Objective To explore and analyze the related factors for cirrhosis patients with hospital infection.Methods Clinical data of 750 patients with cirrhosis in our hospital were retrospectively analyzed.Related factors for hospital infection including gender,age,length of hospital stay,Child-Pugh classification,accompanying invasive procedures,associating the underlying disease,using antibacterial drugs and the sites of hospital infection and pathogen distribution were analyzed.Results The infection rate was 20.7％ (155/750).The infections were mainly spontaneous bacterial peritonitis [54.8％ (85/155)],followed by respiratory,digestive,urinary tract and skin.Pathogenic bacteria were mainly Gram-negative bacteria [56.1％ (101/1)],followed by Gram-positive bacteria and fungi.Patients aged over 70 years,with hospital stay over 4 weeks,with higher Child-Pugh classification,associated with invasive procedures,combined with underlying diseases,and treated with antimicrobial drugs were much easier to get hospital infection (x2=12.2,16.3,49.46,55.2,20.95,26.24,all P＜0.05).Conclusions Patients aged over 70 years with long hospital stay and more severe liver damage,accompanied by invasive procedures,combined with basic diseases and treated with antimicrobial agents are the related factors for hospital infection in patients with cirrhosis.

Objective:To explore the value of multiphasic CT-based radiomics signature in predicting the invasive behavior of pancreatic solid pseudopapillary neoplasm (pSPN).Methods:The multiphasic CT images of patients with pSPN confirmed by postoperative pathology in the First Affiliated Hospital of Zhengzhou University from January 2012 to January 2021 were analyzed retrospectively. There were 23 cases of invasiveness and 59 cases of non-invasiveness. The region of interest(ROI) was artificially delineated layer by layer in the plain scan, arterial-phase and venous-phase images, respectively. The 1 316 image features were extracted from each ROI. The data set was divided into training and validation sets with a ratio of 7∶3 by stratified random sampling, and synthetic minority oversampling technique (SMOTE) algorithm was used for oversampling in the training set to generate invasive and non-invasive balanced data for building the training model. The constructed model was validated in the validation set. The receiver operating characteristic(ROC) analysis was used to evaluate model performance and the Delong′s test was applied to compare the area under the ROC curve (AUC) of different predict models. The improvement for classification efficiency of each independent model or their combinations were also assessed by net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices.Results:After feature extraction, 2, 6 and 3 features were retained to construct plain-scanned model, arterial-phase and venous-phase models, respectively. Seven independent-phase and combined-phase models were established. Except the plain-scanned model, the AUC values of other models were greater than 0.800. The arterial-phase model had the best efficiency for classification among all independent-phase models. The AUC values of arterial-phase model in the SMOTE training and validation sets were 0.913 and 0.873, respectively. By combining the radiomics signature of the arterial-phase and venous-phase models, the AUC values of training and validation sets increased to 0.934 and 0.913 respectively. There were no significant differences of the AUC values between the scan-arterial venous-phase model and arterial venous-phase model in both training and validation sets (both P>0.05). The NRI and IDI indexes showed that the combined form of plain-scan model and arterial-venous-phase model could not significantly improve the classification efficiency in the validation set (both NRI and IDI<0). Conclusions:The arterial-phase CT-based radiomics model has a good predictive performance in the invasive behavior of pSPN, and the combination with a venous-phase radiomics model can further improve the model performance.

Objective:To observe any therapeutic effect of combining early pulmonary rehabilitation training with acupuncture at the back-shu and front-mu acupoints in treating stroke-associated pneumonia (SAP).Methods:Eighty SAP patients were randomly divided into a treatment group and a control group, each of 40. Both groups were given routine symptomatic treatment for pneumonia, nutritional support, lipid-lowering and anti-infection measures, as well as acupuncture at the back-shu and front-mu acupoints. The treatment group additionally received pulmonary rehabilitation training. Before and after 14 days of the treatment, both groups were evaluated in terms of their forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), peak flow rate (PEF), white blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT). Chinese medicine (TCM) scores for expectoration of phlegm, shortness of breath, pulmonary rales, cough, fever and weakness were also assigned. The duration of antibiotic use and intensive care unit (ICU) stay were compared between the two groups.Results:Treatment efficacy was significantly higher in the treatment group (97.5%) than in the control group (85.0%). The treatment group′s average duration of antibiotic use and ICU stay were significantly shorter than in the control group. The treatment improved the average FVC, FEV1, PEF, WBC, CRP and PCT of both groups significantly leaving the average FVC and PEF of the treatment group significantly higher than the control group′s average, but its average WBC, CRP, PCT and the total TCM syndrome score significantly lower.Conclusions:Combining early pulmonary rehabilitation training with acupuncture at the back-shu and front-mu acupoints has a definite therapeutic effect on SAP patients. It can significantly shorten the use of antibiotics and ICU stay, promote the recovery of lung function, reduce inflammation and relieve clinical symptoms.

Objective To compare the effects of different stent configurations on shunt failure,hepatic encephalopathy,and hepatic myelopathy after transjugular intrahepatic portosystemic shunt (TIPS).Methods From March 2014 to June 2015,the clinical data of 73 hospitalized,patients who met the inclusion and exclusion criteria,and underwent TIPS for upper gastrointestinal hemorrhage caused by cirrhotic portal hypertension were retrospectively analyzed.According to the stent configuration during operation,patients were divided into simple coated stent group (hepatic vein,portal vein and hepatic parenchyma coated stent,23 cases),simulated Viatorr stent group (hepatic vein and hepatic parenchyma coated stent plus portal vein bare stent,27 cases) and combined stent group (hepatic vein and portal vein hare stent plus hepatic parenchyma coated stent,23 cases).Patients were followed up for one year,the incidences of shunt failure,hepatic encephalopathy and hepatic myelopathy within one year after TIPS of three groups were compared.Chi-square test,Fisher exact probability method and variance analysis were performed for comparison among groups.Cox regression analysis was used for difference analysis in imbalance of variables and incidence of outcome events among the three groups.Results The portal vein pressure gradient of simple coated stent group,simulated Viatorr stent group and combined stent group decreased from (22.15±4.52),(23.01±5.48) and (21.13±4.49) mmHg (1 mmHg=0.133 kPa) to (9.15±2.94),(11.20±3.27) and (8.75+4.06) mmHg after operation,respectively.Before and after operation,the differences in portal venous pressure gradient were statistically significant of three groups (t=10.488,7.188 and 7.850,all P＜0.05).The shunt failure rates of simple coated stent group,simulated Viatorr stent group and combined stent group were 13.0％ (3/23),18.5％ (5/27) and 30.4％ (7/23),respectively.The results of Cox regression analysis indicated that there was no statistically significant difference in shunt failure rates among different stent configurations after TIPS (P=0.339).The incidences of hepatic encephalopathy of simple coated stent group,simulated Viatorr stent group and combined stent group postoperative were 69.6％ (16/23),33.3％ (9/27) and 30.4％ (7/23),respectively,the difference was not statistically significant among the three groups (P＞ 0.05).The results of Cox regression analysis showed that the relative ratio values (95％ confidence interval) of incidence of postoperative hepatic encephalopathy of simple coated stent group compared with simulated Viatorr stent group and combined stent group were 2.901 (1.279 to 6.584) and 2.735 (1.123 to 6.658),and the differences were statistically significant (both P＜0.05).The incidences of hepatic myelopathy of simple coated stent group,simulated Viatorr stent group and combined stent group were 8.7％ (2/23),3.7％ (1/27) and 4.3％ (1/23),respectively,and there was no statistically significant difference in the incidence of hepatic myelopathy among three groups after operation (P＞0.05).During one-year follow-up,among 73 patients,two patients died,one in simple coated stent group and the other in combined stent group.The one-year survival rate after TIPS was 97.3％.Conclusions One year after operation,the incidences of shunt failure are similar between simple coated stent group,simulated Viatorr stent group and combined stent group.One year after operation,the incidence of hepatic encephalopathy is similar between simulated Viatorr stent group and combined stent group which are both lower than that of simple coated stent.The incidence of hepatic myelopathy is low,and its association with TIPS remains to be further investigated.

Objective: To evaluate the prognostic value of ultrasonographic measurement of optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse diameter (ETD) ratio in stroke patients during hospitalization. Methods: Adult patients with stroke (ischemic stroke or hemorrhagic stroke) admitted to department of critical care medicine of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from November 2017 to November 2018 were enrolled. On the day of admission, ONSD and ETD (retina-retina at 3 mm behind the globe along) were detected by ultrasound, the ONSD/ETD ratio was calculated, and the baseline data and outcomes were recorded. Patients were divided into survival group and death group according to their survival status. Locally weighted scatterplot smoothing (LOWESS) and the receiver operating characteristic (ROC) curve were used to calculate the thresholds of ONSD and ONSD/ETD. The correlation between ONSD, ONSD/ETD and prognosis were assessed. Results: Thirty-eight of 83 patients (45.8%) survived and were discharged from the hospital, while 45 patients died (54.2%). There were significant differences in Glasgow coma score (GCS), shifting of the middle structure, ONSD and ONSD/ETD between the death group and the survival group [GCS: 4.7±2.8 vs. 11.0±3.2, shifting of the middle structure (mm): 5.8±5.9 vs. 1.3±2.6, ONSD (mm): 5.5±0.4 vs. 4.4±0.5, ONSD/ETD: 0.25±0.02 vs. 0.20±0.02, all P < 0.05]. LOWESS and ROC curve analysis suggested thresholds of ONSD and ONSD/ETD for predicting adverse prognosis of stroke patients were 5.0 mm and 0.25, respectively. By adjusting the influence of confounding factors on prognosis, a prediction model based on ONSD was established, and the ROC curve was drawn. The area under the curve (AUC) was 0.978, the optimal predictive point of the model was 0.870, the sensitivity was 89%, and the specificity was 100%. The ONSD/ETD prediction model was also obtained, and the AUC was 0.988, the optimal prediction threshold of the model was 0.768, and the sensitivity for predicting adverse clinical prognosis was 94%, and the specificity was 97%. The stability of ONSD/ETD was better than that of ONSD. ONSD coefficient of variation was 0.14, and ONSD/ETD coefficient of variation was 0.13. Conclusions ONSD and ONSD/ETD were significantly correlated with the prognosis of critical patients with stroke. The mortality increased significantly in patients with an ONSD greater than 5.0 mm and ONSD/ETD greater than 0.25. ONSD and ONSD/ETD may be promising tools for early assessment of clinical outcomes in these patients.