Objective:Lung cancer has the highest incidence and mortality of all malignant tumors in China.Cancer pain dramatically affects patients’comfort level,causing insomnia,anorexia,anxiety,fear,depression,and a decline i...Objective:Lung cancer has the highest incidence and mortality of all malignant tumors in China.Cancer pain dramatically affects patients’comfort level,causing insomnia,anorexia,anxiety,fear,depression,and a decline in the quality of life(QOL).The literature suggests a shortage of adequate cancer pain management for 59.1% of patients in China.The quality control circle(QCC)activity reflects the people-oriented core idea of management.This study aimed to assess the efficacy of QCC in enhancing the effectiveness of drug interventions in lung cancer patients with moderate to severe pain.Methods:From January 2019 to July 2019,lung cancer patients with moderate to severe pain were treated with drugs.The total number of drug interventions was 3072.A QCC activity was performed following the ten steps of the plan-do-check-act(PDCA)model.The reasons for the poor effectiveness of drug intervention in lung cancer patients with moderate to severe pain were analyzed.Countermeasures were designed to improve the effectiveness of drug intervention,including setting up a pain college,writing a medication education manual,and formulating operational rules for the administration of narcotic drugs.The effectiveness of drug intervention in lung cancer patients with moderate to severe pain and activity ability scores of QCC members were analyzed statistically before and after QCC activity.The effectiveness of drug intervention was investigated and compared before and after establishing the QCC.Results:After establishing the PDCA model,the effectiveness of drug intervention for moderate to severe pain in lung cancer patients increased from 56.28% to 85.29%.Members had significant improvement in problem-solving ability,responsibility,communication,coordination,self-confidence,team cohesion,enthusiasm,QCC skills,and harmony.Conclusion:QCC activity can significantly improve the efficiency of drug intervention in lung cancer patients with moderate to severe pain and their quality of life.展开更多
Objective:To describe the clinical,laboratory and radiological characteristics and outcomes of moderate-to-severe coronvirus disease 2019(COVID-19)patients.Methods:We retrospectively analyzed 43 RT-PCR confirmed moder...Objective:To describe the clinical,laboratory and radiological characteristics and outcomes of moderate-to-severe coronvirus disease 2019(COVID-19)patients.Methods:We retrospectively analyzed 43 RT-PCR confirmed moderate-to-severe COVID-19 patients who were admitted to a tertiary care center.The primary composite outcomes were admission to intensive care unit,requirement of mechanical ventilation,and death.Results:The median age of the patients was 50 years,and 62.8%of the patients were male.Out of 43 patients,15(34.88%)were categorized as severe.A total of 26(60.47%)patients had 1 or more comorbidities[diabetes(34.88%)and hypertension(30.23%)].The median duration from the onset of symptoms to admission was 3 days,and the most common symptoms were dyspnoea(90.7%),cough(79.07%),fever(69.77%),and body ache(46.51%).Leucopenia was presented in 14(32.56%)patients,lymphopenia in 26(60.47%)patients,and monocytosis in 7(16.28%)patients.Besides,40(93.02%)patients had bilateral patchy nodular or interstitial infiltration on chest X-ray.The primary outcomes occurred in 20 patients(46.5%),among whom 8 required mechanical ventilation.The patients who had met the primary outcomes were older.They were prone to have at least 1 comorbidity(P=0.004),diabetes(P=0.01),hypertension,higher sequential organ failure assessment score,more tachycardia,lower SpO2,lower PaO2/FiO2,more thrombocytopenia,and more pancytopenia.Conclusions:This retrospective study identified several risk factors for poor outcomes in adults with COVID-19.In particular,older age,tachycardia,high SOFA score,low SpO2,low PaO2/FiO2,presence of comorbidities in form of diabetes and hypertension,thrombocytopenia,and pancytopenia at admission were associated with higher odds of ICU admission,a requirement of mechanical ventilation and in-hospital death.展开更多
AIM:To evaluate whether the effectiveness of Granulomonocyto apheresis(GMA),a technique that consists of the extracorporeal removal of granulocytes and monocytes from the peripheral blood,might vary according to the s...AIM:To evaluate whether the effectiveness of Granulomonocyto apheresis(GMA),a technique that consists of the extracorporeal removal of granulocytes and monocytes from the peripheral blood,might vary according to the severity of ulcerative colitis(UC)in patients with mild to moderate-severe disease UC activity.METHODS:We retrospectively reviewed prospectively collected data of patients undergoing GMA at our inflammatory bowel disease centre who had at least a 6 mo of follow-up.The demographics,clinical and laboratory data were extracted from the patients’charts and electronic records.The severity of UC was scored according to the Modified Truelove Witts Severity Index(MTWSI).A clinical response was defined as a decrease from baseline of≥2 points or a value of MTWSI≤2 points.RESULTS:A total of 41(24 males/17 females;meanage 47 years)patients were included in the study.After GMA cycle completion,21/28(75%)of mild UC patients showed a clinical response compared with 7/13(54%)of patients with moderate to severe disease(P=0.27).At 6-mo,14/28(50%)of the mild UC patients maintained a clinical response compared with 2/13(15%)of the patients with moderate to severe disease(P=0.04).After the GMA cycle completion and during the 6-mo follow up period,13/16(81%)and 9/16(56%)of mild UC patients with intolerance,resistance and contraindications to immunosuppressants and/or biologics showed a clinical response compared with 2/6(33%)and 0/6(0%)of patients with moderate to severe disease activity with these characteristics(P=0.05and P=0.04,respectively).CONCLUSION:Patients with mild UC benefit from GMA more than patients with moderate to severe disease in the short-term period.GMA should be considered a valid therapeutic option in cases of contraindications to immunosuppressants,corticosteroids and/or biologics.展开更多
BACKGROUND Glucose imbalance is common in total parenteral nutrition(TPN).Hypoglycemia seems to be less frequent than hyperglycemia,but it influences the clinical outcome to a greater extent.Therefore,it should be eff...BACKGROUND Glucose imbalance is common in total parenteral nutrition(TPN).Hypoglycemia seems to be less frequent than hyperglycemia,but it influences the clinical outcome to a greater extent.Therefore,it should be effectively prevented and treated.However,there is no relevant report on how to treat hypoglycemia caused by TPN in patients with liver cell injury.CASE SUMMARY We present three patients with liver cell injury who developed severe hypo-glycemia during or after TPN infusion.The causes of severe hypoglycemia and glucose-raising strategies were discussed.According to the physiological charac-teristics of the hepatocellular injury,the ratio of nutrition components prescribed in TPN was appropriately adjusted for the three cases.We simultaneously reduced the dose of insulin and fat emulsion,and increased the dose of glucose in TPN.The blood glucose level was restored to normal range and clinical symptoms were eliminated.CONCLUSION When hypoglycemia occurs during or after TPN in patients with hepatocellular injury,physicians need to simultaneously reduce insulin and fat emulsion,and increase glucose,and correct severe hypoglycemia in time to reduce its adverse consequences.展开更多
Introduction: A traumatic brain injury (TBI) is caused by a forceful bump, blow, or jolt to the head or body, or by an object that pierces the skull and interrupts the normal function of the brain. Severe TBI is estim...Introduction: A traumatic brain injury (TBI) is caused by a forceful bump, blow, or jolt to the head or body, or by an object that pierces the skull and interrupts the normal function of the brain. Severe TBI is estimated at 73 cases per 100,000 people. The mortality of severe TBI can be reduced if a timely diagnosis and treatment of the injuries are made through prognostic factors. Objective: To determine the prognostic factors related to mortality in severe traumatic brain injury at the Hospital General de Zona No. 46. Material and Methods: Retrospective, cross-sectional and descriptive study in beneficiaries admitted to the Hospital General de Zona (HGZ) No. 46 of the Mexican Institute of Social Security (IMSS by its acronym in Spanish), with a diagnosis of severe TBI;the possible prognostic factors related to mortality of severe TBI were obtained from their records. Measures of central tendency and chi square were used for data analysis. Results: The study sample consisted of 60 subjects diagnosed with severe traumatic brain injury, of which 5 (8%) were women and 55 (92%) were men, and all 60 (100%) patients died. The average age of the sample was 26 with a standard deviation of 9 years. The variables that had a p value less than or equal to 0.05 were: Mydriasis, seizures, Hyperglycemia, Normoglycemia, Hypothermia and Hypotension. This means that these variables were associated with mortality. Conclusion: Statistical significance is demonstrated in prognostic factors of mortality in severe traumatic brain injury with p < 0.05 in the case of mydriasis, seizures, hyperglycemia, normoglycemia, hypothermia and hypotension.展开更多
BACKGROUND Severe acute pancreatitis(SAP),a condition with rapid onset,critical condition and unsatisfactory prognosis,poses a certain threat to human health,warranting optimization of relevant treatment plans to impr...BACKGROUND Severe acute pancreatitis(SAP),a condition with rapid onset,critical condition and unsatisfactory prognosis,poses a certain threat to human health,warranting optimization of relevant treatment plans to improve treatment efficacy.AIM To evaluate the efficacy and safety of computerized tomography-guided the-rapeutic percutaneous puncture catheter drainage(CT-TPPCD)combined with somatostatin(SS)in the treatment of SAP.METHODS Forty-two SAP patients admitted to The Second Affiliated Hospital of Fujian Medical University from June 2020 to June 2023 were selected.On the basis of routine treatment,20 patients received SS therapy(control group)and 22 patients were given CT-TPPCD plus SS intervention(research group).The efficacy,safety(pancreatic fistula,intra-abdominal hemorrhage,sepsis,and organ dysfunction syndrome),abdominal bloating and pain relief time,bowel recovery time,hospital stay,inflammatory indicators(C-reactive protein,interleukin-6,and pro-calcitonin),and Acute Physiology and Chronic Health Evaluation(APACHE)II score of both groups were evaluated for comparison.RESULTS Compared with the control group,the research group had a markedly higher total effective rate,faster abdominal bloating and pain relief and bowel recovery,INTRODUCTION Pancreatitis,an inflammatory disease occurring in the pancreatic tissue,is classified as either acute or chronic and is associated with high morbidity and mortality,imposing a socioeconomic burden[1,2].The pathogenesis of this disease involves early protease activation,activation of nuclear factor kappa-B-related inflammatory reactions,and infiltration of immune cells[3].Severe acute pancreatitis(SAP)is a serious condition involving systemic injury and subsequent possible organ failure,accounting for 20%of all acute pancreatitis cases[4].SAP is also characterized by rapid onset,critical illness and unsatisfactory prognosis and is correlated with serious adverse events such as systemic inflammatory response syn-drome and acute lung injury,threatening the health of patients[5,6].Therefore,timely and effective therapeutic inter-ventions are of great significance for improving patient prognosis and ensuring therapeutic effects.Somatostatin(SS),a peptide hormone that can be secreted by endocrine cells and the central nervous system,is in-volved in the regulatory mechanism of glucagon and insulin synthesis in the pancreas[7].It has complex and pleiotropic effects on the gastrointestinal tract,which can inhibit the release of gastrointestinal hormones and negatively modulate the exocrine function of the stomach,pancreas and bile,while exerting a certain influence on the absorption of the di-gestive system[8,9].SS has shown certain clinical effectiveness when applied to SAP patients and can regulate the severity of SAP and immune inflammatory responses,and this regulation is related to its influence on leukocyte apoptosis and adhesion[10,11].Computerized tomography-guided therapeutic percutaneous puncture catheter drainage(CT-TPPCD)is a surgical procedure to collect lesion fluid and pus samples from necrotic lesions and perform puncture and drainage by means of CT image examination and precise positioning[12].In the research of Liu et al[13],CT-TPPCD applied to pa-tients undergoing pancreatic surgery contributes to not only good curative effects but also a low surgical risk.Baudin et al[14]also reported that CT-TPPCD has a clinical success rate of 64.6%in patients with acute infectious necrotizing pan-creatitis,with nonfatal surgery-related complications found in only two cases,suggesting that this procedure is clinically effective and safe in the treatment of the disease.In light of the limited studies on the efficacy and safety of SS plus CT-TPPCD in SAP treatment,this study performed a relevant analysis to improve clinical outcomes in SAP patients.展开更多
[Objectives]To investigate the clinical effect of Yinhuang Qingfei capsules in the treatment of asymptomatic and mild/common severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.[Methods]A total of 362...[Objectives]To investigate the clinical effect of Yinhuang Qingfei capsules in the treatment of asymptomatic and mild/common severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.[Methods]A total of 362 patients with SARS-CoV-2 infection were divided into the treatment group with 242 patients and control group with 120 patients according to their treatment regimen.The patients in the control group were given standard treatment regimen and those in the treatment group were given Yinhuang Qingfei capsules in addition to the treatment in the control group.The two groups were observed in terms of average length of hospital stay,mean time for nucleic acid clearance,TCM syndrome score,and progression to severe/critical illness,and clinical outcome was compared between the two groups.[Results]There was a significant difference in the overall response rate between the treatment group and the control group[97.52%(236/242)vs 95.00%(114/120),P<0.05].Compared with the control group,the treatment group had significantly shorter length of hospital stay and time for nucleic acid clearance(P<0.05).After 7 days of treatment,both groups had a significant change in TCM syndrome score,and there was a significant difference in TCM syndrome score between the two groups(P<0.05);after 15 days of treatment,both groups had a TCM syndrome score of 0.Progression to severe/critical illness was not observed in either group.[Conclusions]Compared with the standard treatment regimen alone,standard treatment regimen combined with Yinhuang Qingfei capsules can effectively shorten the length of hospital stay and time for nucleic acid clearance and improve TCM symptoms in patients with asymptomatic and mild/common SARS-CoV-2 infection.展开更多
Objective:To explore and analyze the effectiveness of targeted nursing in children with severe viral encephalitis complicated with respiratory failure.Methods:From April 2021 to April 2023,74 children with severe vira...Objective:To explore and analyze the effectiveness of targeted nursing in children with severe viral encephalitis complicated with respiratory failure.Methods:From April 2021 to April 2023,74 children with severe viral encephalitis complicated with respiratory failure admitted to the Department of Pediatrics of our hospital were selected as the research objects and divided into the target group(n=37)and the reference group(n=37).Targeted nursing was given to the target group,while general nursing was given to the reference group.Physical rehabilitation,motor scores,and lung function were compared between the groups.Results:The recovery time of limb abnormalities,convulsions,abnormal consciousness,and cranial nerve disorders in the target group was significantly better than that in the reference group(P<0.05).The motor function,joint activity and pain,sensory function,and total score of the target group were significantly lower than those of the reference group(P<0.05).After the intervention,lung function indicators including VC(vital capacity),FVC(forced vital capacity),and MVV(maximum voluntary ventilation)of the target group were better than those of the reference group(P<0.05).Conclusion:Targeted nursing can shorten the recovery period of severe viral encephalitis complicated with respiratory failure in children,speed up the recovery of motor function,and improve lung function.This nursing model has a significant application effect in children with severe viral encephalitis complicated with respiratory failure.展开更多
Introduction: Malnutrition acts on the immune system and thus increases susceptibility to infections. Infections can weaken the body and cause malnutrition, so we speak of a vicious circle between malnutrition and inf...Introduction: Malnutrition acts on the immune system and thus increases susceptibility to infections. Infections can weaken the body and cause malnutrition, so we speak of a vicious circle between malnutrition and infection. Objective: To study the clinical and epidemiological aspects of severe acute malnutrition in children aged 6 to 59 months. Methodology: This was a prospective and descriptive study extending from July 1, 2018 to June 30, 2019. All severely acute malnourished children aged 6 to 59 months were hospitalized at URENI whose parents or careers accepted their participation in the study. Results: Severe acute malnutrition was diagnosed in 398 of the 671 hospitalized children, i.e. 59.3%. The median age was 15.33 months (2 months - 59 months). The sex ratio was 1.03 (M = 50.8 F = 49.2). Eighty-seven percent of mothers were housewives. Parents were uneducated in 49.3% for mothers and 51.8% for fathers. Marasmus represented 93.5% of cases, children diagnosed with HIV+ represented 6.3% with exclusively HIV1 (100%). Pneumopathy was most frequently associated pathology with 33.4%. The duration of hospitalization was less than 7 days in 67.6% of cases and 93.3% of children had been successfully treated. The mortality rate was 4%. Conclusion: Malnutrition still remains a public health problem affecting mainly children aged 13 to 24 months, mainly from low-income families.展开更多
Introduction: In Chad, malnutrition is a silent emergency. Yet the use of local products in the fight against malnutrition is essential. The purpose of this study was to compare the efficacy of locally sourced enriche...Introduction: In Chad, malnutrition is a silent emergency. Yet the use of local products in the fight against malnutrition is essential. The purpose of this study was to compare the efficacy of locally sourced enriched flour in the recovery of children 6 to 59 months of moderate acute malnourishment compared to Ready-to-Use Therapeutic Foods (Plumpy’ Sup) in the city of Abéché-Chad. Methodology: This study took place from 1 October 2021 to 31 January 2022 in the city of Abéché, capital of the province of Ouaddaï. It was conducted in eight (8) urban health centers in the city of Abéché and concerned eighty (80) children with moderate acute malnutrition. It was based on a consumption assessment of two complementary foods by two groups of children. The assessment of nutritional status was made through anthropometric data such as weight, height and brachial perimeter. Results: All 80 children were tested for moderate acute malnutrition. Two complementary foods have been used which are locally produced flour and the Ready-to-Use Therapeutic Food. The study showed that the group 1 who consumed the locally produced flour had an average weight gain of 1100 g and the group 2 who consumed the Plumpy sup had an average weight gain of 400 g. Conclusion: The present study carried out in Abéché allowed us to compare the effectiveness of locally produced weaning flours with Ready-to-Use Therapeutic Foods on moderate malnourished child weight growth in the nutritional units of the town of Abéché.展开更多
Introduction: Malnutrition is a public health problem. It is responsible for high morbidity and mortality in children aged 6 - 59 months. The aim of this study was to determine the outcome of children with complicated...Introduction: Malnutrition is a public health problem. It is responsible for high morbidity and mortality in children aged 6 - 59 months. The aim of this study was to determine the outcome of children with complicated severe acute malnutrition after hospital discharge. Methods: This is a descriptive and analytical cross-sectional study conducted from March 1 to November 31, 2021 at the Albert Royer Children’s Hospital. Children discharged from hospital for complicated severe acute malnutrition were included. Results: A total of 103 children were included. The mean age of children at hospitalization was 16.41 ± 10.11 months and mean duration of follow-up after hospital discharge was 29.63 ± 8.59 months. Three children (2.91%) died after hospital discharge. The mean z-score of the weight-for-current height was -1.34 ± 1.08. Almost a quarter (24.27%) of the children remain acute malnourished with 3.88% of severe acute malnutrition (SAM). The predictors’ factors associated with non-response were weaning before 2 years of age (ORaj: 12.21;95% CI [6.82 - 18.44];p = 0.04) and tuberculosis (ORaj: 21.06;95% CI [12.54 - 41.09];p = 0.03). Conclusion: The rate of recovery of nutritional status in children with complicated severe acute malnutrition is satisfactory. Ablactation before the age of two and the existence of tuberculosis are significantly associated with non-recovery of nutritional status.展开更多
BACKGROUND There is paucity of data on outcomes of acute severe ulcerative colitis(ASUC)in older adults(≥60 years of age).AIM To assess steroid non-response rates during the index admission for ASUC in older adults.S...BACKGROUND There is paucity of data on outcomes of acute severe ulcerative colitis(ASUC)in older adults(≥60 years of age).AIM To assess steroid non-response rates during the index admission for ASUC in older adults.Secondary outcomes were response to medical rescue therapy and colectomy rates;at index admission,3 and 12 mo.METHODS This retrospective multicentre cohort study included ASUC admissions who received intravenous steroids between January 2013 and July 2020 at two tertiary hospitals.Electronic medical records were reviewed to collect clinical,biochemical,and endoscopic data.A modified Poisson regression model was used for analysis.RESULTS Of 226 ASUC episodes,45(19.9%)occurred in patients≥60 years of age.Steroid non-response rates were comparable in older adults and patients<60 years of age[19(42.2%)vs 85(47%),P=0.618],crude risk ratio(RR)=0.89[95%confidence interval(CI):0.61-1.30],adjusted RR=0.99(0.44-2.21).Rates of response to medical rescue therapy in older adults was comparable to the younger cohort[76.5%vs 85.7%,P=0.46,crude RR=0.89(0.67-1.17)].Index admission colectomy[13.3%vs 10.5%,P=0.598,crude RR=1.27(0.53-2.99),adjusted RR=1.43(0.34-6.06)],colectomy at 3 mo[20%vs 16.6%,P=0.66,crude RR=1.18(0.61-2.3),adjusted RR=1.31(0.32-0.53)]and colectomy at 12 mo[20%vs 23.2%,P=0.682,crude RR=0.85(0.45-1.57),adjusted RR=1.21(0.29-4.97)],were similar between the two groups.CONCLUSION In older adults with ASUC,the steroid non-response rate,response to medical rescue therapy,and colectomy rate at index admission,3 and 12 mo is similar to patients less than 60 years of age.展开更多
Voltage scaling has been extensively used in industry for decades to reduce power consumption.In recent years,exploring digital circuit operation in moderate inversion has created an interest among researchers due to ...Voltage scaling has been extensively used in industry for decades to reduce power consumption.In recent years,exploring digital circuit operation in moderate inversion has created an interest among researchers due to its immense capability to provide a perfect tradeoff between high performance and low energy operation.But circuits operating in moderate inversion are susceptible to process variations and variability.To compute variability,statistical parameters such as the probability density function(PDF)and cumulative distribution function(CDF)are required.This paper presents an analytical model framework for delay calculations utilizing log skew normal distribution for ultradeep submicron technology nodes up to 22 nm.The CDF of the proposed model is utilized to calculate minimum and maximum delays with 3σ-accuracy providing better accuracy than the conventional methods.The obtained results are also compared with Monte Carlo simulations with errors lying within the acceptable range of 2%-4%.展开更多
This project paper is to give a prediction for the future of other viral pandemics and to provide recommendations for preparing therapies that could help in the success of effective treatments and benefits for patient...This project paper is to give a prediction for the future of other viral pandemics and to provide recommendations for preparing therapies that could help in the success of effective treatments and benefits for patients in life-threatening situations. The theory of prediction was proposed by Huu S. TIEU on March 25, 2019, and he hypothesized that any malfunctioning cell in the body could have a damaging effect. This paper discusses the prediction that Localized Oxygen Deprivation could be a contributing factor for a future epidemic or other viral pandemics that could affect body function. This paper is based on opinion and does not have sufficient evidence to support the claims made. Therefore, further in-depth study is needed to prove the findings. The author cites Hypoxia to support his idea, but he is not claiming that Hypoxia-Inducible Factor (HIF) has worked on his predictions. The author also tested a theory using cow blood curd for body function, but this test was not a structured test and the findings were not supported by other evidence. To further prove the idea or theory, further study into the subject should be conducted.展开更多
Based on the disaster reports,NCEP2.5X2.5 reanalysis data and radiosonde data of 11 national stations in Ulanqab region from June to August during 2012-2017,the weather situation classification and warning indicators ...Based on the disaster reports,NCEP2.5X2.5 reanalysis data and radiosonde data of 11 national stations in Ulanqab region from June to August during 2012-2017,the weather situation classification and warning indicators of thunderstorm and gale,hail and short-term heavy rainfall were studied.The results show that the cold vortex weather situation was easy to produce hail,and the falling area of severe convection could be found in the downstream of the cold vortex,the intersection area of jet stream at 200 and 500 hPa,and the wet area side of the 700 hPa main line.The cold trough type weather situation was easy to produce thunderstorm and gale,and the falling area of severe convection appeared on the right side of the upper jet stream axis,the left side of the lower jet stream axis,the wet side of the 700 hPa main line,and the east of the shear line at 700 hPa.The weather situation of the low trough and subtropical high type was dominated by short-term rainstorm,and the falling area of severe convection was on the right side of upper jet stream at 200 hPa,the left side of the low southeast jet stream,and the wet side of the 700 hPa main line.The warning index thresholds of the total index,the temperature change at 850-500 hPa with height,the height of 0 and-20℃layer,lifting condensation height,temperature dew point difference and mixing ratio were highly reliable.展开更多
Background:Active-comparator trials are important to inform patient and physician choice.We aimed to evaluate the efficacy and safety of monotherapy with either ustekinumab or adalimumab in biologic-naive patients wit...Background:Active-comparator trials are important to inform patient and physician choice.We aimed to evaluate the efficacy and safety of monotherapy with either ustekinumab or adalimumab in biologic-naive patients with moderately to severely active Crohn's disease.展开更多
BACKGROUND There are many risk factors for severe acute pancreatitis(SAP)complicated with acute gastrointestinal injury(AGI),but few reports on the interaction between these risk factors.AIM To analyze the risk factor...BACKGROUND There are many risk factors for severe acute pancreatitis(SAP)complicated with acute gastrointestinal injury(AGI),but few reports on the interaction between these risk factors.AIM To analyze the risk factors for SAP complicated with AGI and their interactive effects.METHODS We selected 168 SAP patients admitted to our hospital between December 2019 and June 2022.They were divided into AGI group and non-AGI group according to whether AGI was present.Demographic data and laboratory test data were compared between the two groups.The risk factors for SAP with concomitant AGI were analyzed using multifactorial logistic regression,and an analysis of the interaction of the risk factors was performed.RESULTS The percentage of patients with multiple organ dysfunction syndrome,acute physiological and chronic health scoring system II(APACHE II)score,white blood cell count and creatinine(CRE)level was higher in the AGI group than in the non-AGI group.There was a statistically significant difference between the two groups(P<0.05).Logistic regression analysis indicated that an APACHE II score>15 and CRE>100μmol/L were risk factors for SAP complicating AGI.The interaction index of APACHE II score and CRE level was 3.123.CONCLUSION An APACHE II score>15 and CRE level>100μmol/L are independent risk factors for SAP complicated with AGI,and there is a positive interaction between them.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has led to millions of confirmed cases and deaths worldwide.Elderly patients are at high risk of deve...BACKGROUND Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has led to millions of confirmed cases and deaths worldwide.Elderly patients are at high risk of developing and dying from COVID-19 due to advanced age,decreased immune function,intense inflammatory response,and comorbidities.Shanghai has experienced a wave of infection with Omicron,a new variant of SARS-CoV-2,since March 2022.There is a pressing need to identify clinical features and risk factors for disease progression among elderly patients with Omicron infection to provide solid evidence for clinical policy-makers,public health officials,researchers,and the general public.AIM To investigate clinical characteristic differences and risk factors between elderly patients with severe and nonsevere Omicron SARS-CoV-2 variant infection.METHODS A total of 328 elderly patients with COVID-19 admitted to the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 2022 to June 2022 were enrolled and divided into a severe group(82 patients)and a nonsevere group(246 patients)according to the diagnosis and treatment protocol of COVID-19(version 7).The clinical data and laboratory results of both groups were collected and compared.A chi-square test,t test,Mann-Whitney U test,hierarchical log-rank test,univariate and multivariate logistic regression,and hierarchical analyses were used to determine significant differences.RESULTS The severe group was older(84 vs 74 years,P<0.001),included more males(57.3%vs 43.9%,P=0.037),had a lower vaccination rate(P<0.001),and had a higher proportion of comorbidities,including chronic respiratory disease(P=0.001),cerebral infarction(P<0.001),chronic kidney disease(P=0.002),and neurodegenerative disease(P<0.001),than the nonsevere group.In addition,severe disease patients had a higher inflammatory index(P<0.001),greater need for symptomatic treatment(P<0.001),longer hospital stay(P=0.011),extended viral shedding time(P=0.014),and higher mortality than nonsevere disease patients(P<0.001).No difference was observed in the application of Paxlovid in the severe and nonsevere groups(P=0.817).Oxygen saturation,cerebral infarction,and D-dimer were predictive factors for developing severe disease in patients with COVID-19,with D-dimer having an excellent role(area under the curve:90.1%,95%CI:86.1-94.0%).In addition,D-dimer was a risk factor for developing severe COVID-19 according to multivariate stratified analysis.CONCLUSION The clinical course of severe COVID-19 is complex,with a higher need for symptomatic treatment.D-dimer is a suitable biomarker for identifying patients at risk for developing severe COVID-19.展开更多
Chronic heart failure(CHF)is a clinical syndrome manifested by reduced pumping ability of the heart,increased pressure in heart chambers in both physical activity and at rest.The symptoms of this syndrome are dyspnea,...Chronic heart failure(CHF)is a clinical syndrome manifested by reduced pumping ability of the heart,increased pressure in heart chambers in both physical activity and at rest.The symptoms of this syndrome are dyspnea,undue fatigability,peripheral edema,which follow structural and functional changes of the myocardium.[1]The growing incidence of CHF,especially among elderly people,is an urgent problem for medicine in the vast majority of industrialized countries.For instance,in Russian Federation,CHF is diagnosed in about 7%of cardiovascular patients.At the same time,this indicator varies from 0.3%in young people(20-29 years old)to 70%in the older age group.[2,3].展开更多
The liver has many significant functions,such as detoxification,the urea cycle,gluconeogenesis,and protein synthesis.Systemic diseases,hypoxia,infections,drugs,and toxins can easily affect the liver,which is extremely...The liver has many significant functions,such as detoxification,the urea cycle,gluconeogenesis,and protein synthesis.Systemic diseases,hypoxia,infections,drugs,and toxins can easily affect the liver,which is extremely sensitive to injury.Systemic infection of severe acute respiratory syndrome coronavirus 2 can cause liver damage.The primary regulator of intracellular pH in the liver is the Na+/H+exchanger(NHE).Physiologically,NHE protects hepatocytes from apoptosis by making the intracellular pH alkaline.Severe acute respiratory syndrome coronavirus 2 increases local angiotensin II levels by binding to angiotensinconverting enzyme 2.In severe cases of coronavirus disease 2019,high angiotensin II levels may cause NHE overstimulation and lipid accumulation in the liver.NHE overstimulation can lead to hepatocyte death.NHE overstimulation may trigger a cytokine storm by increasing proinflammatory cytokines in the liver.Since the release of proinflammatory cytokines such as interleukin-6 increases with NHE activation,the virus may indirectly cause an increase in fibrinogen and D-dimer levels.NHE overstimulation may cause thrombotic events and systemic damage by increasing fibrinogen levels and cytokine release.Also,NHE overstimulation causes an increase in the urea cycle while inhibiting vitamin D synthesis and gluconeogenesis in the liver.Increasing NHE3 activity leads to Na+loading,which impairs the containment and fluidity of bile acid.NHE overstimulation can change the gut microbiota composition by disrupting the structure and fluidity of bile acid,thus triggering systemic damage.Unlike other tissues,tumor necrosis factor-alpha and angiotensin II decrease NHE3 activity in the intestine.Thus,increased luminal Na+leads to diarrhea and cytokine release.Severe acute respiratory syndrome coronavirus 2-induced local and systemic damage can be improved by preventing virus-induced NHE overstimulation in the liver.展开更多
基金supported by the National Key Research and Development Plan of China(No.2017YFC0909900).
文摘Objective:Lung cancer has the highest incidence and mortality of all malignant tumors in China.Cancer pain dramatically affects patients’comfort level,causing insomnia,anorexia,anxiety,fear,depression,and a decline in the quality of life(QOL).The literature suggests a shortage of adequate cancer pain management for 59.1% of patients in China.The quality control circle(QCC)activity reflects the people-oriented core idea of management.This study aimed to assess the efficacy of QCC in enhancing the effectiveness of drug interventions in lung cancer patients with moderate to severe pain.Methods:From January 2019 to July 2019,lung cancer patients with moderate to severe pain were treated with drugs.The total number of drug interventions was 3072.A QCC activity was performed following the ten steps of the plan-do-check-act(PDCA)model.The reasons for the poor effectiveness of drug intervention in lung cancer patients with moderate to severe pain were analyzed.Countermeasures were designed to improve the effectiveness of drug intervention,including setting up a pain college,writing a medication education manual,and formulating operational rules for the administration of narcotic drugs.The effectiveness of drug intervention in lung cancer patients with moderate to severe pain and activity ability scores of QCC members were analyzed statistically before and after QCC activity.The effectiveness of drug intervention was investigated and compared before and after establishing the QCC.Results:After establishing the PDCA model,the effectiveness of drug intervention for moderate to severe pain in lung cancer patients increased from 56.28% to 85.29%.Members had significant improvement in problem-solving ability,responsibility,communication,coordination,self-confidence,team cohesion,enthusiasm,QCC skills,and harmony.Conclusion:QCC activity can significantly improve the efficiency of drug intervention in lung cancer patients with moderate to severe pain and their quality of life.
文摘Objective:To describe the clinical,laboratory and radiological characteristics and outcomes of moderate-to-severe coronvirus disease 2019(COVID-19)patients.Methods:We retrospectively analyzed 43 RT-PCR confirmed moderate-to-severe COVID-19 patients who were admitted to a tertiary care center.The primary composite outcomes were admission to intensive care unit,requirement of mechanical ventilation,and death.Results:The median age of the patients was 50 years,and 62.8%of the patients were male.Out of 43 patients,15(34.88%)were categorized as severe.A total of 26(60.47%)patients had 1 or more comorbidities[diabetes(34.88%)and hypertension(30.23%)].The median duration from the onset of symptoms to admission was 3 days,and the most common symptoms were dyspnoea(90.7%),cough(79.07%),fever(69.77%),and body ache(46.51%).Leucopenia was presented in 14(32.56%)patients,lymphopenia in 26(60.47%)patients,and monocytosis in 7(16.28%)patients.Besides,40(93.02%)patients had bilateral patchy nodular or interstitial infiltration on chest X-ray.The primary outcomes occurred in 20 patients(46.5%),among whom 8 required mechanical ventilation.The patients who had met the primary outcomes were older.They were prone to have at least 1 comorbidity(P=0.004),diabetes(P=0.01),hypertension,higher sequential organ failure assessment score,more tachycardia,lower SpO2,lower PaO2/FiO2,more thrombocytopenia,and more pancytopenia.Conclusions:This retrospective study identified several risk factors for poor outcomes in adults with COVID-19.In particular,older age,tachycardia,high SOFA score,low SpO2,low PaO2/FiO2,presence of comorbidities in form of diabetes and hypertension,thrombocytopenia,and pancytopenia at admission were associated with higher odds of ICU admission,a requirement of mechanical ventilation and in-hospital death.
文摘AIM:To evaluate whether the effectiveness of Granulomonocyto apheresis(GMA),a technique that consists of the extracorporeal removal of granulocytes and monocytes from the peripheral blood,might vary according to the severity of ulcerative colitis(UC)in patients with mild to moderate-severe disease UC activity.METHODS:We retrospectively reviewed prospectively collected data of patients undergoing GMA at our inflammatory bowel disease centre who had at least a 6 mo of follow-up.The demographics,clinical and laboratory data were extracted from the patients’charts and electronic records.The severity of UC was scored according to the Modified Truelove Witts Severity Index(MTWSI).A clinical response was defined as a decrease from baseline of≥2 points or a value of MTWSI≤2 points.RESULTS:A total of 41(24 males/17 females;meanage 47 years)patients were included in the study.After GMA cycle completion,21/28(75%)of mild UC patients showed a clinical response compared with 7/13(54%)of patients with moderate to severe disease(P=0.27).At 6-mo,14/28(50%)of the mild UC patients maintained a clinical response compared with 2/13(15%)of the patients with moderate to severe disease(P=0.04).After the GMA cycle completion and during the 6-mo follow up period,13/16(81%)and 9/16(56%)of mild UC patients with intolerance,resistance and contraindications to immunosuppressants and/or biologics showed a clinical response compared with 2/6(33%)and 0/6(0%)of patients with moderate to severe disease activity with these characteristics(P=0.05and P=0.04,respectively).CONCLUSION:Patients with mild UC benefit from GMA more than patients with moderate to severe disease in the short-term period.GMA should be considered a valid therapeutic option in cases of contraindications to immunosuppressants,corticosteroids and/or biologics.
文摘BACKGROUND Glucose imbalance is common in total parenteral nutrition(TPN).Hypoglycemia seems to be less frequent than hyperglycemia,but it influences the clinical outcome to a greater extent.Therefore,it should be effectively prevented and treated.However,there is no relevant report on how to treat hypoglycemia caused by TPN in patients with liver cell injury.CASE SUMMARY We present three patients with liver cell injury who developed severe hypo-glycemia during or after TPN infusion.The causes of severe hypoglycemia and glucose-raising strategies were discussed.According to the physiological charac-teristics of the hepatocellular injury,the ratio of nutrition components prescribed in TPN was appropriately adjusted for the three cases.We simultaneously reduced the dose of insulin and fat emulsion,and increased the dose of glucose in TPN.The blood glucose level was restored to normal range and clinical symptoms were eliminated.CONCLUSION When hypoglycemia occurs during or after TPN in patients with hepatocellular injury,physicians need to simultaneously reduce insulin and fat emulsion,and increase glucose,and correct severe hypoglycemia in time to reduce its adverse consequences.
文摘Introduction: A traumatic brain injury (TBI) is caused by a forceful bump, blow, or jolt to the head or body, or by an object that pierces the skull and interrupts the normal function of the brain. Severe TBI is estimated at 73 cases per 100,000 people. The mortality of severe TBI can be reduced if a timely diagnosis and treatment of the injuries are made through prognostic factors. Objective: To determine the prognostic factors related to mortality in severe traumatic brain injury at the Hospital General de Zona No. 46. Material and Methods: Retrospective, cross-sectional and descriptive study in beneficiaries admitted to the Hospital General de Zona (HGZ) No. 46 of the Mexican Institute of Social Security (IMSS by its acronym in Spanish), with a diagnosis of severe TBI;the possible prognostic factors related to mortality of severe TBI were obtained from their records. Measures of central tendency and chi square were used for data analysis. Results: The study sample consisted of 60 subjects diagnosed with severe traumatic brain injury, of which 5 (8%) were women and 55 (92%) were men, and all 60 (100%) patients died. The average age of the sample was 26 with a standard deviation of 9 years. The variables that had a p value less than or equal to 0.05 were: Mydriasis, seizures, Hyperglycemia, Normoglycemia, Hypothermia and Hypotension. This means that these variables were associated with mortality. Conclusion: Statistical significance is demonstrated in prognostic factors of mortality in severe traumatic brain injury with p < 0.05 in the case of mydriasis, seizures, hyperglycemia, normoglycemia, hypothermia and hypotension.
基金Supported by 2022 Fujian Medical University Qihang Fund General Project Plan,No.2022QH1120。
文摘BACKGROUND Severe acute pancreatitis(SAP),a condition with rapid onset,critical condition and unsatisfactory prognosis,poses a certain threat to human health,warranting optimization of relevant treatment plans to improve treatment efficacy.AIM To evaluate the efficacy and safety of computerized tomography-guided the-rapeutic percutaneous puncture catheter drainage(CT-TPPCD)combined with somatostatin(SS)in the treatment of SAP.METHODS Forty-two SAP patients admitted to The Second Affiliated Hospital of Fujian Medical University from June 2020 to June 2023 were selected.On the basis of routine treatment,20 patients received SS therapy(control group)and 22 patients were given CT-TPPCD plus SS intervention(research group).The efficacy,safety(pancreatic fistula,intra-abdominal hemorrhage,sepsis,and organ dysfunction syndrome),abdominal bloating and pain relief time,bowel recovery time,hospital stay,inflammatory indicators(C-reactive protein,interleukin-6,and pro-calcitonin),and Acute Physiology and Chronic Health Evaluation(APACHE)II score of both groups were evaluated for comparison.RESULTS Compared with the control group,the research group had a markedly higher total effective rate,faster abdominal bloating and pain relief and bowel recovery,INTRODUCTION Pancreatitis,an inflammatory disease occurring in the pancreatic tissue,is classified as either acute or chronic and is associated with high morbidity and mortality,imposing a socioeconomic burden[1,2].The pathogenesis of this disease involves early protease activation,activation of nuclear factor kappa-B-related inflammatory reactions,and infiltration of immune cells[3].Severe acute pancreatitis(SAP)is a serious condition involving systemic injury and subsequent possible organ failure,accounting for 20%of all acute pancreatitis cases[4].SAP is also characterized by rapid onset,critical illness and unsatisfactory prognosis and is correlated with serious adverse events such as systemic inflammatory response syn-drome and acute lung injury,threatening the health of patients[5,6].Therefore,timely and effective therapeutic inter-ventions are of great significance for improving patient prognosis and ensuring therapeutic effects.Somatostatin(SS),a peptide hormone that can be secreted by endocrine cells and the central nervous system,is in-volved in the regulatory mechanism of glucagon and insulin synthesis in the pancreas[7].It has complex and pleiotropic effects on the gastrointestinal tract,which can inhibit the release of gastrointestinal hormones and negatively modulate the exocrine function of the stomach,pancreas and bile,while exerting a certain influence on the absorption of the di-gestive system[8,9].SS has shown certain clinical effectiveness when applied to SAP patients and can regulate the severity of SAP and immune inflammatory responses,and this regulation is related to its influence on leukocyte apoptosis and adhesion[10,11].Computerized tomography-guided therapeutic percutaneous puncture catheter drainage(CT-TPPCD)is a surgical procedure to collect lesion fluid and pus samples from necrotic lesions and perform puncture and drainage by means of CT image examination and precise positioning[12].In the research of Liu et al[13],CT-TPPCD applied to pa-tients undergoing pancreatic surgery contributes to not only good curative effects but also a low surgical risk.Baudin et al[14]also reported that CT-TPPCD has a clinical success rate of 64.6%in patients with acute infectious necrotizing pan-creatitis,with nonfatal surgery-related complications found in only two cases,suggesting that this procedure is clinically effective and safe in the treatment of the disease.In light of the limited studies on the efficacy and safety of SS plus CT-TPPCD in SAP treatment,this study performed a relevant analysis to improve clinical outcomes in SAP patients.
基金Supported by the Science and Medicine Joint Fund Project of Natural Science Foundation of Hunan Province(2022JJ80001).
文摘[Objectives]To investigate the clinical effect of Yinhuang Qingfei capsules in the treatment of asymptomatic and mild/common severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.[Methods]A total of 362 patients with SARS-CoV-2 infection were divided into the treatment group with 242 patients and control group with 120 patients according to their treatment regimen.The patients in the control group were given standard treatment regimen and those in the treatment group were given Yinhuang Qingfei capsules in addition to the treatment in the control group.The two groups were observed in terms of average length of hospital stay,mean time for nucleic acid clearance,TCM syndrome score,and progression to severe/critical illness,and clinical outcome was compared between the two groups.[Results]There was a significant difference in the overall response rate between the treatment group and the control group[97.52%(236/242)vs 95.00%(114/120),P<0.05].Compared with the control group,the treatment group had significantly shorter length of hospital stay and time for nucleic acid clearance(P<0.05).After 7 days of treatment,both groups had a significant change in TCM syndrome score,and there was a significant difference in TCM syndrome score between the two groups(P<0.05);after 15 days of treatment,both groups had a TCM syndrome score of 0.Progression to severe/critical illness was not observed in either group.[Conclusions]Compared with the standard treatment regimen alone,standard treatment regimen combined with Yinhuang Qingfei capsules can effectively shorten the length of hospital stay and time for nucleic acid clearance and improve TCM symptoms in patients with asymptomatic and mild/common SARS-CoV-2 infection.
文摘Objective:To explore and analyze the effectiveness of targeted nursing in children with severe viral encephalitis complicated with respiratory failure.Methods:From April 2021 to April 2023,74 children with severe viral encephalitis complicated with respiratory failure admitted to the Department of Pediatrics of our hospital were selected as the research objects and divided into the target group(n=37)and the reference group(n=37).Targeted nursing was given to the target group,while general nursing was given to the reference group.Physical rehabilitation,motor scores,and lung function were compared between the groups.Results:The recovery time of limb abnormalities,convulsions,abnormal consciousness,and cranial nerve disorders in the target group was significantly better than that in the reference group(P<0.05).The motor function,joint activity and pain,sensory function,and total score of the target group were significantly lower than those of the reference group(P<0.05).After the intervention,lung function indicators including VC(vital capacity),FVC(forced vital capacity),and MVV(maximum voluntary ventilation)of the target group were better than those of the reference group(P<0.05).Conclusion:Targeted nursing can shorten the recovery period of severe viral encephalitis complicated with respiratory failure in children,speed up the recovery of motor function,and improve lung function.This nursing model has a significant application effect in children with severe viral encephalitis complicated with respiratory failure.
文摘Introduction: Malnutrition acts on the immune system and thus increases susceptibility to infections. Infections can weaken the body and cause malnutrition, so we speak of a vicious circle between malnutrition and infection. Objective: To study the clinical and epidemiological aspects of severe acute malnutrition in children aged 6 to 59 months. Methodology: This was a prospective and descriptive study extending from July 1, 2018 to June 30, 2019. All severely acute malnourished children aged 6 to 59 months were hospitalized at URENI whose parents or careers accepted their participation in the study. Results: Severe acute malnutrition was diagnosed in 398 of the 671 hospitalized children, i.e. 59.3%. The median age was 15.33 months (2 months - 59 months). The sex ratio was 1.03 (M = 50.8 F = 49.2). Eighty-seven percent of mothers were housewives. Parents were uneducated in 49.3% for mothers and 51.8% for fathers. Marasmus represented 93.5% of cases, children diagnosed with HIV+ represented 6.3% with exclusively HIV1 (100%). Pneumopathy was most frequently associated pathology with 33.4%. The duration of hospitalization was less than 7 days in 67.6% of cases and 93.3% of children had been successfully treated. The mortality rate was 4%. Conclusion: Malnutrition still remains a public health problem affecting mainly children aged 13 to 24 months, mainly from low-income families.
文摘Introduction: In Chad, malnutrition is a silent emergency. Yet the use of local products in the fight against malnutrition is essential. The purpose of this study was to compare the efficacy of locally sourced enriched flour in the recovery of children 6 to 59 months of moderate acute malnourishment compared to Ready-to-Use Therapeutic Foods (Plumpy’ Sup) in the city of Abéché-Chad. Methodology: This study took place from 1 October 2021 to 31 January 2022 in the city of Abéché, capital of the province of Ouaddaï. It was conducted in eight (8) urban health centers in the city of Abéché and concerned eighty (80) children with moderate acute malnutrition. It was based on a consumption assessment of two complementary foods by two groups of children. The assessment of nutritional status was made through anthropometric data such as weight, height and brachial perimeter. Results: All 80 children were tested for moderate acute malnutrition. Two complementary foods have been used which are locally produced flour and the Ready-to-Use Therapeutic Food. The study showed that the group 1 who consumed the locally produced flour had an average weight gain of 1100 g and the group 2 who consumed the Plumpy sup had an average weight gain of 400 g. Conclusion: The present study carried out in Abéché allowed us to compare the effectiveness of locally produced weaning flours with Ready-to-Use Therapeutic Foods on moderate malnourished child weight growth in the nutritional units of the town of Abéché.
文摘Introduction: Malnutrition is a public health problem. It is responsible for high morbidity and mortality in children aged 6 - 59 months. The aim of this study was to determine the outcome of children with complicated severe acute malnutrition after hospital discharge. Methods: This is a descriptive and analytical cross-sectional study conducted from March 1 to November 31, 2021 at the Albert Royer Children’s Hospital. Children discharged from hospital for complicated severe acute malnutrition were included. Results: A total of 103 children were included. The mean age of children at hospitalization was 16.41 ± 10.11 months and mean duration of follow-up after hospital discharge was 29.63 ± 8.59 months. Three children (2.91%) died after hospital discharge. The mean z-score of the weight-for-current height was -1.34 ± 1.08. Almost a quarter (24.27%) of the children remain acute malnourished with 3.88% of severe acute malnutrition (SAM). The predictors’ factors associated with non-response were weaning before 2 years of age (ORaj: 12.21;95% CI [6.82 - 18.44];p = 0.04) and tuberculosis (ORaj: 21.06;95% CI [12.54 - 41.09];p = 0.03). Conclusion: The rate of recovery of nutritional status in children with complicated severe acute malnutrition is satisfactory. Ablactation before the age of two and the existence of tuberculosis are significantly associated with non-recovery of nutritional status.
文摘BACKGROUND There is paucity of data on outcomes of acute severe ulcerative colitis(ASUC)in older adults(≥60 years of age).AIM To assess steroid non-response rates during the index admission for ASUC in older adults.Secondary outcomes were response to medical rescue therapy and colectomy rates;at index admission,3 and 12 mo.METHODS This retrospective multicentre cohort study included ASUC admissions who received intravenous steroids between January 2013 and July 2020 at two tertiary hospitals.Electronic medical records were reviewed to collect clinical,biochemical,and endoscopic data.A modified Poisson regression model was used for analysis.RESULTS Of 226 ASUC episodes,45(19.9%)occurred in patients≥60 years of age.Steroid non-response rates were comparable in older adults and patients<60 years of age[19(42.2%)vs 85(47%),P=0.618],crude risk ratio(RR)=0.89[95%confidence interval(CI):0.61-1.30],adjusted RR=0.99(0.44-2.21).Rates of response to medical rescue therapy in older adults was comparable to the younger cohort[76.5%vs 85.7%,P=0.46,crude RR=0.89(0.67-1.17)].Index admission colectomy[13.3%vs 10.5%,P=0.598,crude RR=1.27(0.53-2.99),adjusted RR=1.43(0.34-6.06)],colectomy at 3 mo[20%vs 16.6%,P=0.66,crude RR=1.18(0.61-2.3),adjusted RR=1.31(0.32-0.53)]and colectomy at 12 mo[20%vs 23.2%,P=0.682,crude RR=0.85(0.45-1.57),adjusted RR=1.21(0.29-4.97)],were similar between the two groups.CONCLUSION In older adults with ASUC,the steroid non-response rate,response to medical rescue therapy,and colectomy rate at index admission,3 and 12 mo is similar to patients less than 60 years of age.
文摘Voltage scaling has been extensively used in industry for decades to reduce power consumption.In recent years,exploring digital circuit operation in moderate inversion has created an interest among researchers due to its immense capability to provide a perfect tradeoff between high performance and low energy operation.But circuits operating in moderate inversion are susceptible to process variations and variability.To compute variability,statistical parameters such as the probability density function(PDF)and cumulative distribution function(CDF)are required.This paper presents an analytical model framework for delay calculations utilizing log skew normal distribution for ultradeep submicron technology nodes up to 22 nm.The CDF of the proposed model is utilized to calculate minimum and maximum delays with 3σ-accuracy providing better accuracy than the conventional methods.The obtained results are also compared with Monte Carlo simulations with errors lying within the acceptable range of 2%-4%.
文摘This project paper is to give a prediction for the future of other viral pandemics and to provide recommendations for preparing therapies that could help in the success of effective treatments and benefits for patients in life-threatening situations. The theory of prediction was proposed by Huu S. TIEU on March 25, 2019, and he hypothesized that any malfunctioning cell in the body could have a damaging effect. This paper discusses the prediction that Localized Oxygen Deprivation could be a contributing factor for a future epidemic or other viral pandemics that could affect body function. This paper is based on opinion and does not have sufficient evidence to support the claims made. Therefore, further in-depth study is needed to prove the findings. The author cites Hypoxia to support his idea, but he is not claiming that Hypoxia-Inducible Factor (HIF) has worked on his predictions. The author also tested a theory using cow blood curd for body function, but this test was not a structured test and the findings were not supported by other evidence. To further prove the idea or theory, further study into the subject should be conducted.
文摘Based on the disaster reports,NCEP2.5X2.5 reanalysis data and radiosonde data of 11 national stations in Ulanqab region from June to August during 2012-2017,the weather situation classification and warning indicators of thunderstorm and gale,hail and short-term heavy rainfall were studied.The results show that the cold vortex weather situation was easy to produce hail,and the falling area of severe convection could be found in the downstream of the cold vortex,the intersection area of jet stream at 200 and 500 hPa,and the wet area side of the 700 hPa main line.The cold trough type weather situation was easy to produce thunderstorm and gale,and the falling area of severe convection appeared on the right side of the upper jet stream axis,the left side of the lower jet stream axis,the wet side of the 700 hPa main line,and the east of the shear line at 700 hPa.The weather situation of the low trough and subtropical high type was dominated by short-term rainstorm,and the falling area of severe convection was on the right side of upper jet stream at 200 hPa,the left side of the low southeast jet stream,and the wet side of the 700 hPa main line.The warning index thresholds of the total index,the temperature change at 850-500 hPa with height,the height of 0 and-20℃layer,lifting condensation height,temperature dew point difference and mixing ratio were highly reliable.
文摘Background:Active-comparator trials are important to inform patient and physician choice.We aimed to evaluate the efficacy and safety of monotherapy with either ustekinumab or adalimumab in biologic-naive patients with moderately to severely active Crohn's disease.
基金This study was approved by the Medical Ethics Committee of Longyan First Affiliated Hospital of Fujian Medical University(Approved No.LYREC2023-k016-01).
文摘BACKGROUND There are many risk factors for severe acute pancreatitis(SAP)complicated with acute gastrointestinal injury(AGI),but few reports on the interaction between these risk factors.AIM To analyze the risk factors for SAP complicated with AGI and their interactive effects.METHODS We selected 168 SAP patients admitted to our hospital between December 2019 and June 2022.They were divided into AGI group and non-AGI group according to whether AGI was present.Demographic data and laboratory test data were compared between the two groups.The risk factors for SAP with concomitant AGI were analyzed using multifactorial logistic regression,and an analysis of the interaction of the risk factors was performed.RESULTS The percentage of patients with multiple organ dysfunction syndrome,acute physiological and chronic health scoring system II(APACHE II)score,white blood cell count and creatinine(CRE)level was higher in the AGI group than in the non-AGI group.There was a statistically significant difference between the two groups(P<0.05).Logistic regression analysis indicated that an APACHE II score>15 and CRE>100μmol/L were risk factors for SAP complicating AGI.The interaction index of APACHE II score and CRE level was 3.123.CONCLUSION An APACHE II score>15 and CRE level>100μmol/L are independent risk factors for SAP complicated with AGI,and there is a positive interaction between them.
基金This study was reviewed and approved by the Ethics Committee of the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine(Ethics Approval No.:SH9H-2022-T139-1).
文摘BACKGROUND Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has led to millions of confirmed cases and deaths worldwide.Elderly patients are at high risk of developing and dying from COVID-19 due to advanced age,decreased immune function,intense inflammatory response,and comorbidities.Shanghai has experienced a wave of infection with Omicron,a new variant of SARS-CoV-2,since March 2022.There is a pressing need to identify clinical features and risk factors for disease progression among elderly patients with Omicron infection to provide solid evidence for clinical policy-makers,public health officials,researchers,and the general public.AIM To investigate clinical characteristic differences and risk factors between elderly patients with severe and nonsevere Omicron SARS-CoV-2 variant infection.METHODS A total of 328 elderly patients with COVID-19 admitted to the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 2022 to June 2022 were enrolled and divided into a severe group(82 patients)and a nonsevere group(246 patients)according to the diagnosis and treatment protocol of COVID-19(version 7).The clinical data and laboratory results of both groups were collected and compared.A chi-square test,t test,Mann-Whitney U test,hierarchical log-rank test,univariate and multivariate logistic regression,and hierarchical analyses were used to determine significant differences.RESULTS The severe group was older(84 vs 74 years,P<0.001),included more males(57.3%vs 43.9%,P=0.037),had a lower vaccination rate(P<0.001),and had a higher proportion of comorbidities,including chronic respiratory disease(P=0.001),cerebral infarction(P<0.001),chronic kidney disease(P=0.002),and neurodegenerative disease(P<0.001),than the nonsevere group.In addition,severe disease patients had a higher inflammatory index(P<0.001),greater need for symptomatic treatment(P<0.001),longer hospital stay(P=0.011),extended viral shedding time(P=0.014),and higher mortality than nonsevere disease patients(P<0.001).No difference was observed in the application of Paxlovid in the severe and nonsevere groups(P=0.817).Oxygen saturation,cerebral infarction,and D-dimer were predictive factors for developing severe disease in patients with COVID-19,with D-dimer having an excellent role(area under the curve:90.1%,95%CI:86.1-94.0%).In addition,D-dimer was a risk factor for developing severe COVID-19 according to multivariate stratified analysis.CONCLUSION The clinical course of severe COVID-19 is complex,with a higher need for symptomatic treatment.D-dimer is a suitable biomarker for identifying patients at risk for developing severe COVID-19.
文摘Chronic heart failure(CHF)is a clinical syndrome manifested by reduced pumping ability of the heart,increased pressure in heart chambers in both physical activity and at rest.The symptoms of this syndrome are dyspnea,undue fatigability,peripheral edema,which follow structural and functional changes of the myocardium.[1]The growing incidence of CHF,especially among elderly people,is an urgent problem for medicine in the vast majority of industrialized countries.For instance,in Russian Federation,CHF is diagnosed in about 7%of cardiovascular patients.At the same time,this indicator varies from 0.3%in young people(20-29 years old)to 70%in the older age group.[2,3].
文摘The liver has many significant functions,such as detoxification,the urea cycle,gluconeogenesis,and protein synthesis.Systemic diseases,hypoxia,infections,drugs,and toxins can easily affect the liver,which is extremely sensitive to injury.Systemic infection of severe acute respiratory syndrome coronavirus 2 can cause liver damage.The primary regulator of intracellular pH in the liver is the Na+/H+exchanger(NHE).Physiologically,NHE protects hepatocytes from apoptosis by making the intracellular pH alkaline.Severe acute respiratory syndrome coronavirus 2 increases local angiotensin II levels by binding to angiotensinconverting enzyme 2.In severe cases of coronavirus disease 2019,high angiotensin II levels may cause NHE overstimulation and lipid accumulation in the liver.NHE overstimulation can lead to hepatocyte death.NHE overstimulation may trigger a cytokine storm by increasing proinflammatory cytokines in the liver.Since the release of proinflammatory cytokines such as interleukin-6 increases with NHE activation,the virus may indirectly cause an increase in fibrinogen and D-dimer levels.NHE overstimulation may cause thrombotic events and systemic damage by increasing fibrinogen levels and cytokine release.Also,NHE overstimulation causes an increase in the urea cycle while inhibiting vitamin D synthesis and gluconeogenesis in the liver.Increasing NHE3 activity leads to Na+loading,which impairs the containment and fluidity of bile acid.NHE overstimulation can change the gut microbiota composition by disrupting the structure and fluidity of bile acid,thus triggering systemic damage.Unlike other tissues,tumor necrosis factor-alpha and angiotensin II decrease NHE3 activity in the intestine.Thus,increased luminal Na+leads to diarrhea and cytokine release.Severe acute respiratory syndrome coronavirus 2-induced local and systemic damage can be improved by preventing virus-induced NHE overstimulation in the liver.
