Liver failure is a clinical syndrome characterized by serious liver damages.It can results from a variety of causes,and the prognosis is usually poor.How to objectively assess the severity of liver failure and accurately predict the prognosis are the hot spots and challenges in studies on liver failure.The assessment criteria and models widely used clinically include:Child-Turotte-Pugh (CTP) score,acute physiology,age and chronic health evaluation(APACHE) Ⅱ/Ⅲ score,King's College Hospital (KCH) criteria,sequential organ failure assessment (SOFA) score and model for end-stage liver disease (MELD) score.Besides,more factors are identified as potential markers in prognosis assessment.This paper reviews the importance of prognosis assessment in liver failure,and introduces current and new systems or markers in prognosis assessment.

Objective To evaluate the model for end-stage liver disease (MELD) and MELD combined with serum natrium level (MELD-Na) in predicting short-term prognosis of liver failure.Methods Clinical data of 322 patients with liver failure admitted in the First Affiliated Hospital of Xinjiang Medical University from April 2003 to April 2012 were retrospectively analyzed.MELD and MELD-Na scores were calculated at diagnosis and one week after the diagnosis,and then △MELD and △MELD-Na were determined.Receiver operating characteristics (ROC) curve and Kaplan-Meier survival curve were used to evaluate the value of the above scores in predicting 3-month prognosis.Results The 3-month mortality rates of acute/sub-acute,acute-on-chronic and chronic liver failure were 77.4％ (24/31),41.7％ (50/120) and 56.1％ (96/171),respectively,and the difference was of statistical significance (x2 =14.273,P ＜0.01).For acute/sub-acute liver failure,the areas under ROC curve (AUCs) were 0.699-0.836 for each scoring system in predicting short-term prognosis,and no significant difference was observed (Z =0.507,0.622,0.712,0.727,0.779 and 0.599,P ＞0.05).For acute-on-chronic liver failure,AUCs were 0.889 and 0.897 for △MELD and △MELD-Na in predicting short-term prognosis,which were higher than those of MELD and MELD-Na scores at the baseline (Z =3.110 and 3.500,P ＜ 0.05),but no significant difference was observed between △MELD and △MELD-Na (Z =0.310,P ＞ 0.05) ; Kaplan-Meier survival curve showed that the 3-month mortality rate for patients with △MELD ＞ 3.5 was 87.8％,and the average survival time was 34.05 d.For chronic liver failure,AUC of △MELD was 0.871 in predicting short-term prognosis,which was higher than that of △MELD-Na (Z =4.229,P ＜0.05) ; Kaplan-Meier survival curve showed that the 3-month mortality rate for patients with △MELD ＞ 4.5 was 89.9％,and the average survival time was 29.08 d.Conclusion For acute/sub-acute liver failure,MELD,MELD-Na,△MELD and △MELD-Na are all satisfactory in predicting short-term prognosis; for acute-on-chronic liver failure,△MELD and △MELD-Na are better than MELD,MELD-Na scores at the baseline; and for chronic liver failure,△MELD is the best indicator.

Objective:To investigate the changes of thyroid hormones and the flow velocity of superior thyroid artery in patients with Graves' disease and Hashimoto's thyrotoxicosis before and after treatment with methimazole.Methods:A case-control study was conducted to select 45 cases of Graves' disease and 45 cases of Hashimoto's thyroiditis from October 2021 to December 2022 in the Department of Endocrinology, North China University of Science and Technology Affiliated Hospital. The changes of thyroid hormone and blood flow velocity of superior thyroid artery in patients with Graves' disease and Hashimoto's thyroiditis before and after treatment with methimazole were analyzed. Measurement data satisfying normal distribution were expressed by xˉ±s, and the mean between two groups was compared by t test. Measurement data not satisfying normal distribution were expressed by M( Q1, Q3), and the median between two groups was compared by Wilcoxon rank sum test. χ 2 test was used to compare the constituent ratio of enumeration data among groups. Results:There was no significant difference in thyroid stimulating hormone (TSH) between the two groups before treatment, and there was no significant difference in TSH between the two groups after 1 month and 3 months of treatment (all P>0.05). The levels of free triiodothyronine (FT3) were (24.09±9.29) pmol/L and (17.41±9.36) pmol/L in Graves' disease group and Hashimoto's thyroiditis group respectively before treatment. FT4 were (60.23±20.82) and (43.47±21.71) pmol/L, respectively, and the peak stolie vloiy (PSV) were (69.53±5.70) and (52.65±4.64) cm/s, respectively in Graves' disease group and Hashimoto's thyroiditis group respectively before treatment. There were significant differences between the two groups ( t values wrere 3.39 and 3.74, Z=13.83, all P<0.001). The difference of FT3 between one month after treatment and before treatment was (-6.36±5.32) and (-12.64±9.08) pmol/L ( t=4.02, P<0.001) and the difference in FT3 between 3 months of treatment and before treatment was (-10.14±9.50) and (-17.80±11.17) pmol/L, respectively ( t=3.51, P<0.001) between the Graves disease group and the Hashimoto's thyroiditis group. The difference in FT4 between the Graves disease group and the Hashimoto's thyroiditis group after 1 month of treatment and before treatment was (-28.47±10.09) and (-20.57±14.48) pmol/L ( t=7.01, P<0.001), and the difference of FT4 was (-47.06±20.57) and (-30.17±20.54) pmol/L ( t=3.91, P<0.001) between the Graves disease group and the Hashimoto toxin group. The difference between one month after treatment and before treatment was (-13.10(-34.10,-2.60)) and (-10.50(-27.5,-0.20)) cm/s ( Z=2.63, P=0.009), respectively. The difference between 3 months and before treatment was (-31.40(-53.20,-12.70)) and (-19.90(-46.00,-4.70)cm/s ( Z=4.40, P<0.001)) between the Graves disease group and the Hashimoto's thyroiditis group, and the difference was statistically significant. Conclusion:Thyroid hormone levels were decreased after treatment with methimazole in patients with diffuse toxic goiter and Hashimoto toxemia, but the difference was not statistically significant. The PSV level of superior thyroid artery in patients with diffuse toxic goiter was significantly lower than that in patients with Hashimoto's thyrotoxicosis.

Objective To investigate the clinical features of cutaneous adverse reactions to tyrosine kinase inhibitors.Methods Thirty patients with cutaneous adverse reactions to tyrosine kinase inhibitors were enrolled from the First Affiliated Hospital of Guangzhou Medical University between January 2015 and December 2016,and their laboratory test results,histopathological findings and treatment response data were collected and analyzed retrospectively.Results Of the 30 patients,15 presented with acneiform eruptions,10 with eczematoid eruptions,2 with morbilliform rashes,1 with telangiectasia,1 with hand-foot skin reaction,9 with xerosis,7 with nail changes and 4 with hair changes.A patient with grade 4 acneiform eruptions showed a markedly elevated alanine transaminase (ALT) level (315 U/L).Mild ALT abnormalities (48.5-88.1 U/L) were found in 3 patients with grade 3 acneiform eruptions,1 with grade 2 acneiform eruptions,1 with grade 1 acneiform eruptions and 1 with eczematoid eruptions complicated by fever.Two patients with eczematoid eruptions and 1 with morbilliform rashes showed elevated proportions of peripheral blood eosinophils (0.057-0.303).Pathological changes of the acneiform eruptions included hyperkeratosis and dilation of hair follicles and neutrophilic infiltration.Pathological manifestations of eczematoid eruptions included different degrees of spongiosis,thickened spinous layer,irregular elongation of rete ridges and liquefaction degeneration of basal cells in the epidermis,and perivascular infiltration of lymphocytes and eosinophils in the superficial dermis.Patients with grade 1-3 acneiform eruptions received oral minocycline for 6 weeks,skin lesions gradually regressed,but relapse occurred after the withdrawal.After withdrawal of targeted antineoplastic agents and 2-week treatment with systemic glucocorticoids,skin lesions gradually regressed in patients with grade 4 acneiform eruptions,those with eczematoid eruptions complicated by fever,and those with morbilliform rashes.Skin rashes also resolved in patients with mild morbilliform rashes and those with mild eczematoid eruptions after 2 weeks of treatment with antianaphylactic agents and topical glucocorticoids.Oral antibiotics were effective for the treatment of periungual erythematous swelling or granulomas.Conclusion Tyrosine kinase inhibitor-related cutaneous adverse reactions include a constellation of disorders,and hepatic function can be impaired.

Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. In addition to smoking COPD caused by cigarette smoke, the phenotype of non-smoking COPD accounts for at least 1/4. Non-smoking COPD accounts for a large proportion, especially in developing countries. Non-smoking COPD and smoking COPD should be paid equal attention. More in-depth study on the prognosis of non-smoking COPD is needed.

Chronic obstructive pulmonary disease (COPD) complicated with pulmonary tuberculosis (PTB) is becoming more and more common. The coexistence of two diseases brings difficulty to the control of the disease. Smoking, biofuel exposure, vitamin D deficiency and diabetes may be common risk factors for both diseases. Complementary prevention and control strategies can be designed for the above risk factors. This article contains review with tuberculosis as a risk factor for COPD, COPD combined with tuberculosis, and the prevention strategies for both diseases.

Objective:To evaluate the clinical differences between smokers and non-smokers with chronic obstructive pulmonary disease (COPD).Methods:The clinical data of 5 183 COPD patients, including 3 688 smoking COPD patients and 1 495 non-smoking patients, were collected from the respiratory and critical medicine clinics of 12 Grade-A hospitals in Hunan Province and Guangxi Zhuang Autonomous Prefecture from December 2016 to December 2019. The general condition, clinical symptoms, acute exacerbation history and pulmonary function of the two groups were compared.Results:⑴ Non-smokers were more likely to be female, to be younger and had a lower educational level ( P<0.05). There was no difference of body mass index (BMI) and marriage statue between two groups ( P>0.05). ⑵ Clinical features: the incidence of chest distress in non-smoking COPD patients was higher than that in smoking COPD patients (86.8% and 81.4%, respectively), and the incidence of asthma was also higher than that of smoking COPD patients (86.0% and 83.1%, respectively), with statistically significant difference ( P<0.05). There was no significant difference in the incidence of cough and expectoration between the two groups ( P>0.05). The COPD assessment test (CAT) score of non-smoking COPD patients was significantly higher than that of smoking group (16.2±6.4) and (15.7± 6.5) ( P<0.05). There was no significant difference in the score of dyspnea modified medical research council dyspnea scale (mMRC) and the risk of acute exacerbation between the two groups ( P>0.05). The first second exertional volume as a percentage of predicted value (FEV 1%) and forced vital capacity (FVC) of non-smoking COPD patients were higher than those of smoking COPD patients ( P<0.05). Conclusions:Compared to smokers with COPD, non-smokers more are more likely to be female and have more severe clinical symptoms.

OBJECTIVE To intr oduce multidisciplinary collaborative blood glucose management mode （hereinafter referred as to blood glucose management mode of the whole hospital ）of the whole hospital with the participation of clinical pharmacists ，and to evaluation it effects on the blood glucose management of perioperative diabetes patients. METHODS The process of blood glucose management mode of the whole hospital in Drum Tower Hospital Affiliated to Medical School of Nanjing University and the work content of clinical pharmacists were introduced. Three hundred patients with type 2 diabetes mellitus who underwent elective surgery were included and randomly divided into general consultation group （control group ）and hospital-wide glucose management group （intervention group ）. The effect of glucose management and indicators such as preoperative waiting time and total length of stay were compared between 2 groups. RESULTS In the blood glucose management team of the whole hospital ，the physicians，clinical pharmacists and nurses of blood glucose management in endocrinology department were the core members ，and the management process was divided into initial management ，daily management ，discharge management and follow-up. As the team secretary ，the clinical pharmacists were mainly responsible for daily summarizing and managing the blood glucose level and special conditions of patients ，regularly evaluating the management effect ，carrying out pharmaceutical ward rounds ，medical order review， pharmaceutical care ， timely assessing the blood glucose of patients and guiding the rational use of drugs. Compared with before intervention ， after 3 days ofintervention，the levels of fasting plasma glucose （FPG）and postprandial blood glucose （PBG） were decreased significantly in 2 groups（P＜0.05）；intervention group was significantly lower than control group （P＜0.05）. Compared with control group ， the fluctuation of blood glucose in intervention group was significantly reduced （P＜0.05），standard deviation of blood glucose had reached the targeted control level ， and the postprandial glucose excursion and the largest amplitude of glycemic excursion were close to the targeted control level ；the rate of bl ood glucose reaching the standard before operation and at discharge were significantly increased （P＜0.05）；the preoperative waiting time and hospitalization days were significantly shortened （P＜0.05）. CONCLUSIONS The multidisciplinary collaborative blood glucose management mode of the whole hospital with the participation of clinical pharmacists can control the blood glucose level of diabetic patients in the perioperative period more stably and effectively ，and has practical significance for the disease treatment and prognosis of patients.

ObjectiveTo determine the scores of patients with a confirmed diagnosis of drug-induced liver injury （DILI） using Roussel Uclaf Causality Assessment Method （RUCAM）， Maria ＆ Victorino assessment scale， and Revised Electronic Causality Assessment Method （RECAM）， to compare the accuracy of the three scales in diagnosis， and to investigate their clinical significance in the diagnosis of DILI. MethodsA total of 98 patients with a confirmed diagnosis of DILI who were hospitalized in Peking University First Hospital from January 2011 to December 2022 were enrolled， with liver biopsy results supporting DILI and a clear history of medication. Clinical data were collected from all subjects， and the above causality assessment scales were used for scoring. The chi-square test was used to analyze the diagnostic accuracy of the causality assessment scales， and the weighted kappa coefficient was used to analyze the consistency between the three scales. ResultsFor all patients with DILI enrolled， RECAM had the highest accuracy， with a significant difference compared with RUCAM （χ²=5.667，P=0.017）. RUCAM and RECAM had moderate consistency in diagnosis （κw=0.469）， while RECAM and Maria ＆ Victorino scale had poor consistency （κw=0.156）. For the patients with acute DILI， RECAM， RUCAM， and Maria ＆ Victorino scales had a diagnostic inconsistency rate of 3.7%， 11.1%， and 42.6%， respectively； for the patients with hepatocellular type DILI， the three scales of a diagnostic inconsistency rate of 8.9%， 21.4%， and 62.5%， respectively； for the patients with cholestasis type or mixed type DILI， the three scales of a diagnostic inconsistency rate of 10.0%， 22.5%， and 47.5%， respectively. ConclusionThe use of RECAM and RUCAM scales in acute DILI can improve diagnostic rate， and for hepatocellular type DILI and DILI with the clinical manifestation of cholestasis （cholestasis type DILI and mixed type DILI）， the use of RECAM and RUCAM scales can also improve diagnostic rate. The selection of causality assessment scales with a relatively high accuracy based on the course and clinical classification of the disease may help to further improve clinical diagnostic rate.

Objective    To explore the efficacy of a novel detection technique of circulating tumor cells (CTCs) to identify benign and malignant lung nodules. Methods     Nanomagnetic CTC detection based on polypeptide with epithelial cell adhesion molecule (EpCAM)-specific recognition was performed on enrolled patients with pulmonary nodules. There were 73 patients including 48 patients with malignant lesions as a malignant group and 25 patients with benign lesion as a benign group. There were 13 males and 35 females at age of 57.0±11.9 years in the malignant group and 11 males and 14 females at age of 53.1±13.2 years in the benign group. e calculated the differential diagnostic efficacy of CTC count, and conducted subgroup analysis according to the consolidation-tumor ratio, while compared with PET/CT on the efficacy. Results     CTC count of the malignant group was significantly higher than that of the benign group  (0.50/ml vs. 0.00/ml, P<0.05). Subgroup analysis according to consolidation tumor ratio (CTR) revealed that the difference was statistically significant in pure ground glass (pGGO) nodules 1.00/ml vs. 0.00/ml, P<0.05), but not in part-solid or pure solid nodules. For pGGO nodules, the area under the receiver operating characteristic (ROC) curve of CTC count was 0.833, which was significantly higher than that of maximum of standardized uptake value (SUVmax) (P<0.001). Its sensitivity and specificity was 80.0% and 83.3%, respectively. Conclusion     The peptide-based nanomagnetic CTC detection system can differentiate malignant tumor and benign lesions in pulmonary nodules presented as pGGO. It is of great clinical potential as a noninvasive, nonradiating method to identify malignancies in pulmonary nodules.