BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU ad...BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.展开更多
BACKGROUND The adoption of telehealth services surged after the coronavirus disease 2019 pandemic,revolutionizing traditional healthcare delivery models.Amazon Clinic's recent nationwide launch marks a significant...BACKGROUND The adoption of telehealth services surged after the coronavirus disease 2019 pandemic,revolutionizing traditional healthcare delivery models.Amazon Clinic's recent nationwide launch marks a significant milestone in this trend.This study aims to offer a strengths,weaknesses,opportunities,and threats(SWOT)analysis of Amazon Clinic and compare its features with leading virtual healthcare platforms.AIM To evaluate Amazon Clinic's telehealth services through a SWOT analysis and compare its features with other leading virtual healthcare platforms.METHODS The initial search terms included were,amazon clinic odds ratio(OR)amwell OR Teladoc OR Walmart virtual health service OR CVS minute clinic OR CirrusMD OR brightside health,from 2000 to 2023.This search yielded 111 articles,from which duplicates were removed,and unrelated titles were filtered out.Eight articles were retained for a final review,including comparative studies,usability research,retrospective analyses,observational studies,and review articles.The data was organized and analyzed using Rayyan software and summarized in a table and PRISMA flowcharts.RESULTS The review included eight articles focusing on various aspects of telehealth.Comparative studies highlighted differences between Teladoc and traditional physician offices,noting lower diagnostic imaging orders and antibiotic prescriptions for Teladoc.User demographics for Teladoc showed younger,less engaged patients.Usability studies emphasized the importance of website design for telemedicine adoption.Tele-mental health platforms like Brightside showed superior outcomes in treating depression compared to traditional methods.Telemedicine for specialized fields like skin reconstruction demonstrated cost efficiency and reduced waiting times.The SWOT analysis identified Amazon Clinic's strengths,such as its vast consumer base and transparent pricing,and weaknesses like the lack of pediatric care.Opportunities included potential partnerships and service expansions,while threats involved competition and regulatory challenges.CONCLUSION Amazon Clinic's entry into the telehealth sector represents a significant development with various strengths and opportunities.However,it faces challenges from established healthcare providers and regulatory landscapes.The future success of Amazon Clinic will depend on strategic collaborations,addressing service gaps,and navigating competition and regulations.Telemedicine's impact will hinge on its ability to effectively leverage these opportunities and overcome inherent challenges in the ever-evolving healthcare landscape.展开更多
BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not scr...BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not screened.Current practice guidelines include male gender as a predisposing factor for BE and EAC.The population-based clinical evidence regarding female gender remains limited.AIM To study comparative trends of gender disparities in patients with BE in the United States.METHODS A nationwide retrospective study was conducted using the 2009-2019 National Inpatient Sample(NIS)database.Patients with a primary or secondary diagnosis code of BE were identified.The major outcome of interest was determining the gender disparities in patients with BE.Trend analysis for respective outcomes for females was also reported to ascertain any time-based shifts.RESULTS We identified 1204190 patients with BE for the study period.Among the included patients,717439(59.6%)were men and 486751(40.4%)were women.The mean age was higher in women than in men(67.1±0.4 vs 66.6±0.3 years,P<0.001).The rate of BE per 100000 total NIS hospitalizations for males increased from 144.6 in 2009 to 213.4 in 2019(P<0.001).The rate for females increased from 96.8 in 2009 to 148.7 in 2019(P<0.001).There was a higher frequency of obesity among women compared to men(17.4%vs 12.6%,P<0.001).Obesity prevalence among females increased from 12.3%in 2009 to 21.9%in 2019(P<0.001).A lower prevalence of smoking was noted in women than in men(20.8%vs 35.7%,P<0.001).However,trend analysis showed an increasing prevalence of smoking among women,from 12.9%in 2009 to 30.7%in 2019(P<0.001).Additionally,there was a lower prevalence of alcohol abuse,Helicobacter pylori(H.pylori),and diabetes mellitus among females than males(P<0.001).Trend analysis showed an increasing prevalence of alcohol use disorder and a decreasing prevalence of H.pylori and diabetes mellitus among women(P<0.001).CONCLUSION The prevalence of BE among women has steadily increased from 2009 to 2019.The existing knowledge concerning BE development has historically focused on men,but our findings show that the risk in women is not insignificant.展开更多
BACKGROUND Hepatitis A virus(HAV)infection remains the most common cause of acute viral hepatitis globally.In the United States,recent outbreaks have been attributed primarily to person-to-person transmission,with vul...BACKGROUND Hepatitis A virus(HAV)infection remains the most common cause of acute viral hepatitis globally.In the United States,recent outbreaks have been attributed primarily to person-to-person transmission,with vulnerable populations such as people who use illicit drugs,those experiencing homelessness,and men who have sex with men disproportionately affected.AIM To assess the trends in HAV hospitalizations over the past decade and evaluate the impact of substance use on these hospitalizations.METHODS We conducted a retrospective study using the National Inpatient Sample database from 2011 to 2020.Adults(≥18 years)hospitalized with a primary diagnosis of HAV infection were included.We identified active substance use as a secondary diagnosis.Statistical analysis involved descriptive statistics,trend analysis,and propensity score matching to compare HAV hospitalizations with and without substance use.Outcomes included hospitalization trends,complications,length of stay(LOS),and mortality.RESULTS From 2011 to 2020,there were 56972 hospitalizations for HAV infections.Hospitalizations increased from 3917 in 2011 to 8290 in 2020,peaking at 9800 in 2018.Caucasian males(55%)were the most affected,with a mean age of 49 years.The prevalence of active substance use among HAV hospitalizations was 27%,with these patients being younger(mean age:39 years)and predominantly male(63.1%).HAV hospitalizations associated with substance use increased significantly,rising from 235 cases in 2011 to 3200 in 2020(P<0.001).Compared to HAV hospitalizations without substance use,those with substance use had higher rates of co-infections(hepatitis C virus 45%vs 11%,hepatitis B virus 11%vs 6%)and complications,including sepsis(1.9%vs 1%)and infective endocarditis(1.4%vs 0.15%,P<0.001).Hospitalizations with substance use also had longer LOS(4.34 days vs 3.97 days,P<0.05),but mortality rates were comparable.Predictors of mortality in HAV-substance use hospitalizations included acute liver failure,sepsis,and acute respiratory failure.CONCLUSION HAV hospitalizations in the United States have significantly increased over the past decade,with the rise driven by cases involving substance use.These patients face a higher burden of complications and healthcare utilization.Tailored public health strategies,including targeted vaccination and outreach programs for at-risk populations,are essential to reduce the morbidity,mortality,and economic burden associated with HAV.展开更多
BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outc...BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.展开更多
The second edition of the United Arab Emirates inflammatory bowel disease(IBD)consensus guidance provides updated recommendations for diagnosing,treating,and monitoring IBD.Significant therapeutic advances and evolvin...The second edition of the United Arab Emirates inflammatory bowel disease(IBD)consensus guidance provides updated recommendations for diagnosing,treating,and monitoring IBD.Significant therapeutic advances and evolving treatment paradigms since 2020(including risk stratification and treat-to-target approaches)necessitated this comprehensive update to standardize care across the United Arab Emirates.Developed via Delphi consensus methodology,this guidance incorporates a systematic literature review and key international gui-delines.It presents 188 summary statements covering the full spectrum of IBD care,including complex scenarios like perianal disease and pregnancy.Key updates feature guidance on newer pharmacologic therapies-interleukin-23,Janus kinase,and sphingosine-1-phosphate receptor inhibitors-with refined therapeutic positioning informed by recent head-to-head trials.The consensus emphasizes early,effective treatment to prevent irreversible bowel damage,optimization strategies like therapeutic drug monitoring,and achieving objective treat-to-target goals to improve long-term outcomes.Recognizing local healthcare system challenges,it offers practical recommendations on reducing variability and enhancing equitable access to IBD care.By integrating current clinical evidence with United Arab Emirates-specific considerations,the second edition United Arab Emirates IBD consensus guidance aims to standardize care across sectors,provide a benchmark for payers and policymakers,optimize treatment outcomes,and improve IBD outcomes,aligning national practice with international standards.展开更多
BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely ...BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely studied.AIM To determine the short-term mortality outcome and identify the potential prognostic factors of CRC cancer patients admitted to the ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at the ICU departments of 37 cancer specialized hospitals in China,and included patients aged≥14 years with ICU duration≥24 hours.Clinical records of patients with a primary CRC diagnosis were reviewed.Patients were separated into groups according to 90-day survival.Characteristics between groups were compared.Univariate and multivariate regression tests were used to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS In total,189 CRC patients were included in the study.The 90-day mortality was 12.2%.Patients who died showed differences compared to patients who survived mostly in terms of disease severity and ICU complications.It appears that patients admitted to the ICU from a clinical ward due to emergencies may have a higher risk of mortality while surgical management was associated with better survival.In multivariate analysis,only chemotherapy,elective surgery and conventional oxygen therapy were identified as independently correlated with 90-day mortality.Sequential organ failure assessment and acute physiology and chronic health evaluation II scores had moderate accuracy in predicting short-term mortality.CONCLUSION ICU admitted CRC patients appear to have low short-term mortality which requires further confirmation in prospective studies.The prognostic tools for these patients need further optimization.展开更多
BACKGROUNDLimited research exists on attitudes and barriers to organ donation in the UnitedArab Emirates, highlighting the need for a deeper understanding of public perceptionsand challenges.AIMTo assess the attitudes...BACKGROUNDLimited research exists on attitudes and barriers to organ donation in the UnitedArab Emirates, highlighting the need for a deeper understanding of public perceptionsand challenges.AIMTo assess the attitudes and barriers toward organ donation.METHODSA cross-sectional study was adopted and included 607 samples consisting ofstudents, faculty, and staff who were selected from three universities in Ajmanand who had signed consent forms. A validated self-administered questionnairethat included 13 attitudes and 14 barrier items was used as a tool. The reliabilityof the tool was 0.89 (Cronbach's alpha). In the analysis of attitude scores, responseswere rated on a scale from 0 to 4, with 0 representing 'strongly disagree'and 4 representing 'strongly agree' for supportive attitudes towards organdonation. Participants with a total attitude score of 39 or higher indicated agreementor strong agreement with all items, reflecting a generally supportiveattitude toward organ donation. Lower scores suggested that the respondent wasneutral or disagreed with one or more items, indicating a less supportive attitudetoward organ donation. Knowledge about organ donation was assessed by selfadministeredquestionnaire that included 13 items. Analysis was done using SPSSversion 29. χ2 was used to assess associations between variables.RESULTSMost participants were young (≤ 30 years old, 83.7%), female (79.2%), from World Health Organization Eastern Mediterranean Region countries (69.5%), Muslim (82.4%), students (80.6%), single(83.9%), and from a nursing college (33.1%). The majority had no personal or family history of organ donation(93.2% and 93.9%, respectively). Supportive attitudes toward organ donation were significantly associated withreligion (P = 0.003), working status (P = 0.009), university (P = 0.019), and knowledge (P < 0.001). Additionally,those with a personal or family history of organ donation were significantly more supportive (56.8% vs 33.3%, P =0.004). Lack of awareness was the most reported barrier for organ donation (64.1%) followed by being afraid oforgan donation due to medical procedures required (51.9%).CONCLUSIONThe findings suggest that supportive attitudes toward organ donation are influenced by demographic factors,personal experiences, and knowledge levels. Lack of awareness and fear of medical procedures were the mostreported barriers to organ donation. These results highlight the need for targeted educational programs to increaseawareness and promote positive attitudes toward organ donation.展开更多
BACKGROUND Regulatory agencies are increasingly recognizing that minority trial repres-entation is inadequate,contributing to healthcare disparities.The scope of min-ority population disparities in clinical trial part...BACKGROUND Regulatory agencies are increasingly recognizing that minority trial repres-entation is inadequate,contributing to healthcare disparities.The scope of min-ority population disparities in clinical trial participation remains unclear,as previous studies have compiled enrollment data from published trials,which AIM To evaluate sex,racial and ethnic inequities in liver transplantation(LT)trials participation in the United States.METHODS We used data from completed United States liver transplant clinical trials registered and reported on the National Institute of Health(NIH)website(clincaltrials.gov).Demographic data,including race,ethnicity,sex,and age were collected.To make inferences to a larger population,95%CIs were computed for estimates in each demographic group using the Wilson method for binomial proportions.We also computed the simultaneous 95%CIs by applying a Bonferroni correction to reflect the multinomial distribution of race proportions.The numbers and percentages of racial/ethnic minority and female individuals compared with United States census data from 2010 and 2018.Secondary outcome measures were inclusion by trial funding source and year of completion.RESULTS A total of 69 United States based clinical trials involving 6990 participants were included in the analysis.Of these,35 trials(51%)were randomized,and 26(38%)were conducted across multiple United States regions.All trials reported sex,while 42(61%)reported race and 27(39%)reported ethnicity.Compared to United States census data,Asian individuals were overrepresented(9.3%;95%CI:8.1%-10.5%),whereas African American(7.8%;95%CI:6.7%-8.9%)and American Indian or Alaska Native individuals(0.4%;95%CI:0.1%-0.6%)were underrepresented.The proportion of White participants(75.9%;95%CI:74.1%-77.7%)was consistent with census estimates.Hispanic participants were underrepresented(13.3%;95%CI:12.2%-14.5%)regardless of the census year referenced.In industry-sponsored trials,Asian representation was three times higher than in the general population(15%).NIH funded trials showed overrepresentation of White participants(83.8%)and underrepresentation of Black participants(4.1%)relative to census data.Women comprised 31.1%of all participants(95%CI:30.0%-32.2%),in-dicating underrepresentation.Among trials that reported racial data,62(90%)did not include participants of American Indian or Alaska Native,Native Hawaiian,or Pacific Islander descent.CONCLUSION Our analysis indicates that women,African Americans,and Hispanic individuals are underrepresented in LT clinical trials compared to the general United States population.These results highlight the need for regulatory initiatives aimed at enhancing the inclusion of historically marginalized racial and ethnic groups in clinical re-search.展开更多
BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits f...BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.展开更多
Temporary mechanical circulatory support (tMCS) devices such as intra-aorticballoon pumps, veno-arterial extracorporeal membrane oxygenation, and percutaneousventricular assist devices, play a major role in supporting...Temporary mechanical circulatory support (tMCS) devices such as intra-aorticballoon pumps, veno-arterial extracorporeal membrane oxygenation, and percutaneousventricular assist devices, play a major role in supporting patients withend-stage heart failure and bridging them to transplant. In 2018, the United Networkfor Organ Sharing heart allocation criteria was modified by increasing thenumber of statuses in the heart transplant waitlist to differentiate and favor thesickest patients awaiting transplantation. Within this new system, patients withtMCS devices receive the highest priority statuses. While the 2018 allocationsystem has reduced waitlist times and mortality for the highest-priority patients,some studies have shown a concomitant rise in the utilization of tMCS devices asbridge to transplant after its enaction. In this narrative review, we describe thesechanges in tMCS utilization and provide insights on how the upcoming creationof a continuous distribution allocation system may further impact these trends.展开更多
Knowledge graphs (KGs) offer a structured, machine-readable format for organizing complex information. In heterogeneous catalysis, where data on catalytic materials, reaction conditions, mechanisms, and synthesis rout...Knowledge graphs (KGs) offer a structured, machine-readable format for organizing complex information. In heterogeneous catalysis, where data on catalytic materials, reaction conditions, mechanisms, and synthesis routes are dispersed across diverse sources, KGs provide a semantic framework that supports data integration under the FAIR (Findable, Accessible, Interoperable, and Reusable) principles. This review aims to survey recent developments in catalysis KGs, describe the main techniques for graph construction, and highlight how artificial intelligence, particularly large language models (LLMs), enhances graph generation and query. We conducted a systematic analysis of the literature, focusing on ontology-guided text mining pipelines, graph population methods, and maintenance strategies. Our review identifies key trends: ontology-based approaches enable the automated extraction of domain knowledge, LLM-driven retrieval-augmented generation supports natural-language queries, and scalable graph architectures range from a few thousand to over a million triples. We discuss state-of-the-art applications, such as catalyst recommendation systems and reaction mechanism discovery tools, and examine the major challenges, including data heterogeneity, ontology alignment, and long-term graph curation. We conclude that KGs, when combined with AI methods, hold significant promise for accelerating catalyst discovery and knowledge management, but progress depends on establishing community standards for ontology development and maintenance. This review provides a roadmap for researchers seeking to leverage KGs to advance heterogeneous catalysis research.展开更多
Objectives This study aimed to develop a hospital-community-family trinity cardiac rehabilitation(CR)intervention program and assess its’effects on patients with acute myocardial infarction(AMI)after percutaneous cor...Objectives This study aimed to develop a hospital-community-family trinity cardiac rehabilitation(CR)intervention program and assess its’effects on patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods Between April 2022 and April 2023,patients who had experienced AMI after PCI were enrolled.These patients were randomly assigned to an intervention group(IG)or a control group(CG)in equal numbers.The CG received standard CR,while the IG participated in the advanced trinity CR program in addition to the standard CR.Key parameters measured included the anaerobic threshold(AT),maximum oxygen uptake(V̇O2max),maximum exercise load(MEL),metabolic equivalent(MET),left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),and quality of life(measured by the SF-36).These were assessed pre-intervention and at 3,6,9,and 12 months post-intervention.SPSS.26 was employed for data analysis,with statistical methods such as repeated measures analysis of variance(ANOVA),Chi-square tests,and independent sample t-tests.Results A total of 110 patients completed the intervention,55 in each group.There was no significant difference in the scores of all indicators between the two groups before intervention(P>0.05).However,at 3,6,9 and 12 months after intervention,the scores of AT,VO2max,MEL,MET,LVEDV,LVESV,LVEF,and quality of life in the intervention group were higher than those in the control group,there was statistical significance at four-time points,group,time,and interaction effect(P<0.05).Conclusions The hospital-community-family trinity CR intervention program developted in this study significantly improved exercise endurance,cardiac function,and quality of life in patients with AMI after PCI.展开更多
BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,whil...BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,while non-cardiac/nonthoracic surgery has a reported incidence between 0.4% to 15%,with new onset POAF occurring at a rate of 0.4% to 3%.While AF has been extensively studied,it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting(ICU).AIM To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.METHODS This retrospective study included patients≥18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU.Data of interest included occurrence of POAF,demographic characteristics,comorbidities,laboratory values,administered fluids,medications,and postoperative outcomes.Statistical analyses consisted of identifying predic-tors of POAF and associations of POAF with outcomes of interest.RESULTS A total of 347 ICU patients were included,16.4% had a history of AF,13.0% developed POAF,and 7.9%developed new-onset POAF.Patients with new-onset POAF were older(79.6±9.1 vs 68.1±14.8 years,<0.001),of white race(47.8%vs 28.8,P<0.001),hypertensive(87.0%vs 71.2%,P=0.011),had longer ICU length of stay(ICU-LOS)(13.4 vs 6.7 days,P=0.042),higher mortality(43.5%vs 17.6%,P=0.016)and higher rate of cardiac arrest(34.8%vs 14.6%,P=0.005)compared to patients without new-onset POAF.Multivariable analysis revealed increased POAF risk with advanced age(OR=1.06;95%CI:1.02-1.10,P=0.005),white race(OR=2.85;95%CI:1.26-6.76,P=0.014),high intraoperative fluid(OR>1;95%CI:1.00-1.00,P=0.018),and longer ICU-LOS(OR=1.04;95%CI:1.00-1.08,P=0.023).After adjusting for demographics,new onset POAF significantly predicted mortality(OR=3.07;95%CI:1.14-8.01,P=0.022).CONCLUSION POAF was associated with prolonged ICU-LOS,white race,and high intraoperative fluid.New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.展开更多
BACKGROUND Normothermic liver machine perfusion(NMP)is a novel technology used to preserve and evaluate the function of liver allografts.AIM To assess NMP utilization in liver transplant(LT)practices.METHODS All adult...BACKGROUND Normothermic liver machine perfusion(NMP)is a novel technology used to preserve and evaluate the function of liver allografts.AIM To assess NMP utilization in liver transplant(LT)practices.METHODS All adult deceased-donor LT recipients between January 2021 and September 2023 in the United States were analyzed.Outcomes including discard rates,survival,preservation time and timing of surgery were compared between two groups:NMP vs non-NMP.RESULTS Between 2021 and 2023,NMP was utilized in 1493(6.3%)of all LTs in the United States.Compared to non-NMP group,NMP group had lower allograft discard rate(6.5%vs 10%,P<0.001),older recipients’age(median:47 vs 42 years,P<0.001),and higher utilization of donors from donation after circulatory death(DCD)(55%vs 11%,P<0.001).NMP group also had longer distances between recipient and donor hospitals(median:156 vs 138 miles,P<0.001),longer preser-vation time(median:12.2 vs 5.8 hours,P<0.001),and more daytime reperfusion(74%vs 55%,P<0.001).Post-transplant survival outcomes were comparable between the two groups.In a subgroup analysis of NMP,recipients in the long preservation time(≥8 hours)group had higher daytime reperfusion(78%vs 55%,P<0.001)and similar post-transplant survival when compared to the short preservation time(<8 hours)group.CONCLUSION The utilization of NMP is associated with lower discard rates and increased DCD organs for LT.NMP allows for prolonging the preservation time and increased occurrence of daytime LT,without any impact on the survival outcomes.展开更多
In this editorial,we comment on the article by Xu et al published in the recent issue of the World Journal of Hepatology.The hepatitis B virus(HBV)has evolved sophisticated mechanisms to evade host innate immunity,a h...In this editorial,we comment on the article by Xu et al published in the recent issue of the World Journal of Hepatology.The hepatitis B virus(HBV)has evolved sophisticated mechanisms to evade host innate immunity,a hallmark of its persistent infections.This study highlights a pivotal role for HBV-encoded microRNA,specifically HBV-miR-3,in undermining the cyclic GMP-AMP synthase(cGAS)-stimulator of interferon genes(STING)-IFN signaling axis.This pathway is critical for recognizing viral DNA and subsequent production of type I interferons,key antiviral cytokines.HBV-miR-3 achieves this immune evasion by directly downregulating the expression of cGAS,an essential DNA sensor,and STING,its downstream adaptor.By silencing these components,HBV-miR-3 disrupts the activation of downstream interferon regulatory factor 3 and Nuclear Factor Kappa-light-chain-enhancer of Activated B Cells transcription factors,thereby blunting interferon beta production and antiviral gene expression.This strategy allows HBV to persist in hepatocytes by dampening innate immune responses and contributes to immune tolerance,fostering chronic infection.Understanding the role of HBV-miR-3 provides novel insights into HBV pathogenesis and identifies potential therapeutic targets to restore antiviral immunity.Targeting HBV-miR-3 or reactivating the cGAS-STING-IFN pathway could offer promising strategies to counteract HBV immune evasion and resolve chronic infection.展开更多
BACKGROUND In patients with chronic liver disease or hepatic dysfunction with sarcopenia,there is an increased risk of frailty as measured by functional impairment,making frailty a vital predictor of post-transplant m...BACKGROUND In patients with chronic liver disease or hepatic dysfunction with sarcopenia,there is an increased risk of frailty as measured by functional impairment,making frailty a vital predictor of post-transplant mortality.AIM To investigate the effects of frailty on mortality after liver transplantation.METHODS A retrospective review of post-transplant outcomes in liver transplant recipients assessed frailty using Karnofsky Performance Score.Data from the Scientific Registry of Transplant Recipients database for 37427 liver transplant recipients was used.RESULTS Of 82.7%frail patients,42.7%were severely frail and 40%were moderately frail(P<0.001)at the time of transplantation.Compared with non-frail patients,post-transplant mortality in frail patients was significantly higher at 12 months[odds ratio(OR)=1.94,P=0.02].Secondary analysis of the data revealed that liver grafts from donation after circulatory death(DCD)were more likely to be associated with frail patients at transplant(OR=1.86,P<0.001).Furthermore,a donor history of hypertension was associated with a lower likelihood of frailty in the recipient at the time of transplant(OR=0.65,P=0.03).CONCLUSION Recipient frailty is associated with increased mortality at 12 months following liver transplantation,and liver transplants from donors with DCD are associated with increased frailty of the liver transplant recipient.展开更多
BACKGROUND Viral hepatitis is characterized by a group of hepatotropic viruses that contribute to high rates of liver disease and mortality.It is well-documented that viral hepatitis is the leading cause of liver canc...BACKGROUND Viral hepatitis is characterized by a group of hepatotropic viruses that contribute to high rates of liver disease and mortality.It is well-documented that viral hepatitis is the leading cause of liver cancer and liver failure,with Hepatitis B and Hepatitis C being the most common viruses associated with these outcomes.AIM To study viral hepatitis-related mortality trends from 1999 to 2022,focusing on gender,race/ethnicity,age,region,and urban/rural classifications.METHODS We used the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database to identify viral hepatitis-related deaths in the United States from 1999 to 2022.Data on demographic and regional information were analyzed and stratified by gender,race/ethnicity,age,regional,and urban rural classifications.Using the Joinpoint Regression Program(version 4.9.0.0 used,available from the National Cancer Institute,Bethesda,Maryland)the annual percentage change(APC)and average APC(AAPC)were calculated with 95%CI for extracted Age Adjusted Mortality Rates(AAMR).RESULTS From 1999 to 2022,there were 389916 viral hepatitis-related deaths in the United States.The overall AAMR increased from 1999 to 2013(APC:3.20%;95%CI:2.54-3.99;P<0.001),then declined through 2022(APC:-5.54%;95%CI:-6.75 to-4.47;P<0.001).Males accounted for 70.4%of deaths,with steeper declines in females(AAPC:-0.48%;95%CI:-0.87 to-0.12;P<0.05).The American Indian/Alaska Native population had the highest AAMR(AAPC:2.90%;95%CI:2.30 to 3.68;P<0.001).The population of 65-74 years had the largest increase in overall crude mortality rate(AAPC:3.20%;95%CI:2.77 to 3.85;P<0.001).Mortality was highest in the West(AAPC:-0.78%;95%CI-1.28 to-0.29;P<0.05).Rural AAMR exceeded urban rates after 2015.CONCLUSION This study found significant racial,ethnic,and geographical disparities in viral hepatitis AAMR.Key factors for mortality reduction include patient education,screening,and access to hepatitis vaccination and treatment.展开更多
This paper conducts clustering,potential semantic indexing,comparison,and inductive analysis of research papers on marketing between China and the UK from January 2020 to September 2024.The study found that the Chines...This paper conducts clustering,potential semantic indexing,comparison,and inductive analysis of research papers on marketing between China and the UK from January 2020 to September 2024.The study found that the Chinese marketing research focuses on digital transformation,policy impact,value co-creation,and emerging e-commerce models.In contrast,the UK marketing research focuses more on sustainability,technology integration,real-time research,and personalized marketing strategies.The study also found that there were few marketing articles published in Chinese and CSSCI journals in China,while the SSCI journals published in English were 62 times more than in Chinese.According to the research,digital marketing and data-driven decision-making,diversified marketing channels,sustainability and circular economy,technological innovation and cutting-edge technology application,meta-universe and blockchain technology,AI+marketing development,brand building,and international market expansion will become the research hotspots in the field of marketing in the future.The research suggests that China should strengthen the construction of an academic marketing platform,and China and the UK should strengthen cooperation in marketing research,learn from each other's strengths,and jointly give full play to their advantages in technology application,market and economy,strategy and innovation,and social media,to contribute to global economic development and marketing research.展开更多
The Tube, Pipe & Bar Business Unit of Baosteel(hereinafter referred to as the Business Unit) actively practices the concept of green and low-carbon development and is committed to building a near-zero carbon pro-d...The Tube, Pipe & Bar Business Unit of Baosteel(hereinafter referred to as the Business Unit) actively practices the concept of green and low-carbon development and is committed to building a near-zero carbon pro-duction line.The low-carbon operation of the Business Unit is explored from seven aspects, including low-carbon and energy-saving operation in an electric arc furnace and extreme energy efficiency.Currently, extreme energy efficiency is the best practice for energy conservation and carbon reduction, and the research and development of low-carbon metallurgical technology, green energy development, biomass utilization, and carbon capture, utilization, and storage are important measures for achieving emission reduction goals, requiring further investments, research, and development.The Business Unit works closely with users in carrying out demonstration projects, continuously enhancing the influence of low-carbon products and continuing efforts to achieve the “Dual Carbon” goal.展开更多
文摘BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.
文摘BACKGROUND The adoption of telehealth services surged after the coronavirus disease 2019 pandemic,revolutionizing traditional healthcare delivery models.Amazon Clinic's recent nationwide launch marks a significant milestone in this trend.This study aims to offer a strengths,weaknesses,opportunities,and threats(SWOT)analysis of Amazon Clinic and compare its features with leading virtual healthcare platforms.AIM To evaluate Amazon Clinic's telehealth services through a SWOT analysis and compare its features with other leading virtual healthcare platforms.METHODS The initial search terms included were,amazon clinic odds ratio(OR)amwell OR Teladoc OR Walmart virtual health service OR CVS minute clinic OR CirrusMD OR brightside health,from 2000 to 2023.This search yielded 111 articles,from which duplicates were removed,and unrelated titles were filtered out.Eight articles were retained for a final review,including comparative studies,usability research,retrospective analyses,observational studies,and review articles.The data was organized and analyzed using Rayyan software and summarized in a table and PRISMA flowcharts.RESULTS The review included eight articles focusing on various aspects of telehealth.Comparative studies highlighted differences between Teladoc and traditional physician offices,noting lower diagnostic imaging orders and antibiotic prescriptions for Teladoc.User demographics for Teladoc showed younger,less engaged patients.Usability studies emphasized the importance of website design for telemedicine adoption.Tele-mental health platforms like Brightside showed superior outcomes in treating depression compared to traditional methods.Telemedicine for specialized fields like skin reconstruction demonstrated cost efficiency and reduced waiting times.The SWOT analysis identified Amazon Clinic's strengths,such as its vast consumer base and transparent pricing,and weaknesses like the lack of pediatric care.Opportunities included potential partnerships and service expansions,while threats involved competition and regulatory challenges.CONCLUSION Amazon Clinic's entry into the telehealth sector represents a significant development with various strengths and opportunities.However,it faces challenges from established healthcare providers and regulatory landscapes.The future success of Amazon Clinic will depend on strategic collaborations,addressing service gaps,and navigating competition and regulations.Telemedicine's impact will hinge on its ability to effectively leverage these opportunities and overcome inherent challenges in the ever-evolving healthcare landscape.
文摘BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not screened.Current practice guidelines include male gender as a predisposing factor for BE and EAC.The population-based clinical evidence regarding female gender remains limited.AIM To study comparative trends of gender disparities in patients with BE in the United States.METHODS A nationwide retrospective study was conducted using the 2009-2019 National Inpatient Sample(NIS)database.Patients with a primary or secondary diagnosis code of BE were identified.The major outcome of interest was determining the gender disparities in patients with BE.Trend analysis for respective outcomes for females was also reported to ascertain any time-based shifts.RESULTS We identified 1204190 patients with BE for the study period.Among the included patients,717439(59.6%)were men and 486751(40.4%)were women.The mean age was higher in women than in men(67.1±0.4 vs 66.6±0.3 years,P<0.001).The rate of BE per 100000 total NIS hospitalizations for males increased from 144.6 in 2009 to 213.4 in 2019(P<0.001).The rate for females increased from 96.8 in 2009 to 148.7 in 2019(P<0.001).There was a higher frequency of obesity among women compared to men(17.4%vs 12.6%,P<0.001).Obesity prevalence among females increased from 12.3%in 2009 to 21.9%in 2019(P<0.001).A lower prevalence of smoking was noted in women than in men(20.8%vs 35.7%,P<0.001).However,trend analysis showed an increasing prevalence of smoking among women,from 12.9%in 2009 to 30.7%in 2019(P<0.001).Additionally,there was a lower prevalence of alcohol abuse,Helicobacter pylori(H.pylori),and diabetes mellitus among females than males(P<0.001).Trend analysis showed an increasing prevalence of alcohol use disorder and a decreasing prevalence of H.pylori and diabetes mellitus among women(P<0.001).CONCLUSION The prevalence of BE among women has steadily increased from 2009 to 2019.The existing knowledge concerning BE development has historically focused on men,but our findings show that the risk in women is not insignificant.
文摘BACKGROUND Hepatitis A virus(HAV)infection remains the most common cause of acute viral hepatitis globally.In the United States,recent outbreaks have been attributed primarily to person-to-person transmission,with vulnerable populations such as people who use illicit drugs,those experiencing homelessness,and men who have sex with men disproportionately affected.AIM To assess the trends in HAV hospitalizations over the past decade and evaluate the impact of substance use on these hospitalizations.METHODS We conducted a retrospective study using the National Inpatient Sample database from 2011 to 2020.Adults(≥18 years)hospitalized with a primary diagnosis of HAV infection were included.We identified active substance use as a secondary diagnosis.Statistical analysis involved descriptive statistics,trend analysis,and propensity score matching to compare HAV hospitalizations with and without substance use.Outcomes included hospitalization trends,complications,length of stay(LOS),and mortality.RESULTS From 2011 to 2020,there were 56972 hospitalizations for HAV infections.Hospitalizations increased from 3917 in 2011 to 8290 in 2020,peaking at 9800 in 2018.Caucasian males(55%)were the most affected,with a mean age of 49 years.The prevalence of active substance use among HAV hospitalizations was 27%,with these patients being younger(mean age:39 years)and predominantly male(63.1%).HAV hospitalizations associated with substance use increased significantly,rising from 235 cases in 2011 to 3200 in 2020(P<0.001).Compared to HAV hospitalizations without substance use,those with substance use had higher rates of co-infections(hepatitis C virus 45%vs 11%,hepatitis B virus 11%vs 6%)and complications,including sepsis(1.9%vs 1%)and infective endocarditis(1.4%vs 0.15%,P<0.001).Hospitalizations with substance use also had longer LOS(4.34 days vs 3.97 days,P<0.05),but mortality rates were comparable.Predictors of mortality in HAV-substance use hospitalizations included acute liver failure,sepsis,and acute respiratory failure.CONCLUSION HAV hospitalizations in the United States have significantly increased over the past decade,with the rise driven by cases involving substance use.These patients face a higher burden of complications and healthcare utilization.Tailored public health strategies,including targeted vaccination and outreach programs for at-risk populations,are essential to reduce the morbidity,mortality,and economic burden associated with HAV.
文摘BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.
文摘The second edition of the United Arab Emirates inflammatory bowel disease(IBD)consensus guidance provides updated recommendations for diagnosing,treating,and monitoring IBD.Significant therapeutic advances and evolving treatment paradigms since 2020(including risk stratification and treat-to-target approaches)necessitated this comprehensive update to standardize care across the United Arab Emirates.Developed via Delphi consensus methodology,this guidance incorporates a systematic literature review and key international gui-delines.It presents 188 summary statements covering the full spectrum of IBD care,including complex scenarios like perianal disease and pregnancy.Key updates feature guidance on newer pharmacologic therapies-interleukin-23,Janus kinase,and sphingosine-1-phosphate receptor inhibitors-with refined therapeutic positioning informed by recent head-to-head trials.The consensus emphasizes early,effective treatment to prevent irreversible bowel damage,optimization strategies like therapeutic drug monitoring,and achieving objective treat-to-target goals to improve long-term outcomes.Recognizing local healthcare system challenges,it offers practical recommendations on reducing variability and enhancing equitable access to IBD care.By integrating current clinical evidence with United Arab Emirates-specific considerations,the second edition United Arab Emirates IBD consensus guidance aims to standardize care across sectors,provide a benchmark for payers and policymakers,optimize treatment outcomes,and improve IBD outcomes,aligning national practice with international standards.
文摘BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely studied.AIM To determine the short-term mortality outcome and identify the potential prognostic factors of CRC cancer patients admitted to the ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at the ICU departments of 37 cancer specialized hospitals in China,and included patients aged≥14 years with ICU duration≥24 hours.Clinical records of patients with a primary CRC diagnosis were reviewed.Patients were separated into groups according to 90-day survival.Characteristics between groups were compared.Univariate and multivariate regression tests were used to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS In total,189 CRC patients were included in the study.The 90-day mortality was 12.2%.Patients who died showed differences compared to patients who survived mostly in terms of disease severity and ICU complications.It appears that patients admitted to the ICU from a clinical ward due to emergencies may have a higher risk of mortality while surgical management was associated with better survival.In multivariate analysis,only chemotherapy,elective surgery and conventional oxygen therapy were identified as independently correlated with 90-day mortality.Sequential organ failure assessment and acute physiology and chronic health evaluation II scores had moderate accuracy in predicting short-term mortality.CONCLUSION ICU admitted CRC patients appear to have low short-term mortality which requires further confirmation in prospective studies.The prognostic tools for these patients need further optimization.
文摘BACKGROUNDLimited research exists on attitudes and barriers to organ donation in the UnitedArab Emirates, highlighting the need for a deeper understanding of public perceptionsand challenges.AIMTo assess the attitudes and barriers toward organ donation.METHODSA cross-sectional study was adopted and included 607 samples consisting ofstudents, faculty, and staff who were selected from three universities in Ajmanand who had signed consent forms. A validated self-administered questionnairethat included 13 attitudes and 14 barrier items was used as a tool. The reliabilityof the tool was 0.89 (Cronbach's alpha). In the analysis of attitude scores, responseswere rated on a scale from 0 to 4, with 0 representing 'strongly disagree'and 4 representing 'strongly agree' for supportive attitudes towards organdonation. Participants with a total attitude score of 39 or higher indicated agreementor strong agreement with all items, reflecting a generally supportiveattitude toward organ donation. Lower scores suggested that the respondent wasneutral or disagreed with one or more items, indicating a less supportive attitudetoward organ donation. Knowledge about organ donation was assessed by selfadministeredquestionnaire that included 13 items. Analysis was done using SPSSversion 29. χ2 was used to assess associations between variables.RESULTSMost participants were young (≤ 30 years old, 83.7%), female (79.2%), from World Health Organization Eastern Mediterranean Region countries (69.5%), Muslim (82.4%), students (80.6%), single(83.9%), and from a nursing college (33.1%). The majority had no personal or family history of organ donation(93.2% and 93.9%, respectively). Supportive attitudes toward organ donation were significantly associated withreligion (P = 0.003), working status (P = 0.009), university (P = 0.019), and knowledge (P < 0.001). Additionally,those with a personal or family history of organ donation were significantly more supportive (56.8% vs 33.3%, P =0.004). Lack of awareness was the most reported barrier for organ donation (64.1%) followed by being afraid oforgan donation due to medical procedures required (51.9%).CONCLUSIONThe findings suggest that supportive attitudes toward organ donation are influenced by demographic factors,personal experiences, and knowledge levels. Lack of awareness and fear of medical procedures were the mostreported barriers to organ donation. These results highlight the need for targeted educational programs to increaseawareness and promote positive attitudes toward organ donation.
文摘BACKGROUND Regulatory agencies are increasingly recognizing that minority trial repres-entation is inadequate,contributing to healthcare disparities.The scope of min-ority population disparities in clinical trial participation remains unclear,as previous studies have compiled enrollment data from published trials,which AIM To evaluate sex,racial and ethnic inequities in liver transplantation(LT)trials participation in the United States.METHODS We used data from completed United States liver transplant clinical trials registered and reported on the National Institute of Health(NIH)website(clincaltrials.gov).Demographic data,including race,ethnicity,sex,and age were collected.To make inferences to a larger population,95%CIs were computed for estimates in each demographic group using the Wilson method for binomial proportions.We also computed the simultaneous 95%CIs by applying a Bonferroni correction to reflect the multinomial distribution of race proportions.The numbers and percentages of racial/ethnic minority and female individuals compared with United States census data from 2010 and 2018.Secondary outcome measures were inclusion by trial funding source and year of completion.RESULTS A total of 69 United States based clinical trials involving 6990 participants were included in the analysis.Of these,35 trials(51%)were randomized,and 26(38%)were conducted across multiple United States regions.All trials reported sex,while 42(61%)reported race and 27(39%)reported ethnicity.Compared to United States census data,Asian individuals were overrepresented(9.3%;95%CI:8.1%-10.5%),whereas African American(7.8%;95%CI:6.7%-8.9%)and American Indian or Alaska Native individuals(0.4%;95%CI:0.1%-0.6%)were underrepresented.The proportion of White participants(75.9%;95%CI:74.1%-77.7%)was consistent with census estimates.Hispanic participants were underrepresented(13.3%;95%CI:12.2%-14.5%)regardless of the census year referenced.In industry-sponsored trials,Asian representation was three times higher than in the general population(15%).NIH funded trials showed overrepresentation of White participants(83.8%)and underrepresentation of Black participants(4.1%)relative to census data.Women comprised 31.1%of all participants(95%CI:30.0%-32.2%),in-dicating underrepresentation.Among trials that reported racial data,62(90%)did not include participants of American Indian or Alaska Native,Native Hawaiian,or Pacific Islander descent.CONCLUSION Our analysis indicates that women,African Americans,and Hispanic individuals are underrepresented in LT clinical trials compared to the general United States population.These results highlight the need for regulatory initiatives aimed at enhancing the inclusion of historically marginalized racial and ethnic groups in clinical re-search.
文摘BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.
文摘Temporary mechanical circulatory support (tMCS) devices such as intra-aorticballoon pumps, veno-arterial extracorporeal membrane oxygenation, and percutaneousventricular assist devices, play a major role in supporting patients withend-stage heart failure and bridging them to transplant. In 2018, the United Networkfor Organ Sharing heart allocation criteria was modified by increasing thenumber of statuses in the heart transplant waitlist to differentiate and favor thesickest patients awaiting transplantation. Within this new system, patients withtMCS devices receive the highest priority statuses. While the 2018 allocationsystem has reduced waitlist times and mortality for the highest-priority patients,some studies have shown a concomitant rise in the utilization of tMCS devices asbridge to transplant after its enaction. In this narrative review, we describe thesechanges in tMCS utilization and provide insights on how the upcoming creationof a continuous distribution allocation system may further impact these trends.
基金support from the Full Bridge Fellowship for enabling the research stay at Virginia Tech.H.Xin acknowledge the financial support from the US Department of Energy,Office of Basic Energy Sciences under contract no.DE-SC0023323from the National Science Foundation through the grant 2245402 from CBET Catalysis and CDS&E programs.
文摘Knowledge graphs (KGs) offer a structured, machine-readable format for organizing complex information. In heterogeneous catalysis, where data on catalytic materials, reaction conditions, mechanisms, and synthesis routes are dispersed across diverse sources, KGs provide a semantic framework that supports data integration under the FAIR (Findable, Accessible, Interoperable, and Reusable) principles. This review aims to survey recent developments in catalysis KGs, describe the main techniques for graph construction, and highlight how artificial intelligence, particularly large language models (LLMs), enhances graph generation and query. We conducted a systematic analysis of the literature, focusing on ontology-guided text mining pipelines, graph population methods, and maintenance strategies. Our review identifies key trends: ontology-based approaches enable the automated extraction of domain knowledge, LLM-driven retrieval-augmented generation supports natural-language queries, and scalable graph architectures range from a few thousand to over a million triples. We discuss state-of-the-art applications, such as catalyst recommendation systems and reaction mechanism discovery tools, and examine the major challenges, including data heterogeneity, ontology alignment, and long-term graph curation. We conclude that KGs, when combined with AI methods, hold significant promise for accelerating catalyst discovery and knowledge management, but progress depends on establishing community standards for ontology development and maintenance. This review provides a roadmap for researchers seeking to leverage KGs to advance heterogeneous catalysis research.
文摘Objectives This study aimed to develop a hospital-community-family trinity cardiac rehabilitation(CR)intervention program and assess its’effects on patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods Between April 2022 and April 2023,patients who had experienced AMI after PCI were enrolled.These patients were randomly assigned to an intervention group(IG)or a control group(CG)in equal numbers.The CG received standard CR,while the IG participated in the advanced trinity CR program in addition to the standard CR.Key parameters measured included the anaerobic threshold(AT),maximum oxygen uptake(V̇O2max),maximum exercise load(MEL),metabolic equivalent(MET),left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),and quality of life(measured by the SF-36).These were assessed pre-intervention and at 3,6,9,and 12 months post-intervention.SPSS.26 was employed for data analysis,with statistical methods such as repeated measures analysis of variance(ANOVA),Chi-square tests,and independent sample t-tests.Results A total of 110 patients completed the intervention,55 in each group.There was no significant difference in the scores of all indicators between the two groups before intervention(P>0.05).However,at 3,6,9 and 12 months after intervention,the scores of AT,VO2max,MEL,MET,LVEDV,LVESV,LVEF,and quality of life in the intervention group were higher than those in the control group,there was statistical significance at four-time points,group,time,and interaction effect(P<0.05).Conclusions The hospital-community-family trinity CR intervention program developted in this study significantly improved exercise endurance,cardiac function,and quality of life in patients with AMI after PCI.
文摘BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,while non-cardiac/nonthoracic surgery has a reported incidence between 0.4% to 15%,with new onset POAF occurring at a rate of 0.4% to 3%.While AF has been extensively studied,it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting(ICU).AIM To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.METHODS This retrospective study included patients≥18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU.Data of interest included occurrence of POAF,demographic characteristics,comorbidities,laboratory values,administered fluids,medications,and postoperative outcomes.Statistical analyses consisted of identifying predic-tors of POAF and associations of POAF with outcomes of interest.RESULTS A total of 347 ICU patients were included,16.4% had a history of AF,13.0% developed POAF,and 7.9%developed new-onset POAF.Patients with new-onset POAF were older(79.6±9.1 vs 68.1±14.8 years,<0.001),of white race(47.8%vs 28.8,P<0.001),hypertensive(87.0%vs 71.2%,P=0.011),had longer ICU length of stay(ICU-LOS)(13.4 vs 6.7 days,P=0.042),higher mortality(43.5%vs 17.6%,P=0.016)and higher rate of cardiac arrest(34.8%vs 14.6%,P=0.005)compared to patients without new-onset POAF.Multivariable analysis revealed increased POAF risk with advanced age(OR=1.06;95%CI:1.02-1.10,P=0.005),white race(OR=2.85;95%CI:1.26-6.76,P=0.014),high intraoperative fluid(OR>1;95%CI:1.00-1.00,P=0.018),and longer ICU-LOS(OR=1.04;95%CI:1.00-1.08,P=0.023).After adjusting for demographics,new onset POAF significantly predicted mortality(OR=3.07;95%CI:1.14-8.01,P=0.022).CONCLUSION POAF was associated with prolonged ICU-LOS,white race,and high intraoperative fluid.New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.
文摘BACKGROUND Normothermic liver machine perfusion(NMP)is a novel technology used to preserve and evaluate the function of liver allografts.AIM To assess NMP utilization in liver transplant(LT)practices.METHODS All adult deceased-donor LT recipients between January 2021 and September 2023 in the United States were analyzed.Outcomes including discard rates,survival,preservation time and timing of surgery were compared between two groups:NMP vs non-NMP.RESULTS Between 2021 and 2023,NMP was utilized in 1493(6.3%)of all LTs in the United States.Compared to non-NMP group,NMP group had lower allograft discard rate(6.5%vs 10%,P<0.001),older recipients’age(median:47 vs 42 years,P<0.001),and higher utilization of donors from donation after circulatory death(DCD)(55%vs 11%,P<0.001).NMP group also had longer distances between recipient and donor hospitals(median:156 vs 138 miles,P<0.001),longer preser-vation time(median:12.2 vs 5.8 hours,P<0.001),and more daytime reperfusion(74%vs 55%,P<0.001).Post-transplant survival outcomes were comparable between the two groups.In a subgroup analysis of NMP,recipients in the long preservation time(≥8 hours)group had higher daytime reperfusion(78%vs 55%,P<0.001)and similar post-transplant survival when compared to the short preservation time(<8 hours)group.CONCLUSION The utilization of NMP is associated with lower discard rates and increased DCD organs for LT.NMP allows for prolonging the preservation time and increased occurrence of daytime LT,without any impact on the survival outcomes.
文摘In this editorial,we comment on the article by Xu et al published in the recent issue of the World Journal of Hepatology.The hepatitis B virus(HBV)has evolved sophisticated mechanisms to evade host innate immunity,a hallmark of its persistent infections.This study highlights a pivotal role for HBV-encoded microRNA,specifically HBV-miR-3,in undermining the cyclic GMP-AMP synthase(cGAS)-stimulator of interferon genes(STING)-IFN signaling axis.This pathway is critical for recognizing viral DNA and subsequent production of type I interferons,key antiviral cytokines.HBV-miR-3 achieves this immune evasion by directly downregulating the expression of cGAS,an essential DNA sensor,and STING,its downstream adaptor.By silencing these components,HBV-miR-3 disrupts the activation of downstream interferon regulatory factor 3 and Nuclear Factor Kappa-light-chain-enhancer of Activated B Cells transcription factors,thereby blunting interferon beta production and antiviral gene expression.This strategy allows HBV to persist in hepatocytes by dampening innate immune responses and contributes to immune tolerance,fostering chronic infection.Understanding the role of HBV-miR-3 provides novel insights into HBV pathogenesis and identifies potential therapeutic targets to restore antiviral immunity.Targeting HBV-miR-3 or reactivating the cGAS-STING-IFN pathway could offer promising strategies to counteract HBV immune evasion and resolve chronic infection.
文摘BACKGROUND In patients with chronic liver disease or hepatic dysfunction with sarcopenia,there is an increased risk of frailty as measured by functional impairment,making frailty a vital predictor of post-transplant mortality.AIM To investigate the effects of frailty on mortality after liver transplantation.METHODS A retrospective review of post-transplant outcomes in liver transplant recipients assessed frailty using Karnofsky Performance Score.Data from the Scientific Registry of Transplant Recipients database for 37427 liver transplant recipients was used.RESULTS Of 82.7%frail patients,42.7%were severely frail and 40%were moderately frail(P<0.001)at the time of transplantation.Compared with non-frail patients,post-transplant mortality in frail patients was significantly higher at 12 months[odds ratio(OR)=1.94,P=0.02].Secondary analysis of the data revealed that liver grafts from donation after circulatory death(DCD)were more likely to be associated with frail patients at transplant(OR=1.86,P<0.001).Furthermore,a donor history of hypertension was associated with a lower likelihood of frailty in the recipient at the time of transplant(OR=0.65,P=0.03).CONCLUSION Recipient frailty is associated with increased mortality at 12 months following liver transplantation,and liver transplants from donors with DCD are associated with increased frailty of the liver transplant recipient.
文摘BACKGROUND Viral hepatitis is characterized by a group of hepatotropic viruses that contribute to high rates of liver disease and mortality.It is well-documented that viral hepatitis is the leading cause of liver cancer and liver failure,with Hepatitis B and Hepatitis C being the most common viruses associated with these outcomes.AIM To study viral hepatitis-related mortality trends from 1999 to 2022,focusing on gender,race/ethnicity,age,region,and urban/rural classifications.METHODS We used the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database to identify viral hepatitis-related deaths in the United States from 1999 to 2022.Data on demographic and regional information were analyzed and stratified by gender,race/ethnicity,age,regional,and urban rural classifications.Using the Joinpoint Regression Program(version 4.9.0.0 used,available from the National Cancer Institute,Bethesda,Maryland)the annual percentage change(APC)and average APC(AAPC)were calculated with 95%CI for extracted Age Adjusted Mortality Rates(AAMR).RESULTS From 1999 to 2022,there were 389916 viral hepatitis-related deaths in the United States.The overall AAMR increased from 1999 to 2013(APC:3.20%;95%CI:2.54-3.99;P<0.001),then declined through 2022(APC:-5.54%;95%CI:-6.75 to-4.47;P<0.001).Males accounted for 70.4%of deaths,with steeper declines in females(AAPC:-0.48%;95%CI:-0.87 to-0.12;P<0.05).The American Indian/Alaska Native population had the highest AAMR(AAPC:2.90%;95%CI:2.30 to 3.68;P<0.001).The population of 65-74 years had the largest increase in overall crude mortality rate(AAPC:3.20%;95%CI:2.77 to 3.85;P<0.001).Mortality was highest in the West(AAPC:-0.78%;95%CI-1.28 to-0.29;P<0.05).Rural AAMR exceeded urban rates after 2015.CONCLUSION This study found significant racial,ethnic,and geographical disparities in viral hepatitis AAMR.Key factors for mortality reduction include patient education,screening,and access to hepatitis vaccination and treatment.
文摘This paper conducts clustering,potential semantic indexing,comparison,and inductive analysis of research papers on marketing between China and the UK from January 2020 to September 2024.The study found that the Chinese marketing research focuses on digital transformation,policy impact,value co-creation,and emerging e-commerce models.In contrast,the UK marketing research focuses more on sustainability,technology integration,real-time research,and personalized marketing strategies.The study also found that there were few marketing articles published in Chinese and CSSCI journals in China,while the SSCI journals published in English were 62 times more than in Chinese.According to the research,digital marketing and data-driven decision-making,diversified marketing channels,sustainability and circular economy,technological innovation and cutting-edge technology application,meta-universe and blockchain technology,AI+marketing development,brand building,and international market expansion will become the research hotspots in the field of marketing in the future.The research suggests that China should strengthen the construction of an academic marketing platform,and China and the UK should strengthen cooperation in marketing research,learn from each other's strengths,and jointly give full play to their advantages in technology application,market and economy,strategy and innovation,and social media,to contribute to global economic development and marketing research.
文摘The Tube, Pipe & Bar Business Unit of Baosteel(hereinafter referred to as the Business Unit) actively practices the concept of green and low-carbon development and is committed to building a near-zero carbon pro-duction line.The low-carbon operation of the Business Unit is explored from seven aspects, including low-carbon and energy-saving operation in an electric arc furnace and extreme energy efficiency.Currently, extreme energy efficiency is the best practice for energy conservation and carbon reduction, and the research and development of low-carbon metallurgical technology, green energy development, biomass utilization, and carbon capture, utilization, and storage are important measures for achieving emission reduction goals, requiring further investments, research, and development.The Business Unit works closely with users in carrying out demonstration projects, continuously enhancing the influence of low-carbon products and continuing efforts to achieve the “Dual Carbon” goal.
