Azvudine and nirmatrelvir/ritonavir (Paxlovid) are recommended for COVID-19 treatment in China, but their safety and efficacy in the elderly population are not fully known. In this multicenter, retrospective, cohort study, we identified 5131 elderly hospitalized COVID-19 patients from 32,864 COVID-19 patients admitted to nine hospitals in Henan Province, China, from December 5, 2022, to January 31, 2023. The primary outcome was all-cause death, and the secondary outcome was composite disease progression. Propensity score matching (PSM) was performed to control for confounding factors, including demographics, vaccination status, comorbidities, and laboratory tests. After 2:1 PSM, 1786 elderly patients receiving azvudine and 893 elderly patients receiving Paxlovid were included. Kaplan-Meier and Cox regression analyses revealed that compared with Paxlovid group, azvudine could significantly reduce the risk of all-cause death (log-rank P = 0.002; HR: 0.71, 95% CI: 0.573-0.883, P = 0.002), but there was no difference in composite disease progression (log-rank P = 0.52; HR: 1.05, 95% CI: 0.877-1.260, P = 0.588). Four sensitivity analyses verified the robustness of above results. Subgroup analysis suggested that a greater benefit of azvudine over Paxlovid was observed in elderly patients with primary malignant tumors (P for interaction = 0.005, HR: 0.32, 95% CI: 0.18-0.57) compared to patients without primary malignant tumors. Safety analysis revealed that azvudine treatment had a lower incidence of adverse events and higher lymphocyte levels than Paxlovid treatment. In conclusion, azvudine treatment is not inferior to Paxlovid treatment in terms of all-cause death, composite disease progression and adverse events in elderly hospitalized COVID-19 patients.

Objective:To evaluate the effect of ulinastatin on the postoperative pulmonary complications (PPCs) in the patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods:Medical records from patients scheduled for elective OPCABG from September 2021 to August 2023 were retrospectively collected. The patients were divided into ulinastatin and control groups based on the intraoperative use of ulinastatin. Confounding factors were adjusted using propensity score matching and an extended Cox proportional hazards model. The primary outcome was the development of PPCs within 30 days after surgery, and secondary outcomes included length of stay in intensive care unit, length of hospital stay and occurrence of other adverse events.Results:A total of 1 532 patients were included in this cohort study, and 585 cases (38.2%) experienced PPCs. Compared with control group, the incidence of PPCs was significantly decreased (before matching: 42.7% vs. 35.2%, P=0.004; after matching: 42.2% vs. 35.6%, P=0.033), the incidence of acute kidney injury was decreased and no significant differences were found in the length of stay in intensive care unit, length of hospital stay and incidence of other adverse events in ulinastatin group ( P>0.05). In the extended Cox proportional hazard model before and after adjustment for confounding factors, the risk of PPCs was significantly reduced after the use of ulinastatin ( HR value before adjustment was 0.81, 95% confidence interval [ CI] 0.67-0.99, P=0.004; the HR value after adjustment was 0.79, 95% CI 0.65-0.96, P=0.022). The risk of PPCs was significantly decreased in patients aged >65 yr and at high risk of PPCs after using ulinastatin ( HR=0.667, 95% CI 0.542-0.821, P<0.001; hR value was 0.641, 95% CI 0.516-0.812, P<0.001). Conclusions:The intraoperative use of ulinastatin is helpful in decreasing the risk of PPCs in patients undergoing OPCABG.

Objective:To analyze the risk factors for the development of moderate to severe liver fibrosis in male metabolic syndrome (MetS) patients.Methods:In this study, a single-center retrospective study was conducted to select 414 male patients with MetS who were diagnosed by physical examination at the First Affiliated Hospital of Zhengzhou University from January 2022 to November 2023. The patients were classified into MetS with no/slight hepatic fibrosis group (MetS F0-1 group, 294 cases) and MetS with moderate to severe hepatic fibrosis group (MetS F2-4 group, 120 cases) according to the results of liver hardness test. The independent risk factors for the development of moderate-to-severe liver fibrosis in male MetS patients were explored by univariate and multivariate analyses of whether they had diabetes, and the levels of body mass index (BMI), serum glutamate aminotransferase (ALT), aspartate aminotransferase (AST), glutamyltransferase (GGT), and uric acid.Results:Compared with the MetS F0-1 group, theMets F2-4 group had the characteristics of high obesity rate, high diabetes rate and high serum ALT, AST. GGT and uric acid levels (all P<0.05). One-way regression analysis revealed that those with diabetes mellitus ( OR=2.891, 95% CI: 1.627-5.138), high BMI ( OR=1.276, 95% CI: 1.191-1.368), high level of serum ALT ( OR=1.024, 95% CI: 1.015-1.034), AST ( OR=1.052, 95% CI: 1.032-1.072), GGT ( OR=1.011, 95% CI: 1.005-1.016) and uric acid ( OR=1.003, 95% CI: 1.001-1.006) were the risk factors for the development of moderate-to-severe hepatic fibrosis in male patients with MetS, whereas a multifactorial regression analysis found that the presence of diabetes ( OR=5.561, 95% CI: 2.706-11.428), high BMI ( OR=1.271, 95% CI: 1.177-1.372) and high serum uric acid ( OR=1.004, 95% CI: 1.001-1.007) were the independent risk factors for the development of moderate-to-severe hepatic fibrosis in male MetS patients. Conclusion:Diabetes, high BMI and high level of serum uric acid are independent risk factors for the development of moderate-to-severe hepatic fibrosis in male patients with MetS.

Objective:To identify the risk factors for intraoperative hemorrhage and transfusion in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods:A total of 1, 442 patients, regardless of gender, of American Society of Anesthesiologists Physical Status classification≥Ⅱ, scheduled for elective OPCABG from June 7, 2021 to March 8, 2023, were enrolled in a prospective, observational study. Patients′ general characteristics, preoperative hemodynamics, preoperative blood routine, duration of operation, the number of transplanted vessels, intraoperative application of vasoactive agents, intraoperative consumption of crystalloid and colloid, urine volume, blood products, use of tranatemic acid and ulinastatin were collected. Univariable and multiple linear regression models were used to screen the risk factors for intraoperative blood loss and infusion volume of concentrated red blood cell (CRBC), and univariable and multivariable logistic regression models were used to screen the risk factors for intraoperative CRBC infusion requirement.Results:One thousand four hundred and twenty patients were finally included. Prolonged operation duration, increased number of transplanted vessels and older age were risk factors for intraoperative blood loss, while male, increased intraoperative usage of fresh frozen plasma (FFP), increased urine volume, and application of ulinastatin and tranexamic acid were protective factors for intraoperative blood loss in OPCABG patients ( P<0.05). Prolonged operation duration and increased intraoperative usage of FFP were risk factors for intraoperative CRBC transfusion volume, while elevation of preoperative hemoglobin levels was a protective factor for intraoperative CRBC transfusion volume in OPCABG patients ( P<0.05). Prolonged operation duration and increased intraoperative usage of FFP were risk factors for intraoperative CRBC infusion requirement, while increased body mass index, elevation of preoperative hemoglobin levels and application of ulinastatin were protective factors for CRBC infusion requirement ( P<0.05). Conclusions:Prolonged operation duration, increased number of transplanted vessels and older age are risk factors for intraoperative blood loss, and increased intraoperative usage of FFP, increased urine volume, and application of ulinastatin and tranexamic acid are protective factors for intraoperative blood loss in OPCABG patients. Prolonged operation duration and increased intraoperative usage of FFP are risk factors for intraoperative CRBC infusion requirement and transfusion volume, elevation of preoperative hemoglobin levels is a protective factor for intraoperative CRBC infusion volume, and increased body mass index, elevation of preoperative hemoglobin levels and intraoperative application of ulinastatin are protective factors for intraoperative CRBC infusion requirement in patients undergoing OPCABG.

BACKGROUND:Photothermal therapy is a novel tumor treatment strategy that uses photothermal agents to transform light energy into heat energy to accomplish non-invasive tumor ablation.The rise of photothermal therapy and nanotechnology has provided a new perspective on breast cancer treatment.OBJECTIVE:To prepare a new type of near-infrared biomimetic nanoprobe that has been modified by breast cancer cell membrane,to investigate the effect of near-infrared fluorescence/ultrasound imaging in vitro,and to observe its targeting ability and photothermal therapy effect on homologous tumor cells in vitro.METHODS:Organic small molecule ITIC-4CI with A-D-A structure was used as photothermal agents;polylactic acid/glycolic acid copolymer as nanocarrier;4T1 cell membrane of mouse breast cancer cells as a surface modifier of nanoparticles;perfluorohexane(PFH)was loaded.A novel near-infrared biomimetic nanoprobe(4T1m/ITIC-4CI/PFH)was prepared by the double emulsion evaporation method and sonication method.The basic characterization of the nanoprobe and the homologous targeting ability were detected.The photothermal properties and photothermal stability of the probe were investigated,and the near-infrared fluorescence/ultrasound imaging effect of the probe under laser irradiation was observed.The CCK-8 assay and calcein/propidium iodide staining were used to assess the efficacy of photothermal therapy.RESULTS AND CONCLUSION:(1)The prepared 4T1m/ITIC-4CI/PFH nanoprobes had uniform size,high stability,and an average particle size of(92.7±2.3)nm.The probe's protein composition was identical to that of the 4T1 cell membrane.The nanoprobe's ability to target homologous 4T1 cells was validated by an in vitro cell uptake assay.(2)The nanoprobe had a red-shift absorption spectrum and tail emission extending to the near-infrared-Ⅱ,which emitted a bright near-infrared-Ⅱ fluorescence signal under laser irradiation.(3)After laser irradiation,the nanoprobe 4T1m/ITIC-4CI/PFH could be turned into microbubbles and enhanced ultrasound imaging.The results of CCK-8 assay and calcein/propidium iodide staining showed that the nanoprobe 4T1m/ITIC-4CI/PFH had an obvious photothermal killing effect on 4T1 cells.(4)The results show that the nanoprobe 4T1m/ITIC-4CI/PFH has the ability to target homologous tumors and enhance near-infrared-Ⅱ fluorescence imaging/ultrasound imaging and photothermal therapy effects.

BACKGROUND:Patients with diabetes mellitus(DM)are vulnerable to community-acquired pneumonia(CAP),which have a high mortality rate.We aimed to investigate the value of heparin-binding protein(HBP)as a prognostic marker of mortality in patients with DM and CAP. METHODS:This retrospective study included CAP patients who were tested for HBP at intensive care unit(ICU)admission from January 2019 to April 2020.Patients were allocated to the DM or non-DM group and paired with propensity score matching.Baseline characteristics and clinical outcomes up to 90 days were evaluated.The primary outcome was the 10-day mortality.Receiver operating characteristic(ROC)curves,Kaplan-Meier analysis,and Cox regression were used for statistical analysis. RESULTS:Among 152 enrolled patients,60 pairs were successfully matched.There was no significant difference in 10-day mortality,while more patients in the DM group died within 28 d(P=0.024)and 90 d(P=0.008).In the DM group,HBP levels at ICU admission were higher in 10-day non-survivors than in 10-day survivors(median 182.21[IQR:55.43-300]ng/ml vs.median 66.40[IQR:34.13-107.85]ng/mL,P=0.019),and HBP levels could predict the 10-day mortality with an area under the ROC curve of 0.747.The cut-offvalue,sensitivity,and specificity were 160.6 ng/mL,66.7%,and 90.2%,respectively.Multivariate Cox regression analysis indicated that HBP was an independent prognostic factor for 10-day(HR 7.196,95%CI:1.596-32.455,P=0.01),28-day(HR 4.381,95%CI:1.449-13.245,P=0.009),and 90-day mortality(HR 4.581,95%CI:1.637-12.819,P=0.004)in patients with DM. CONCLUSION:Plasma HBP at ICU admission was associated with the 10-day,28-day,and 90-day mortality,and might be a prognostic factor in patients with DM and CAP.

BACKGROUND:Patients with diabetes mellitus(DM)are vulnerable to community-acquired pneumonia(CAP),which have a high mortality rate.We aimed to investigate the value of heparin-binding protein(HBP)as a prognostic marker of mortality in patients with DM and CAP. METHODS:This retrospective study included CAP patients who were tested for HBP at intensive care unit(ICU)admission from January 2019 to April 2020.Patients were allocated to the DM or non-DM group and paired with propensity score matching.Baseline characteristics and clinical outcomes up to 90 days were evaluated.The primary outcome was the 10-day mortality.Receiver operating characteristic(ROC)curves,Kaplan-Meier analysis,and Cox regression were used for statistical analysis. RESULTS:Among 152 enrolled patients,60 pairs were successfully matched.There was no significant difference in 10-day mortality,while more patients in the DM group died within 28 d(P=0.024)and 90 d(P=0.008).In the DM group,HBP levels at ICU admission were higher in 10-day non-survivors than in 10-day survivors(median 182.21[IQR:55.43-300]ng/ml vs.median 66.40[IQR:34.13-107.85]ng/mL,P=0.019),and HBP levels could predict the 10-day mortality with an area under the ROC curve of 0.747.The cut-offvalue,sensitivity,and specificity were 160.6 ng/mL,66.7%,and 90.2%,respectively.Multivariate Cox regression analysis indicated that HBP was an independent prognostic factor for 10-day(HR 7.196,95%CI:1.596-32.455,P=0.01),28-day(HR 4.381,95%CI:1.449-13.245,P=0.009),and 90-day mortality(HR 4.581,95%CI:1.637-12.819,P=0.004)in patients with DM. CONCLUSION:Plasma HBP at ICU admission was associated with the 10-day,28-day,and 90-day mortality,and might be a prognostic factor in patients with DM and CAP.

BACKGROUND:Patients with diabetes mellitus(DM)are vulnerable to community-acquired pneumonia(CAP),which have a high mortality rate.We aimed to investigate the value of heparin-binding protein(HBP)as a prognostic marker of mortality in patients with DM and CAP. METHODS:This retrospective study included CAP patients who were tested for HBP at intensive care unit(ICU)admission from January 2019 to April 2020.Patients were allocated to the DM or non-DM group and paired with propensity score matching.Baseline characteristics and clinical outcomes up to 90 days were evaluated.The primary outcome was the 10-day mortality.Receiver operating characteristic(ROC)curves,Kaplan-Meier analysis,and Cox regression were used for statistical analysis. RESULTS:Among 152 enrolled patients,60 pairs were successfully matched.There was no significant difference in 10-day mortality,while more patients in the DM group died within 28 d(P=0.024)and 90 d(P=0.008).In the DM group,HBP levels at ICU admission were higher in 10-day non-survivors than in 10-day survivors(median 182.21[IQR:55.43-300]ng/ml vs.median 66.40[IQR:34.13-107.85]ng/mL,P=0.019),and HBP levels could predict the 10-day mortality with an area under the ROC curve of 0.747.The cut-offvalue,sensitivity,and specificity were 160.6 ng/mL,66.7%,and 90.2%,respectively.Multivariate Cox regression analysis indicated that HBP was an independent prognostic factor for 10-day(HR 7.196,95%CI:1.596-32.455,P=0.01),28-day(HR 4.381,95%CI:1.449-13.245,P=0.009),and 90-day mortality(HR 4.581,95%CI:1.637-12.819,P=0.004)in patients with DM. CONCLUSION:Plasma HBP at ICU admission was associated with the 10-day,28-day,and 90-day mortality,and might be a prognostic factor in patients with DM and CAP.

BACKGROUND:Patients with diabetes mellitus(DM)are vulnerable to community-acquired pneumonia(CAP),which have a high mortality rate.We aimed to investigate the value of heparin-binding protein(HBP)as a prognostic marker of mortality in patients with DM and CAP. METHODS:This retrospective study included CAP patients who were tested for HBP at intensive care unit(ICU)admission from January 2019 to April 2020.Patients were allocated to the DM or non-DM group and paired with propensity score matching.Baseline characteristics and clinical outcomes up to 90 days were evaluated.The primary outcome was the 10-day mortality.Receiver operating characteristic(ROC)curves,Kaplan-Meier analysis,and Cox regression were used for statistical analysis. RESULTS:Among 152 enrolled patients,60 pairs were successfully matched.There was no significant difference in 10-day mortality,while more patients in the DM group died within 28 d(P=0.024)and 90 d(P=0.008).In the DM group,HBP levels at ICU admission were higher in 10-day non-survivors than in 10-day survivors(median 182.21[IQR:55.43-300]ng/ml vs.median 66.40[IQR:34.13-107.85]ng/mL,P=0.019),and HBP levels could predict the 10-day mortality with an area under the ROC curve of 0.747.The cut-offvalue,sensitivity,and specificity were 160.6 ng/mL,66.7%,and 90.2%,respectively.Multivariate Cox regression analysis indicated that HBP was an independent prognostic factor for 10-day(HR 7.196,95%CI:1.596-32.455,P=0.01),28-day(HR 4.381,95%CI:1.449-13.245,P=0.009),and 90-day mortality(HR 4.581,95%CI:1.637-12.819,P=0.004)in patients with DM. CONCLUSION:Plasma HBP at ICU admission was associated with the 10-day,28-day,and 90-day mortality,and might be a prognostic factor in patients with DM and CAP.

BACKGROUND:Patients with diabetes mellitus(DM)are vulnerable to community-acquired pneumonia(CAP),which have a high mortality rate.We aimed to investigate the value of heparin-binding protein(HBP)as a prognostic marker of mortality in patients with DM and CAP. METHODS:This retrospective study included CAP patients who were tested for HBP at intensive care unit(ICU)admission from January 2019 to April 2020.Patients were allocated to the DM or non-DM group and paired with propensity score matching.Baseline characteristics and clinical outcomes up to 90 days were evaluated.The primary outcome was the 10-day mortality.Receiver operating characteristic(ROC)curves,Kaplan-Meier analysis,and Cox regression were used for statistical analysis. RESULTS:Among 152 enrolled patients,60 pairs were successfully matched.There was no significant difference in 10-day mortality,while more patients in the DM group died within 28 d(P=0.024)and 90 d(P=0.008).In the DM group,HBP levels at ICU admission were higher in 10-day non-survivors than in 10-day survivors(median 182.21[IQR:55.43-300]ng/ml vs.median 66.40[IQR:34.13-107.85]ng/mL,P=0.019),and HBP levels could predict the 10-day mortality with an area under the ROC curve of 0.747.The cut-offvalue,sensitivity,and specificity were 160.6 ng/mL,66.7%,and 90.2%,respectively.Multivariate Cox regression analysis indicated that HBP was an independent prognostic factor for 10-day(HR 7.196,95%CI:1.596-32.455,P=0.01),28-day(HR 4.381,95%CI:1.449-13.245,P=0.009),and 90-day mortality(HR 4.581,95%CI:1.637-12.819,P=0.004)in patients with DM. CONCLUSION:Plasma HBP at ICU admission was associated with the 10-day,28-day,and 90-day mortality,and might be a prognostic factor in patients with DM and CAP.