BACKGROUND Autoimmune pancreatitis(AIP)has been linked with elevated immunoglobulin(Ig)G4 levels.The characteristics and outcomes of AIP based on serum markers have not been fully evaluated.AIM To compare clinical fea...BACKGROUND Autoimmune pancreatitis(AIP)has been linked with elevated immunoglobulin(Ig)G4 levels.The characteristics and outcomes of AIP based on serum markers have not been fully evaluated.AIM To compare clinical features,treatment efficacy,and outcome of AIP based on serum IgG4 levels and analyze predictors of relapse.METHODS A total of 213 patients with AIP were consecutively reviewed in our hospital from 2006 to 2021.According to the serum IgG4 level,all patients were divided into two groups,the abnormal group(n=148)with a high level of IgG4[>2×upper limit of normal(ULN)]and the normal group(n=65).The t-test or Mann-Whitney U test was used to compare continuous variables.Categorical parameters were compared by theχ^(2) test or Fisher’s exact test.Kaplan-Meier curves Zhou GZ et al.Clinical characteristics and outcome of AIP WJG https://www.wjgnet.com 5126 September 21,2023 Volume 29 Issue 35 and log-rank tests were established to assess the cumulative relapse rates.Univariate and multivariate analyses were used to investigate potential risk factors of AIP relapse.RESULTS Compared with the normal group,the abnormal group had a higher average male age(60.3±10.4 vs 56.5±12.9 years,P=0.047);higher level of serum total protein(72.5±7.9 g/L vs 67.2±7.5 g/L,P<0.001),IgG4(1420.5±1110.9 mg/dL vs 252.7±106.6 mg/dL,P<0.001),and IgE(635.6±958.1 IU/mL vs 231.7±352.5 IU/mL,P=0.002);and a lower level of serum complement C3(100.6±36.2 mg/dL vs 119.0±45.7 mg/dL,P=0.050).In addition,a lower number of cases with abnormal pancreatic duct and pancreatic atrophy(23.6%vs 37.9%,P=0.045;1.6%vs 8.6%,P=0.020,respectively)and a higher rate of relapse(17.6%vs 6.2%,P=0.030)were seen in the abnormal group.Multivariate analyses revealed that serum IgG4[(>2×ULN),hazard ratio(HR):3.583;95%confidence interval(CI):1.218–10.545;P=0.020]and IgA(>1×ULN;HR:5.908;95%CI:1.199–29.120;P=0.029)and age>55 years(HR:2.383;95%CI:1.056–5.378;P=0.036)were independent risk factors of relapse.CONCLUSION AIP patients with high IgG4 levels have clinical features including a more active immune system and higher relapse rate.Several factors,such as IgG4 and IgA,are associated with relapse.展开更多
Objective:Traditional Chinese medicine(TCM)has been extensively used as one of popular alternative therapies for several cancers.However,it remains unclear whether TCM treatment is associated with longer survival in l...Objective:Traditional Chinese medicine(TCM)has been extensively used as one of popular alternative therapies for several cancers.However,it remains unclear whether TCM treatment is associated with longer survival in lung cancer patients.In this study,we explored the effect of long-term TCM treatment on patients with different stages of lung cancer.Methods:All information of lung cancer patients with stage I-III disease from January 2007 to September 2015 was collected for this retrospective cohort study.Those who were treated with TCM after surgery were divided into TCM group and the others were into the non-TCM group(control group).All patients were regularly followed up by clinic appointment or phone,and all survival data were collected from databases after the last follow-up in October 2017.Results:A total of 575 patients were included in this study,with 299 patients in the TCM group and 276 in the control group.For all patients,5-year disease-free survival(DFS)was 62.2% in TCM group and 42.1% in the control group,and 6-year DFSs were 51.8% and 35.4%,respectively(HR=0.51,95% CI:0.40 to 0.66,log-rank P≤0.001).For patients with stage I,5-year DFSs were 83.7%(TCM group)and 57.5%(control group)and 6-year DFSs were 73.7% and 51.9%,respectively(HR=0.30,95% CI:0.18 to 0.50,log-rank P≤0.001).For patients with stage II in the TCM group and the control group,5-year DFSs were 59.4% and 17.6% and 6-year DFSs were 44.7% and 17.6%,respectively(HR=0.31,95% CI:0.19 to 0.52,log-rank P≤0.001),and for patients with stage III,5-year and 6-year DFSs in the TCM group were 18.7% and 12.5% compared with 28.4% and 20.3% in the control group(HR=1.06,95% CI:0.72 to 1.56,log-rank P=0.76).Conclusions:This study demonstrated that long-term TCM treatment as an adjuvant therapy is able to improve the DFS of postoperative stage I-III lung cancer patients,especially in patients with stage I and II disease.However,these observational findings need being validated by large sample randomized controlled trials.展开更多
AIM To verify the value of Gutuo Jiejiu decoction in improving the survival of patients with severe alcoholic hepatitis(SAH).METHODS We performed a retrospective cohort study in consecutive patients diagnosed with SAH...AIM To verify the value of Gutuo Jiejiu decoction in improving the survival of patients with severe alcoholic hepatitis(SAH).METHODS We performed a retrospective cohort study in consecutive patients diagnosed with SAH at the Teaching Hospital of Chengdu University of Traditional Chinese Medicine and Shuguang Hospital, Shanghai University of Traditional Chinese Medicine. The traditional Chinese medicine formula Gutuo Jiejiu decoction was employed as an exposure factor. Patients from the Teaching Hospital of Chengdu University of Traditional Chinese Medicine who had been treated with Gutuo Jiejiu decoction + prednisone were assigned to an observation group, and patients from Shuguang Hospital, Shanghai University of Traditional Chinese Medicine who had been treated with prednisone alone were selected as a control group. A retrospective analysis was performed by comparing age, alcohol intake, and clinical parameters of liver injury beforeand after treatment. Additionally, the 3-and 12-mo survival rates and the occurrence of complications were analyzed.RESULTS One hundred and twenty-eight eligible patients were selected from 175 cases with SAH, of which 68 were assigned to the observation group and the other 60 to the control group. No significant difference was found in the patients' baseline characteristics(P > 0.05). However, significant improvements of 90-d survival rate [56/68(82.4%) vs 27/60(45.0%), P = 0.0000] and 365-d survival rate [48/68(70.6%) vs 13/60(21.7%), P = 00000] were observed in the observation group after treatment. After the first 3 mo of treatment, more improvements in the clinical parameters and scoring systems related to liver injury occurred in the observation group than in the control group(P < 0.05). After treatment for 12 mo, the differences in the clinical parameters and scoring systems related to liver injury between the two groups were more significant(P < 0.05). No significant differences in complications and adverse effects were found between the two groups.CONCLUSION Gutuo Jiejiu decoction could improve the survival rates and clinical parameters of liver injury in patients with SAH, and may represent a new option for treating SAH.展开更多
BACKGROUND Hepatorenal syndrome(HRS)is a severe complication of cirrhosis with high mortality,which necessitates accurate clinical decision.However,studies on prognostic factors and scoring systems to predict overall ...BACKGROUND Hepatorenal syndrome(HRS)is a severe complication of cirrhosis with high mortality,which necessitates accurate clinical decision.However,studies on prognostic factors and scoring systems to predict overall survival of HRS are not enough.Meanwhile,a multicenter cohort study with a long span of time could be more convincing.AIM To develop a novel and effective prognostic model for patients with HRS and clarify new prognostic factors.METHODS We retrospectively enrolled 1667 patients from four hospitals,and 371 eligible patients were finally analyzed to develop and validate a novel prognostic model for patients with HRS.Characteristics were compared between survivors and non-survivors,and potential prognostic factors were selected according to the impact on 28-d mortality.Accuracy in predicting 28-d mortality was compared between the novel and other scoring systems,including Model for End-Stage Liver Disease(MELD),Chronic Liver Failure-Sequential Organ Failure Assessment(CLIF-SOFA),and Chinese Group on the Study of Severe Hepatitis BAcute-on-Chronic Liver Failure(COSSH-ACLF).RESULTS Five prognostic factors,comprised of gender,international normalized ratio,mean corpuscular hemoglobin concentration,neutrophil percentage,and stage,were integrated into a new score,GIMNS;stage is a binary variable defined by the number of failed organs.GIMNS was positively correlated with MELD,CLIFSOFA,and COSSH-ACLF.Additionally,it had better accuracy[area under the receiver operating characteristic curve(AUROC):0.830]than MELD(AUROC:0.759),CLIF-SOFA(AUROC:0.767),and COSSH-ACLF(AUROC:0.759)in the derivation cohort(P<0.05).It performed better than MELD and CLIF-SOFA in the validation cohort(P<0.050)and had a higher AUROC than COSSH-ACLF(P=0.122).CONCLUSION We have developed a new scoring system,GIMNS,to predict 28-d mortality of HRS patients.Mean corpuscular hemoglobin concentration and stage were first proposed and found to be related to the mortality of HRS.Additionally,the GIMNS score showed better accuracy than MELD and CLIF-SOFA,and the AUROC was higher than that of COSSH-ACLF.展开更多
BACKGROUND Primary tumor location is a prognostic factor for metastatic colorectal cancer(m CRC).Post hoc analyses of m CRC clinical trials,including FIRE-3,CALGB/SWOG 80405,suggest that primary tumor location is also...BACKGROUND Primary tumor location is a prognostic factor for metastatic colorectal cancer(m CRC).Post hoc analyses of m CRC clinical trials,including FIRE-3,CALGB/SWOG 80405,suggest that primary tumor location is also predictive of survival benefit with cetuximab or bevacizumab in combination with 5-fluorouracil-based chemotherapy.AIM Evaluate prognostic/predictive roles of primary tumor location in real-world m CRC patients treated with cetuximab or bevacizumab plus 5-fluorouracil-based chemotherapy.METHODS This retrospective cohort study selected patients with KRAS wild-type m CRC who initiated first-line therapy with cetuximab or bevacizumab in combination with 5-fluorouracil/leucovorin/irinotecan(FOLFIRI)or 5-fluorouracil/leucovorin/oxaliplatin(FOLFOX)between January 2013 and April 2017 from the Flatiron Health electronic health record-derived database of de-identified patientlevel data in the United States.Primary tumor location was abstracted from patients’charts.Left-sided primary tumor location(LPTL)was defined as tumors that originated in the splenic flexure,descending colon,sigmoid colon,or rectum;right-sided primary tumor location(RPTL)was defined as tumors that originated from the appendix,cecum,ascending colon,hepatic flexure,or transverse colon.Propensity score matching was used to balance the baseline demographic and clinical characteristics between patients treated with cetuximab and patientstreated with bevacizumab.Kaplan-Meier and Cox regression methods were used for survival analyses.RESULTS A total of 1312 patients met the selection criteria.Of 248 cetuximab plus FOLFIRI or FOLFOX patients,164 had LPTL and 84 had RPTL;of 1064 bevacizumab plus FOLFIRI or FOLFOX patients,679 had LPTL and 385 had RPTL.Cetuximab LPTL and RPTL patients were more likely to receive FOLFIRI vs bevacizumab patients(LPTL:64.0%vs 24.3%;RPTL:76.2%vs 24.9%,P<0.001).Stage at initial diagnosis was different between cetuximab RPTL vs bevacizumab RPTL patients(P<0.001);cetuximab RPTL patients were more likely to have stage III disease(44.0%vs 22.6%),while bevacizumab RPTL patients were more likely to have stage IV disease(65.7%vs 48.8%).Cetuximab RPTL patients were more likely to have a documented history of adjuvant chemotherapy vs bevacizumab RPTL patients(47.6%vs 22.3%,P<0.001).In the propensity score-matched sample,median overall survival(OS)was 29.7 mo(95%CI:26.9-35.2)for LPTL patients vs 18.3 mo(95%CI:15.8-21.3)for RPTL patients(P<0.001).Median OS was 29.7 mo(95%CI:27.4-NA)for cetuximab LPTL patients vs 29.1 mo(95%CI:26.6-35.6)for bevacizumab LPTL patients(HR=0.87;95%CI:0.63-1.19;P=0.378)and 17.0 mo(95%CI:12.0-32.6)for cetuximab RPTL patients vs 18.8 mo(95%CI:15.8-22.3)for bevacizumab RPTL patients(HR=1.00;95%CI:0.68-1.46;P=0.996).The interaction of treatment and primary tumor location was not significant in the Cox regression.CONCLUSION In this real-world m CRC cohort,the prognostic role of primary tumor location was substantiated,but not the predictive role for treatment with cetuximab vs bevacizumab in combination with 5-fluorouracil-based chemotherapy.展开更多
BACKGROUND Polycystic ovary syndrome(PCOS)is a common disorder in women of reproductive age.Over the last few decades,research studies have revealed that PCOS is strongly associated with metabolic disorders,including ...BACKGROUND Polycystic ovary syndrome(PCOS)is a common disorder in women of reproductive age.Over the last few decades,research studies have revealed that PCOS is strongly associated with metabolic disorders,including metabolic syndrome,obesity,insulin resistance and prediabetes.Clinical observation has shown that women with PCOS are expected to have an increased risk of developing type 2 diabetes(T2DM)in the future.AIM To assess the hazard ratio(HR)of T2DM between women with/without PCOS.METHODS This population-based,retrospective cohort study evaluated data retrieved from the National Health Insurance Research Database.The subjects were women with PCOS(n=2545)identified on the basis of diagnosis,testing,or treatment codes,and women without PCOS as controls(n=2545).The HR of T2DM between women with or without PCOS was the main outcome measure analyzed.RESULTS Our study found that, during a 10-year follow-up period, the overall incidence of T2DM was 6.25per 1000 person-years in the PCOS group compared with 1.49 in the control group. Afteradjustment for potential confounding variables, the overall incidence of T2DM was higher in thePCOS group vs the control group (HR = 5.13, 95%CI: 3.51-7.48, P < 0.0001). The risk of developingT2DM subsequent to PCOS decreased with increasing diagnosis age: the adjusted HR was 10.4 inthe 18–24-year age group, 5.28 in the 25-29-year age group, and 4.06 in the 29-34-year age group.However, no such significant association was noted in women older than 35 years.CONCLUSIONThese findings highlight the importance of prompting a more aggressive treatment to preventdiabetes in women diagnosed with PCOS at a young age, and, in contrast, the lessened importanceof this type of intervention in women diagnosed with PCOS at a late reproductive age.展开更多
BACKGROUND Day case total shoulder arthroplasty(TSA)is a novel approach,not widely practiced in Europe.We conducted a retrospective cohort study of patients comparing elective day case and inpatient TSAs in our United...BACKGROUND Day case total shoulder arthroplasty(TSA)is a novel approach,not widely practiced in Europe.We conducted a retrospective cohort study of patients comparing elective day case and inpatient TSAs in our United Kingdom centre.AIM To evaluate the efficacy and cost-effectiveness of day case TSA compared to standard inpatient total shoulder arthroplasty.METHODS All patients undergoing TSA between January 2017 and July 2018 were included.Outcome measures were:Change in abduction and extension 3 mo postoperatively;30-d postoperative adverse events and re-admissions in day case and inpatient groups.We also conducted an economic evaluation of outpatient arthroplasty.Multivariate linear and logistic regression were used to adjust for demographic and operative covariates.RESULTS Fifty nine patients were included,18 d cases and 41 inpatients.There were no adverse events or re-admissions at 30 d postoperatively in either group.There were no significant differences in adjusted flexion(mean difference 16.4,95%CI:17.6-50.5,P=0.337)or abduction(mean difference:13.2,95%CI:18.4-44.9,P=0.405)postoperatively between groups.Median savings with outpatient arthroplasty were￡529(interquartile range:247.33-789,P<0.0001).CONCLUSION Day case TSA is a safe,effective procedure,with significant cost benefit.Wider use may be warranted in the United Kingdom and beyond,with potential for significant cost savings and improved efficiency.展开更多
BACKGROUND There is indication that fecal microbiota transplant(FMT)has the potential to alter the course of chronic skin disease,but few studies have investigated this phenomenon beyond case reports.Research with lar...BACKGROUND There is indication that fecal microbiota transplant(FMT)has the potential to alter the course of chronic skin disease,but few studies have investigated this phenomenon beyond case reports.Research with larger sample sizes is needed to provide a more thorough assessment of possible associations and to establish a broader foundation upon which to base hypotheses.AIM To identify associations between FMT and skin conditions,particularly infectious and inflammatory etiologies,and the role of dermatology post-FMT.METHODS We conducted a retrospective cohort study involving a chart review of all patients whom received FMT between January 2013 and December 2019 at a single academic medical center.Dermatologic follow-up was assessed for the two years after FMT or through March 2020 for more recent procedures.Dermatologic diagnoses and visits within the study time frame were recorded and assessed for trends.This study was exploratory in nature.Descriptive statistics were calculated,and the t-test,Pearson’s chi-squared test,and Fisher’s exact test were used to calculate P values.RESULTS Median age was 38(range,17-90).In total,109 patients who underwent 111 fecal microbiota transplant events were included.Twenty-six events(23.4%)involved a dermatology office visit post-procedure,and of these events,20 out of the 26(76.9%)had an infectious or inflammatory skin condition.The mean time to first visit was 10.0(±7.0)mo.The most common diagnoses were dermatophyte,wart(s),and dermatitis,though no specific diagnoses predominated in a way indicating FMT had a significant impact.More patients with a post-FMT skin disease diagnosis had a history of Crohn’s disease compared to those without(P=0.022),but results could be affected by a small sample size.CONCLUSION Our study is limited by its retrospective nature,but the findings allow a glimpse at dermatologic conditions post-FMT.Few significant associations were found,but potential associations between FMT and skin disease should be further investigated,preferably in prospective studies,to identify how FMT might be of use for treating infectious and inflammatory skin diseases.展开更多
Objective There is a dilemma of ibuprofen treatment with patent ductus arteriosus(PDA)as to how and when to treat.We aimed to clarify this issue in very preterm infants(VPIs;<32 weeks).Methods:This retrospective st...Objective There is a dilemma of ibuprofen treatment with patent ductus arteriosus(PDA)as to how and when to treat.We aimed to clarify this issue in very preterm infants(VPIs;<32 weeks).Methods:This retrospective study included 1659 VPIs who were diagnosed with PDA according to echocardiographic examinations and cardiovascular dysfunction scoring system(the CVD scoring).The VPIs were classified into six groups(A1,A2,A3,B1,B2,and B3)based on CVD scores(A,<3,and B,≥3),and treatment with ibuprofen for PDA(1,conservational management;2,early ibuprofen treatment;and 3,late ibuprofen treatment).Treatment was stopped when PDA was closed,CVD score was zero or PDA needed ligation.Results:VPIs with CVD scores<3 had most PDA closure without surgery,and early ibuprofen treatment did not significantly affect PDA closure.VPIs with CVD scores≥3 had some PDA closure after 2 courses of treatment,but closure rates decreased linearly with ibuprofen course(1^(st)75.2%,2^(nd)62.3%,3^(rd)50.0%,P<0.0001),and early ibuprofen treatment(group B2)did not increase PDA closure compared to late ibuprofen treatment(group B3).In these same infants,the longer they were in CVD scores≥3,the more the complications of preterm were increased(retinopathy of prematurity ROP 1^(st)16.5%,2^(nd)23.8%,3^(rd)29.6%,P=0.016;bronchopulmonary dysplasia BPD 1^(st)15.5%,2^(nd)26.7%,3^(rd)33.8%,P<0.0001;intraventricular hemorrhage IVH 1^(st)20.4%,2^(nd)32.4%,3^(rd)23.8%,P=0.015).Conclusion:Ibuprofen is suggested for PDA closure when the PDA reopens or has developed into the stage when the CVD score≥3.展开更多
Objective:To evaluate the efficacy and safety of Huashi Baidu Granules(HSBD)in treating patients with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron variant.Methods:A single-center retrospective co...Objective:To evaluate the efficacy and safety of Huashi Baidu Granules(HSBD)in treating patients with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron variant.Methods:A single-center retrospective cohort study was conducted during COVID-19 Omicron epidemic in the Mobile Cabin Hospital of Shanghai New International Expo Center from April 1st to May 23rd,2022.All COVID-19 patients with asymptomatic or mild infection were assigned to the treatment group(HSBD users)and the control group(non-HSBD users).After propensity score matching in a 1:1 ratio,496 HSBD users of treatment group were matched by propensity score to 496 non-HSBD users.Patients in the treatment group were administrated HSBD(5 g/bag)orally for 1 bag twice a day for 7 consecutive days.Patients in the control group received standard care and routine treatment.The primary outcomes were the negative conversion time of nucleic acid and negative conversion rate at day 7.Secondary outcomes included the hospitalized days,the time of the first nucleic acid negative conversion,and new-onset symptoms in asymptomatic patients.Adverse events(AEs)that occurred during the study were recorded.Further subgroup analysis was conducted in vaccinated(378 HSBD users and 390 non-HSBD users)and unvaccinated patients(118 HSBD users and 106 non-HSBD users).Results:The median negative conversion time of nucleic acid in the treatment group was significantly shortened than the control group[3 days(IQR:2-5 days)vs.5 days(IQR:4-6 days);P<0.01].The negative conversion rate of nucleic acid in the treatment group were significantly higher than those in the control group at day 7(91.73%vs.86.90%,P=0.014).Compared with the control group,the hospitalized days in the treatment group were significantly reduced[10 days(IQR:8-11 days)vs.11 days(IQR:10.25-12 days);P<0.01].The time of the first nucleic acid negative conversion had significant differences between the treatment and control groups[3 days(IQR:2-4 days)vs.5 days(IQR:4-6 days);P<0.01].The incidence of new-onset symptoms including cough,pharyngalgia,expectoration and fever in the treatment group were lower than the control group(P<0.05 or P<0.01).In the vaccinated patients,the median negative conversion time and hospitalized days were significantly shorter than the control group after HSDB treatment[3days(IQR:2-5days)vs.5 days(IQR:4-6 days),P<0.01;10 days(IQR:8-11 days)vs.11 days(IQR:10-12 days),P<0.01].In the unvaccinatedpatients,HSBD treatment efficiently shorten the median negative conversion time and hospitalized days[4 days(IQR:2-6 days)vs.5 days(IQR:4-7 days),P<0.01;10.5 days(IQR:8.75-11 days)vs.11.0 days(IQR:10.75-13 days);P<0.01].No serious AEs were reported during the study.Conclusion:HSBD treatment significantly shortened the negative conversion time of nuclear acid,the length of hospitalization,and the time of the first nucleic acid negative conversion in patients infectedwith SARS-COV-2Omicronvariant(Trial registry No.ChiCTR2200060472).展开更多
Background:The effect of intra-operative chemotherapy(IOC)on the long-term survival of patients with colorectal cancer(CRC)remains unclear.In this study,we evaluated the independent effect of intra-operative infusion ...Background:The effect of intra-operative chemotherapy(IOC)on the long-term survival of patients with colorectal cancer(CRC)remains unclear.In this study,we evaluated the independent effect of intra-operative infusion of 5-fluorouracil in combination with calcium folinate on the survival of CRC patients following radical resection.Methods:1820 patients were recruited,and 1263 received IOC and 557 did not.Clinical and demographic data were collected,including overall survival(OS),clinicopathological features,and treatment strategies.Risk factors for IOC-related deaths were identified using multivariate Cox proportional hazards models.A regression model was developed to analyze the independent effects of IOC.Results:Proportional hazard regression analysis showed that IOC(hazard ratio[HR]=0.53,95%confidence intervals[CI][0.43,0.65],P<0.001)was a protective factor for the survival of patients.The mean overall survival time in IOC group was 82.50(95%CI[80.52,84.49])months,and 71.21(95%CI[67.92,74.50])months in non-IOC group.The OS in IOC-treated patients were significantly higher than non-IOC-treated patients(P<0.001,log-rank test).Further analysis revealed that IOC decreased the risk of death in patients with CRC in a non-adjusted model(HR=0.53,95%CI[0.43,0.65],P<0.001),model 2(adjusted for age and gender,HR=0.52,95%CI[0.43,0.64],P<0.001),and model 3(adjusted for all factors,95%CI 0.71[0.55,0.90],P=0.006).The subgroup analysis showed that the HR for the effect of IOC on survival was lower in patients with stage II(HR=0.46,95%CI[0.31,0.67])or III disease(HR=0.59,95%CI[0.45,0.76]),regardless of pre-operative radiotherapy(HR=0.55,95%CI[0.45,0.68])or pre-operative chemotherapy(HR=0.54,95%CI[0.44,0.66]).Conclusions:IOC is an independent factor that influences the survival of CRC patients.It improved the OS of patients with stages II and III CRC after radical surgery.Trial registration:chictr.org.cn,ChiCTR 2100043775.展开更多
OBJECTIVE:To provide the evidence for the efficacy of acupoint application(AA)for patients with diarrhea in a real-world setting.METHODS:This study is a national multicenter retrospective cohort study.Our study consec...OBJECTIVE:To provide the evidence for the efficacy of acupoint application(AA)for patients with diarrhea in a real-world setting.METHODS:This study is a national multicenter retrospective cohort study.Our study consecutively collected outpatient medical records of patients with diarrhea from hundreds of primary hospitals nationwide registered in Chun Bo Wan Xiang cloud platform from 22nd August,2020 to 5th November,2020.The patients were divided into the treatment group and the control group according to patient's condition and willingness.The control group was treated with Western Medicine,oral Chinese Medicine decoction,or both.The treatment group was added with AA based on the control group.Multiple logistic regression was used to evaluate the independent efficacy of AA in diarrheal recovery on the 3rd,7th,14th and 28th day.As a next step,we also performed stratified analysis and likelihood ratio test(LRT).Sensitivity analyses included propensity score matching(PSM),four PSM-related analyses and E-value.RESULTS:The treatment group showed better efficacy than the control group on the 14th and 28th day[the 14th day:OR=1.58,95%CI(1.15,2.19),P=0.005;the 28th day:OR=2.03,95%CI(1.43,2.88),P<0.001].No difference was observed in efficacy of AA for the treatment of diarrhea among the subgroups(P>0.05).PSM-related analyses confirmed the efficacy of AA in diarrheal recovery.The findings are unlikely to be nullified by an unmeasured confounding variable according to the results of E-values.CONCLUSIONS:The efficacy in the treatment group was significantly more improved than that in the control group on the 14th and 28th day.展开更多
Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic ...Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.展开更多
BACKGROUND For children and adolescents,deliberate self-harm(DSH)is becoming a mental health problem of concern.Despite several studies on the prevalence and factors of DSH in the world,there is little information on ...BACKGROUND For children and adolescents,deliberate self-harm(DSH)is becoming a mental health problem of concern.Despite several studies on the prevalence and factors of DSH in the world,there is little information on DSH among children and adolescents in China.This study explores the prevalence,types,associated risk factors and tendency of DSH in pediatric psychiatric inpatients in China.AIM To understand the situation of DSH among hospitalized children and adolescents and its related factors.METHODS In this study,we retrospectively studied 1414 hospitalized children and adolescents with mental illness at Xiamen Mental Health Center from 2014 to 2019,extracted the demographic and clinical data of all patients,and analyzed clinical risk factors of DSH.RESULTS A total of 239(16.90%)patients engaged in at least one type of DSH in our study.Cutting(n=115,48.12%)was the most common type of DSH.Females(n=171,71.55%)were more likely to engage in DSH than males(n=68,28.45%).DSH was positively associated with depressive disorders[OR=3.845(2.196-6.732);P<0.01],female[OR=2.536(1.815-3.542);P<0.01],parental marital status[OR=5.387(2.254-12.875);P<0.01]and negative family history of psychiatric illness[OR=7.767(2.952-20.433);P<0.01],but not with occupation,substance use and history of physical abuse.CONCLUSION Our findings suggest that for patients with depression,females,an abnormal marriage of parents,and no history of mental illness,attention should be paid to the occurrence of DSH.展开更多
Objective:Accurate measurement of QT interval,the ventricular action potential from depolarization to repolarization,is important for the early detection of Long QT syndrome.The most effective QT correction(QTc)formul...Objective:Accurate measurement of QT interval,the ventricular action potential from depolarization to repolarization,is important for the early detection of Long QT syndrome.The most effective QT correction(QTc)formula has yet to be determined in the pediatric population,although it has intrinsically greater extremes in heart rate(HR)and is more susceptible to errors in measurement.The authors of this study compare six dif-ferent QTc methods(Bazett,Fridericia,Framingham,Hodges,Rautaharju,and a computer algorithm utilizing the Bazett formula)for consistency against variations in HR and RR interval.Methods:Descriptive Retrospective Study.We included participants from a pediatric cardiology practice of a community hospital who had an ECG performed in 2017.All participants were healthy patients with no past medical history and no regular med-ications.Results:ECGs from 95 participants from one month to 21 years of age(mean 9.7 years)were included with a mean HR of 91 beats per minute(bpm).The two-sample paired t-test or Wilcoxon signed-rank test assessed for any difference between QTc methods.A statistically significant difference was observed between every combination of two QTc formulae.The Spearman’s rank correlation analysis explored the QTc/HR and QTc/RR relationships for each formula.Fridericia method was most independent of HR and RR with the lowest absolute value of correlation coefficients.Bazett and Computer had moderate correlations,while Framingham and Rautaharju exhibited strong correlations.Correlations were positive for Bazett and Computer,reflecting results from prior studies demonstrating an over-correction of Bazett at higher HRs.In the linear QTc/HR regression analysis,Bazett had the slope closest to zero,although Computer,Hodges,and Fridericia had comparable values.Alternatively,Fridericia had the linear QTc/RR regression coefficient closest to zero.The Bland-Altman method assessed for bias and the limits of agreement between correction formulae.Bazett and Computer exhibited good agreement with minimal bias along with Framingham and Rautaharju.To account for a possible skewed distri-bution of QT,all the above analyses were also performed excluding the top and bottom 2%of data as sorted by heart rate ranges(N=90).Results from this data set were consistent with those derived from all participants(N=95).Conclusions:Overall,the Fridericia correction method provided the best rate correction in our pedia-tric study cohort.展开更多
BACKGROUND Patients with diabetes mellitus(DM)are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications.The Centers for Disease ...BACKGROUND Patients with diabetes mellitus(DM)are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications.The Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices(CDC/ACIP)issued immunization recommendations to protect this patient population.AIM To assess the adherence of patients with DM to the CDC/ACIP immunization recommendations in Saudi Arabia and to identify the factors associated with the vaccine adherence rate.METHODS An observational retrospective study conducted in 2023 was used to collect data on the vaccination records from 13 diabetes care centers in Saudi Arabia with 1000 eligible patients in phase I with data collected through chart review and 709 patients in phase II through online survey.RESULTS Among participants,10.01%(n=71)had never received any vaccine,while 85.89%(n=609)received at least one dose of the coronavirus disease 2019(COVID-19)vaccine,and 34.83%(n=247)had received the annual influenza vaccine.Only 2.96%(n=21),2.11%(n=15),and 1.12%(n=8)received herpes zoster,tetanus,diphtheria,and pertussis(Tdap),and human papillomavirus(HPV)vaccines,respectively.For patients with DM in Saudi Arabia,the rate of vaccination for annual influenza and COVID-19 vaccines was higher compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,site of care,income level,DM-related hospitalization history,residency site,hemoglobin A1c(HbA1c)level,and health sector type can significantly influence the vaccination rate in patients with DM.Among non-vaccinated patients with DM,the most reported barriers were lack of knowledge and fear of side effects.This signifies the need for large-scale research in this area to identify additional factors that might facilitate adherence to CDC/ACIP vaccine recommendations in patients with DM.CONCLUSION In Saudi Arabia,patients with DM showed higher vaccination rates for annual influenza and COVID-19 vaccines compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,the site of care,income level,DM-related hospitalization history,residency site,HbA1c level,and health sector type can significantly influence the vaccination rate in patients with DM.展开更多
This study aimed to evaluate the efficacy of Chinese herbal medicine(CHM)in patients with severe/critical coronavirus disease 2019(COVID-19).In this retrospective study,data were collected from 662 patients with sever...This study aimed to evaluate the efficacy of Chinese herbal medicine(CHM)in patients with severe/critical coronavirus disease 2019(COVID-19).In this retrospective study,data were collected from 662 patients with severe/critical COVID-19 who were admitted to a designated hospital to treat patients with severe COVID-19 in Wuhan before March 20,2020.All patients were divided into an exposed group(CHM users)and a control group(non-users).After propensity score matching in a 1:1 ratio,156 CHM users were matched by propensity score to 156 non-users.No significant differences in seven baseline clinical variables were found between the two groups of patients.All-cause mortality was reported in 13 CHM users who died and 36 non-users who died.After multivariate adjustment,the mortality risk of CHM users was reduced by 82.2%(odds ratio 0.178,95%CI 0.076–0.418;P<0.001)compared with the non-users.Secondly,age(odds ratio 1.053,95%CI 1.023–1.084;P<0.001)and the proportion of severe/critical patients(odds ratio 0.063,95%CI 0.028–0.143;P<0.001)were the risk factors of mortality.These results show that the use of CHM may reduce the mortality of patients with severe/critical COVID-19.展开更多
Background and Aims:Acute-on-chronic liver failure(ACLF)is acute decompensation of liver function in the setting of chronic liver disease,and characterized by high short-term mortality.In this study,we sought to inves...Background and Aims:Acute-on-chronic liver failure(ACLF)is acute decompensation of liver function in the setting of chronic liver disease,and characterized by high short-term mortality.In this study,we sought to investigate the clinical course of patients at specific time points,and to propose dynamic prognostic criteria.Methods:We assessed the clinical course of 453 patients with ACLF during a 12-week follow-up period in this retrospective multicenter study.The clinical course of patients was defined as disease recovery,improvement,worsening or steady patterns based on the variation tendency in prothrombin activity(PTA)and total bilirubin(TB)at different time points.Results:Resolution of PTA was observed in 231 patients(51%)at 12 weeks after the diagnosis of ACLF.Among the remaining patients,66(14.6%)showed improvement and 156(34.4%)showed a steady or worsening course.In patients with resolved PTA,the clinical course of TB exhibited resolved pattern in 95.2%,improved in 3.9%,and steady or worse in 0.8%.Correspondingly,in patients with improved PTA,these values for TB were 28.8%,27.3%,and 43.9%,respectively.In patients with steady or worsening PTA,these values for TB were 5.7%,32.3%,and 65.6%,respectively.Dynamic prognostic criteria were developed by combining the clinical course of PTA/TB and the clinical outcomes at 4 and 12 weeks after diagnosis in ACLF patients.Conclusions:We propose the following dynamic prognostic criteria:rapid progression,slow progression,rapid recovery,slow recovery,and slow persistence,which lay the foundation for precise prediction of prognosis and the improvement of ACLF therapy.展开更多
BACKGROUND Liver cancer is among the top five most common cancers globally. Lipid-lowering drugs such as statins can lower the risk of liver cancer, but may also cause liver damage. LipoCol Forte capsules(LFC), a red ...BACKGROUND Liver cancer is among the top five most common cancers globally. Lipid-lowering drugs such as statins can lower the risk of liver cancer, but may also cause liver damage. LipoCol Forte capsules(LFC), a red yeast rice product, have demonstrated significant antihypercholesterolemic effects and a good safety profile in clinical studies.AIM To evaluate whether LFC lowers the risk of liver cancer in adults in this propensity score-matched, nationwide, population-based cohort study.METHODS We used data from Taiwan’s National Health Insurance Research Database, which includes electronic medical records for up to 99.99% of Taiwan’s population. LFC users and LFC non-users were matched 1:1 by propensity scores between January 2010 and December 2017. All had followup data for at least 1 year. Statistical analyses compared demographic distributions including sex, age, comorbidities, and prescribed medications. Cox regression analyses estimated adjusted hazard ratios(aHRs) after adjusting for potential confounders.RESULTS We enrolled 33231 LFC users and 33231 non-LFC users(controls). No significant differences between the study cohorts were identified regarding comorbidities and medications [standardized mean difference(SMD) < 0.05]. At follow-up, the overall incidence of liver cancer was significantly lower in the LFC cohort compared with controls [aHR 0.91;95% confidence interval(CI): 0.86-0.95;P < 0.001]. The risk of liver cancer was significantly reduced in both females(aHR 0.87;95%CI: 0.8-0.94;P < 0.001) and males(aHR 0.93;95%CI: 0.87-0.98;P < 0.01) in the LFC cohort compared with their counterparts in the non-LFC cohort. The antitumor protective effects applied to patients with comorbidities(including hypertension, ischemic stroke, diabetes mellitus, hyperlipidemia, hepatitis B infection and hepatitis C infection). Those using LFC for more than 84 drug days had a 0.64-fold lower risk of liver cancer compared with controls(P < 0.001). Compared with controls, the risk of developing liver cancer in the LFC cohort progressively decreased over time;the lowest incidence of liver cancer occurred in LFC users followed-up for more than 6 years(27.44 vs 31.49 per 1,000 person-years;aHR 0.75;95%CI: 0.68-0.82;P < 0.001).CONCLUSION This retrospective cohort study indicates that LFC has a significantly protective effect on lowering the risk of liver cancer, in a dose-dependent and time-dependent manner.展开更多
基金Young Scholar Independent Innovation Science Fund of Chinese PLA General Hospital,No.22QNCZ020National Key Research and Development Program,No.2022YFC2504003.
文摘BACKGROUND Autoimmune pancreatitis(AIP)has been linked with elevated immunoglobulin(Ig)G4 levels.The characteristics and outcomes of AIP based on serum markers have not been fully evaluated.AIM To compare clinical features,treatment efficacy,and outcome of AIP based on serum IgG4 levels and analyze predictors of relapse.METHODS A total of 213 patients with AIP were consecutively reviewed in our hospital from 2006 to 2021.According to the serum IgG4 level,all patients were divided into two groups,the abnormal group(n=148)with a high level of IgG4[>2×upper limit of normal(ULN)]and the normal group(n=65).The t-test or Mann-Whitney U test was used to compare continuous variables.Categorical parameters were compared by theχ^(2) test or Fisher’s exact test.Kaplan-Meier curves Zhou GZ et al.Clinical characteristics and outcome of AIP WJG https://www.wjgnet.com 5126 September 21,2023 Volume 29 Issue 35 and log-rank tests were established to assess the cumulative relapse rates.Univariate and multivariate analyses were used to investigate potential risk factors of AIP relapse.RESULTS Compared with the normal group,the abnormal group had a higher average male age(60.3±10.4 vs 56.5±12.9 years,P=0.047);higher level of serum total protein(72.5±7.9 g/L vs 67.2±7.5 g/L,P<0.001),IgG4(1420.5±1110.9 mg/dL vs 252.7±106.6 mg/dL,P<0.001),and IgE(635.6±958.1 IU/mL vs 231.7±352.5 IU/mL,P=0.002);and a lower level of serum complement C3(100.6±36.2 mg/dL vs 119.0±45.7 mg/dL,P=0.050).In addition,a lower number of cases with abnormal pancreatic duct and pancreatic atrophy(23.6%vs 37.9%,P=0.045;1.6%vs 8.6%,P=0.020,respectively)and a higher rate of relapse(17.6%vs 6.2%,P=0.030)were seen in the abnormal group.Multivariate analyses revealed that serum IgG4[(>2×ULN),hazard ratio(HR):3.583;95%confidence interval(CI):1.218–10.545;P=0.020]and IgA(>1×ULN;HR:5.908;95%CI:1.199–29.120;P=0.029)and age>55 years(HR:2.383;95%CI:1.056–5.378;P=0.036)were independent risk factors of relapse.CONCLUSION AIP patients with high IgG4 levels have clinical features including a more active immune system and higher relapse rate.Several factors,such as IgG4 and IgA,are associated with relapse.
基金the Nation Natural Science Foundation of China (No.814737627, No.81673947)the Science and Technology Commission of Shanghai Municipality (No.17401933500)the Shanghai Municipal Population and Family Planning Commission (No.201740059).
文摘Objective:Traditional Chinese medicine(TCM)has been extensively used as one of popular alternative therapies for several cancers.However,it remains unclear whether TCM treatment is associated with longer survival in lung cancer patients.In this study,we explored the effect of long-term TCM treatment on patients with different stages of lung cancer.Methods:All information of lung cancer patients with stage I-III disease from January 2007 to September 2015 was collected for this retrospective cohort study.Those who were treated with TCM after surgery were divided into TCM group and the others were into the non-TCM group(control group).All patients were regularly followed up by clinic appointment or phone,and all survival data were collected from databases after the last follow-up in October 2017.Results:A total of 575 patients were included in this study,with 299 patients in the TCM group and 276 in the control group.For all patients,5-year disease-free survival(DFS)was 62.2% in TCM group and 42.1% in the control group,and 6-year DFSs were 51.8% and 35.4%,respectively(HR=0.51,95% CI:0.40 to 0.66,log-rank P≤0.001).For patients with stage I,5-year DFSs were 83.7%(TCM group)and 57.5%(control group)and 6-year DFSs were 73.7% and 51.9%,respectively(HR=0.30,95% CI:0.18 to 0.50,log-rank P≤0.001).For patients with stage II in the TCM group and the control group,5-year DFSs were 59.4% and 17.6% and 6-year DFSs were 44.7% and 17.6%,respectively(HR=0.31,95% CI:0.19 to 0.52,log-rank P≤0.001),and for patients with stage III,5-year and 6-year DFSs in the TCM group were 18.7% and 12.5% compared with 28.4% and 20.3% in the control group(HR=1.06,95% CI:0.72 to 1.56,log-rank P=0.76).Conclusions:This study demonstrated that long-term TCM treatment as an adjuvant therapy is able to improve the DFS of postoperative stage I-III lung cancer patients,especially in patients with stage I and II disease.However,these observational findings need being validated by large sample randomized controlled trials.
文摘AIM To verify the value of Gutuo Jiejiu decoction in improving the survival of patients with severe alcoholic hepatitis(SAH).METHODS We performed a retrospective cohort study in consecutive patients diagnosed with SAH at the Teaching Hospital of Chengdu University of Traditional Chinese Medicine and Shuguang Hospital, Shanghai University of Traditional Chinese Medicine. The traditional Chinese medicine formula Gutuo Jiejiu decoction was employed as an exposure factor. Patients from the Teaching Hospital of Chengdu University of Traditional Chinese Medicine who had been treated with Gutuo Jiejiu decoction + prednisone were assigned to an observation group, and patients from Shuguang Hospital, Shanghai University of Traditional Chinese Medicine who had been treated with prednisone alone were selected as a control group. A retrospective analysis was performed by comparing age, alcohol intake, and clinical parameters of liver injury beforeand after treatment. Additionally, the 3-and 12-mo survival rates and the occurrence of complications were analyzed.RESULTS One hundred and twenty-eight eligible patients were selected from 175 cases with SAH, of which 68 were assigned to the observation group and the other 60 to the control group. No significant difference was found in the patients' baseline characteristics(P > 0.05). However, significant improvements of 90-d survival rate [56/68(82.4%) vs 27/60(45.0%), P = 0.0000] and 365-d survival rate [48/68(70.6%) vs 13/60(21.7%), P = 00000] were observed in the observation group after treatment. After the first 3 mo of treatment, more improvements in the clinical parameters and scoring systems related to liver injury occurred in the observation group than in the control group(P < 0.05). After treatment for 12 mo, the differences in the clinical parameters and scoring systems related to liver injury between the two groups were more significant(P < 0.05). No significant differences in complications and adverse effects were found between the two groups.CONCLUSION Gutuo Jiejiu decoction could improve the survival rates and clinical parameters of liver injury in patients with SAH, and may represent a new option for treating SAH.
基金Chinese High Tech Research&Development(863)Program,No.2013AA020102.
文摘BACKGROUND Hepatorenal syndrome(HRS)is a severe complication of cirrhosis with high mortality,which necessitates accurate clinical decision.However,studies on prognostic factors and scoring systems to predict overall survival of HRS are not enough.Meanwhile,a multicenter cohort study with a long span of time could be more convincing.AIM To develop a novel and effective prognostic model for patients with HRS and clarify new prognostic factors.METHODS We retrospectively enrolled 1667 patients from four hospitals,and 371 eligible patients were finally analyzed to develop and validate a novel prognostic model for patients with HRS.Characteristics were compared between survivors and non-survivors,and potential prognostic factors were selected according to the impact on 28-d mortality.Accuracy in predicting 28-d mortality was compared between the novel and other scoring systems,including Model for End-Stage Liver Disease(MELD),Chronic Liver Failure-Sequential Organ Failure Assessment(CLIF-SOFA),and Chinese Group on the Study of Severe Hepatitis BAcute-on-Chronic Liver Failure(COSSH-ACLF).RESULTS Five prognostic factors,comprised of gender,international normalized ratio,mean corpuscular hemoglobin concentration,neutrophil percentage,and stage,were integrated into a new score,GIMNS;stage is a binary variable defined by the number of failed organs.GIMNS was positively correlated with MELD,CLIFSOFA,and COSSH-ACLF.Additionally,it had better accuracy[area under the receiver operating characteristic curve(AUROC):0.830]than MELD(AUROC:0.759),CLIF-SOFA(AUROC:0.767),and COSSH-ACLF(AUROC:0.759)in the derivation cohort(P<0.05).It performed better than MELD and CLIF-SOFA in the validation cohort(P<0.050)and had a higher AUROC than COSSH-ACLF(P=0.122).CONCLUSION We have developed a new scoring system,GIMNS,to predict 28-d mortality of HRS patients.Mean corpuscular hemoglobin concentration and stage were first proposed and found to be related to the mortality of HRS.Additionally,the GIMNS score showed better accuracy than MELD and CLIF-SOFA,and the AUROC was higher than that of COSSH-ACLF.
文摘BACKGROUND Primary tumor location is a prognostic factor for metastatic colorectal cancer(m CRC).Post hoc analyses of m CRC clinical trials,including FIRE-3,CALGB/SWOG 80405,suggest that primary tumor location is also predictive of survival benefit with cetuximab or bevacizumab in combination with 5-fluorouracil-based chemotherapy.AIM Evaluate prognostic/predictive roles of primary tumor location in real-world m CRC patients treated with cetuximab or bevacizumab plus 5-fluorouracil-based chemotherapy.METHODS This retrospective cohort study selected patients with KRAS wild-type m CRC who initiated first-line therapy with cetuximab or bevacizumab in combination with 5-fluorouracil/leucovorin/irinotecan(FOLFIRI)or 5-fluorouracil/leucovorin/oxaliplatin(FOLFOX)between January 2013 and April 2017 from the Flatiron Health electronic health record-derived database of de-identified patientlevel data in the United States.Primary tumor location was abstracted from patients’charts.Left-sided primary tumor location(LPTL)was defined as tumors that originated in the splenic flexure,descending colon,sigmoid colon,or rectum;right-sided primary tumor location(RPTL)was defined as tumors that originated from the appendix,cecum,ascending colon,hepatic flexure,or transverse colon.Propensity score matching was used to balance the baseline demographic and clinical characteristics between patients treated with cetuximab and patientstreated with bevacizumab.Kaplan-Meier and Cox regression methods were used for survival analyses.RESULTS A total of 1312 patients met the selection criteria.Of 248 cetuximab plus FOLFIRI or FOLFOX patients,164 had LPTL and 84 had RPTL;of 1064 bevacizumab plus FOLFIRI or FOLFOX patients,679 had LPTL and 385 had RPTL.Cetuximab LPTL and RPTL patients were more likely to receive FOLFIRI vs bevacizumab patients(LPTL:64.0%vs 24.3%;RPTL:76.2%vs 24.9%,P<0.001).Stage at initial diagnosis was different between cetuximab RPTL vs bevacizumab RPTL patients(P<0.001);cetuximab RPTL patients were more likely to have stage III disease(44.0%vs 22.6%),while bevacizumab RPTL patients were more likely to have stage IV disease(65.7%vs 48.8%).Cetuximab RPTL patients were more likely to have a documented history of adjuvant chemotherapy vs bevacizumab RPTL patients(47.6%vs 22.3%,P<0.001).In the propensity score-matched sample,median overall survival(OS)was 29.7 mo(95%CI:26.9-35.2)for LPTL patients vs 18.3 mo(95%CI:15.8-21.3)for RPTL patients(P<0.001).Median OS was 29.7 mo(95%CI:27.4-NA)for cetuximab LPTL patients vs 29.1 mo(95%CI:26.6-35.6)for bevacizumab LPTL patients(HR=0.87;95%CI:0.63-1.19;P=0.378)and 17.0 mo(95%CI:12.0-32.6)for cetuximab RPTL patients vs 18.8 mo(95%CI:15.8-22.3)for bevacizumab RPTL patients(HR=1.00;95%CI:0.68-1.46;P=0.996).The interaction of treatment and primary tumor location was not significant in the Cox regression.CONCLUSION In this real-world m CRC cohort,the prognostic role of primary tumor location was substantiated,but not the predictive role for treatment with cetuximab vs bevacizumab in combination with 5-fluorouracil-based chemotherapy.
基金Supported by the Show Chwan Memorial Hospital,No. SRD-108014
文摘BACKGROUND Polycystic ovary syndrome(PCOS)is a common disorder in women of reproductive age.Over the last few decades,research studies have revealed that PCOS is strongly associated with metabolic disorders,including metabolic syndrome,obesity,insulin resistance and prediabetes.Clinical observation has shown that women with PCOS are expected to have an increased risk of developing type 2 diabetes(T2DM)in the future.AIM To assess the hazard ratio(HR)of T2DM between women with/without PCOS.METHODS This population-based,retrospective cohort study evaluated data retrieved from the National Health Insurance Research Database.The subjects were women with PCOS(n=2545)identified on the basis of diagnosis,testing,or treatment codes,and women without PCOS as controls(n=2545).The HR of T2DM between women with or without PCOS was the main outcome measure analyzed.RESULTS Our study found that, during a 10-year follow-up period, the overall incidence of T2DM was 6.25per 1000 person-years in the PCOS group compared with 1.49 in the control group. Afteradjustment for potential confounding variables, the overall incidence of T2DM was higher in thePCOS group vs the control group (HR = 5.13, 95%CI: 3.51-7.48, P < 0.0001). The risk of developingT2DM subsequent to PCOS decreased with increasing diagnosis age: the adjusted HR was 10.4 inthe 18–24-year age group, 5.28 in the 25-29-year age group, and 4.06 in the 29-34-year age group.However, no such significant association was noted in women older than 35 years.CONCLUSIONThese findings highlight the importance of prompting a more aggressive treatment to preventdiabetes in women diagnosed with PCOS at a young age, and, in contrast, the lessened importanceof this type of intervention in women diagnosed with PCOS at a late reproductive age.
文摘BACKGROUND Day case total shoulder arthroplasty(TSA)is a novel approach,not widely practiced in Europe.We conducted a retrospective cohort study of patients comparing elective day case and inpatient TSAs in our United Kingdom centre.AIM To evaluate the efficacy and cost-effectiveness of day case TSA compared to standard inpatient total shoulder arthroplasty.METHODS All patients undergoing TSA between January 2017 and July 2018 were included.Outcome measures were:Change in abduction and extension 3 mo postoperatively;30-d postoperative adverse events and re-admissions in day case and inpatient groups.We also conducted an economic evaluation of outpatient arthroplasty.Multivariate linear and logistic regression were used to adjust for demographic and operative covariates.RESULTS Fifty nine patients were included,18 d cases and 41 inpatients.There were no adverse events or re-admissions at 30 d postoperatively in either group.There were no significant differences in adjusted flexion(mean difference 16.4,95%CI:17.6-50.5,P=0.337)or abduction(mean difference:13.2,95%CI:18.4-44.9,P=0.405)postoperatively between groups.Median savings with outpatient arthroplasty were￡529(interquartile range:247.33-789,P<0.0001).CONCLUSION Day case TSA is a safe,effective procedure,with significant cost benefit.Wider use may be warranted in the United Kingdom and beyond,with potential for significant cost savings and improved efficiency.
文摘BACKGROUND There is indication that fecal microbiota transplant(FMT)has the potential to alter the course of chronic skin disease,but few studies have investigated this phenomenon beyond case reports.Research with larger sample sizes is needed to provide a more thorough assessment of possible associations and to establish a broader foundation upon which to base hypotheses.AIM To identify associations between FMT and skin conditions,particularly infectious and inflammatory etiologies,and the role of dermatology post-FMT.METHODS We conducted a retrospective cohort study involving a chart review of all patients whom received FMT between January 2013 and December 2019 at a single academic medical center.Dermatologic follow-up was assessed for the two years after FMT or through March 2020 for more recent procedures.Dermatologic diagnoses and visits within the study time frame were recorded and assessed for trends.This study was exploratory in nature.Descriptive statistics were calculated,and the t-test,Pearson’s chi-squared test,and Fisher’s exact test were used to calculate P values.RESULTS Median age was 38(range,17-90).In total,109 patients who underwent 111 fecal microbiota transplant events were included.Twenty-six events(23.4%)involved a dermatology office visit post-procedure,and of these events,20 out of the 26(76.9%)had an infectious or inflammatory skin condition.The mean time to first visit was 10.0(±7.0)mo.The most common diagnoses were dermatophyte,wart(s),and dermatitis,though no specific diagnoses predominated in a way indicating FMT had a significant impact.More patients with a post-FMT skin disease diagnosis had a history of Crohn’s disease compared to those without(P=0.022),but results could be affected by a small sample size.CONCLUSION Our study is limited by its retrospective nature,but the findings allow a glimpse at dermatologic conditions post-FMT.Few significant associations were found,but potential associations between FMT and skin disease should be further investigated,preferably in prospective studies,to identify how FMT might be of use for treating infectious and inflammatory skin diseases.
文摘Objective There is a dilemma of ibuprofen treatment with patent ductus arteriosus(PDA)as to how and when to treat.We aimed to clarify this issue in very preterm infants(VPIs;<32 weeks).Methods:This retrospective study included 1659 VPIs who were diagnosed with PDA according to echocardiographic examinations and cardiovascular dysfunction scoring system(the CVD scoring).The VPIs were classified into six groups(A1,A2,A3,B1,B2,and B3)based on CVD scores(A,<3,and B,≥3),and treatment with ibuprofen for PDA(1,conservational management;2,early ibuprofen treatment;and 3,late ibuprofen treatment).Treatment was stopped when PDA was closed,CVD score was zero or PDA needed ligation.Results:VPIs with CVD scores<3 had most PDA closure without surgery,and early ibuprofen treatment did not significantly affect PDA closure.VPIs with CVD scores≥3 had some PDA closure after 2 courses of treatment,but closure rates decreased linearly with ibuprofen course(1^(st)75.2%,2^(nd)62.3%,3^(rd)50.0%,P<0.0001),and early ibuprofen treatment(group B2)did not increase PDA closure compared to late ibuprofen treatment(group B3).In these same infants,the longer they were in CVD scores≥3,the more the complications of preterm were increased(retinopathy of prematurity ROP 1^(st)16.5%,2^(nd)23.8%,3^(rd)29.6%,P=0.016;bronchopulmonary dysplasia BPD 1^(st)15.5%,2^(nd)26.7%,3^(rd)33.8%,P<0.0001;intraventricular hemorrhage IVH 1^(st)20.4%,2^(nd)32.4%,3^(rd)23.8%,P=0.015).Conclusion:Ibuprofen is suggested for PDA closure when the PDA reopens or has developed into the stage when the CVD score≥3.
基金Supported by Traditional Chinese Medicine Emergency Project on Novel Coronavirus-Infected Pneumonia of State Administration of Traditional Chinese Medicine (No. 2022ZYLCYJ05-4)Shanghai Key Clinical Specialty Project (No. shslczdzk04401)+1 种基金National Traditional Chinese Medicine Emergency Medical Rescue Base Construction Project [No. ZY(2021-2023)-0101-01]National Traditional Chinese Medicine Multidisciplinary Cross Innovation Team Project (No. ZYYCXTD-D-202203)
文摘Objective:To evaluate the efficacy and safety of Huashi Baidu Granules(HSBD)in treating patients with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron variant.Methods:A single-center retrospective cohort study was conducted during COVID-19 Omicron epidemic in the Mobile Cabin Hospital of Shanghai New International Expo Center from April 1st to May 23rd,2022.All COVID-19 patients with asymptomatic or mild infection were assigned to the treatment group(HSBD users)and the control group(non-HSBD users).After propensity score matching in a 1:1 ratio,496 HSBD users of treatment group were matched by propensity score to 496 non-HSBD users.Patients in the treatment group were administrated HSBD(5 g/bag)orally for 1 bag twice a day for 7 consecutive days.Patients in the control group received standard care and routine treatment.The primary outcomes were the negative conversion time of nucleic acid and negative conversion rate at day 7.Secondary outcomes included the hospitalized days,the time of the first nucleic acid negative conversion,and new-onset symptoms in asymptomatic patients.Adverse events(AEs)that occurred during the study were recorded.Further subgroup analysis was conducted in vaccinated(378 HSBD users and 390 non-HSBD users)and unvaccinated patients(118 HSBD users and 106 non-HSBD users).Results:The median negative conversion time of nucleic acid in the treatment group was significantly shortened than the control group[3 days(IQR:2-5 days)vs.5 days(IQR:4-6 days);P<0.01].The negative conversion rate of nucleic acid in the treatment group were significantly higher than those in the control group at day 7(91.73%vs.86.90%,P=0.014).Compared with the control group,the hospitalized days in the treatment group were significantly reduced[10 days(IQR:8-11 days)vs.11 days(IQR:10.25-12 days);P<0.01].The time of the first nucleic acid negative conversion had significant differences between the treatment and control groups[3 days(IQR:2-4 days)vs.5 days(IQR:4-6 days);P<0.01].The incidence of new-onset symptoms including cough,pharyngalgia,expectoration and fever in the treatment group were lower than the control group(P<0.05 or P<0.01).In the vaccinated patients,the median negative conversion time and hospitalized days were significantly shorter than the control group after HSDB treatment[3days(IQR:2-5days)vs.5 days(IQR:4-6 days),P<0.01;10 days(IQR:8-11 days)vs.11 days(IQR:10-12 days),P<0.01].In the unvaccinatedpatients,HSBD treatment efficiently shorten the median negative conversion time and hospitalized days[4 days(IQR:2-6 days)vs.5 days(IQR:4-7 days),P<0.01;10.5 days(IQR:8.75-11 days)vs.11.0 days(IQR:10.75-13 days);P<0.01].No serious AEs were reported during the study.Conclusion:HSBD treatment significantly shortened the negative conversion time of nuclear acid,the length of hospitalization,and the time of the first nucleic acid negative conversion in patients infectedwith SARS-COV-2Omicronvariant(Trial registry No.ChiCTR2200060472).
基金Youth Science and Technology Project of Hebei Health Commission(No.20210029)Hebei Provincial Natural Science Foundation Precision Medicine Joint Project(No.H2020206485)Hebei Provincial Department of Science and Technology Key Project(No.206Z7705G)
文摘Background:The effect of intra-operative chemotherapy(IOC)on the long-term survival of patients with colorectal cancer(CRC)remains unclear.In this study,we evaluated the independent effect of intra-operative infusion of 5-fluorouracil in combination with calcium folinate on the survival of CRC patients following radical resection.Methods:1820 patients were recruited,and 1263 received IOC and 557 did not.Clinical and demographic data were collected,including overall survival(OS),clinicopathological features,and treatment strategies.Risk factors for IOC-related deaths were identified using multivariate Cox proportional hazards models.A regression model was developed to analyze the independent effects of IOC.Results:Proportional hazard regression analysis showed that IOC(hazard ratio[HR]=0.53,95%confidence intervals[CI][0.43,0.65],P<0.001)was a protective factor for the survival of patients.The mean overall survival time in IOC group was 82.50(95%CI[80.52,84.49])months,and 71.21(95%CI[67.92,74.50])months in non-IOC group.The OS in IOC-treated patients were significantly higher than non-IOC-treated patients(P<0.001,log-rank test).Further analysis revealed that IOC decreased the risk of death in patients with CRC in a non-adjusted model(HR=0.53,95%CI[0.43,0.65],P<0.001),model 2(adjusted for age and gender,HR=0.52,95%CI[0.43,0.64],P<0.001),and model 3(adjusted for all factors,95%CI 0.71[0.55,0.90],P=0.006).The subgroup analysis showed that the HR for the effect of IOC on survival was lower in patients with stage II(HR=0.46,95%CI[0.31,0.67])or III disease(HR=0.59,95%CI[0.45,0.76]),regardless of pre-operative radiotherapy(HR=0.55,95%CI[0.45,0.68])or pre-operative chemotherapy(HR=0.54,95%CI[0.44,0.66]).Conclusions:IOC is an independent factor that influences the survival of CRC patients.It improved the OS of patients with stages II and III CRC after radical surgery.Trial registration:chictr.org.cn,ChiCTR 2100043775.
基金Major Science and Technology Innovation Project of China Academy of Chinese Medical Sciences:Research on the Key Techniques of Clinical Evaluation of New Chinese Medicine under the System of Three-in-one Combination Evidence Review(No.CI2021A04701)。
文摘OBJECTIVE:To provide the evidence for the efficacy of acupoint application(AA)for patients with diarrhea in a real-world setting.METHODS:This study is a national multicenter retrospective cohort study.Our study consecutively collected outpatient medical records of patients with diarrhea from hundreds of primary hospitals nationwide registered in Chun Bo Wan Xiang cloud platform from 22nd August,2020 to 5th November,2020.The patients were divided into the treatment group and the control group according to patient's condition and willingness.The control group was treated with Western Medicine,oral Chinese Medicine decoction,or both.The treatment group was added with AA based on the control group.Multiple logistic regression was used to evaluate the independent efficacy of AA in diarrheal recovery on the 3rd,7th,14th and 28th day.As a next step,we also performed stratified analysis and likelihood ratio test(LRT).Sensitivity analyses included propensity score matching(PSM),four PSM-related analyses and E-value.RESULTS:The treatment group showed better efficacy than the control group on the 14th and 28th day[the 14th day:OR=1.58,95%CI(1.15,2.19),P=0.005;the 28th day:OR=2.03,95%CI(1.43,2.88),P<0.001].No difference was observed in efficacy of AA for the treatment of diarrhea among the subgroups(P>0.05).PSM-related analyses confirmed the efficacy of AA in diarrheal recovery.The findings are unlikely to be nullified by an unmeasured confounding variable according to the results of E-values.CONCLUSIONS:The efficacy in the treatment group was significantly more improved than that in the control group on the 14th and 28th day.
基金supported by the National Key Research and Development Project,No.2019YFA0112100(to SF).
文摘Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.
基金Supported by Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties,No.SZGSP013Shenzhen Key Medical Discipline Construction Fund,No.SZXK042+2 种基金Sanming Project of Medicine in Shenzhen,No.SZSM202311025Natural Science Fund of Fujian Province,No.2023J011622Natural Science Fund of Xiamen City,No.3502Z20224ZD1259.
文摘BACKGROUND For children and adolescents,deliberate self-harm(DSH)is becoming a mental health problem of concern.Despite several studies on the prevalence and factors of DSH in the world,there is little information on DSH among children and adolescents in China.This study explores the prevalence,types,associated risk factors and tendency of DSH in pediatric psychiatric inpatients in China.AIM To understand the situation of DSH among hospitalized children and adolescents and its related factors.METHODS In this study,we retrospectively studied 1414 hospitalized children and adolescents with mental illness at Xiamen Mental Health Center from 2014 to 2019,extracted the demographic and clinical data of all patients,and analyzed clinical risk factors of DSH.RESULTS A total of 239(16.90%)patients engaged in at least one type of DSH in our study.Cutting(n=115,48.12%)was the most common type of DSH.Females(n=171,71.55%)were more likely to engage in DSH than males(n=68,28.45%).DSH was positively associated with depressive disorders[OR=3.845(2.196-6.732);P<0.01],female[OR=2.536(1.815-3.542);P<0.01],parental marital status[OR=5.387(2.254-12.875);P<0.01]and negative family history of psychiatric illness[OR=7.767(2.952-20.433);P<0.01],but not with occupation,substance use and history of physical abuse.CONCLUSION Our findings suggest that for patients with depression,females,an abnormal marriage of parents,and no history of mental illness,attention should be paid to the occurrence of DSH.
基金This study was reviewed and approved by the New York-Presbyterian Brooklyn Methodist Hospital Institutional Review Committee.The study follows the guidelines outlined in the Declaration of Helsinki.
文摘Objective:Accurate measurement of QT interval,the ventricular action potential from depolarization to repolarization,is important for the early detection of Long QT syndrome.The most effective QT correction(QTc)formula has yet to be determined in the pediatric population,although it has intrinsically greater extremes in heart rate(HR)and is more susceptible to errors in measurement.The authors of this study compare six dif-ferent QTc methods(Bazett,Fridericia,Framingham,Hodges,Rautaharju,and a computer algorithm utilizing the Bazett formula)for consistency against variations in HR and RR interval.Methods:Descriptive Retrospective Study.We included participants from a pediatric cardiology practice of a community hospital who had an ECG performed in 2017.All participants were healthy patients with no past medical history and no regular med-ications.Results:ECGs from 95 participants from one month to 21 years of age(mean 9.7 years)were included with a mean HR of 91 beats per minute(bpm).The two-sample paired t-test or Wilcoxon signed-rank test assessed for any difference between QTc methods.A statistically significant difference was observed between every combination of two QTc formulae.The Spearman’s rank correlation analysis explored the QTc/HR and QTc/RR relationships for each formula.Fridericia method was most independent of HR and RR with the lowest absolute value of correlation coefficients.Bazett and Computer had moderate correlations,while Framingham and Rautaharju exhibited strong correlations.Correlations were positive for Bazett and Computer,reflecting results from prior studies demonstrating an over-correction of Bazett at higher HRs.In the linear QTc/HR regression analysis,Bazett had the slope closest to zero,although Computer,Hodges,and Fridericia had comparable values.Alternatively,Fridericia had the linear QTc/RR regression coefficient closest to zero.The Bland-Altman method assessed for bias and the limits of agreement between correction formulae.Bazett and Computer exhibited good agreement with minimal bias along with Framingham and Rautaharju.To account for a possible skewed distri-bution of QT,all the above analyses were also performed excluding the top and bottom 2%of data as sorted by heart rate ranges(N=90).Results from this data set were consistent with those derived from all participants(N=95).Conclusions:Overall,the Fridericia correction method provided the best rate correction in our pedia-tric study cohort.
文摘BACKGROUND Patients with diabetes mellitus(DM)are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications.The Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices(CDC/ACIP)issued immunization recommendations to protect this patient population.AIM To assess the adherence of patients with DM to the CDC/ACIP immunization recommendations in Saudi Arabia and to identify the factors associated with the vaccine adherence rate.METHODS An observational retrospective study conducted in 2023 was used to collect data on the vaccination records from 13 diabetes care centers in Saudi Arabia with 1000 eligible patients in phase I with data collected through chart review and 709 patients in phase II through online survey.RESULTS Among participants,10.01%(n=71)had never received any vaccine,while 85.89%(n=609)received at least one dose of the coronavirus disease 2019(COVID-19)vaccine,and 34.83%(n=247)had received the annual influenza vaccine.Only 2.96%(n=21),2.11%(n=15),and 1.12%(n=8)received herpes zoster,tetanus,diphtheria,and pertussis(Tdap),and human papillomavirus(HPV)vaccines,respectively.For patients with DM in Saudi Arabia,the rate of vaccination for annual influenza and COVID-19 vaccines was higher compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,site of care,income level,DM-related hospitalization history,residency site,hemoglobin A1c(HbA1c)level,and health sector type can significantly influence the vaccination rate in patients with DM.Among non-vaccinated patients with DM,the most reported barriers were lack of knowledge and fear of side effects.This signifies the need for large-scale research in this area to identify additional factors that might facilitate adherence to CDC/ACIP vaccine recommendations in patients with DM.CONCLUSION In Saudi Arabia,patients with DM showed higher vaccination rates for annual influenza and COVID-19 vaccines compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,the site of care,income level,DM-related hospitalization history,residency site,HbA1c level,and health sector type can significantly influence the vaccination rate in patients with DM.
基金This study was approved by the institutional ethics board of Wuhan Integrated TCM and Western Medicine Hospital(No.[2020]8)and was registered with chictr.org.cn(ChiCTR2000030719)all procedures followed were in accordance with the ethical standards.
文摘This study aimed to evaluate the efficacy of Chinese herbal medicine(CHM)in patients with severe/critical coronavirus disease 2019(COVID-19).In this retrospective study,data were collected from 662 patients with severe/critical COVID-19 who were admitted to a designated hospital to treat patients with severe COVID-19 in Wuhan before March 20,2020.All patients were divided into an exposed group(CHM users)and a control group(non-users).After propensity score matching in a 1:1 ratio,156 CHM users were matched by propensity score to 156 non-users.No significant differences in seven baseline clinical variables were found between the two groups of patients.All-cause mortality was reported in 13 CHM users who died and 36 non-users who died.After multivariate adjustment,the mortality risk of CHM users was reduced by 82.2%(odds ratio 0.178,95%CI 0.076–0.418;P<0.001)compared with the non-users.Secondly,age(odds ratio 1.053,95%CI 1.023–1.084;P<0.001)and the proportion of severe/critical patients(odds ratio 0.063,95%CI 0.028–0.143;P<0.001)were the risk factors of mortality.These results show that the use of CHM may reduce the mortality of patients with severe/critical COVID-19.
基金This study was supported by the National 13th 5-Year Plan for Hepatitis Research(Grant No.2017ZX10203201-005,2017ZX10203201-007)National Key R&D Program of China(Grant No.2017YFA0103000)+2 种基金Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support(Grant No.ZYLX201806)the National Natural Science Foundation of China(Grant No.81870429)Capital Clinic Characteristic Application Research(Grant No.Z181100001718143).
文摘Background and Aims:Acute-on-chronic liver failure(ACLF)is acute decompensation of liver function in the setting of chronic liver disease,and characterized by high short-term mortality.In this study,we sought to investigate the clinical course of patients at specific time points,and to propose dynamic prognostic criteria.Methods:We assessed the clinical course of 453 patients with ACLF during a 12-week follow-up period in this retrospective multicenter study.The clinical course of patients was defined as disease recovery,improvement,worsening or steady patterns based on the variation tendency in prothrombin activity(PTA)and total bilirubin(TB)at different time points.Results:Resolution of PTA was observed in 231 patients(51%)at 12 weeks after the diagnosis of ACLF.Among the remaining patients,66(14.6%)showed improvement and 156(34.4%)showed a steady or worsening course.In patients with resolved PTA,the clinical course of TB exhibited resolved pattern in 95.2%,improved in 3.9%,and steady or worse in 0.8%.Correspondingly,in patients with improved PTA,these values for TB were 28.8%,27.3%,and 43.9%,respectively.In patients with steady or worsening PTA,these values for TB were 5.7%,32.3%,and 65.6%,respectively.Dynamic prognostic criteria were developed by combining the clinical course of PTA/TB and the clinical outcomes at 4 and 12 weeks after diagnosis in ACLF patients.Conclusions:We propose the following dynamic prognostic criteria:rapid progression,slow progression,rapid recovery,slow recovery,and slow persistence,which lay the foundation for precise prediction of prognosis and the improvement of ACLF therapy.
基金Supported by the Ministry of Science and Technology of Taiwan,No. NSTC111-2320-B-039-025China Medical University Hospital,No. DMR-111-013 and No. DMR-111-195
文摘BACKGROUND Liver cancer is among the top five most common cancers globally. Lipid-lowering drugs such as statins can lower the risk of liver cancer, but may also cause liver damage. LipoCol Forte capsules(LFC), a red yeast rice product, have demonstrated significant antihypercholesterolemic effects and a good safety profile in clinical studies.AIM To evaluate whether LFC lowers the risk of liver cancer in adults in this propensity score-matched, nationwide, population-based cohort study.METHODS We used data from Taiwan’s National Health Insurance Research Database, which includes electronic medical records for up to 99.99% of Taiwan’s population. LFC users and LFC non-users were matched 1:1 by propensity scores between January 2010 and December 2017. All had followup data for at least 1 year. Statistical analyses compared demographic distributions including sex, age, comorbidities, and prescribed medications. Cox regression analyses estimated adjusted hazard ratios(aHRs) after adjusting for potential confounders.RESULTS We enrolled 33231 LFC users and 33231 non-LFC users(controls). No significant differences between the study cohorts were identified regarding comorbidities and medications [standardized mean difference(SMD) < 0.05]. At follow-up, the overall incidence of liver cancer was significantly lower in the LFC cohort compared with controls [aHR 0.91;95% confidence interval(CI): 0.86-0.95;P < 0.001]. The risk of liver cancer was significantly reduced in both females(aHR 0.87;95%CI: 0.8-0.94;P < 0.001) and males(aHR 0.93;95%CI: 0.87-0.98;P < 0.01) in the LFC cohort compared with their counterparts in the non-LFC cohort. The antitumor protective effects applied to patients with comorbidities(including hypertension, ischemic stroke, diabetes mellitus, hyperlipidemia, hepatitis B infection and hepatitis C infection). Those using LFC for more than 84 drug days had a 0.64-fold lower risk of liver cancer compared with controls(P < 0.001). Compared with controls, the risk of developing liver cancer in the LFC cohort progressively decreased over time;the lowest incidence of liver cancer occurred in LFC users followed-up for more than 6 years(27.44 vs 31.49 per 1,000 person-years;aHR 0.75;95%CI: 0.68-0.82;P < 0.001).CONCLUSION This retrospective cohort study indicates that LFC has a significantly protective effect on lowering the risk of liver cancer, in a dose-dependent and time-dependent manner.
