Background: Early identification of patients with high mortality risk is critical for optimizing the clinical management of drug-induced liver injury(DILI). We aimed to develop and validate a new prognostic model to p...Background: Early identification of patients with high mortality risk is critical for optimizing the clinical management of drug-induced liver injury(DILI). We aimed to develop and validate a new prognostic model to predict death within 6 months in DILI patients. Methods: This multicenter study retrospectively reviewed the medical records of DILI patients admitted to three hospitals. A DILI mortality predictive score was developed using multivariate logistic regression and was validated with area under the receiver operating characteristic curve(AUC). A high-mortality-risk subgroup was identified according to the score. Results: Three independent DILI cohorts, including one derivation cohort( n = 741) and two validation cohorts( n = 650, n = 617) were recruited. The DILI mortality predictive(DMP) score was calculated using parameters at disease onset as follows: 1.913 × international normalized ratio + 0.060 × total bilirubin(mg/d L) + 0.439 × aspartate aminotransferase/alanine aminotransferase – 1.579 × albumin(g/d L) –0.006 × platelet count(109/L) + 9.662. The predictive performance for 6-month mortality of DMP score was desirable, with an AUC of 0.941(95% CI: 0.922-0.957), 0.931(0.908-0.949) and 0.960(0.942-0.974) in the derivation, validation cohorts 1 and 2, respectively. DILI patients with a DMP score ≥ 8.5 were stratified into high-risk group, whose mortality rates were 23-, 36-, and 45-fold higher than those of other patients in the three cohorts. Conclusions: The novel model based on common laboratory findings can accurately predict mortality within 6 months in DILI patients, which should serve as an effective guidance for management of DILI in clinical practice.展开更多
Objective:In 2022,a pneumonia caused by novel coronavirus broke out in Shanghai.A large number of medical personnel were deployed nationwide to support the Fangcang Shelter Hospital of National Exhibition and Conventi...Objective:In 2022,a pneumonia caused by novel coronavirus broke out in Shanghai.A large number of medical personnel were deployed nationwide to support the Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai).Because the of the underdeveloped infrastructure and the disorganized layout process,the phenomenon of infection among medical personnel was rampant given the highly contagious nature of the Omicron variant.This paper discusses the effect of 6S management in infection control management of Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai).Methods:A series of 6S management practices were carried out based on the evaluation of the control management of Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai)during the anti-epidemic period,and the effect of the implementation of 6S management was studied based on the rapport among team members and the overall control system process,the management of wearing and stripping channels,the time of wearing protective articles and the psychological and emotional changes of the team members.Results:After the implementation of 6S management mode,the management of dressing room,epidemic prevention materials,and occupational protection awareness and infection control safety were significantly improved.More than 95.5%of the team members believed that improving the working environment in the shelter increased the confidence of victory in the fight against the epidemic,reduced the preparations before entering and leaving the cabin,improved the work efficiency and ensured occupational safety.It ensures the realization of the goal of“zero infection”and is set as a benchmark of control work of Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai).Conclusion:The application of 6S management mode to the shelter infection control management can create and maintain a good working environment in the shelter,promote the implementation effect of various systems and processes of infection control,reduce the potential infection risk in the shelter and improve the efficiency of infection control management.展开更多
Objective:To study the factors influencing the length of stay in patients with COVID-19.Methods:The clinical data of 110 patients with COVID-19 who were infected with Omicron virus for more than 10 days from April to ...Objective:To study the factors influencing the length of stay in patients with COVID-19.Methods:The clinical data of 110 patients with COVID-19 who were infected with Omicron virus for more than 10 days from April to May 2022 were collected.Their gender,age,smoking status,clinical manifestations related to pneumonia,whether they were combined with other basic diseases and vaccination status were analyzed.The above influencing factors were analyzed by single factor regression analysis,followed by Cox regression model analysis.Results:The age of patients had an effect on the length of hospital stay.The median length of hospital stay of patients that are<50 years old,50-64 years old and≥65 years old were 14,14,and 17 days respectively(χ^(2)=9.346,P=0.009).The presence of coronavirus-related symptoms also affects the length of hospital stay(χ^(2)=4.840,P=0.028).The results of multivariate regression model showed that age(χ^(2)=8.669,P=0.006)and coronavirus-related symptoms(χ^(2)=5.424,P=0.020)were independent factors affecting the length of hospital stay.Conclusion:During the development of COVID-19,the age of patients and whether they have coronavirus-related symptoms are positively correlated with the length of stay.Gender,habit of smoking,presence of other basic diseases and vaccination are not related to the length of stay.展开更多
Liver pathology remains the gold standard for diagnosing liver fibrosis,yet it falls short in meeting the broad clinical needs for screening,diagnosis,monitoring,and efficacy assessment.Non-invasive tests(NITs)offer a...Liver pathology remains the gold standard for diagnosing liver fibrosis,yet it falls short in meeting the broad clinical needs for screening,diagnosis,monitoring,and efficacy assessment.Non-invasive tests(NITs)offer a crucial alternative.The recent review by Lai et al.comprehensively covers various NITs and their applications across liver diseases of different etiologies,enhancing their clinical use by healthcare providers[1].This commentary expands on the evolving role of non-invasive assessment for liver fibrosis discussed in the review by Lai et al.,highlighting recent advancements and comparisons,and the significance of dynamic changes in the research development and clinical utilization of non-invasive assessment in patients with liver disease.展开更多
基金supported by grants from the National Key R&D Program of China (2021ZD0113200)the National Natural Sci-ence Foundation of China (81900526)
文摘Background: Early identification of patients with high mortality risk is critical for optimizing the clinical management of drug-induced liver injury(DILI). We aimed to develop and validate a new prognostic model to predict death within 6 months in DILI patients. Methods: This multicenter study retrospectively reviewed the medical records of DILI patients admitted to three hospitals. A DILI mortality predictive score was developed using multivariate logistic regression and was validated with area under the receiver operating characteristic curve(AUC). A high-mortality-risk subgroup was identified according to the score. Results: Three independent DILI cohorts, including one derivation cohort( n = 741) and two validation cohorts( n = 650, n = 617) were recruited. The DILI mortality predictive(DMP) score was calculated using parameters at disease onset as follows: 1.913 × international normalized ratio + 0.060 × total bilirubin(mg/d L) + 0.439 × aspartate aminotransferase/alanine aminotransferase – 1.579 × albumin(g/d L) –0.006 × platelet count(109/L) + 9.662. The predictive performance for 6-month mortality of DMP score was desirable, with an AUC of 0.941(95% CI: 0.922-0.957), 0.931(0.908-0.949) and 0.960(0.942-0.974) in the derivation, validation cohorts 1 and 2, respectively. DILI patients with a DMP score ≥ 8.5 were stratified into high-risk group, whose mortality rates were 23-, 36-, and 45-fold higher than those of other patients in the three cohorts. Conclusions: The novel model based on common laboratory findings can accurately predict mortality within 6 months in DILI patients, which should serve as an effective guidance for management of DILI in clinical practice.
文摘Objective:In 2022,a pneumonia caused by novel coronavirus broke out in Shanghai.A large number of medical personnel were deployed nationwide to support the Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai).Because the of the underdeveloped infrastructure and the disorganized layout process,the phenomenon of infection among medical personnel was rampant given the highly contagious nature of the Omicron variant.This paper discusses the effect of 6S management in infection control management of Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai).Methods:A series of 6S management practices were carried out based on the evaluation of the control management of Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai)during the anti-epidemic period,and the effect of the implementation of 6S management was studied based on the rapport among team members and the overall control system process,the management of wearing and stripping channels,the time of wearing protective articles and the psychological and emotional changes of the team members.Results:After the implementation of 6S management mode,the management of dressing room,epidemic prevention materials,and occupational protection awareness and infection control safety were significantly improved.More than 95.5%of the team members believed that improving the working environment in the shelter increased the confidence of victory in the fight against the epidemic,reduced the preparations before entering and leaving the cabin,improved the work efficiency and ensured occupational safety.It ensures the realization of the goal of“zero infection”and is set as a benchmark of control work of Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai).Conclusion:The application of 6S management mode to the shelter infection control management can create and maintain a good working environment in the shelter,promote the implementation effect of various systems and processes of infection control,reduce the potential infection risk in the shelter and improve the efficiency of infection control management.
文摘Objective:To study the factors influencing the length of stay in patients with COVID-19.Methods:The clinical data of 110 patients with COVID-19 who were infected with Omicron virus for more than 10 days from April to May 2022 were collected.Their gender,age,smoking status,clinical manifestations related to pneumonia,whether they were combined with other basic diseases and vaccination status were analyzed.The above influencing factors were analyzed by single factor regression analysis,followed by Cox regression model analysis.Results:The age of patients had an effect on the length of hospital stay.The median length of hospital stay of patients that are<50 years old,50-64 years old and≥65 years old were 14,14,and 17 days respectively(χ^(2)=9.346,P=0.009).The presence of coronavirus-related symptoms also affects the length of hospital stay(χ^(2)=4.840,P=0.028).The results of multivariate regression model showed that age(χ^(2)=8.669,P=0.006)and coronavirus-related symptoms(χ^(2)=5.424,P=0.020)were independent factors affecting the length of hospital stay.Conclusion:During the development of COVID-19,the age of patients and whether they have coronavirus-related symptoms are positively correlated with the length of stay.Gender,habit of smoking,presence of other basic diseases and vaccination are not related to the length of stay.
基金Beijing High-Level Public Health Technical Talent Construction Project[grant number 03-23]Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support[grant number ZLRK202301]Scientific Research Project of Beijing Youan Hospital,CCMU[grant number BJYAYY-YN2022-21].
文摘Liver pathology remains the gold standard for diagnosing liver fibrosis,yet it falls short in meeting the broad clinical needs for screening,diagnosis,monitoring,and efficacy assessment.Non-invasive tests(NITs)offer a crucial alternative.The recent review by Lai et al.comprehensively covers various NITs and their applications across liver diseases of different etiologies,enhancing their clinical use by healthcare providers[1].This commentary expands on the evolving role of non-invasive assessment for liver fibrosis discussed in the review by Lai et al.,highlighting recent advancements and comparisons,and the significance of dynamic changes in the research development and clinical utilization of non-invasive assessment in patients with liver disease.
