Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Aim To investigate the relationship between fat attenuation index(FAI)of pericoronary adipose tis-sue and coronary slow flow(CSF).Methods The clinical data of 135 hospitalized patients who underwent coronary angiography(CAG)due to chest tightness,chest pain and other similar symptoms from November 2023 to July 2024 were retrospectively collected.According to the blood flow grading criteria,the patients were divided into CSF group(n=61)and normal blood flow group(n=74).The basic information of the patients,the laboratory test results on the day of ad-mission and the data of coronary CT angiography(CCTA)were also collected.Multivariate Logistic regression was used to analyze the risk factors for CSF.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy of FAI in predicting CSF.Results The white blood cell count(WBC),fasting blood glucose(FBG),high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6)and right coronary artery(RCA)FAI in the CSF group were 1.23,1.10,1.33 1.53 and 1.13 times that of those in the normal blood flow group,respectively(P＜0.05).The left ventricu-lar ejection fraction(LVEF)in the CSF group was 94.78％of the normal blood flow group(P＜0.05).Multivariate Lo-gistic regression analysis showed that elevated WBC(OR=1.891),elevated FBG(OR=1.774),decreased LVEF(OR=0.094),elevated hs-CRP increased(OR=1.124),increased RCA-FAI(OR=1.077)were independent risk factors for CSF(P＜0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of RCA-FAI in predic-ting CSF was 0.715(95％CI:0.627～0.802),the optimal cut-off value was-81.5 HU,the sensitivity was 0.803,and the specificity was 0.581.Conclusion Elevated WBC,elevated FBG,decreased LVEF,increased hs-CRP,and in-creased RCA-FAI are risk factors for CSF.Among them,RCA-FAI has a good efficacy in predicting the occurrence of CSF,which can be used to identify high-risk CSF patients as early as possible and reduce the incidence of CSF.

Aim To investigate the relationship between fat attenuation index(FAI)of pericoronary adipose tis-sue and coronary slow flow(CSF).Methods The clinical data of 135 hospitalized patients who underwent coronary angiography(CAG)due to chest tightness,chest pain and other similar symptoms from November 2023 to July 2024 were retrospectively collected.According to the blood flow grading criteria,the patients were divided into CSF group(n=61)and normal blood flow group(n=74).The basic information of the patients,the laboratory test results on the day of ad-mission and the data of coronary CT angiography(CCTA)were also collected.Multivariate Logistic regression was used to analyze the risk factors for CSF.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy of FAI in predicting CSF.Results The white blood cell count(WBC),fasting blood glucose(FBG),high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6)and right coronary artery(RCA)FAI in the CSF group were 1.23,1.10,1.33 1.53 and 1.13 times that of those in the normal blood flow group,respectively(P＜0.05).The left ventricu-lar ejection fraction(LVEF)in the CSF group was 94.78％of the normal blood flow group(P＜0.05).Multivariate Lo-gistic regression analysis showed that elevated WBC(OR=1.891),elevated FBG(OR=1.774),decreased LVEF(OR=0.094),elevated hs-CRP increased(OR=1.124),increased RCA-FAI(OR=1.077)were independent risk factors for CSF(P＜0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of RCA-FAI in predic-ting CSF was 0.715(95％CI:0.627～0.802),the optimal cut-off value was-81.5 HU,the sensitivity was 0.803,and the specificity was 0.581.Conclusion Elevated WBC,elevated FBG,decreased LVEF,increased hs-CRP,and in-creased RCA-FAI are risk factors for CSF.Among them,RCA-FAI has a good efficacy in predicting the occurrence of CSF,which can be used to identify high-risk CSF patients as early as possible and reduce the incidence of CSF.

Objective:To investigate the clinical efficacy and prognostic factors of 125I seeds implantation in the treatment of patients with advanced lung cancer after radiotherapy and chemotherapy. Methods:From January 2017 to December 2019, 44 patients (39 males, 5 females, age 41-84 years) with advanced lung cancer after radiotherapy and chemotherapy who received 125I seeds implantation in Hebei General Hospital were retrospectively analyzed. All patients were followed up for ≥12 months, and the clinical efficacies were observed. χ2 test was used to analyze the difference of effective rates between groups. The cut-off value of postoperative dose delivered to 90% gross tumor volume ( D90) was obtained by ROC curve analysis. Kaplan-Meier method was used to calculate the survival rate and log-rank test was used for univariate analysis. Cox proportional hazards model was used for multivariate analysis to find the influencing factors for clinical efficacy. Results:The total effective rate was 72.73%(32/44) after 6 months treatment. The cut-off value of D90 was 120 Gy with the AUC of 0.771. The short-term effective rate of D90≥120 Gy group was better than that of D90<120 Gy group (18/19 vs 56.00%(14/25); χ2=8.17, P=0.004). The 1-year survival rate was 77.27%(34/44). Univariate analysis showed that age ( χ2=3.99, P=0.046), preoperative Hb ( χ2=10.60, P=0.001), tumor maximum diameter ( χ2=11.50, P=0.001) and postoperative D90( χ2=5.81, P=0.016) could affect the survival of patients. Multivariate analysis showed that preoperative Hb (hazard ratio ( HR)=0.023, 95% CI: 0.001-0.882, P=0.043) and tumor maximum diameter ( HR=40.889, 95% CI: 1.458-1 146.586, P=0.029) were prognostic factors. Conclusions:125I seeds implantation shows a good effect in the treatment of lung cancer patients after the progress of radiotherapy and chemotherapy. The short-term effect of patients with D90≥120 Gy is better than that of patients with D90<120 Gy. Preoperative Hb and tumor maximum diameter are prognostic factors of survival after implantation.

Objective:To establish a model C-GALAD for detecting hepatocellular carcinoma (HCC) from the chronic liver disease and healthy people based on the serum markers.Methods:A clinical cohort including 229 hepatocellular carcinoma patients, 2 317 patients with chronic liver disease and 982 healthy people, was retrospectively collected from eight hospitals or physical examination institutions from April 2018 to October 2020. The data were divided into a training set and a testing set by stratified sampling with a 6∶4 ratio. A predictive model was established on the training set using a logistic backward regression method and validated on the testing set. In addition, clinical data from March to July 2021 in Beijing You′ an Hospital affiliated to Capital Medical University, including 84 patients with liver cancer and 204 patients with chronic liver disease collected were used for external independent validation of the model. The receiver operating characteristic curve (ROC) area under curve (AUC), the sensitivity and the specificity were used to evaluate the effectiveness of the model.Results:Through the logistic backward regression method, the seven signatures including age, gender, alpha-fetoprotein (AFP), alpha-fetoprotein alloplasm-3 ratio (AFP-L3%), des-gamma-carboxyprothrombin(DCP), platelet (PLT) and total bilirubin (TBIL) were selected as risk factors in the detection model. The area under the ROC curve (AUC) of the model on the testing set was 0.954, with an 88.04% sensitivity and a 94.85% specificity, and the AUC of model on the external independent validation set was 0.943, with an 89.29% sensitivity and a 90.2% specificity, which were better than other published models.Conclusion:The C-GALAD Ⅱ model can accurately predict the risk of hepatocellular carcinoma occurrence, and thus provide a trustworthy diagnosis method of hepatocellular carcinoma.

Objective:To apply the best evidence of evidence-based volume management in patients with chronic heart failure to clinical practice and evaluate its effect.Methods:From February 2018 to May 2019, according to the clinical evidence practice application mode of Joanna Briggs Institute (JBI), and the best evidence obtained in the previous study, we constructed audit indicators. And then perfomed clinical audits for the patients with chronic heart failure in the department of cardiology of Shandong Provincial Hospital affiliated to Shandong First Medical University. The obstacle factors were analyzed, and the action strategies were formulated. The cognition of the medical staff on the volume management, and the fasting body mass monitoring rate, the volume management target compliance rate, the time to dry body mass, average hospitalization day of the patients′, number of negative events related to volume management were compared before and after the application of the best evidence.Results:After the implementation of the reform, Indicator 8-14 and Indicator 20 of the 20 audit indicators implementation rate had been improved, and the difference was statistically significant ( χ 2 values were 6.668-97.000, P<0.05); the volume management target compliance rate increased from (34.24±30.33)% to (61.28±16.10)%, the difference was statistically significant ( t value was 30.21, P<0.001); the time to dry body mass decreased from (10.89±3.46) days to (5.48±1.58) days, the difference was statistically significant ( t value was 13.97, P<0.001); compared with the negative events related to the access control, the number of acute left heart failure cases decreased from 7 to 2 ( χ2 value was 4.194, P=0.041). Conclusion:Evidence-based volume management of patients with chronic heart failure can improve clinical nursing practice, shorten the time for patients to reach dry body mass, and reduce the average hospitalization day. Quality review still needs to continue to improve the quality of nursing.

Objective: To analyze the factors influencing the short-term efficacy of CT-guided ¹²⁵I seeds implantation in the treatment of recurrent and metastatic tumors in head and neck. Methods: A total of 73 patients (61 males, 12 females; age: (59.1±11.5) years) with head and neck tumors recurrence and metastasis treated by ¹²⁵I seeds implantation in Hebei General Hospital from January 2015 to April 2019 were retrospectively enrolled. The implanted seeds activity was 11.1-29.6 MBq, and the prescription dose was 80.0-145.0 Gy. CT examination was conducted 3 months after ¹²⁵I seeds implantation. According to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, short-term efficacy was classified as effective (complete remission (CR), partial remission (PR)) and ineffective (stable disease (SD), progressive disease (PD)). Univariate analysis of factors affecting short-term effect (gender, age, history of radiation therapy, Karnofsky performance status (KPS) scores, pathological type, the longest diameter of tumor, implantation patterns, seeds activity, immediate postoperative dose delivered to 90% gross tumor volume (D₉₀), and with adjuvant chemotherapy post-surgery or not) were conducted. Variables with P<0.2 were enrolled in logistic multivariate regression analysis. In addition, artificial neural network (ANN) was constructed with all influencing factors as independent variables and short-term efficacy as dependent variables. Finally, receiver operating characteristic (ROC) curve analysis was performed for the common influencing factors in logistic regression analysis and ANN analysis. Results: There were 34 with effective results and 39 with ineffective results. Logistic regression analysis indicated that the longest diameter of tumor, immediate postoperative D₉₀, with adjuvant chemotherapy post-surgery or not had significant impacts on the short-term efficacy (Wald values: 6.950, 4.804, 4.790, all P<0.05); According to results of ANN analysis, the top 5 in order of importance for short-term efficacy prediction were immediate postoperative D₉₀, the longest diameter of tumor, age, seeds activity and gender. ROC curve analysis indicated that the longest diameter of tumor and immediate postoperative D₉₀ were the best predictors for short-term efficacy, with the threshold of 5.25 cm and 110.05 Gy respectively, and the area under the curve (AUC) was 0.843 and 0.847 respectively (both P<0.001). Conclusions The short-term efficacy of ¹²⁵I seeds implantation in the recurrence and metastasis of head and neck tumors is mainly related to the longest diameter of tumor and immediate postoperative D₉₀. Patients with the longest diameter of tumor <5.25 cm and with D₉₀>110.05 Gy can achieve better efficacy.

Objective To study the characteristics of fluid intake and central venous pressure (CVP) within 4 days after birth in very low birth weight (VLBW) premature infants complicated with bronchopulmonary dysplasia (BPD).Method From February 2015 to March 2019,VLBW preterm infants without serious complications were enrolled in two hospitals.Their CVP were measured every 4 ～ 6 hours after birth.They were assigned into BPD group and non-BPD group,and the fluid intake and CVP within 4 days after birth were compared between these two groups.Result A total of 45 VLBW preterm infants were included,including 17 in the BPD group and 28 in the non-BPD group.The fluid intake in the BPD group showed no significant difference with the non-BPD group within 4 days after birth (P ＞ 0.05).No significant correlation existed between the mean liquid intake and the mean CVP in 1 ～ 4 days after birth (r =0.093,P=0.542).From day1 to day4,the CVPs of the BPD group were (3.97 ± 0.68),(4.49 ± 0.75),(4.55 ± 0.66),(4.02 ± 1.05) cmH2O,and the non-BPD group were (3.66 ± 1.09),(3.96 ±0.76),(3.81 ± 0.69),(3.91 ± 0.65) cmH2O.The differences between the BPD group and the nonBPD group were statistically significant (P ＜ 0.05).The CVP of the BPD group was increasing from day 2 to day 3 (P ＜ 0.05).Conclusion VLBW premature infants complicated with BPD may have higher CVP at the early stage of life,which may not be related with the fluid intake.

OBJECTIVES: To compare the differences in clinical characteristics between Type 1 diabetes mellitus (T1DM) and fulminant Type 1 diabetes mellitus (FT1DM), and to reduce the missed diagnosis, misdiagnosis, and mistreatment of FT1DM by medical staff. METHODS: A total of 101 hospitalized patients with T1DM (including 8 cases of FT1DM) were enrolled in this study from Changsha Central Hospital between June 2012 and December 2018. Clinical characteristics of the 8 FT1DM patients were collected and compared with all T1DM patients. RESULTS: All FT1DM patients were adult with the average age of (30.25±5.28) years old, accompanied by severe diabetic ketoacidosis (DKA) occurred within 1 week after onset. Moreover, pancreatic beta cells in these patients were destroyed and the islet-related antibodies were negative, while the serum pancreatic enzyme levels were increased. Compared with classic T1DM patients, the plasma glucose levels in FT1DM patients were much higher [(41.89±12.54) mmol/L vs (22.57±9.74) mmol/L], but glycosylated hemoglobin (HbA1c) and fasting C peptide levels were significantly lower [(6.08±0.41)% vs (10.87±2.46%)%, CONCLUSIONS The onset time of FT1DM patients is very urgent via driving DKA. These patients have higher blood glucose concentration than classic T1DM patients, accompanied by electrolyte disturbances, impaired renal function, partially impaired liver function, as well as gastrointestinal symptoms and elevated trypsin. Most FTDM patients are adolescents and adults with no gender difference, especially pregnant women who are at high risk. Lifelong insulin dependence in FT1DM patients should be paid more attention in clinical treatment.
Adolescent ; Adult ; Diabetes Mellitus, Type 1/complications* ; Diabetic Ketoacidosis ; Female ; Glycated Hemoglobin A/analysis* ; Humans ; Insulin ; Pregnancy ; Sex Factors ; Young Adult

Objective To study the range of central venous pressure (CVP) in very low birth weight (VLBW) infants within the first week after birth.Method From February 2014 to February 2018,50 VLBW infants without serious diseases during the first 7 days of life received umbilical venous catheters were prospectively enrolled.CVPs were measured every 4～6 h.The trend of CVP and the correlation of CVP (within 24 h) and birth weight,gestational age were analyzed.Result A total of 50 VLBW infants and 1 291 CVP measurements were included.The CVP increased slightly within 48 h after birth,and then declined.The 95％CI of CVPs were 3.67～4.21,4.03～4.49,3.90～4.33,3.67～4.19,3.29～3.97,3.14～3.94 and 2.64～ 3.55 cmH2O from day 1 to day 7.No significant correlation existed between CVP in the first day and birth weight,nor gestational age (r=-0.267,P=0.073;r=0.106,P=0.762).Conclusion The CVP of VLBW infants increased slightly within 48 h after birth,and then declined.There was no significant correlation between CVP in the first day and birth weight,nor CVP and gestational age.