease(ESLD)patients and its association to clinical variables and mortality.METHODS The QT interval was measured and corrected for heart rate for each patient,with a prolonged QT cutoff defined as QT>450 ms for males and QT>470 ms for females.Multiple clinical variables were evaluated including sex,age,serum sodium,international normalized ratio,creatinine,total bilirubin,beta-blocker use,Model for EndStage Liver Disease(MELD),MELD-Na,and etiology of liver disease.RESULTS Among 406 ESLD patients analyzed,207(51.0%)had QT prolongation.The only clinical variable associated with QT prolongation was male gender(OR=3.04,95%CI:2.01-4.60,P<0.001).During the study period,187patients(46.1%)died.QT prolongation was a significant independent predictor of mortality(OR=1.69,95%CI:1.03-2.77,P=0.039).In addition,mortality was also associated with viral etiology of ESLD,elevated MELD score and its components(P<0.05 for all).No significant reversibility in the QT interval was seen after liver transplantation.CONCLUSION QT prolongation was commonly encountered in an ESLD population,especially in males,and served as a strong independent marker for increased mortality in ESLD patients.展开更多
基金supported by the Guangzhou Science and Technology Plan Project(2024B03J0191)to Hu Haothe Research Projects of the Sixth Affiliated Hospital,Sun Yat-sen University(No.2023-053 and No.2023-063)to Hu Hao.
文摘Genetic variations are risk factors for neonatal hyperbilirubinemia(NHB),a common cause of infant hospitalization in the first postnatal week,but their contribution and long-term impacts remain unclear.This population-based multicenter study enrolls 1780 hospitalized NHB newborns and 38,158 genetically screened newborns across 20 hospitals(2019-2022).Excluding cases with clear clinical causes,977 NHB cases are categorized into genetic variation-positive and-negative groups.Results show significantly higher NHB-related gene variants(81.63%vs.65.62%)and positive variation rates(36.29%vs.9.4%)in NHB cases than in the general newborn population(all P<0.001).Among the 977 NHB cases,325(33.3%)have positive variants,with higher rates of severe hyperbilirubinemia(16.9%vs.9.7%,P=0.001),prolonged jaundice(36.3%vs.27.6%,P=0.005),and cholestasis/hypercholanaemia(23.7%vs.14.7%,P<0.001)in the positive group.Cumulative genetic variants in bilirubin metabolism pathways exhibit dosedependent associations with increased risks of complications.Long-term follow-up reveals that UGT1A1 variants prolong jaundice up to one month,while severe SLC10A1 variants cause persistent cholestasis/hypercholanaemia beyond nine months.This large-scale evidence highlights genetic factors as key NHB determinants,with implications for neonatal care protocols to integrate genetic testing and establish longterm surveillance for variant carriers.
基金financially supported by the National Natural Science Foundation of China(No.22202187)the Hubei Provincial Natural Science Foundation of China(No.2025AFB492)
文摘The development of photocatalysts that combine high efficiency,durability,and visible-light responsiveness remains a central challenge for solar-to-hydrogen conversion.In a recent study,Cabrero-Antonino et al.report a 2D/2D Schottky heterojunction constructed from ultrasmall Cu_(2)[CuTCPP]MOF nanosheets and conductive Ti_(3)C_(2)MXene.This hybrid interface generates a built-in interfacial electric field that promotes directional charge transfer,suppresses recombination,and significantly prolongs carrier lifetimes,as evidenced by femtosecond transient absorption spectroscopy.The MXene component not only functions as a hole acceptor to improve charge separation but also mitigates photooxidative degradation of the MOF,thereby enhancing long-term stability.The optimized heterojunction achieves a hydrogen evolution rate exceeding 5000μmol g^(-1)under visible light,nearly 20 times higher than that of pristine MOF,with notable operational durability.These findings demonstrate the critical role of interfacial engineering in achieving synergistic charge dynamics across hybrid architectures.The work provides a scalable,sustainable strategy for noble-metalfree photocatalysis,offering valuable insights for the rational design of next-generation systems for water splitting,CO_(2)reduction,and solar-driven chemical transformations.
基金Supported by National Natural Science Foundation of China,No.82172441Suzhou City Major Disease Multicenter Clinical Research Project,No.DZXYJ202312+2 种基金Special Funding for Jiangsu Province Science and Technology Plan(Key Research and Development Program for Social Development),No.BE2023737Gusu Health Talent Plan Scientific Research Project,No.GSWS2022109Postgraduate Research and Practice Innovation Program of Jiangsu Province,No.SJCX24_2446.
文摘BACKGROUND Fracture nonunion represents a challenging complication during fracture repair,often necessitating surgical intervention.Teriparatide,a recombinant human parathyroid hormone,has demonstrated promise in enhancing fracture healing,although its efficacy in treating established nonunion remains under investigation.CASE SUMMARY We report a case of a 27-year-old male who presented with a right humerus fracture following a traffic accident.Despite undergoing open reduction and internal fixation,the fracture resulted in a delayed union and subsequent nonunion.After 4 years of conservative management,teriparatide treatment was initiated due to persistent nonunion.Teriparatide injections were administered daily for 6 months,resulting in complete fracture healing and resolution of pain.CONCLUSION Our case demonstrates the successful use of teriparatide in treating a prolonged nonunion of a humerus fracture.Teriparatide may provide a valuable therapeutic option for established bone nonunion,even in cases that have not responded to conservative treatments.
文摘Hepatitis A virus(HAV)infection remains a significant public health concern in many developing countries.The annual incidence of HAV infection is 1.5 million,though this figure may be underestimated owing to the infection’s asymptomatic nature and the presence of milder disease variants.The clinical spectrum of HAV infection now ranges from asymptomatic infection to fulminant hepatitis.Despite the availability of safe and highly effective vaccines,HAV infections remain a major contributor to acute viral hepatitis worldwide.
基金supported fnancially by the Nanseishoto Project of WWFJ,Pro Natura Foundation Japan’s 31st Pro Natura Fundthe Project for Biodiversity Conservation Promotion of the Japan Ministry of the Environment.
文摘There are many short-lived animals,but those displaying a lifecycle with more than one generation per year(multivoltine lifecycle)are rare amongterrestrial vertebrates.The multivoltine lifecycle requires rapid growth and maturation and a long active season.Thus,small lizards in humidtropical or subtropical areas are candidates for multivoltine lifecycles.To test this prediction,we conducted a capture-mark-recapture study of asubtropical grass lizard,Takydromus toyamai,endemic to Miyako Islands,Japan.Juveniles grew very quickly,averaging 0.3 mm/day in the warmseason,and attained sexual maturity at 2.5 months post-hatching.The breeding season was very long,and hatchlings emerged from May toNovember.The prolonged breeding season and rapid growth to maturity allowed some individuals to produce a second generation in their frstyear.Estimates of hatching date from growth rates indicated that many females that hatched in May-June became gravid 76-120 days afterhatching and 122-165 days after oviposition of the eggs from which they hatched.Analyses of juvenile survivorship and month of hatching suggest that nearly half of breeding adults were members of multivoltine generations,although the 2 generations were not discrete.The species isshort-lived,with only 16% of individuals surviving beyond 12 months,and few individuals reproduced in a second year.We refer to this conditionas a“semi-multivoltine lifecycle.”Individuals that hatch late in the season defer reproduction until the following year and become founders ofthe next season’s cohort.This putative advantage of late-hatching individuals may have driven the evolution of this lifecycle.
基金Project supported by the National Natural Science Foundation of China(Grant No.12261072)。
文摘The widespread popularization and application of laser technology have provided a powerful tool for a deeper understanding of the material world and given birth to several emerging research fields.This study mainly focuses on the following three key aspects.First,the classical ensemble method is adopted to conduct a comprehensive and in-depth analysis of two-dimensional(2D)matter–wave pulses in Bose–Fermi mixed gases(including linear and nonlinear pulses).Second,under the strict constraints of unitary systems,a coupled Kd V equation is successfully derived,and the prolongation structure theory is skillfully used to carry out detailed calculations and analyses on this equation.Thus,the prolongation algebra of this equation is accurately determined,and the corresponding Lax pair is rigorously derived.Finally,based on the carefully obtained Lax pair from the prolongation structure theory,the soliton solutions of this equation are further analyzed in depth,and intuitive images of each soliton solution are carefully drawn.This lays a solid foundation for subsequent detailed research on these soliton characteristics and provides great convenience.
基金supported by the National Natural Science Foundation of China(82230074,81971809 and 82372159)the Liangshan Prefecture Science and Technology Plan Project(23ZDYF0180 and 24YYYJ0043).
文摘BACKGROUND:This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit(ICU)stays.METHODS:Pediatric patients who underwent cardiac surgery were included,with data collected from the pediatric intensive care database.The datasets were randomly divided into a training set(75%)and a testing set(25%).A nomogram model was developed to predict prolonged ICU stays in the training set and then validated in the testing set.RESULTS:A total of 795 patients and 266 patients were assigned to the training and testing sets,respectively,with consistent variables.The nomogram developed from the training set included eight characteristics:age,systolic blood pressure,respiratory rate,bicarbonate,direct bilirubin,high-sensitivity C-reactive protein,international normalized ratio,and operation time.The area under the curve values of the nomogram in the training and testing sets were 0.812 and 0.736,respectively.The nomogram demonstrated excellent discrimination and calibration.Decision curve analysis showed that the use of the nomogram resulted in more favorable outcomes compared with the strategies of treating all or none of the patients.CONCLUSION:This study presents a nomogram that may enable early identification of high-risk patients and facilitates tailored postoperative care and better outcomes after pediatric cardiac surgery.
文摘Atrial fibrillation(AF)is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment options include pharmacological and electrical cardioversion,each carrying specific risks.AF may resolve spontaneously,but often recurs,making a“watch-andwait”strategy a reasonable approach to avoid unnecessary antiarrhythmic therapy.
文摘BACKGROUND Venlafaxine,a serotonin-norepinephrine reuptake inhibitor,is widely prescribed for the treatment of major depressive disorder.At therapeutic dose,it is generally safe,with a low incidence of adverse effects.However,massive venlafaxine inge-stion can cause serious cardiotoxicity,leading to life-threatening arrhythmias.CASE SUMMARY A 31-year-old woman with a history of depression ingested 14.8 g of venlafaxine along with 6 mg of estazolam and 6 mg of flunitrazepam.On admission,2 hours post-ingestion,she presented only with mild QTc prolongation.At 4 hours post-ingestion,she developed a generalized tonic-clonic seizure.Following endo-tracheal intubation,intravenous midazolam infusion was initiated and 50 g of activated charcoal was administered via a nasogastric tube.At 15 hours post-ingestion,she developed ventricular tachycardia that rapidly progressed to refr-actory ventricular fibrillation,which was successfully treated with veno-arterial extracorporeal membrane oxygenation.Toxicological analysis revealed serum ve-nlafaxine and O-desmethylvenlafaxine concentrations 17µg/mL and 10µg/mL,respectively,at 15 hours post-ingestion.CONCLUSION In cases of massive venlafaxine ingestion,continuous intensive monitoring,particularly of QTc,is essential for at least 24 hours,even when initial clinical signs are mild.If refractory ventricular arrhythmias occur,prompt ini-tiation of veno-arterial extracorporeal membrane oxygenation should be considered.
基金supported by the National Natural Science Foundation of China(No.32260275)Fundamental Research Funds of CAF(CAFYBB2024ZA033)。
文摘Poyang Lake,China's largest freshwater lake,is a critical wintering ground for most of the global Siberian Grane(Grus leucogeranus)population.However,increasingly prolonged dry seasons have degraded the natural wetlands of Poyang Lake,forcing Siberian Cranes to shift to artificial habitats.From 2015 to 2023,field surveys revealed a substantial increase in the number of Siberian Cranes in artificial habitats,with peak counts reaching 3000individuals,accounting for up to 53%of the species'global population.Satellite telemetry of 13 individuals further confirmed the spatial use of these habitats,highlighting their consistent reliance on artificial sites over multiple years.Seven high-use hotspots were identified outside of Poyang Lake,including two artificial provisioning sites that supported dense foraging flocks for extended periods.Satellite telemetry confirmed this trend,with artificial habitats making up to 64.2%of the occurrence sites in some years.This reliance on artificial habitats was closely linked to the reduced tuber biomass in natural wetlands and low winter water levels in Poyang Lake,which collectively explained 83%of the variance in crane abundance in artificial habitats.Artificial habitat use peaked in December and January,indicating marked seasonal variation.Siberian Cranes also exhibited a pronounced circadian rhythm,foraging in artificial habitats during the day and returning to natural wetlands to roost at night.Despite the shift toward artificial habitats,natural wetlands remain critical for nighttime refuge.The continued dependence on artificial habitats raises concerns about disease transmission owing to dense congregations.Conservation strategies should prioritize both the careful management of artificial provisioning sites and the restoration of natural wetlands to improve food and habitat availability within natural ecosystems,ultimately enabling the return of Siberian Cranes to their traditional natural habitats.
基金financially supported by the National Natural Science Foundation of China(U23A20591 and 52273158).
文摘Glioblastoma(GBM)is a highly infiltrative brain tumor.The treatment of GBM is challenging due to the existence of blood brain barrier,its highly invasive nature,and its heterogeneity.Given the limitations of conventional therapies,this Perspective explores the development trajectory of implantable devices,highlighting the advantages of current models.With the progression in research,these implantable devices certainly hold promising potential for GBM therapy.
文摘Prolonged grief disorder(PGD)is characterized by intense and persistent grief that significantly impairs daily functioning.For bereaved parents,the loss of a child represents an unparalleled emotional challenge,placing them at heightened risk of developing PGD.This review traces the evolution of PGD from early con-ceptualization to current definitions in the International Classification of Diseases,11th revision,and Diagnostic and Statistical Manual of Mental Disorders,5th Edition,Text Revision.Building on this historical foundation,the analysis examined the prevalence,risk factors,and diagnostic criteria of PGD in bereaved parents,with particular attention to sex differences,the nature of the loss,and the time elapsed since the child’s death.Furthermore,this review examines the multidimensional consequences of PGD on parents,including its emotional,physiological,and functional effects.Evidence-based treatments for PGD,such as psychotherapeutic approaches and emerging interventions,are also discussed.By synthesizing existing research,this review provides a comprehensive under-standing of PGD among bereaved parents,highlights the unique challenges they face,and offers practical insights and recommendations for clinicians working with this population.
文摘To evaluate the efficacy and safety of gemcitabine （GEM） at 30 min standard-dose infusion （30 min-SDI） compared with prolonged low-dose infusion （P-LDI） in patients with advanced non-small-cell lung cancer （NSCLC）. Electronic databases including Pubmed, EMbase, Cochrane Library, CNKI, CBM, and VIP were searched using keywords ＂GEM＂, ＂P-LDI＂, and ＂NSCLC＂. Review Manager 5.3 was used to perform the recta-analysis. Primary endpoints were overall response rate （ORR） and 1-year survival rate （1-year SR）. Secondary endpoints were grade 3/4 hematotoxicity and nausea/vomiting. Six randomized controlled trials （RCTs） with a total of 637 patients were included. The results showed that P-LDI was superior in ORR （OR = 1.50, 95% CI： 1.08-2.10, P = 0.02）, but had an equal 1-year SR （OR = 1.27, 95 % CI： 0.90-1.79, P = 0.18） as compared with 30 min-SDl. For grade 3/4 adverse events, there was no significant difference in anemia （OR = 1.84, 95% CI： 0.61-5.57, P = 0.28） and nausea/vomiting （OR = 1.15, 95% CI： 0.63-2.12, P = 0.64） between the two treatments. However, patients with P-LDI experienced less leukopenia （OR = 0.64, 95% CI： 0.43-0.97, P = 0.04） and thrombocytopenia （OR = 0.37, 95% CI： 0.17-0.80, P = 0.01）. P-LDI was superior in terms of ORR, experienced less grade 3/4 thrombocytopenia and leukopenia compared with 30 min-SDI, and could be a viable treatment option for advanced NSCLC.
基金supported jointly by the National Natural Science Foundation of China (GrantNo. 40975039)the Key Technologies R&D Program(Grant No. 2009BAC51B00)
文摘This study examined regional prolonged low temperature （PLT） events in China from the observational station data for the period 1960–2008 using the new criteria. The new definition of a site PLT event is that the daily minimum temperature does not exceed the 10th percentile threshold of the local daily minimum temperature climatology for at least 5 days at a station. The regional PLT event is defined as at least five adjacent stations exhibiting site PLT simultaneously for 5 d. Under the new definition, 552 regional PLT events were identified, and three indices： duration, extent, and intensity, as well as a comprehensive index （CI） were used to quantify the event severity. In addition, geographical patterns and temporal variations of regional PLT events were investigated using three event categories： strong, moderate, and weak. Spatially, strong events were mainly located in the north of Xinjiang and along the Yangtze River to the south of the Yangtze River; moderate events occurred in Xinjiang and south of the Yangtze River; and weak events occurred south of the Yellow River. The variation for the annual frequency of regional PLT events in China in the last 49 years showed a significant decreasing trend with a rate of-1.99 times per decade, and the significant transition decade was the 1980s.
基金Supported by the National Nature Science Foundation of China,No.81672319,No.81602507,and No.81773135the National Key Research and Development Plan,No.2017YFC0908300Beijing Nova Program,No.Z181100006218011
文摘BACKGROUND Prolonged postoperative ileus(PPOI)is one of the common complications in gastric cancer patients who underwent gastrectomy.Evidence on the predictors of PPOI after gastrectomy is limited and few prediction models of nomogram are used to estimate the risk of PPOI.We hypothesized that a predictive nomogram can be used for clinical risk estimation of PPOI in gastric cancer patients.AIM To investigate the risk factors for PPOI and establish a nomogram for clinical risk estimation.METHODS Between June 2016 and March 2017,the data of 162 patients with gastrectomy were obtained from a prospective and observational registry database.Clinical data of patients who fulfilled the criteria were obtained.Univariate and multivariable logistic regression models were performed to detect the relationship between variables and PPOI.A nomogram for PPOI was developed and verified by bootstrap resampling.The calibration curve was employed to detect the concentricity between the model probability curve and ideal curve.The clinical usefulness of our model was evaluated using the net benefit curve.RESULTS This study analyzed 14 potential variables of PPOI in 162 gastric cancer patients who underwent gastrectomy.The incidence of PPOI was 19.75%in patients with gastrectomy.Age older than 60 years,open surgery,advanced stage(III–IV),and postoperative use of opioid analgesic were independent risk factors for PPOI.We developed a simple and easy-to-use prediction nomogram of PPOI after gastrectomy.This nomogram had an excellent diagnostic performance[area under the curve(AUC)=0.836,sensitivity=84.4%,and specificity=75.4%].This nomogram was further validated by bootstrapping for 500 repetitions.The AUC of the bootstrap model was 0.832(95%CI:0.741–0.924).This model showed a good fitting and calibration and positive net benefits in decision curve analysis.CONCLUSION We have developed a prediction nomogram of PPOI for gastric cancer.This novel nomogram might serve as an essential early warning sign of PPOI in gastric cancer patients.
文摘Objective:To discuss the effect of prolonged second stage of labor on maternal and neonatal outcomes.Methods:A total of 101 primiparas with the length of second stage of labor longer than 2 h were selected and pregnant women with the length less than 2 h served as control.The maternal and neonatal outcomes of two groups were observed and compared.Results:A total of 62.1%(18/11) with the length of second stage of labor between 120 min and 180 min,46.7%(28/32) between 181 min and 240 min and 12 longer than 241 min underwent vaginal delivery.The longer the length of second stage of labor,the lower score of Apgar scale for infants in 1 min,and the higher the incidence of asphyxia.But there was no difference in scale in 5 min.As second stage of labor prolonged,the incidences of cesarean section and of postpartum hemorrhage increased. Conclusions:Almost half of puerperas with the length of second stage of labor longer than 2 h underwent vaginal delivery.The prolonged second stage of labor can decrease the score of Apgar scale in 1 min,increase the incidence of asphyxia,but has no effect on scale in 5 min.It still need more evidence from evidence medicine to definition of time and treatment of second stage of labor.
基金the National Nature Science Foundation of China,No.81672319 and No.81972790Beijing Nova Program,No.Z181100006218011。
文摘BACKGROUND Prolonged postoperative ileus(PPOI) is a prolonged state of "pathological"gastrointestinal(GI) tract dysmotility. There are relatively few studies examining the influence of preoperative nutritional status on the development of PPOI in patients who underwent GI surgery. The association between preoperative albumin and PPOI has not been fully studied. We hypothesized that preoperative albumin may be an independent indicator of PPOI.AIM To analyze the role of preoperative albumin in predicting PPOI and to establish a nomogram for clinical risk evaluation.METHODS Patients were drawn from a prospective hospital registry database of GI surgery.A total of 311 patients diagnosed with gastric or colorectal cancer between June 2016 and March 2017 were included. Potential predictors of PPOI were analyzed by univariate and multivariable logistic regression analyses, and a nomogram for quantifying the presence of PPOI was developed and internally validated.RESULTS The overall PPOI rate was 21.54%. Advanced tumor stage and postoperative opioid analgesic administration were associated with PPOI. Preoperative albumin was an independent predictor of PPOI, and an optimal cutoff value of 39.15 was statistically calculated. After adjusting multiple variables, per unit or per SD increase in albumin resulted in a significant decrease in the incidence of PPOI of 8%(OR = 0.92, 95%CI: 0.85-1.00, P = 0.046) or 27%(OR = 0.73, 95%CI:0.54-0.99, P = 0.046), respectively. Patients with a high level of preoperative albumin(≥ 39.15) tended to experience PPOI compared to those with low levels(< 39.15)(OR = 0.43, 95%CI: 0.24-0.78, P = 0.006). A nomogram for predicting PPOI was developed [area under the curve(AUC) = 0.741] and internally validated by bootstrap resampling(AUC = 0.725, 95%CI: 0.663-0.799).CONCLUSION Preoperative albumin is an independent predictive factor of PPOI in patients who underwent GI surgery. The nomogram provided a model to screen for early indications in the clinical setting.
基金supported by the National Natural Science Foundation of China (No. 30771113, 30870810)the Program for New Century Excellent Talents in University
文摘We examined the possible multiple defects induced by acute and prolonged exposure to high levels of manganese（Mn） solution by monitoring the endpoints of lifespan,development,reproduction,and stress response.Our data suggest that acute exposure（6 h） to Mn did not cause severe defects of life span,development,and reproduction,similarly,no significant defect could be found in animals exposed to a low concentration of Mn（2.5 μmol/L） for 48 h.In contrast,prolonged exposure（48 h） to high Mn concentrations（75 and 200 μmol/L） resulted in significant defects of life span,development,and reproduction,as well as the increase of the percentage of population with hsp-16.2：：gfp expression indicating the obvious induction of stress responses in exposed animals.Moreover,prolonged exposure（48 h） to high concentrations（75 and 200 μmol/L） of Mn decreased the expression levels of antioxidant genes of sod-1,sod-2,sod-3,and sod-4 compared to control.Therefore,prolonged exposure to high concentrations of Mn will induce the severe defects of life span,development,and reproduction in nematodes possibly by affecting the stress response and expression of antioxidant genes in Caenorhabditis elegans.
文摘AIM To investigate feasibility of combined assessment of biochemical and electrophysiological myocardial impairment markers risk-stratifying patients with chronic heart failure(CHF). METHODS Serum levels of heart-type fatty acid binding protein(H-FABP) as a marker of ongoing myocardial damage and QRS duration on electrocardiogram were measured at admission in 322 consecutive patients with CHF. A prolonged QRS duration was defined as 120 ms or longer. The cut-off value for H-FABP level(4.5 ng/mL) was determined from a previous study. Patients were prospectively followed during a median follow up period of 534 d. The primary endpoint was cardiac deaths and rehospitalization for worsening CHF.RESULTS There were 117 primary events, including 27 cardiac deaths and 90 rehospitalizations. Patients were stratified into four groups according to H-FABP level and QRS duration(≥ 120 ms). Multivariate analysis demonstrated that high H-FABP levels [hazard ratio(HR) = 1.745, P = 0.021] and QRS prolongation(HR1.612, P = 0.0258) were independent predictors of cardiac events. Kaplan-Meier analysis demonstrated that the combination of high H-FABP levels and QRS prolongation could be used to reliably stratify patients at high risk for cardiac events(log rank test P < 0.0001).CONCLUSION Combined assessment of myocardial damage and electrical disturbance can be used to risk-stratify patients with CHF.
文摘AIM To determine the prevalence of QT prolongation in a large series of end stage liver disease(ESLD)patients and its association to clinical variables and mortality.METHODS The QT interval was measured and corrected for heart rate for each patient,with a prolonged QT cutoff defined as QT>450 ms for males and QT>470 ms for females.Multiple clinical variables were evaluated including sex,age,serum sodium,international normalized ratio,creatinine,total bilirubin,beta-blocker use,Model for EndStage Liver Disease(MELD),MELD-Na,and etiology of liver disease.RESULTS Among 406 ESLD patients analyzed,207(51.0%)had QT prolongation.The only clinical variable associated with QT prolongation was male gender(OR=3.04,95%CI:2.01-4.60,P<0.001).During the study period,187patients(46.1%)died.QT prolongation was a significant independent predictor of mortality(OR=1.69,95%CI:1.03-2.77,P=0.039).In addition,mortality was also associated with viral etiology of ESLD,elevated MELD score and its components(P<0.05 for all).No significant reversibility in the QT interval was seen after liver transplantation.CONCLUSION QT prolongation was commonly encountered in an ESLD population,especially in males,and served as a strong independent marker for increased mortality in ESLD patients.
