Objective To study the economic burden caused by healthcare-associated infection(HAI)in patients with severe acute pancreatitis(SAP),and provide theoretical basis for formulating HAI prevention and control measures.Methods Patients with SAP discharged from a tertiary first-class hospital in Jiangxi Province from July 1,2023 to June 30,2024 were selected as the study subjects.Information including demographic characteristics,clinical data,and hospitalization expense were collected.Patients were divided into a HAI group and a non-HAI group according to HAI occurrence.A propensity score matching(PSM)method was used to conduct a 1∶2 ma-tching,and differences in the length of hospital stay and hospitalization expense between the two groups of patients after PSM were compared.Results A total of 709 patients were included in the analysis,out of which 65 cases ex-perienced HAI,with a HAI incidence of 9.17％.After PSM,all 65 patients in the HAI group were successfully matched.The length of hospital stay,total hospitalization expense,expenses of medication and hygiene product of patients in the HAI group were all higher than those in the non-HAI group,and differences were all statistically sig-nificant(all P＜0.001).Patients who experienced≥2 episodes of HAI had a higher economic burden than those who experienced only once(P＜0.05).HAI of bloodstream,abdomen,digestive system,and respiratory system significantly increased the economic burden of patients(all P＜0.05).Conclusion HAI in SAP patients can extend the length of hospital stay and increase economic burden of patients.Targeted infection prevention and control mea-sures should be formulated to reduce the incidence of HAI and save medical resources.

Objective To study the economic burden caused by healthcare-associated infection(HAI)in patients with severe acute pancreatitis(SAP),and provide theoretical basis for formulating HAI prevention and control measures.Methods Patients with SAP discharged from a tertiary first-class hospital in Jiangxi Province from July 1,2023 to June 30,2024 were selected as the study subjects.Information including demographic characteristics,clinical data,and hospitalization expense were collected.Patients were divided into a HAI group and a non-HAI group according to HAI occurrence.A propensity score matching(PSM)method was used to conduct a 1∶2 ma-tching,and differences in the length of hospital stay and hospitalization expense between the two groups of patients after PSM were compared.Results A total of 709 patients were included in the analysis,out of which 65 cases ex-perienced HAI,with a HAI incidence of 9.17％.After PSM,all 65 patients in the HAI group were successfully matched.The length of hospital stay,total hospitalization expense,expenses of medication and hygiene product of patients in the HAI group were all higher than those in the non-HAI group,and differences were all statistically sig-nificant(all P＜0.001).Patients who experienced≥2 episodes of HAI had a higher economic burden than those who experienced only once(P＜0.05).HAI of bloodstream,abdomen,digestive system,and respiratory system significantly increased the economic burden of patients(all P＜0.05).Conclusion HAI in SAP patients can extend the length of hospital stay and increase economic burden of patients.Targeted infection prevention and control mea-sures should be formulated to reduce the incidence of HAI and save medical resources.

The purpose of this study was to explore the clinical efficacy and safety of Gynostemma pentaphyllum (G. pentaphyllum) in the treatment of hyperlipidemia, and to provide systematic evaluation basis for clinical application. CNKI, Wanfang Data, VIP, Web of science, PubMed, Embase and Cochrane Library were searched for randomized controlled trials (RCTs) about G. pentaphyllum in the treatment of hyperlipidemia. Review Manager 5.4 were used for statistical analysis. Through reading topics, abstracts, and full texts, 27 papers with 2311 cases involved that met the inclusion and exclusion criteria were finally included for the analysis. In terms of curative effect, the effect of G. pentaphyllum alone in increasing high density lipoprotein (HDL) index was better than that of conventional treatment, and the effect of reducing total cholesterol (TC), triglyceride (TG) and low density lipoprotein (LDL) was similar to that of conventional treatment. There was a synergistic effect between G. pentaphyllum and conventional drugs, and the combination of G. pentaphyllum and conventional drugs was superior to conventional treatment in reducing TG and increasing HDL. G. pentaphyllum can also decrease the levels of serum glutamic pyruvic transaminase and glutamic oxaloacetic transaminase in the treatment of hyperlipidemia, indicating a certain protective function of the liver. In terms of safety, there were fewer cases of adverse reactions in the G. pentaphyllum treatment group, and the adverse reaction events reported in the literature was mild. According to the results of meta-analysis, G. pentaphyllum was effective in the treatment of hyperlipidemia, and it has the potential to be combined with traditional drugs, has a certain liver protection function, and was superior to traditional drugs in the treatment of hyperlipidemia.

Objective: To establish a nomogram prognostic model for predicting the 5-, 10-, and 15-year overall survival (OS) of non-metastatic renal cell carcinoma patients managed with radical nephrectomy (RN), compare the modelled results with the results of pure pathologic staging, the Karakiewicz nomogram and the Mayo Clinic Stage, Size, Grade, and Necrosis (SSIGN) score commonly used in foreign countries, and stratify the patients into different prognostic risk subgroups. Methods: A total of 1 246 non-metastatic renal cell carcinoma patients managed with RN in Sun Yat-sen University Cancer Center (SYSUCC) from 1999 to 2020 were retrospectively analyzed. Multivariate Cox regression analysis was used to screen the variables that influence the prognosis for nomogram establishment, and the bootstrap random sampling was used for internal validation. The time-receiver operating characteristic curve (ROC), the calibration curve and the clinical decision curve analysis (DCA) were applied to evaluate the nomogram. The prediction efficacy of the nomogram and that of the pure pathologic staging, the Karakiewicz nomogram and the SSIGN score was compared through the area under the curve (AUC). Finally, patients were stratified into different risk subgroups according to our nomogram scores. Results: A total of 1 246 patients managed with RN were enrolled in this study. Multivariate Cox regression analysis showed that age, smoking history, pathological nuclear grade, sarcomatoid differentiation, tumor necrosis and pathological T and N stages were independent prognostic factors for RN patients (all P<0.05). A nomogram model named SYSUCC based on these factors was built to predict the 5-, 10-, and 15-year survival rate of the participating patients. In the bootstrap random sampling with 1 000 iterations, all these factors occurred for more than 800 times as independent predictors. The Harrell's concordance index (C-index) of SYSUCC was higher compared with pure pathological staging [0.770 (95% CI: 0.716-0.823) vs 0.674 (95% CI: 0.621-0.728)]. The calibration curve showed that the survival rate as predicted by the SYSUCC model simulated the actual rate, while the clinical DCA showed that the SYSUCC nomogram has a benefit in certain probability ranges. In the ROC analysis that included 857 patients with detailed pathological nuclear stages, the nomogram had a larger AUC (5-/10-year AUC: 0.823/0.804) and better discriminating ability than pure pathological staging (5-/10-year AUC: 0.701/0.658), Karakiewicz nomogram (5-/10-year AUC: 0.772/0.734) and SSIGN score (5-/10-year AUC: 0.792/0.750) in predicting the 5-/10-year OS of RN patients (all P<0.05). In addition, the AUC of the SYSUCC nomogram for predicting the 15-year OS (0.820) was larger than that of the SSIGN score (0.709), and there was no statistical difference (P<0.05) between the SYSUCC nomogram, pure pathological staging (0.773) and the Karakiewicz nomogram (0.826). The calibration curve was close to the standard curve, which indicated that the model has good predictive performance. Finally, patients were stratified into low-, intermediate-, and high-risk subgroups (738, 379 and 129, respectively) according to the SYSUCC nomogram scores, among whom patients in intermediate- and high-risk subgroups had a worse OS than patients in the low-risk subgroup (intermediate-risk group vs. low-risk group: HR=4.33, 95% CI: 3.22-5.81, P<0.001; high-risk group vs low-risk group: HR=11.95, 95% CI: 8.29-17.24, P<0.001), and the high-risk subgroup had a worse OS than the intermediate-risk group (HR=2.63, 95% CI: 1.88-3.68, P<0.001). Conclusions: Age, smoking history, pathological nuclear grade, sarcomatoid differentiation, tumor necrosis and pathological stage were independent prognostic factors for non-metastasis renal cell carcinoma patients after RN. The SYSUCC nomogram based on these independent prognostic factors can better predict the 5-, 10-, and 15-year OS than pure pathological staging, the Karakiewicz nomogram and the SSIGN score of patients after RN. In addition, the SYSUCC nomogram has good discrimination, agreement, risk stratification and clinical application potential.
Humans ; Nomograms ; Retrospective Studies ; Carcinoma, Renal Cell/pathology* ; Prognosis ; Risk Factors ; Nephrectomy ; Kidney Neoplasms/pathology* ; Necrosis

Objective: To establish a nomogram prognostic model for predicting the 5-, 10-, and 15-year overall survival (OS) of non-metastatic renal cell carcinoma patients managed with radical nephrectomy (RN), compare the modelled results with the results of pure pathologic staging, the Karakiewicz nomogram and the Mayo Clinic Stage, Size, Grade, and Necrosis (SSIGN) score commonly used in foreign countries, and stratify the patients into different prognostic risk subgroups. Methods: A total of 1 246 non-metastatic renal cell carcinoma patients managed with RN in Sun Yat-sen University Cancer Center (SYSUCC) from 1999 to 2020 were retrospectively analyzed. Multivariate Cox regression analysis was used to screen the variables that influence the prognosis for nomogram establishment, and the bootstrap random sampling was used for internal validation. The time-receiver operating characteristic curve (ROC), the calibration curve and the clinical decision curve analysis (DCA) were applied to evaluate the nomogram. The prediction efficacy of the nomogram and that of the pure pathologic staging, the Karakiewicz nomogram and the SSIGN score was compared through the area under the curve (AUC). Finally, patients were stratified into different risk subgroups according to our nomogram scores. Results: A total of 1 246 patients managed with RN were enrolled in this study. Multivariate Cox regression analysis showed that age, smoking history, pathological nuclear grade, sarcomatoid differentiation, tumor necrosis and pathological T and N stages were independent prognostic factors for RN patients (all P<0.05). A nomogram model named SYSUCC based on these factors was built to predict the 5-, 10-, and 15-year survival rate of the participating patients. In the bootstrap random sampling with 1 000 iterations, all these factors occurred for more than 800 times as independent predictors. The Harrell's concordance index (C-index) of SYSUCC was higher compared with pure pathological staging [0.770 (95% CI: 0.716-0.823) vs 0.674 (95% CI: 0.621-0.728)]. The calibration curve showed that the survival rate as predicted by the SYSUCC model simulated the actual rate, while the clinical DCA showed that the SYSUCC nomogram has a benefit in certain probability ranges. In the ROC analysis that included 857 patients with detailed pathological nuclear stages, the nomogram had a larger AUC (5-/10-year AUC: 0.823/0.804) and better discriminating ability than pure pathological staging (5-/10-year AUC: 0.701/0.658), Karakiewicz nomogram (5-/10-year AUC: 0.772/0.734) and SSIGN score (5-/10-year AUC: 0.792/0.750) in predicting the 5-/10-year OS of RN patients (all P<0.05). In addition, the AUC of the SYSUCC nomogram for predicting the 15-year OS (0.820) was larger than that of the SSIGN score (0.709), and there was no statistical difference (P<0.05) between the SYSUCC nomogram, pure pathological staging (0.773) and the Karakiewicz nomogram (0.826). The calibration curve was close to the standard curve, which indicated that the model has good predictive performance. Finally, patients were stratified into low-, intermediate-, and high-risk subgroups (738, 379 and 129, respectively) according to the SYSUCC nomogram scores, among whom patients in intermediate- and high-risk subgroups had a worse OS than patients in the low-risk subgroup (intermediate-risk group vs. low-risk group: HR=4.33, 95% CI: 3.22-5.81, P<0.001; high-risk group vs low-risk group: HR=11.95, 95% CI: 8.29-17.24, P<0.001), and the high-risk subgroup had a worse OS than the intermediate-risk group (HR=2.63, 95% CI: 1.88-3.68, P<0.001). Conclusions: Age, smoking history, pathological nuclear grade, sarcomatoid differentiation, tumor necrosis and pathological stage were independent prognostic factors for non-metastasis renal cell carcinoma patients after RN. The SYSUCC nomogram based on these independent prognostic factors can better predict the 5-, 10-, and 15-year OS than pure pathological staging, the Karakiewicz nomogram and the SSIGN score of patients after RN. In addition, the SYSUCC nomogram has good discrimination, agreement, risk stratification and clinical application potential.
Humans ; Nomograms ; Retrospective Studies ; Carcinoma, Renal Cell/pathology* ; Prognosis ; Risk Factors ; Nephrectomy ; Kidney Neoplasms/pathology* ; Necrosis

From January 2019 to December 2021, overweight and obese children who visited in health outpatient Center of Hunan Children's Hospital were studied to explore and analyze the rate, related factors and patterns of multimorbidity of overweight and obesity-related diseases in children in Hunan Province. Univariate and multivariate logistic regression models were used to analyze the multimorbidity-related factors of overweight and obesity-related diseases in children. Association rules (apriori algorithm) were used to explore the multimorbidity patterns of overweight and obesity-related diseases in children. A total of 725 overweight and obese children were included in this study. The multimorbidity rate of overweight and obesity-related diseases in children was 46.07% (334/725). Age, waist circumference, the frequency of food consumption such as hamburgers and fries and adding meals before bedtime were multimorbidity-related factors of overweight and obesity-related diseases in children. The multimorbidity associated with nonalcoholic fatty liver disease (NAFLD) was relatively common. The patterns with the top three support degrees were "NAFLD+dyslipidemia","NAFLD+hypertension" and "NAFLD+hyperuricemia". The patterns with the top three confidence and elevation degrees were "Hypertension+dyslipidemia => NAFLD","Hyperuricemia => NAFLD" and "NAFLD+hypertension => dyslipidemia".
Child ; Humans ; Overweight/complications* ; Non-alcoholic Fatty Liver Disease ; Pediatric Obesity/epidemiology* ; Hyperuricemia ; Multimorbidity ; Hypertension/epidemiology* ; Dyslipidemias ; Body Mass Index ; Risk Factors

Objective:To analyze the risk factors of anaphylaxis caused by sodium dimercaptopropane sulfonate (DMPS) in patients with hepatolenticular degeneration (HLD) and its predictive value.Methods:The electronic medical records of patients who were hospitalized for the first time in the First Affiliated Hospital of Anhui University of Chinese Medicine due to HLD from January 2019 to December 2021 and received DMPS treatment were collected. The basic information, relevant laboratory test results before the application of DMPS, daily dose of DMPS, and occurrence, treatment and outcome of allergic reactions in patients were recorded. The patients were divided into allergy group and control group based on whether DMPS-related anaphylaxis occurred. The clinical characteristics in patients in the 2 groups were compared. The risk factors of DMPS-induced anaphylaxis were analyzed using binary logistic regression, and the odds ratio ( OR) and its 95% confidence interval ( CI) were calculated. All independent risk factors were merged into joint predictor and the predictive value of individual risk factors and joint predictor for risk of anaphylaxis were analyzed using receiver operating characteristic (ROC) curve. Results:A total of 477 patients were enrolled in the study, including 124 patients in the allergy group and 353 patients in the control group. Among the 124 patients in the allergy group, 80 were male and 44 were female, aged 1-51 years, with 55 patients <18 years of age. Among the 353 patients in the control group, 237 were male and 116 were female, aged 2-66 years, with 106 patients <18 years of age. A total of 191 times of allergic reactions occurred in patients in the allergy group, the main manifestations were pruritus (67 times, 35.1%) and drug-induced dermatitis (58 times, 30.4%). The allergic reactions occurred during the 1st to the 5th course of treatment, with 74 (59.7%) and 31 cases (25.0%) occurring in the 1st and 2nd course of treatment, respectively. DMPS was discontinued in all patients. Of them, 5 patients did not receive any intervention because of mild symptoms and the rest were treated with glucocorticoids and/or antihistamines, and the symptoms of anaphylaxis subsided. The differences in age, DMPS medication history before admission, drug allergy history, and peripheral blood lymphocyte count, ceruloplasmin, alanine aminotransferase (ALT), aspartate aminotrans-ferase, alkaline phosphatase (ALP), γ-glutamyltransferase, lactate dehydrogenase, and blood urea nitrogen levels before DMPS application between the 2 groups were statistically significant (all P<0.05). Binary logistic regression analysis showed that the history of drug allergy ( OR=3.698, 95% CI: 2.233-6.124, P<0.001), the level of ALT before medication ( OR=1.004, 95% CI: 1.000-1.007, P=0.044) and the level of ALP before medication ( OR=1.003, 95% CI: 1.002-1.005, P<0.001) were independent risk factors for allergic reactions caused by DMPS in HLD patients. ROC curve analysis showed that the area under the curve (AUC) of ALT level before medication was 0.613 (95% CI: 0.553-0.673), the cutoff value was 50 U/L, the sensitivity was 0.419, and the specificity was 0.788; the AUC of ALP level before medication was 0.600 (95% CI: 0.537- 0.663), the cutoff value was 202 U/L, the sensitivity was 0.411, and the specificity was 0.816. Allergy history, ALP and ALT levels before medication were converted into joint predictor by logistic regression model. ROC curve analysis showed that the AUC of joint predictor was 0.703 (95% CI: 0.648-0.757), the cutoff value was 0.465, the sensitivity was 0.685, and the specificity was 0.657. Conclusions:The history of drug allergy, the level of ALT and ALP before medication are independent risk factors of anaphylaxis induced by DMPS in HLD patients. The joint predictor has good predictive value for anaphylaxis induced by DMPS in HLD patients.

Objective:To investigate the expression of microRNA-27b (miRNA-27b) , miRNA-221 and miRNA-222 in keloids and their relationship with vascular endothelial growth factor (VEGF).Methods:From January 2021 to January 2022, 36 cases of keloid tissue (keloid group) , 36 cases of normal adjacent scar tissue (normal control group) and 12 cases of flat scar (flat scar group) were selected from Dermatology and Venereology Department of Xinjiang Uygur Autonomous Region People’ s Hospital. VEGF protein expression and microvascular density in the three groups were determined by immunohistochemistry, and the expression levels of miRNA-27b, miRNA-221 and miRNA-222 were detected by real-time quantitative PCR. SPSS 27. 0 statistical software was used for analysis. The measurement data of normal distribution were expressed as Mean ± SD. ANOVA was used for multi-group comparison, and LSD method was used for pound-for-pair multiple comparison. The measurement data of non-normal distribution were expressed as M ( Q1, Q3) , and Kruskal-Wallis H test was used for comparison between groups. Spearman correlation analysis was used for correlation analysis among data. All tests were bilateral tests, and P<0. 05 was considered statistically significant. Results:The levels of VEGF protein and microvascular count in keloid group [(0. 28±0. 08) , (47. 78±14. 06) bar/×400 view] were significantly higher than those in normal control group [(0.09±0.05), (10.25±5.08) bar/×400 view] and flat scar group [(0.19±0.06) , (23.75±7.94) bar/× 400 view] , the difference was statistically significant ( P < 0. 01) . The expression level of miR-27b in keloid group [0.50 (0.32, 0.64) ] was significantly lower than that in normal control group [0.69 (0.37, 1.69) ] and flat scar group [1.35 (0.68, 1.74) ] , the difference was statistically significant ( P<0. 05). There were no significant difference in the expression levels of miR-221 and miR-222 among the three groups ( P>0. 05 ). Correlation analysis showed that miR-27b, miR-221, miR-222 were positively correlated with VEGF protein expression in keloid group ( r=0.36, 0.41, 0.37, P<0. 05). Conclusions:miR-27b, miR-221 and miR-222 in keloid are positively correlated with the expression of VEGF, which may have certain regulatory effects on its angiogenesis, and the low expression of miR-27b may play an important role in the occurrence and development of keloid.

Objective:To investigate the expression of microRNA-27b (miR-27b), miR-221 and miR-222 in keloids and their relationships with vascular endothelial growth factor (VEGF).Methods:From January 2021 to January 2022, 36 cases of keloid tissue (keloid group), 36 cases of adjacent normal tissue (normal control group) and 12 cases of flat scars (flat scar group) were collected from Dermatology and Venereology Department of Xinjiang Uygur Autonomous Region People's Hospital. VEGF protein expression and microvessel density in the three groups were determined by immunohistochemistry, and the expression levels of miR-27b, miR-221 and miR-222 were detected by real-time quantitative PCR. SPSS 27.0 statistical software was used for statistical analysis. The normally distributed measurement data were expressed as Mean±SD. ANOVA was used for multi-group comparison, and the LSD method was used for pound-for-pair multiple comparisons. The measurement data of non-normal distribution were expressed as M ( Q1, Q3), and Kruskal-Wallis H test was used for the comparison between groups. Spearman correlation analysis was used for the correlation analysis among data. All tests were bilateral tests, and P<0.05 was considered statistically significant. Results:The levels of VEGF protein and microvessel count in the keloid group [0.28±0.08, (47.78±14.06) bar /×400 view] were significantly higher than those in normal control group [0.09±0.05, (10.25±5.08) bar /×400 view] and flat scar group [0.19±0.06, (23.75±7.94) bar /×400 view], the difference was statistically significant ( P<0.01). The expression level of miR-27b in keloid group [0.50 (0.32, 0.64)] was significantly lower than that in normal control group [0.69 (0.37, 1.69)] and flat scar group [1.35 (1.25, 1.74)], the difference was statistically significant ( P<0.01). There were no significant differences in the expression levels of miR-221 and miR-222 among the three groups ( P>0.05). Correlation analysis showed that miR-27b, miR-221, miR-222 were positively correlated with VEGF protein expression in keloid group ( r=0.36, 0.41, 0.37, P<0.05). Conclusion:The expression of miR-27b is different in keloid, flat scar and normal tissue. miR-27b, miR-221 and miR-222 are positively correlated with VEGF expression in keloid, suggesting that the miRNA/VEGF axis may play a key role in the occurrence and progression of keloid.

Objectives: To analyze the long-term survival of patients with localized renal cell carcinoma after partical nephrectomy. Methods: The clinicopathological records and survival follow-up data of 2 046 patients with localized renal cell carcinoma, who were treated with partial nephrectomy from August 2001 to February 2021 in the Department of Urology, Sun Yat-sen University Cancer Center, were retrospectively analyzed. There were 1 402 males and 644 females, aged (M(IQR)) 51 (19) years (range: 6 to 86 years). The primary end point of this study was cancer-specific survival. Survival curves were estimated using the Kaplan-Meier method, and the difference test was performed by Log-rank test. Univariate and multivariate Cox analysis were fitted to determine factors associated with cancer-specific survival. Results: The follow-up time was 49.2 (48.0) months (range: 1 to 229 months), with 1 974 patients surviving and 72 dying. The median cancer-specific survival time has not yet been reached. The 5- and 10-year cancer specific survival rates were 97.0% and 91.2%, respectively. The 10-year cancer-specific survival rates for stage pT1a (n=1 447), pT1b (n=523) and pT2 (n=58) were 95.3%, 81.8%, and 81.7%, respectively. The 10-year cancer-specific survival rates of patients with nuclear grade 1 (n=226), 2 (n=1 244) and 3 to 4 (n=278) were 96.6%, 89.4%, and 85.5%, respectively. There were no significant differences in 5-year cancer-specific survival rates among patients underwent open, laparoscopic, or robotic surgery (96.7% vs. 97.1% vs. 97.5%, P=0.600). Multivariate analysis showed that age≥50 years (HR=3.93, 95%CI: 1.82 to 8.47, P<0.01), T stage (T1b vs. T1a: HR=3.31, 95%CI: 1.83 to 5.99, P<0.01; T2+T3 vs. T1a: HR=2.88, 95%CI: 1.00 to 8.28, P=0.049) and nuclear grade (G3 to 4 vs. G1: HR=2.81, 95%CI: 1.01 to 7.82, P=0.048) were independent prognostic factors of localized renal cell carcinoma after partial nephrectomy. Conclusions: The long-term cancer-specific survival rates of patients with localized renal cancer after partial nephrectomy are satisfactory. The type of operation (open, laparoscopic, or robotic) has no significant effect on survival. However, patients with older age, higher nuclear grade, and higher T stage have a lower cancer-specific survival rate. Grasping surgical indications, attaching importance to preoperative evaluation, perioperative management, and postoperative follow-up, could benefit achieving satisfactory long-term survival.