Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

ObjectiveTo investigate the value of different noninvasive diagnostic models in the diagnosis of esophageal and gastric varices since there is a high risk of esophageal and gastric varices in patients with compensated hepatitis B cirrhosis and significant portal hypertension， and to provide a basis for the early diagnosis of esophageal and gastric varices. MethodsA total of 108 patients with significant portal hypertension due to compensated hepatitis B cirrhosis who attended Guangdong Provincial Hospital of Traditional Chinese Medicine from November 2017 to November 2023 were enrolled， and according to the presence or absence of esophageal and gastric varices under gastroscopy， they were divided into esophageal and gastric varices group （GOV group） and non-esophageal and gastric varices group （NGOV group）. Related data were collected， including age， sex， imaging findings， and laboratory markers. The chi-square test was used for comparison of categorical data between groups； the least significant difference t-test was used for comparison of normally distributed continuous data between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The receiver operating characteristic （ROC） curve was plotted to evaluate the diagnostic value of five scoring models， i.e.， fibrosis-4 （FIB-4）， LOK index， LPRI， aspartate aminotransferase-to-platelet ratio index （APRI）， and aspartate aminotransferase/alanine aminotransferase ratio （AAR）. The binary logistic regression method was used to establish a combined model， and the area under the ROC curve （AUC） was compared between the combined model and each scoring model used alone. The Delong test was used to compare the AUC value between any two noninvasive diagnostic models. ResultsThere were 55 patients in the GOV group and 53 patients in the NGOV group. Compared with the NGOV group， the GOV group had a significantly higher age （52.64±1.44 years vs 47.96±1.68 years， t=0.453， P<0.05） and significantly lower levels of alanine aminotransferase ［42.00 （24.00 — 17.00） U/L vs 82.00 （46.00 — 271.00） U/L， Z=-3.065， P<0.05］， aspartate aminotransferase ［44.00 （32.00 — 96.00） U/L vs 62.00 （42.50 — 154.50） U/L，Z=-2.351， P<0.05］， and platelet count ［100.00 （69.00 — 120.00）×10⁹/L vs 119.00 （108.50 — 140.50）×10⁹/L， Z=-3.667， P<0.05］. The ROC curve analysis showed that FIB-4， LOK index， LPRI， and AAR used alone had an accuracy of 0.667， 0.681， 0.730， and 0.639， respectively， in the diagnosis of esophageal and gastric varices （all P<0.05）， and the positive diagnostic rates of GOV were 69.97%， 65.28%， 67.33%， and 58.86%， respectively， with no significant differences in AUC values （all P>0.05）， while APRI used alone had no diagnostic value （P>0.05）. A combined model （LAF） was established based on the binary logistic regression analysis and had an AUC of 0.805 and a positive diagnostic rate of GOV of 75.80%， with a significantly higher AUC than FIB-4， LOK index， LPRI， and AAR used alone （Z=-2.773，-2.479，-2.206， and-2.672， all P<0.05）. ConclusionFIB-4， LOK index， LPRI， and AAR have a similar diagnostic value for esophageal and gastric varices in patients with compensated hepatitis B cirrhosis and significant portal hypertension， and APRI alone has no diagnostic value. The combined model LAF had the best diagnostic efficacy， which provides a certain reference for clinical promotion and application.

Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

The quality of clinical practice teaching is an important factor affecting the quality of intensive care unit (ICU) specialist nurse training. We investigated the current situation of ICU specialist nurse training and teaching quality evaluation in China and around the world. There are several aspects that can be improved in the evaluation of the quality of clinical practice teaching for ICU specialist nurses in China. Result-oriented summative evaluation is mainly used in China, and there are few studies on the quality evaluation of clinical practice teaching process. Effective feedback mechanism has not been established for teaching quality evaluation. There is a lack of systematic theoretical guidance and few studies have been conducted on the formation of the quality of clinical practice teaching and the affecting factors. Therefore, there is an urgent need to construct a set of scientific and practical clinical practice teaching quality evaluation system for ICU specialist nurses under the guidance of systematic theory and in line with China's national conditions. We should formulate reasonable and uniform quality evaluation standards for clinical practice teaching, strengthen the quality evaluation of the training process on the basis of result-oriented quality evaluation. Moreover, the needs of all parties in the evaluation system should be comprehensively evaluated to improve the quality of clinical practice teaching.

Objective:To explore the association between child abuse and suicidal ideation in patients with bi-polar disorder.The mediation of self-esteem and depression in this association was also investigated.Methods:A to-tal of 292 patients with bipolar disorder who met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)were enrolled.Their child abuse,suicidal ideation,self-esteem,depres-sion,and mania were assessed with the Childhood Trauma Questionnaire(CTQ),Beck Scale for Suicide Ideation-Chinese Version(BSICV),Self-Esteem Scale(SES),17-item Hamilton Depression Rating Scale(HAMD-17)and Young Mania Rating Scale(YMRS).The mediating effects were evaluated using PROCESS for SPSS.Results:The BSICV scores were positively associated with the scores of CTQ(r=0.37,P＜0.01)and HAMD-17(r=0.53,P＜0.01)and negatively associated with SES scores(r=-0.50,P＜0.01)in patients with bipolar disorder.Self-esteem and depression played mediating roles between child abuse and suicidal ideation,respectively(95％CI:0.01-0.09,0.01-0.10).Besides,self-esteem and depression sequentially mediated the relationship between child a-buse and suicidal ideation(95％CI:0.02-0.06).Conclusion:Child abuse,low self-esteem,and depression may be related factors of suicidal ideation in patients with bipolar disorder.

Objective:To study the correlation between different body weight metabolic phenotypes and their changes and new-onset hyperuricemia in physical examination population.Methods:This study was a retrospective cohort study. A total of 31 956 people who underwent routine physical examination and met the inclusion and exclusion criteria at the Health Management Center of the Second Affiliated Hospital of Dalian Medical University from January 1, 2014 to August 31, 2022 were selected as the study subjects to establish a dynamic physical examination cohort. The end point of follow-up was new-onset hyperuricemia or the end of follow-up period. Cox regression stepwise fitting model was used to analyze the risk of different body weight metabolic phenotypes and hyperuricemia, and stratified analysis was performed for gender. According to body weight metabolic phenotype, the subjects were divided into normal metabolism and normal weight(NMNW) group, normal metabolism and obesity (NMO) group, abnormal metabolism and normal weight (AMNW) group and abnormal metabolism and obesity (AMO) group. The risk of hyperuricemia was calculated according to the changes of body weight metabolic phenotype during the follow-up period. In the sensitivity analysis, the robustness of the results was verified by changing the diagnostic criteria for hyperuricemia, removing patients with hyperuricemia at the first year of follow-up, and removing subjects aged ≥65 years.Results:Compared with the NMNW group, the risk of hyperuricemia in the NMO group, AMNW group and AMO group increased by 78.9%, 61.3%, 115.4%, respectively ( χ2=272.88, 128.15, 496.12, all P<0.001). Patients who were initially classified as NMNW at baseline, if transitioned to NMO or AMO by the follow-up endpoint, their risk of hyperuricemia increased by 122.5% ( χ2=8.01, P<0.05) and 137.4% ( χ2=15.99, P<0.001), respectively. When the baseline AMNW group changed to AMO, the risk of hyperuricemia was increased by 119.2% ( χ2=6.63, P<0.05). For patients with AMO as baseline, if they turned into NMNW and AMNW at the end of follow-up, their risk of hyperuricemia would decrease by 58.3% ( χ2=43.67, P<0.001) and 27.2% ( χ2=16.07, P<0.001). Patients with a baseline of NMO who transitioned to NMNW and AMNW at the follow-up endpoint had their risk of developing hyperuricemia decreased by 36.7% ( χ2=25.35, P<0.001) and 30.9% ( χ2=9.70, P<0.05), respectively. Conclusions:The transition from metabolic health and non-overweight obesity to metabolic abnormalities and overweight obesity is associated with an increased risk of hyperuricemia, and improvements in metabolic health or weight are associated with a decreased risk of hyperuricemia.

Objective:To explore the relationship between weight change and the development of hyperuricemia (HUA) in adults receiving health checkups.Methods:A retrospective cohort study. A total of 37 722 subjects who underwent two or more health checkups at the Health Management Center of the Second Affiliated Hospital of Dalian Medical University from January 2014 to December 2022 were included, and the general information and laboratory findings at the time of the initial health checkups and follow-up were collected. Weight change was defined as the ratio of difference between the weight at the last follow-up and the baseline weight to baseline weight. The subjects were grouped with weight change: significant weight loss group (weight change ≤-5.0%), mild weight loss group (-5.0%

Objective:To investigate the association between different dietary patterns and subtypes of metabolic associated fatty liver disease(MAFLD).Methods:A total of 6 022 check-ups at the health management center of the Second Hospital of Dalian Medical University from January 2022 to March 2023 were selected as study subjects. MAFLD was categorised into three subtypes: overweight/obese type, metabolic disorder type, and diabetic type. Factor analysis was used to extract dietary patterns. Logistic regression was used to assess the impact of dietary patterns on MAFLD occurrence, constructing interaction models between dietary patterns intake and age, gender, and physical exercise levels. Results:Four dietary patterns were extracted based on feature sorting after factor analysis and were named as the high-quality protein pattern, the fruit-vegetable pattern, egg-aquatic pattern, and the processed meat pattern. Regression analysis of the unadjusted model showed that overweight/obese and diabetic types of MAFLD were negatively associated with the high-quality protein mode, while model-adjusted regression analysis showed that the processed meat pattern was positively associated with the risk of MAFLD, and fruit-vegetable pattern was positively associated with overweight/obese MAFLD( P<0.05). The results of subgroup analyses suggested that female( OR=1.55, 95% CI 1.14-2.15) with a high intake of pickle pattern had a higher risk of overweight/obese MAFLD than male( OR=1.18, 95% CI 1.02-1.49). Conclusion:High-quality protein pattern was negatively correlated with MAFLD, whereas fruit-vegetable pattern and processed meat pattern were positively correlated with MAFLD. Female with high consumption of processed meat pattern are more likely to develop overweight/obesity MAFLD compared with male. It is recommended that people with MAFLD reduce their intake of processed products and high-fructose food, and consume adequate amounts of high-quality protein food to maintain a balanced diet.

Objective:To investigate the relationship between obesity and incident chronic kidney disease(CKD) in a population undergoing health check-ups.Methods:This is a retrospective cohort study. A total of 31 251 participants who had at least 2 health physical examinations in the Health Management Center of the Second Affiliated Hospital of Dalian Medical University from January 2017 to December 2022 and met the inclusion criteria were selected. The participants were divided into normal body weight group, overweight group, and obese group according to baseline body mass index. Cox proportional hazard regression model was used to analyze the relationship between obesity and new-onset CKD, and the dose-response relationship between body mass index and CKD was analyzed with restricted cubic splines.Results:Multivariate Cox regression analysis showed that the risk of developing CKD increased by 13%( HR=1.13, 95% CI 1.01-1.25) and 55%( HR=1.55, 95% CI 1.36-1.76) in the overweight and obese group compared to the normal weight group. Subgroup analysis indicated that obese women had a higher risk of developing CKD compared to men. There was a " U-shaped" correlation between body mass index and CKD in male population, with the lowest risk of CKD occurring at body mass index of 19.6-24.2 kg/m 2. In women, the relationship between body mass index and CKD was approximately linear, with the risk of CKD gradually increasing when body mass index exceeded 22.5 kg/m 2. Conclusions:Obesity is an independent risk factor for new-onset CKD, and obese women have a higher risk of developing CKD than men. Regarding CKD prevention, men are advised to maintain a higher level of body weight within the normal range of body mass index, while women are encouraged to control their weight to a lower level within the normal body mass index range.