Background Acute-on-chronic hepatitis B liver failure （ACLF-HBV） is a clinically severe disease associated with major life-threatening complications including hepatic encephalopathy and hepatorenal syndrome. The aim...Background Acute-on-chronic hepatitis B liver failure （ACLF-HBV） is a clinically severe disease associated with major life-threatening complications including hepatic encephalopathy and hepatorenal syndrome. The aim of this study was to evaluate the short-term prognostic predictability of the model for end-stage liver disease （MELD）, MELD-based indices, and their dynamic changes in patients with ACLF-HBV, and to establish a new model for predicting the prognosis of ACLF-HBV. Methods A total of 172 patients with ACLF-HBV who stayed in the hospital for more than 2 weeks were retrospectively recruited. The predictive accuracy of MELD, MELD-based indices, and their dynamic change （A） were compared using the area under the receiver operating characteristic curve method. The associations between mortality and patient characteristics were studied by univariate and multivariate analyses. Results The 3-month mortality was 43.6%. The largest concordance （c） statistic predicting 3-month mortality was the MELD score at the end of 2 weeks of admission （0.8）, followed by the MELD：sodium ratio （MESO） （0.796） and integrated MELD （iMELD） （0.758） scores, AMELD （0.752）, AMESO （0.729）, and MELD plus sodium （MELD-Na） （0.728） scores. In multivariate Logistic regression analysis, the independent factors predicting prognosis were hepatic encephalopathy （OR=3.466）, serum creatinine, international normalized ratio （INR）, and total bilirubin at the end of 2 weeks of admission （OR=10.302, 6.063, 5.208, respectively）, and cholinesterase on admission （OR=0.255）. This regression model had a greater prognostic value （c=0.85, 95% CI 0.791-0.909） compared to the MELD score at the end of 2 weeks of admission （Z=4.9851, P=0.0256）. Conclusions MELD score at the end of 2 weeks of admission is a useful predictor for 3-month mortality in ACLF-HBV patients. Hepatic encephalopathy, serum creatinine, international normalized ratio, and total bilirubin at the end of 2 weeks of ad展开更多
Congenital absence of portal vein （CAPV） was a rare event in the past. However, the number of detected CAPV cases has increased in recent years because of advances in imaging techniques. Patients with CAPV present w...Congenital absence of portal vein （CAPV） was a rare event in the past. However, the number of detected CAPV cases has increased in recent years because of advances in imaging techniques. Patients with CAPV present with portal hypertension （PH） or portosystemic encephalopathy （PSE）, but these conditions rarely occur until the patients grow up or become old. The patients usually visit doctors for the complications of venous shunts, hepatic or cardiac abnormalities detected by ultrasonography （US）, computed tomography （CT） and magnetic resonance imaging （MR1）. The etiology of this disease is not clear, but most investigators consider that it is associated with abnormal embryologic development of the portal vein. Usually, surgical intervention can relieve the symptoms and prevent occurrence of complications in CAPV patients. Moreover, its management should be stressed on a case-by-case basis, depending on the type or anatomy of the disease, as well as the symptoms and clinical conditions of the patient.展开更多
Thalidomide inducesγ-globin expression in erythroid progenitor cells,but its efficacy on patients with transfusion-dependentβ-thalassemia(TDT)remains unclear.In this phase 2,multi-center,randomized,double-blind clin...Thalidomide inducesγ-globin expression in erythroid progenitor cells,but its efficacy on patients with transfusion-dependentβ-thalassemia(TDT)remains unclear.In this phase 2,multi-center,randomized,double-blind clinical trial,we aimed to determine the safety and efficacy of thalidomide in TDT patients.A hundred patients of 14 years or older were randomly assigned to receive placebo or thalidomide for 12 weeks,followed by an extension phase of at least 36 weeks.The primary endpoint was the change of hemoglobin(Hb)level in the patients.The secondary endpoints included the red blood cell(RBC)units transfused and adverse effects.In the placebo-controlled period,Hb concentrations in patients treated with thalidomide achieved a median elevation of 14.0(range,2.5 to 37.5)g/L,whereas Hb in patients treated with placebo did not significantly change.Within the 12 weeks,the mean RBC transfusion volume for patients treated with thalidomide and placebo was 5.4±5.0 U and 10.3±6.4 U,respectively(P<0.001).Adverse events of drowsiness,dizziness,fatigue,pyrexia,sore throat,and rash were more common with thalidomide than placebo.In the extension phase,treatment with thalidomide for 24 weeks resulted in a sustainable increase in Hb concentrations which reached 104.9±19.0 g/L,without blood transfusion.Significant increase in Hb concentration and reduction in RBC transfusions were associated with nonβ0/β0 and HBS1L-MYB(rs9399137 C/T,C/C;rs4895441 A/G,G/G)genotypes.These results demonstrated that thalidomide is effective in patients with TDT.展开更多
BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling techn...BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling technique(SMOTE)-based model for predicting postoperative delirium in elderly abdominal cancer patients.METHODS In this retrospective cohort study,we analyzed data from 611 elderly patients who underwent abdominal malignant tumor surgery at our hospital between September 2020 and October 2022.The incidence of postoperative delirium was recorded for 7 d post-surgery.Patients were divided into delirium and non-delirium groups based on the occurrence of postoperative delirium or not.A multivariate logistic regression model was used to identify risk factors and develop a predictive model for postoperative delirium.The SMOTE technique was applied to enhance the model by oversampling the delirium cases.The model’s predictive accuracy was then validated.RESULTS In our study involving 611 elderly patients with abdominal malignant tumors,multivariate logistic regression analysis identified significant risk factors for postoperative delirium.These included the Charlson comorbidity index,American Society of Anesthesiologists classification,history of cerebrovascular disease,surgical duration,perioperative blood transfusion,and postoperative pain score.The incidence rate of postoperative delirium in our study was 22.91%.The original predictive model(P1)exhibited an area under the receiver operating characteristic curve of 0.862.In comparison,the SMOTE-based logistic early warning model(P2),which utilized the SMOTE oversampling algorithm,showed a slightly lower but comparable area under the curve of 0.856,suggesting no significant difference in performance between the two predictive approaches.CONCLUSION This study confirms that the SMOTE-enhanced predictive model for postoperative delirium in elderly abdominal tumor patients shows performance equivalent to that of traditional methods,effectively addressing data imb展开更多
We operated a p-type point contact high purity germanium(PPCGe)detector(CDEX-1B,1.008 kg)in the China Jinping Underground Laboratory(CJPL)for 500.3 days to search for neutrinoless double beta(0νββ)decay of ^(76)Ge....We operated a p-type point contact high purity germanium(PPCGe)detector(CDEX-1B,1.008 kg)in the China Jinping Underground Laboratory(CJPL)for 500.3 days to search for neutrinoless double beta(0νββ)decay of ^(76)Ge.A total of 504.3 kg⋅day effective exposure data was accumulated.The anti-coincidence and the multi/single-site event(MSE/SSE)discrimination methods were used to suppress the background in the energy region of interest(ROI,1989–2089 keV for this work)with a factor of 23.A background level of 0.33 counts/(keV⋅kg⋅yr)was realized.The lower limit on the half life of^(76)Ge 0νββdecay was constrained as T_(1/2)^(0ν)>1.0×10^(23)yr(90%C.L.),corresponding to the upper limits on the effective Majorana neutrino mass:<mββ><3.2–7.5 eV.展开更多
文摘Background Acute-on-chronic hepatitis B liver failure （ACLF-HBV） is a clinically severe disease associated with major life-threatening complications including hepatic encephalopathy and hepatorenal syndrome. The aim of this study was to evaluate the short-term prognostic predictability of the model for end-stage liver disease （MELD）, MELD-based indices, and their dynamic changes in patients with ACLF-HBV, and to establish a new model for predicting the prognosis of ACLF-HBV. Methods A total of 172 patients with ACLF-HBV who stayed in the hospital for more than 2 weeks were retrospectively recruited. The predictive accuracy of MELD, MELD-based indices, and their dynamic change （A） were compared using the area under the receiver operating characteristic curve method. The associations between mortality and patient characteristics were studied by univariate and multivariate analyses. Results The 3-month mortality was 43.6%. The largest concordance （c） statistic predicting 3-month mortality was the MELD score at the end of 2 weeks of admission （0.8）, followed by the MELD：sodium ratio （MESO） （0.796） and integrated MELD （iMELD） （0.758） scores, AMELD （0.752）, AMESO （0.729）, and MELD plus sodium （MELD-Na） （0.728） scores. In multivariate Logistic regression analysis, the independent factors predicting prognosis were hepatic encephalopathy （OR=3.466）, serum creatinine, international normalized ratio （INR）, and total bilirubin at the end of 2 weeks of admission （OR=10.302, 6.063, 5.208, respectively）, and cholinesterase on admission （OR=0.255）. This regression model had a greater prognostic value （c=0.85, 95% CI 0.791-0.909） compared to the MELD score at the end of 2 weeks of admission （Z=4.9851, P=0.0256）. Conclusions MELD score at the end of 2 weeks of admission is a useful predictor for 3-month mortality in ACLF-HBV patients. Hepatic encephalopathy, serum creatinine, international normalized ratio, and total bilirubin at the end of 2 weeks of ad
文摘Congenital absence of portal vein （CAPV） was a rare event in the past. However, the number of detected CAPV cases has increased in recent years because of advances in imaging techniques. Patients with CAPV present with portal hypertension （PH） or portosystemic encephalopathy （PSE）, but these conditions rarely occur until the patients grow up or become old. The patients usually visit doctors for the complications of venous shunts, hepatic or cardiac abnormalities detected by ultrasonography （US）, computed tomography （CT） and magnetic resonance imaging （MR1）. The etiology of this disease is not clear, but most investigators consider that it is associated with abnormal embryologic development of the portal vein. Usually, surgical intervention can relieve the symptoms and prevent occurrence of complications in CAPV patients. Moreover, its management should be stressed on a case-by-case basis, depending on the type or anatomy of the disease, as well as the symptoms and clinical conditions of the patient.
基金This work was supported by the National Key Research and Development Program of China(No.2020YFA0803300)the CAMS Innovation Fund for Medical Sciences(CIFMS,Nos.2021-RC310-003,2020-RC310-002)+6 种基金CAMS Initiative for Innovative Medicine(2021-1-I2M-012)the Key Project of the National Natural Science Foundation of China(81830093)Guangxi Natural Science Foundation(2020GXNSFAA159097)the Funding for Guangxi Thalassemia Prevention Capacity Improvement Project,the Overseas Expertise Introduction Project for Discipline Innovation(111 Project,B17029)the Double First-Class Project(WF510162602)of Shanghai Jiao Tong UniversityShanghai Collaborative Innovation Program on Regenerative Medicine and Stem Cell Research(2019CXJQ01)Shanghai Guangci Translational Medical Research Development Foundation.
文摘Thalidomide inducesγ-globin expression in erythroid progenitor cells,but its efficacy on patients with transfusion-dependentβ-thalassemia(TDT)remains unclear.In this phase 2,multi-center,randomized,double-blind clinical trial,we aimed to determine the safety and efficacy of thalidomide in TDT patients.A hundred patients of 14 years or older were randomly assigned to receive placebo or thalidomide for 12 weeks,followed by an extension phase of at least 36 weeks.The primary endpoint was the change of hemoglobin(Hb)level in the patients.The secondary endpoints included the red blood cell(RBC)units transfused and adverse effects.In the placebo-controlled period,Hb concentrations in patients treated with thalidomide achieved a median elevation of 14.0(range,2.5 to 37.5)g/L,whereas Hb in patients treated with placebo did not significantly change.Within the 12 weeks,the mean RBC transfusion volume for patients treated with thalidomide and placebo was 5.4±5.0 U and 10.3±6.4 U,respectively(P<0.001).Adverse events of drowsiness,dizziness,fatigue,pyrexia,sore throat,and rash were more common with thalidomide than placebo.In the extension phase,treatment with thalidomide for 24 weeks resulted in a sustainable increase in Hb concentrations which reached 104.9±19.0 g/L,without blood transfusion.Significant increase in Hb concentration and reduction in RBC transfusions were associated with nonβ0/β0 and HBS1L-MYB(rs9399137 C/T,C/C;rs4895441 A/G,G/G)genotypes.These results demonstrated that thalidomide is effective in patients with TDT.
基金Supported by Discipline Advancement Program of Shanghai Fourth People’s Hospital,No.SY-XKZT-2020-2013.
文摘BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling technique(SMOTE)-based model for predicting postoperative delirium in elderly abdominal cancer patients.METHODS In this retrospective cohort study,we analyzed data from 611 elderly patients who underwent abdominal malignant tumor surgery at our hospital between September 2020 and October 2022.The incidence of postoperative delirium was recorded for 7 d post-surgery.Patients were divided into delirium and non-delirium groups based on the occurrence of postoperative delirium or not.A multivariate logistic regression model was used to identify risk factors and develop a predictive model for postoperative delirium.The SMOTE technique was applied to enhance the model by oversampling the delirium cases.The model’s predictive accuracy was then validated.RESULTS In our study involving 611 elderly patients with abdominal malignant tumors,multivariate logistic regression analysis identified significant risk factors for postoperative delirium.These included the Charlson comorbidity index,American Society of Anesthesiologists classification,history of cerebrovascular disease,surgical duration,perioperative blood transfusion,and postoperative pain score.The incidence rate of postoperative delirium in our study was 22.91%.The original predictive model(P1)exhibited an area under the receiver operating characteristic curve of 0.862.In comparison,the SMOTE-based logistic early warning model(P2),which utilized the SMOTE oversampling algorithm,showed a slightly lower but comparable area under the curve of 0.856,suggesting no significant difference in performance between the two predictive approaches.CONCLUSION This study confirms that the SMOTE-enhanced predictive model for postoperative delirium in elderly abdominal tumor patients shows performance equivalent to that of traditional methods,effectively addressing data imb
基金Supported by the National Key Research and Development Program of China(2017YFA0402201,2022YFA1604701,2022YFA1605000)the National Natural Science Foundation of China(12322511,12175112,12005111,11725522)。
文摘We operated a p-type point contact high purity germanium(PPCGe)detector(CDEX-1B,1.008 kg)in the China Jinping Underground Laboratory(CJPL)for 500.3 days to search for neutrinoless double beta(0νββ)decay of ^(76)Ge.A total of 504.3 kg⋅day effective exposure data was accumulated.The anti-coincidence and the multi/single-site event(MSE/SSE)discrimination methods were used to suppress the background in the energy region of interest(ROI,1989–2089 keV for this work)with a factor of 23.A background level of 0.33 counts/(keV⋅kg⋅yr)was realized.The lower limit on the half life of^(76)Ge 0νββdecay was constrained as T_(1/2)^(0ν)>1.0×10^(23)yr(90%C.L.),corresponding to the upper limits on the effective Majorana neutrino mass:<mββ><3.2–7.5 eV.
