Dengue is an arboviral disease caused by the dengue virus,with 390 million infections reported annually worldwide.It is classified into two categories:dengue without or with warning signs and severe dengue.[1]Given th...Dengue is an arboviral disease caused by the dengue virus,with 390 million infections reported annually worldwide.It is classified into two categories:dengue without or with warning signs and severe dengue.[1]Given the moderate efficacy of the dengue vaccine,[2]there is an urgent necessity to design host-directed therapeutic strategies,such as the repurposing of FDA-approved drugs,to combat dengue virus infection.展开更多
The clinical treatment of severe trauma withsternoclavicular joint injury is challenging,primarilydue to the irregular shape of the bones surrounding thesternoclavicular joint,as well as the posterior clavicle beingcl...The clinical treatment of severe trauma withsternoclavicular joint injury is challenging,primarilydue to the irregular shape of the bones surrounding thesternoclavicular joint,as well as the posterior clavicle beingclose to the aorta and mediastinal organs.^([1])These patientsnot only suffer direct injuries to the sternoclavicularjoint,but also frequently experience severe injuries toother body parts.The systemic physiological disordersand multi-organ dysfunction caused by severe traumaincrease the surgery di?culty and mortality risk.^([2])展开更多
BACKGROUND:The lack of a stable,easy-to-operate animal model for severe trauma has hindered the research progress.The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of ...BACKGROUND:The lack of a stable,easy-to-operate animal model for severe trauma has hindered the research progress.The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of severe trauma,providing a reliable research tool.METHODS:Male C57BL/6J mice(aged 8-10 weeks and weighting approximately 20 g)were used to establish the severe trauma model.Under anesthesia,a midshaft femoral fracture was created and packed with sterile cotton.A midline incision was made from the inguinal region to the sternum,exposing the abdominal organs for 30 min.The right femoral artery was cannulated to induce controlled blood loss at 30%,35%,40%,and 50%of the total blood volume.Survival rates were monitored for 24 h post-induction.In the mice that experienced 30%blood loss,the mean arterial pressure,body temperature,blood gas parameters,peripheral blood inflammatory markers,and major organ pathological changes were assessed.RESULTS:Mice with femoral fractures,soft tissue injuries,abdominal organ exposure,and 30%blood loss exhibited stable survival rates.Increased blood loss significantly reduced survival rates.Mean arterial pressure decreased initially,recovering within 0-15 min and returning to baseline by 50 min.Similarly,the body temperature decreased initially and gradually recovered to baseline within 50 min.Levels of peripheral blood inflammatory markers remained elevated for 12 h post-injury.Distant organs,including intestines,lungs,liver,spleen and kidneys,displayed varying degrees of injury.CONCLUSION:The established mouse model replicates the pathophysiological responses to severe trauma,indicating stability and reproducibility,which could be an useful tool for further trauma research.展开更多
Severe fever with thrombocytopenia syndrome(SFTS)is a novel emerging acute infectious disease caused by severe fever with thrombocytopenia syndrome virus(SFTSV),characterized by high fever and thrombocytopenia.It has ...Severe fever with thrombocytopenia syndrome(SFTS)is a novel emerging acute infectious disease caused by severe fever with thrombocytopenia syndrome virus(SFTSV),characterized by high fever and thrombocytopenia.It has been proved that traditional Chinese medicine(TCM)has displayed definite therapeutic effects on viral hemorrhagic fever,indicating its potential to treat SFTS.In this study,SFTS-relative key targets were predicted via gene ontology(GO)analysis and kyoto encyclopedia of genes and genomes(KEGG)enrichment analysis.Molecular docking was then used to select stable binders.Molecules matched TCMs were identified,and a new prescription,Qingqi Guxue decoction(QQGX),was formulated to clear heat and nourish blood,with a resulting drug composition network.We explored the optimal drug proportion for QQGX.Through an in-depth study of molecular mechanisms,we found that QQGX induces S phase arrest by promoting the degradation of cyclin A2(CCNA2)and cyclin-dependent kinase 2(CDK2),thereby inhibiting SFTSV replication.Finally,we verified the effectiveness and safety of QQGX based on the mouse liver bile duct organoid model infected with SFTSV.In summary,our study prepared a TCM decoction using the method of network pharmacology.This decoction has a significant inhibitory effect on the replication of SFTSV and provides a new treatment strategy for hemorrhagic fever with TCM.展开更多
BACKGROUND Boerhaave syndrome,or spontaneous esophageal rupture,is a rare and lifethreatening emergency,typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting.Early diagnosis ...BACKGROUND Boerhaave syndrome,or spontaneous esophageal rupture,is a rare and lifethreatening emergency,typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting.Early diagnosis is challenging as its symptoms often resemble those of other diseases.Understanding its pathological features and treatment strategies is therefore critical for clinical practice.CASE SUMMARY This report describes a case of spontaneous esophageal rupture triggered by violent coughing in a 55-year-old male with a history of smoking and hypertension.Following severe coughing,the patient developed chest pain,vomiting,and respiratory distress.Initial clinical evaluation was inconclusive,with a suspected diagnosis of cardiovascular or gastrointestinal conditions.After further examination,the diagnosis of spontaneous esophageal rupture was confirmed.Chest X-ray,computed tomography,and endoscopy revealed a rupture in the lower esophagus,along with mediastinal abscess and pleural effusion.Laboratory tests showed mild infection markers.The patient underwent surgical repair of the esophageal rupture(approximately 3 cm in length)with mediastinal drainage.Postoperatively,the patient’s temperature normalized within 3 days,respiratory function improved,and pleural effusion significantly decreased.After two weeks of treatment,the patient was discharged without complications and had a favorable prognosis.The study suggests that while violent coughing is a rare trigger,it can lead to severe damage,and imaging techniques play a crucial role in diagnosis.CONCLUSION Spontaneous esophageal rupture presents significant diagnostic and therapeutic challenges.Early recognition and timely intervention are crucial for improving prognosis.This case highlights the importance of imaging and surgical treatment,offering new insights for managing similar cases and providing valuable clinical guidance.展开更多
Objective:To investigate the expression level of interleukin-17D(IL-17D)in the serum of patients with severe pneumonia and its correlation with disease severity.Methods:This study included 50 patients with severe pneu...Objective:To investigate the expression level of interleukin-17D(IL-17D)in the serum of patients with severe pneumonia and its correlation with disease severity.Methods:This study included 50 patients with severe pneumonia who were diagnosed and treated in the hospital from May 2024 to May 2025.The expression level of IL-17D in the serum of all patients was recorded.Patients were divided into severe and mild groups based on their disease severity.Gender,age,disease duration,presence of fever,atelectasis,pneumothorax,interleukin-2(IL-2),interleukin-4(IL-4),interleukin-6(IL-6),and interleukin-17D were selected as independent variables.Statistical software SPSS 22.00 was used for univariate analysis,and variables with statistical significance in the univariate analysis were included in a multivariate logistic regression analysis to determine the correlation between IL-17D and the severity of severe pneumonia.Results:The results of this study showed that the level of IL-17D in patients with severe pneumonia was significantly higher than the normal threshold.Univariate analysis indicated that atelectasis,IL-2,IL-6,and IL-17D were statistically significant(P<0.05)and could be considered as influencing factors for the severity of severe pneumonia.Multivariate logistic regression analysis revealed that atelectasis(OR=2.141,95%CI:1.684–2.391),IL-2(OR=2.884,95%CI:2.240–3.614),IL-6(OR=2.571,95%CI:2.190–2.943),and IL-17D(OR=2.416,95%CI:2.093–2.735)were positively correlated with the severity of severe pneumonia.Conclusion:The expression level of IL-17D in the serum of patients with severe pneumonia is higher than the normal threshold and is positively correlated with disease severity.展开更多
This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadi...This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.展开更多
Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 3...Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 34% mortality in under-five children with severe acute malnutrition. This study aimed to determine the impacts of severe acute malnutrition on the kidney among the admitted under-five children. Methods: In this prospective longitudinal observational study, a total of 190 children aged 6 to 59 months were enrolled from Iringa and Dodoma tertiary hospitals. Socio-demographic, clinical and laboratory data were collected using a structured questionnaire. Estimated Glomerular Filtration Rate (eGFR) and urine albumin creatinine ratio (uACR) were used to determine RD. Data analysis was done using SPSS version 26 and statistical significance was assumed for factors with p-value Results: Out of 190 children with severe acute malnutrition, 36 (19%) had renal dysfunction. Factors associated with RD in malnourished children were the history of local herbs used within one week (AOR = 5.85, 95% CI [1.41, 24.319], p = 0.0152), Acute watery diarrhea with severe dehydration (AOR = 2.15, 95% CI [1.033, 4.711], p = 0.0166), and positive urine leukocytes (AOR = 19.91, 95% CI [4.09, 96.989], p = 0.0002). At three months of follow up, out of 36 children with RD, 20 (55.56%) attained full recovery, while 4 (11.11%) developed chronic kidney disease (CKD). Children with RD had prolonged hospital stays for more than 14 days with a mean 12.25 ± 5.00 days compared to those with no RD with a mean 6.29 ± 1.68 days (p Conclusion: Renal dysfunction is common among children with severe acute malnutrition. It is associated with prolonged hospital stays and increased mortality. Further studies which can determine the burden of RD in children with severe acute malnutrition as compared to those with no severe acute malnutrition are needed.展开更多
Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary su...Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary surgery subsequent to experiencing breakthrough infection of coronavirus disease 2019(COVID-19).This study aimed to find factors predicting postoperative complications and construct an innovative nomogram to pinpoint patients who were susceptible to developing severe complications following breakthrough infection of COVID-19 after undergoing elective hepato-pancreato-biliary surgery.Methods:This multicenter retrospective cohort study included consecutive patients who underwent elective hepato-pancreato-biliary surgeries between January 3 and April 1,2023 from four hospitals in China.All of these patients had experienced breakthrough infection of COVID-19 prior to their surgeries.Additionally,two groups of patients without preoperative COVID-19 infection were included as comparative controls.Surgical complications were meticulously documented and evaluated using the comprehensive complication index(CCI),which ranged from 0(uneventful course)to 100(death).A CCI value of 20.9 was identified as the threshold for defining severe complications.Results:Among 2636 patients who were included in this study,873 were included in the reference group I,941 in the reference group II,389 in the internal cohort,and 433 in the external validation cohort.Multivariate logistic regression analysis revealed that completing a full course of COVID-19 vaccination>6 months before surgery,undergoing surgery within 4 weeks of diagnosis of COVID-19 breakthrough infection,operation duration of 4 h or longer,cancer-related surgery,and major surgical procedures were significantly linked to a CCI>20.9.A nomogram model was constructed utilizing CCI>20.9 in the training cohort[area under the curve(AUC):0.919,95%confidence interval(CI):0.881–0.957],the internal validation cohort(AUC:0.910,95%CI:0.847–0.973),and the external validation cohort(AUC:0.841,95%CI:0.799–0.883).The calibration curve for the probability of CCI>20.9 demonstrated good agreement between the predictions made by the nomogram and the actual observations.Conclusions:The developed model holds significant potential in aiding clinicians with clinical decisionmaking and risk stratification for patients who have experienced breakthrough infection of COVID-19 prior to undergoing elective hepato-pancreato-biliary surgery.展开更多
Objective:To analyze the clinical application and effects of the body restraint reduction program for severe neurological patients.Methods:A total of 206 patients admitted to the neurology department of the hospital f...Objective:To analyze the clinical application and effects of the body restraint reduction program for severe neurological patients.Methods:A total of 206 patients admitted to the neurology department of the hospital from January 2022 to May 2025 were selected as the research subjects.Among them,102 patients from January 2022 to May 2025 were assigned to the observation group,and 104 patients during the same period served as the control group.In practice,the control group received conventional body restraint,while the observation group adopted the reduction program.The incidence of unplanned extubation and restraint-related complications were compared between the two groups.Results:The body restraint rate and complication rate in the observation group were significantly lower(P<0.05).After nurse training,their knowledge mastery and operational ability were significantly higher than before training(P<0.01).Conclusion:The body restraint reduction program for severe neurological patients can effectively reduce the restraint rate and complication incidence,while helping improve nurses’restraint management capabilities,serving as an effective means to enhance overall nursing quality.展开更多
Objective:To investigate whether the presence or absence of improvement in chronic severe functional constipation(CSFC)at the early stage of treatment with electroacupuncture predicts subsequent response or non-respon...Objective:To investigate whether the presence or absence of improvement in chronic severe functional constipation(CSFC)at the early stage of treatment with electroacupuncture predicts subsequent response or non-response,and to determine the optimal treatment duration for assessing subsequent responses to electroacupuncture.Methods:This is a post hoc analysis using data pooled from two large-scale randomized controlled trials.Patients with CSFC were recruited,and those in the electroacupuncture groups were included in the present study.Early improvement was defined as a weekly increase of≥1 complete spontaneous bowel movement(CSBM)compared to baseline.Three treatment response criteria were evaluated:≥3CSBMs per week,overall CSBM response,and sustained CSBM response.Predictive statistics,including sensitivity,specificity,positive predictive value,and negative predictive value,were calculated at weeks1–4.Receiver operating characteristic curves and accuracy rates were used to determine the optimal timepoint for differentiation between responders and non-responders.Results:Cases from a total of 813 participants who received electroacupuncture were analyzed.The proportion of improvers was 40.34%by week 1,increasing to 52.52%by week 4.After 8 weeks of treatment,the response rates were 30.14%,25.83%and 25.58%according to the three aforementioned criteria,respectively.Early improvement was a strong predictor of treatment response,with week 3 demonstrating the highest predictive accuracy.Conclusion:Early improvement with electroacupuncture,especially at week 3,can predict subsequent outcomes.Our findings suggest that acupuncturists may identify non-responders who might require adjustments to therapeutic strategies early in treatment.展开更多
Microscopic polyangiitis (MPA) is an autoimmune disorder characterized by pulmonary capillaritis and necrotizing glomerulonephritis triggered by the deposition of oligoimmune complexes.This condition primarily aff ect...Microscopic polyangiitis (MPA) is an autoimmune disorder characterized by pulmonary capillaritis and necrotizing glomerulonephritis triggered by the deposition of oligoimmune complexes.This condition primarily aff ects the lungs and kidneys.^([1])The key pathological features in the lungs associated with MPA include pulmonary interstitial fibrosis and diffuse alveolar hemorrhage (DAH),which clinically present as cough,sputum production,hemoptysis,and dyspnea.[2] In this report,we present a patient with MPA complicated by severe anemia and DAH,notably without the typical symptoms of hemoptysis.展开更多
BACKGROUND: Severe acute pancreatitis(SAP) is commonly associated with acute organ failure, but its effects on cerebral function within intensive care unit(ICU) patients remains inadequately researched. This study aim...BACKGROUND: Severe acute pancreatitis(SAP) is commonly associated with acute organ failure, but its effects on cerebral function within intensive care unit(ICU) patients remains inadequately researched. This study aims to determine the prevalence of delirium in critically ill patients diagnosed with SAP, and to identify risk factors associated with delirium in this patient population.METHODS: This was a retrospective, multicenter study, which enrolled adult patients diagnosed with SAP who admitted intensive care unit(ICU) for at least 24 h. Patient assessment was conducted using the Richmond Agitation-Sedation Scale(RASS) and the Confusion Assessment Method for the ICU(CAM-ICU). The cumulative incidence of delirium was determined. Demographic, clinical data, and length of ICU stay were compared between patients with and without delirium. A logistic regression model was employed to identify potential risk factors for delirium. RESuLTS: A total of 1,814 patients were included from seven hospitals in Anhui province, China. Delirium was observed in 25.2% of patients. Logistic regression analysis identified APACHE II scores(odds ratio [OR]=3.37, 95% confidence interval [CI]: 1.09–10.43, P=0.04), physical restraint(OR=11.11, 95%CI: 4.35–28.39, P<0.05), invasive mechanical ventilation(IMV)(OR=2.44, 95%CI: 1.41–4.25, P=0.002), and ICU length of stay ≥ 7 days(OR=3.14, 95%CI: 2.27–4.36, P<0.05) as independent risk factors of delirium.cONcLuSION: The present study revealed a substantial incidence of delirium in critically ill patients with SAP, associated with factors including APACHE II score, IMV, physical restraint, and prolonged ICU stays.展开更多
Objective:To explore the role of lung ultrasound combined with multi-organ evaluation in assessing the risk of weaning from mechanical ventilation(MV)in severe patients.Methods:A retrospective analysis was conducted o...Objective:To explore the role of lung ultrasound combined with multi-organ evaluation in assessing the risk of weaning from mechanical ventilation(MV)in severe patients.Methods:A retrospective analysis was conducted on 60 severe patients admitted to the hospital from December 2022 to December 2024,all of whom underwent MV treatment.Based on weaning status,thirty-eight patients were successfully weaned(success group),and 22 patients failed weaning(failure group).All patients underwent lung ultrasound and multi-organ evaluation.The parameter differences between the two groups were compared,risk factors for weaning risk were evaluated,and a receiver operating characteristic curve(ROC)was drawn to assess the predictive value of lung ultrasound combined with multi-organ evaluation for weaning risk.Results:The lung ultrasound score(LUS)of the success group was lower than that of the failure group,the left ventricular ejection fraction(LVEF)was higher than that of the failure group,and the diaphragmatic excursion(DE)and diaphragmatic thickening fraction(DTF)were higher than those of the failure group(P<0.05).Multifactor analysis showed that LUS was a risk factor for weaning risk,while LVEF,DE,and DTF were protective factors(P<0.05).The ROC showed that the area under the curve(AUC)of a single parameter for weaning risk was smaller than that of the combined parameters(P<0.05).Conclusion:Lung ultrasound combined with multi-organ evaluation can predict the weaning risk of severe patients undergoing MV treatment,and the diagnostic efficiency of multiple parameters combined evaluation is higher.展开更多
Infective endocarditis(IE) remains a severe and life-t hreatening disease, with rising incidence and a particularly high mortality rate, especially among elderly patients.^([1]) While antibiotics are the mainstay of t...Infective endocarditis(IE) remains a severe and life-t hreatening disease, with rising incidence and a particularly high mortality rate, especially among elderly patients.^([1]) While antibiotics are the mainstay of treatment, the success rate in left-sided IE is often limited,as nearly half of all patients eventually require surgical intervention for definitive management.^([2]) Heart failure is the main indication for surgery, but access to surgery is frequently restricted by several factors, particularly in patients with advanced age, often driven by the presence of comorbidities or hemodynamic instability.^([3,4])展开更多
BACKGROUND Angiostrongylus cantonensis-induced acute parasitic infection is a rare food-borne disease in clinical practice.Lack of its specific laboratory markers and subsequent difficulty in detecting pathogens cause...BACKGROUND Angiostrongylus cantonensis-induced acute parasitic infection is a rare food-borne disease in clinical practice.Lack of its specific laboratory markers and subsequent difficulty in detecting pathogens cause high misdiagnosis and missed diagnosis rates.CASE SUMMARY A 20-year-old male developed persistent neck and back pain after consuming raw snail meat,followed by urinary retention and low fever.After admission,the patient was misdiagnosed as viral infection and Mycobacterium tuberculosis in central nervous system.After detection of Angiostrongylus cantonensis in blood and cerebrospinal fluid by metagenomics next generation sequencing,albendazole was administered with ceftriaxone and methylprednisolone treatment simultaneously.With effective antiparasitic treatment,the patient weaned from mechanical ventilation successfully and transferred out of intensive care unit for hyperbaric oxygen and rehabilitation treatment.CONCLUSION This case highlights the diagnostic challenges of Angiostrongylus cantonensis infection and the importance of advanced sequencing techniques in identifying rare pathogens.展开更多
This review aims to gain a deeper understanding of the current interventions used in high-income and low-and middle-income countries worldwide on treatment engagement among persons with severe mental illnesses.Treatme...This review aims to gain a deeper understanding of the current interventions used in high-income and low-and middle-income countries worldwide on treatment engagement among persons with severe mental illnesses.Treatment engagement involves cultivating therapeutic partnerships to address patients’unique needs and challenges.This multifaceted process requires sensitivity,collaboration,and a tailored approach to promote positive outcomes.Effective treatment engagement reduces the chances of relapse and rehospitalization and helps individuals steer through their daily lives and social relationships.Through literature analysis,it was found that individual,situational,and environmental factors affected treatment engagement.Community nurses are crucial in promoting behavioral changes by engaging patients and applying tailor-made interventions.Applying problem-solving,coping skills,and strategies to address factors influencing adherence,motivational interviewing,and telephone follow-ups yielded significant results.The interventions recommended in community settings are tele-aftercare programs and home visits to address issues of dropped-out persons with severe mental illnesses and ensure continuity of treatment.Accessible,nonstigmatizing,non-coercive,informal,and appropriate services are suggested.These interventions can improve treatment engagement,medication adherence,and therapeutic alliance,thereby reducing symptoms and improving patients’quality of life.展开更多
Taking short-duration heavy rainfall and convective wind gusts as examples, the present study examined the characteristics of radar reflectivity and several convective parameters. We analyzed nowcasting techniques by ...Taking short-duration heavy rainfall and convective wind gusts as examples, the present study examined the characteristics of radar reflectivity and several convective parameters. We analyzed nowcasting techniques by integrating a high-resolution numerical weather prediction model with these convective parameters. Based on the CMA-GD 1-km model and its assimilation system, we conducted repeated tests on radar reflectivity data assimilation and analyzed their impact on nowcasting accuracy. Based on these analyses, we proposed a method to improve model forecasts using the useful indicative information provided by high-frequency radar reflectivity data and convective parameters. The improved method was applied to the CMA-GD 1-km model for nowcasting tests. Evaluations from batch tests and case analysis show that the proposed method significantly reduced the model's false alarm rates and improved its nowcasting performance.展开更多
Background:Hemorrhage remains a formidable complication of severe acute pancreatitis(SAP),with a high mortality rate.However,there is currently no effective method for identifying SAP patients who are at high risk for...Background:Hemorrhage remains a formidable complication of severe acute pancreatitis(SAP),with a high mortality rate.However,there is currently no effective method for identifying SAP patients who are at high risk for massive bleeding.The present study aimed to explore risk factors for predicting massive bleeding in SAP patients and to develop a predictive nomogram,which could facilitate early prediction,and timely appropriate interventions.Methods:We conducted a multivariate logistic regression analysis to examine the relationship between massive bleeding and variables including patient demographics,disease severity,laboratory indexes and local pancreatic complications.A novel nomogram was constructed based on these factors,and was vali-dated both internally and externally assessing its discrimination,calibration,and clinical applicability.Results:The study involved 351 patients in the training cohort,104 patients in the internal validation cohort,and 123 patients in the external validation cohort.Logistic regression analysis identified several independent risk factors for massive bleeding,including computed tomography severity index score above 8 points,Acute Physiology and Chronic Health Evaluation II score greater than 16 points,abdominal com-partment syndrome,pancreatic fistula,and sepsis.The nomogram constructed from these factors yielded an area under the receiver operating characteristic curve(AUC)of 0.896 and a coefficient of determination(R²)of 0.093.The Hosmer-Lemeshow test indicated good model fitness(P=0.654).Furthermore,the nomogram demonstrated reliable performance in both validation cohorts.Conclusions:The nomogram showed strong predictive capability for massive bleeding and could be a valuable tool for clinicians in identifying SAP patients at high risk for this complication at an early stage.展开更多
Objective: To explore the application effect of nursing interventions based on APACHE II scores in patients with severe pancreatitis and its impact on the recovery time of the gastrointestinal function. Methods: A tot...Objective: To explore the application effect of nursing interventions based on APACHE II scores in patients with severe pancreatitis and its impact on the recovery time of the gastrointestinal function. Methods: A total of 86 patients with severe pancreatitis treated in our hospital from March 2023 to March 2024 were selected. Using a random number table method, the patients were divided into a control group receiving conventional nursing care and a study group receiving nursing interventions based on APACHE II scores, with 43 patients in each group. The intervention effects of the two groups were compared. Results: The recovery time of gastrointestinal function in the study group was significantly shorter than that in the control group (P < 0.05). After the intervention, the quality of life scores in the study group was significantly higher than those in the control group (P < 0.05). The incidence of complications in the study group was significantly lower than in the control group (P < 0.05). Conclusion: Nursing interventions based on APACHE II scores can shorten gastrointestinal recovery time and reduce complications in patients with severe pancreatitis, contributing to improved quality of life.展开更多
基金funded by grants Pronaii 302979A1-S-9005 CONACyT (México) from RMDA。
文摘Dengue is an arboviral disease caused by the dengue virus,with 390 million infections reported annually worldwide.It is classified into two categories:dengue without or with warning signs and severe dengue.[1]Given the moderate efficacy of the dengue vaccine,[2]there is an urgent necessity to design host-directed therapeutic strategies,such as the repurposing of FDA-approved drugs,to combat dengue virus infection.
文摘The clinical treatment of severe trauma withsternoclavicular joint injury is challenging,primarilydue to the irregular shape of the bones surrounding thesternoclavicular joint,as well as the posterior clavicle beingclose to the aorta and mediastinal organs.^([1])These patientsnot only suffer direct injuries to the sternoclavicularjoint,but also frequently experience severe injuries toother body parts.The systemic physiological disordersand multi-organ dysfunction caused by severe traumaincrease the surgery di?culty and mortality risk.^([2])
基金supported by the National Natural Science Foundation of China(82102315).
文摘BACKGROUND:The lack of a stable,easy-to-operate animal model for severe trauma has hindered the research progress.The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of severe trauma,providing a reliable research tool.METHODS:Male C57BL/6J mice(aged 8-10 weeks and weighting approximately 20 g)were used to establish the severe trauma model.Under anesthesia,a midshaft femoral fracture was created and packed with sterile cotton.A midline incision was made from the inguinal region to the sternum,exposing the abdominal organs for 30 min.The right femoral artery was cannulated to induce controlled blood loss at 30%,35%,40%,and 50%of the total blood volume.Survival rates were monitored for 24 h post-induction.In the mice that experienced 30%blood loss,the mean arterial pressure,body temperature,blood gas parameters,peripheral blood inflammatory markers,and major organ pathological changes were assessed.RESULTS:Mice with femoral fractures,soft tissue injuries,abdominal organ exposure,and 30%blood loss exhibited stable survival rates.Increased blood loss significantly reduced survival rates.Mean arterial pressure decreased initially,recovering within 0-15 min and returning to baseline by 50 min.Similarly,the body temperature decreased initially and gradually recovered to baseline within 50 min.Levels of peripheral blood inflammatory markers remained elevated for 12 h post-injury.Distant organs,including intestines,lungs,liver,spleen and kidneys,displayed varying degrees of injury.CONCLUSION:The established mouse model replicates the pathophysiological responses to severe trauma,indicating stability and reproducibility,which could be an useful tool for further trauma research.
基金supported by the National Natural Science Foundation of China(32170144 and 32470146).
文摘Severe fever with thrombocytopenia syndrome(SFTS)is a novel emerging acute infectious disease caused by severe fever with thrombocytopenia syndrome virus(SFTSV),characterized by high fever and thrombocytopenia.It has been proved that traditional Chinese medicine(TCM)has displayed definite therapeutic effects on viral hemorrhagic fever,indicating its potential to treat SFTS.In this study,SFTS-relative key targets were predicted via gene ontology(GO)analysis and kyoto encyclopedia of genes and genomes(KEGG)enrichment analysis.Molecular docking was then used to select stable binders.Molecules matched TCMs were identified,and a new prescription,Qingqi Guxue decoction(QQGX),was formulated to clear heat and nourish blood,with a resulting drug composition network.We explored the optimal drug proportion for QQGX.Through an in-depth study of molecular mechanisms,we found that QQGX induces S phase arrest by promoting the degradation of cyclin A2(CCNA2)and cyclin-dependent kinase 2(CDK2),thereby inhibiting SFTSV replication.Finally,we verified the effectiveness and safety of QQGX based on the mouse liver bile duct organoid model infected with SFTSV.In summary,our study prepared a TCM decoction using the method of network pharmacology.This decoction has a significant inhibitory effect on the replication of SFTSV and provides a new treatment strategy for hemorrhagic fever with TCM.
基金Supported by Guangzhou Municipal Science and Technology Bureau,No.SL2024AD3JD0112.
文摘BACKGROUND Boerhaave syndrome,or spontaneous esophageal rupture,is a rare and lifethreatening emergency,typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting.Early diagnosis is challenging as its symptoms often resemble those of other diseases.Understanding its pathological features and treatment strategies is therefore critical for clinical practice.CASE SUMMARY This report describes a case of spontaneous esophageal rupture triggered by violent coughing in a 55-year-old male with a history of smoking and hypertension.Following severe coughing,the patient developed chest pain,vomiting,and respiratory distress.Initial clinical evaluation was inconclusive,with a suspected diagnosis of cardiovascular or gastrointestinal conditions.After further examination,the diagnosis of spontaneous esophageal rupture was confirmed.Chest X-ray,computed tomography,and endoscopy revealed a rupture in the lower esophagus,along with mediastinal abscess and pleural effusion.Laboratory tests showed mild infection markers.The patient underwent surgical repair of the esophageal rupture(approximately 3 cm in length)with mediastinal drainage.Postoperatively,the patient’s temperature normalized within 3 days,respiratory function improved,and pleural effusion significantly decreased.After two weeks of treatment,the patient was discharged without complications and had a favorable prognosis.The study suggests that while violent coughing is a rare trigger,it can lead to severe damage,and imaging techniques play a crucial role in diagnosis.CONCLUSION Spontaneous esophageal rupture presents significant diagnostic and therapeutic challenges.Early recognition and timely intervention are crucial for improving prognosis.This case highlights the importance of imaging and surgical treatment,offering new insights for managing similar cases and providing valuable clinical guidance.
基金Chongqing Shapingba District Technology Innovation Project(Project No.:2024046)。
文摘Objective:To investigate the expression level of interleukin-17D(IL-17D)in the serum of patients with severe pneumonia and its correlation with disease severity.Methods:This study included 50 patients with severe pneumonia who were diagnosed and treated in the hospital from May 2024 to May 2025.The expression level of IL-17D in the serum of all patients was recorded.Patients were divided into severe and mild groups based on their disease severity.Gender,age,disease duration,presence of fever,atelectasis,pneumothorax,interleukin-2(IL-2),interleukin-4(IL-4),interleukin-6(IL-6),and interleukin-17D were selected as independent variables.Statistical software SPSS 22.00 was used for univariate analysis,and variables with statistical significance in the univariate analysis were included in a multivariate logistic regression analysis to determine the correlation between IL-17D and the severity of severe pneumonia.Results:The results of this study showed that the level of IL-17D in patients with severe pneumonia was significantly higher than the normal threshold.Univariate analysis indicated that atelectasis,IL-2,IL-6,and IL-17D were statistically significant(P<0.05)and could be considered as influencing factors for the severity of severe pneumonia.Multivariate logistic regression analysis revealed that atelectasis(OR=2.141,95%CI:1.684–2.391),IL-2(OR=2.884,95%CI:2.240–3.614),IL-6(OR=2.571,95%CI:2.190–2.943),and IL-17D(OR=2.416,95%CI:2.093–2.735)were positively correlated with the severity of severe pneumonia.Conclusion:The expression level of IL-17D in the serum of patients with severe pneumonia is higher than the normal threshold and is positively correlated with disease severity.
基金supported by funding from the Medical Research Funding of Guangdong(No.A2022499 to QGX)the National Natural Science Foundation of China(No.82301796 to PL)the Guangdong Province Regional Joint Fund-Youth Fund Project of China(No.2022A1515111201 to PL).
文摘This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.
文摘Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 34% mortality in under-five children with severe acute malnutrition. This study aimed to determine the impacts of severe acute malnutrition on the kidney among the admitted under-five children. Methods: In this prospective longitudinal observational study, a total of 190 children aged 6 to 59 months were enrolled from Iringa and Dodoma tertiary hospitals. Socio-demographic, clinical and laboratory data were collected using a structured questionnaire. Estimated Glomerular Filtration Rate (eGFR) and urine albumin creatinine ratio (uACR) were used to determine RD. Data analysis was done using SPSS version 26 and statistical significance was assumed for factors with p-value Results: Out of 190 children with severe acute malnutrition, 36 (19%) had renal dysfunction. Factors associated with RD in malnourished children were the history of local herbs used within one week (AOR = 5.85, 95% CI [1.41, 24.319], p = 0.0152), Acute watery diarrhea with severe dehydration (AOR = 2.15, 95% CI [1.033, 4.711], p = 0.0166), and positive urine leukocytes (AOR = 19.91, 95% CI [4.09, 96.989], p = 0.0002). At three months of follow up, out of 36 children with RD, 20 (55.56%) attained full recovery, while 4 (11.11%) developed chronic kidney disease (CKD). Children with RD had prolonged hospital stays for more than 14 days with a mean 12.25 ± 5.00 days compared to those with no RD with a mean 6.29 ± 1.68 days (p Conclusion: Renal dysfunction is common among children with severe acute malnutrition. It is associated with prolonged hospital stays and increased mortality. Further studies which can determine the burden of RD in children with severe acute malnutrition as compared to those with no severe acute malnutrition are needed.
基金supported by grants from the Science Fund for Creative Research Groups of the National Natural Science Founda-tion of China(81521091 and 82073031)the National Natural Sci-ence Foundation of China(92269204)Clinical Research Plan of SHDC(SHDC2020CR5007 and SHDC22020213)。
文摘Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary surgery subsequent to experiencing breakthrough infection of coronavirus disease 2019(COVID-19).This study aimed to find factors predicting postoperative complications and construct an innovative nomogram to pinpoint patients who were susceptible to developing severe complications following breakthrough infection of COVID-19 after undergoing elective hepato-pancreato-biliary surgery.Methods:This multicenter retrospective cohort study included consecutive patients who underwent elective hepato-pancreato-biliary surgeries between January 3 and April 1,2023 from four hospitals in China.All of these patients had experienced breakthrough infection of COVID-19 prior to their surgeries.Additionally,two groups of patients without preoperative COVID-19 infection were included as comparative controls.Surgical complications were meticulously documented and evaluated using the comprehensive complication index(CCI),which ranged from 0(uneventful course)to 100(death).A CCI value of 20.9 was identified as the threshold for defining severe complications.Results:Among 2636 patients who were included in this study,873 were included in the reference group I,941 in the reference group II,389 in the internal cohort,and 433 in the external validation cohort.Multivariate logistic regression analysis revealed that completing a full course of COVID-19 vaccination>6 months before surgery,undergoing surgery within 4 weeks of diagnosis of COVID-19 breakthrough infection,operation duration of 4 h or longer,cancer-related surgery,and major surgical procedures were significantly linked to a CCI>20.9.A nomogram model was constructed utilizing CCI>20.9 in the training cohort[area under the curve(AUC):0.919,95%confidence interval(CI):0.881–0.957],the internal validation cohort(AUC:0.910,95%CI:0.847–0.973),and the external validation cohort(AUC:0.841,95%CI:0.799–0.883).The calibration curve for the probability of CCI>20.9 demonstrated good agreement between the predictions made by the nomogram and the actual observations.Conclusions:The developed model holds significant potential in aiding clinicians with clinical decisionmaking and risk stratification for patients who have experienced breakthrough infection of COVID-19 prior to undergoing elective hepato-pancreato-biliary surgery.
文摘Objective:To analyze the clinical application and effects of the body restraint reduction program for severe neurological patients.Methods:A total of 206 patients admitted to the neurology department of the hospital from January 2022 to May 2025 were selected as the research subjects.Among them,102 patients from January 2022 to May 2025 were assigned to the observation group,and 104 patients during the same period served as the control group.In practice,the control group received conventional body restraint,while the observation group adopted the reduction program.The incidence of unplanned extubation and restraint-related complications were compared between the two groups.Results:The body restraint rate and complication rate in the observation group were significantly lower(P<0.05).After nurse training,their knowledge mastery and operational ability were significantly higher than before training(P<0.01).Conclusion:The body restraint reduction program for severe neurological patients can effectively reduce the restraint rate and complication incidence,while helping improve nurses’restraint management capabilities,serving as an effective means to enhance overall nursing quality.
基金supported by High-Level Chinese Medical Hospital Promotion ProjectHLCMHPP2023089.
文摘Objective:To investigate whether the presence or absence of improvement in chronic severe functional constipation(CSFC)at the early stage of treatment with electroacupuncture predicts subsequent response or non-response,and to determine the optimal treatment duration for assessing subsequent responses to electroacupuncture.Methods:This is a post hoc analysis using data pooled from two large-scale randomized controlled trials.Patients with CSFC were recruited,and those in the electroacupuncture groups were included in the present study.Early improvement was defined as a weekly increase of≥1 complete spontaneous bowel movement(CSBM)compared to baseline.Three treatment response criteria were evaluated:≥3CSBMs per week,overall CSBM response,and sustained CSBM response.Predictive statistics,including sensitivity,specificity,positive predictive value,and negative predictive value,were calculated at weeks1–4.Receiver operating characteristic curves and accuracy rates were used to determine the optimal timepoint for differentiation between responders and non-responders.Results:Cases from a total of 813 participants who received electroacupuncture were analyzed.The proportion of improvers was 40.34%by week 1,increasing to 52.52%by week 4.After 8 weeks of treatment,the response rates were 30.14%,25.83%and 25.58%according to the three aforementioned criteria,respectively.Early improvement was a strong predictor of treatment response,with week 3 demonstrating the highest predictive accuracy.Conclusion:Early improvement with electroacupuncture,especially at week 3,can predict subsequent outcomes.Our findings suggest that acupuncturists may identify non-responders who might require adjustments to therapeutic strategies early in treatment.
基金supported by the Provincial Natural Science Foundation of Hunan Province (2024JJ5603)。
文摘Microscopic polyangiitis (MPA) is an autoimmune disorder characterized by pulmonary capillaritis and necrotizing glomerulonephritis triggered by the deposition of oligoimmune complexes.This condition primarily aff ects the lungs and kidneys.^([1])The key pathological features in the lungs associated with MPA include pulmonary interstitial fibrosis and diffuse alveolar hemorrhage (DAH),which clinically present as cough,sputum production,hemoptysis,and dyspnea.[2] In this report,we present a patient with MPA complicated by severe anemia and DAH,notably without the typical symptoms of hemoptysis.
基金supported by Anhui Provincial Scientific Research Preparation Plan Project(2023AH040079)Anhui Provincial Health Research Project(AHWJ2023A10095).
文摘BACKGROUND: Severe acute pancreatitis(SAP) is commonly associated with acute organ failure, but its effects on cerebral function within intensive care unit(ICU) patients remains inadequately researched. This study aims to determine the prevalence of delirium in critically ill patients diagnosed with SAP, and to identify risk factors associated with delirium in this patient population.METHODS: This was a retrospective, multicenter study, which enrolled adult patients diagnosed with SAP who admitted intensive care unit(ICU) for at least 24 h. Patient assessment was conducted using the Richmond Agitation-Sedation Scale(RASS) and the Confusion Assessment Method for the ICU(CAM-ICU). The cumulative incidence of delirium was determined. Demographic, clinical data, and length of ICU stay were compared between patients with and without delirium. A logistic regression model was employed to identify potential risk factors for delirium. RESuLTS: A total of 1,814 patients were included from seven hospitals in Anhui province, China. Delirium was observed in 25.2% of patients. Logistic regression analysis identified APACHE II scores(odds ratio [OR]=3.37, 95% confidence interval [CI]: 1.09–10.43, P=0.04), physical restraint(OR=11.11, 95%CI: 4.35–28.39, P<0.05), invasive mechanical ventilation(IMV)(OR=2.44, 95%CI: 1.41–4.25, P=0.002), and ICU length of stay ≥ 7 days(OR=3.14, 95%CI: 2.27–4.36, P<0.05) as independent risk factors of delirium.cONcLuSION: The present study revealed a substantial incidence of delirium in critically ill patients with SAP, associated with factors including APACHE II score, IMV, physical restraint, and prolonged ICU stays.
基金Sichuan Provincial Medical Scientific Research Project(Project No.:s19085)。
文摘Objective:To explore the role of lung ultrasound combined with multi-organ evaluation in assessing the risk of weaning from mechanical ventilation(MV)in severe patients.Methods:A retrospective analysis was conducted on 60 severe patients admitted to the hospital from December 2022 to December 2024,all of whom underwent MV treatment.Based on weaning status,thirty-eight patients were successfully weaned(success group),and 22 patients failed weaning(failure group).All patients underwent lung ultrasound and multi-organ evaluation.The parameter differences between the two groups were compared,risk factors for weaning risk were evaluated,and a receiver operating characteristic curve(ROC)was drawn to assess the predictive value of lung ultrasound combined with multi-organ evaluation for weaning risk.Results:The lung ultrasound score(LUS)of the success group was lower than that of the failure group,the left ventricular ejection fraction(LVEF)was higher than that of the failure group,and the diaphragmatic excursion(DE)and diaphragmatic thickening fraction(DTF)were higher than those of the failure group(P<0.05).Multifactor analysis showed that LUS was a risk factor for weaning risk,while LVEF,DE,and DTF were protective factors(P<0.05).The ROC showed that the area under the curve(AUC)of a single parameter for weaning risk was smaller than that of the combined parameters(P<0.05).Conclusion:Lung ultrasound combined with multi-organ evaluation can predict the weaning risk of severe patients undergoing MV treatment,and the diagnostic efficiency of multiple parameters combined evaluation is higher.
文摘Infective endocarditis(IE) remains a severe and life-t hreatening disease, with rising incidence and a particularly high mortality rate, especially among elderly patients.^([1]) While antibiotics are the mainstay of treatment, the success rate in left-sided IE is often limited,as nearly half of all patients eventually require surgical intervention for definitive management.^([2]) Heart failure is the main indication for surgery, but access to surgery is frequently restricted by several factors, particularly in patients with advanced age, often driven by the presence of comorbidities or hemodynamic instability.^([3,4])
基金Supported by the Hainan Provincial Natural Science Foundation of China,No.824MS173 and No.823MS165the Project of Hainan Province Clinical Medical Center.
文摘BACKGROUND Angiostrongylus cantonensis-induced acute parasitic infection is a rare food-borne disease in clinical practice.Lack of its specific laboratory markers and subsequent difficulty in detecting pathogens cause high misdiagnosis and missed diagnosis rates.CASE SUMMARY A 20-year-old male developed persistent neck and back pain after consuming raw snail meat,followed by urinary retention and low fever.After admission,the patient was misdiagnosed as viral infection and Mycobacterium tuberculosis in central nervous system.After detection of Angiostrongylus cantonensis in blood and cerebrospinal fluid by metagenomics next generation sequencing,albendazole was administered with ceftriaxone and methylprednisolone treatment simultaneously.With effective antiparasitic treatment,the patient weaned from mechanical ventilation successfully and transferred out of intensive care unit for hyperbaric oxygen and rehabilitation treatment.CONCLUSION This case highlights the diagnostic challenges of Angiostrongylus cantonensis infection and the importance of advanced sequencing techniques in identifying rare pathogens.
文摘This review aims to gain a deeper understanding of the current interventions used in high-income and low-and middle-income countries worldwide on treatment engagement among persons with severe mental illnesses.Treatment engagement involves cultivating therapeutic partnerships to address patients’unique needs and challenges.This multifaceted process requires sensitivity,collaboration,and a tailored approach to promote positive outcomes.Effective treatment engagement reduces the chances of relapse and rehospitalization and helps individuals steer through their daily lives and social relationships.Through literature analysis,it was found that individual,situational,and environmental factors affected treatment engagement.Community nurses are crucial in promoting behavioral changes by engaging patients and applying tailor-made interventions.Applying problem-solving,coping skills,and strategies to address factors influencing adherence,motivational interviewing,and telephone follow-ups yielded significant results.The interventions recommended in community settings are tele-aftercare programs and home visits to address issues of dropped-out persons with severe mental illnesses and ensure continuity of treatment.Accessible,nonstigmatizing,non-coercive,informal,and appropriate services are suggested.These interventions can improve treatment engagement,medication adherence,and therapeutic alliance,thereby reducing symptoms and improving patients’quality of life.
基金Key-Area Research and Development Program of Guangdong (2020B1111200001)National Natural Science Foundation of China (42230105, U2142213, 42175167)。
文摘Taking short-duration heavy rainfall and convective wind gusts as examples, the present study examined the characteristics of radar reflectivity and several convective parameters. We analyzed nowcasting techniques by integrating a high-resolution numerical weather prediction model with these convective parameters. Based on the CMA-GD 1-km model and its assimilation system, we conducted repeated tests on radar reflectivity data assimilation and analyzed their impact on nowcasting accuracy. Based on these analyses, we proposed a method to improve model forecasts using the useful indicative information provided by high-frequency radar reflectivity data and convective parameters. The improved method was applied to the CMA-GD 1-km model for nowcasting tests. Evaluations from batch tests and case analysis show that the proposed method significantly reduced the model's false alarm rates and improved its nowcasting performance.
基金supported by grants from the National Nature Science Foundation of China(82370651 and 82070657).
文摘Background:Hemorrhage remains a formidable complication of severe acute pancreatitis(SAP),with a high mortality rate.However,there is currently no effective method for identifying SAP patients who are at high risk for massive bleeding.The present study aimed to explore risk factors for predicting massive bleeding in SAP patients and to develop a predictive nomogram,which could facilitate early prediction,and timely appropriate interventions.Methods:We conducted a multivariate logistic regression analysis to examine the relationship between massive bleeding and variables including patient demographics,disease severity,laboratory indexes and local pancreatic complications.A novel nomogram was constructed based on these factors,and was vali-dated both internally and externally assessing its discrimination,calibration,and clinical applicability.Results:The study involved 351 patients in the training cohort,104 patients in the internal validation cohort,and 123 patients in the external validation cohort.Logistic regression analysis identified several independent risk factors for massive bleeding,including computed tomography severity index score above 8 points,Acute Physiology and Chronic Health Evaluation II score greater than 16 points,abdominal com-partment syndrome,pancreatic fistula,and sepsis.The nomogram constructed from these factors yielded an area under the receiver operating characteristic curve(AUC)of 0.896 and a coefficient of determination(R²)of 0.093.The Hosmer-Lemeshow test indicated good model fitness(P=0.654).Furthermore,the nomogram demonstrated reliable performance in both validation cohorts.Conclusions:The nomogram showed strong predictive capability for massive bleeding and could be a valuable tool for clinicians in identifying SAP patients at high risk for this complication at an early stage.
文摘Objective: To explore the application effect of nursing interventions based on APACHE II scores in patients with severe pancreatitis and its impact on the recovery time of the gastrointestinal function. Methods: A total of 86 patients with severe pancreatitis treated in our hospital from March 2023 to March 2024 were selected. Using a random number table method, the patients were divided into a control group receiving conventional nursing care and a study group receiving nursing interventions based on APACHE II scores, with 43 patients in each group. The intervention effects of the two groups were compared. Results: The recovery time of gastrointestinal function in the study group was significantly shorter than that in the control group (P < 0.05). After the intervention, the quality of life scores in the study group was significantly higher than those in the control group (P < 0.05). The incidence of complications in the study group was significantly lower than in the control group (P < 0.05). Conclusion: Nursing interventions based on APACHE II scores can shorten gastrointestinal recovery time and reduce complications in patients with severe pancreatitis, contributing to improved quality of life.
