Although there are several risk classification and management guidelines for invasive procedures in cirrhotic patients,consensus on the bleeding risk and thresholds of hemostatic parameters has not been achieved.The purpose of this consensus is to establish an expert opinion on the bleeding risk associated with invasive procedures in cirrhotic patients,categorizing 80 procedures as"high risk"and"low risk".The consensus also informs physicians of the laboratory thresholds for platelet count,international normalized ratio,fibrinogen,and activated partial thromboplastin time that experts consider acceptable for elective invasive procedures in patients with cirrhosis.This experience-based classification may help refine future research design and guide clinical decision-making for invasive procedures in cirrhotic patients.

Although there are several risk classification and management guidelines for invasive procedures in cirrhotic patients,consensus on the bleeding risk and thresholds of hemostatic parameters has not been achieved.The purpose of this consensus is to establish an expert opinion on the bleeding risk associated with invasive procedures in cirrhotic patients,categorizing 80 procedures as"high risk"and"low risk".The consensus also informs physicians of the laboratory thresholds for platelet count,international normalized ratio,fibrinogen,and activated partial thromboplastin time that experts consider acceptable for elective invasive procedures in patients with cirrhosis.This experience-based classification may help refine future research design and guide clinical decision-making for invasive procedures in cirrhotic patients.

OBJECTIVES: Augmented renal clearance (ARC), in contrast to renal dysfunction, refers to enhanced renal elimination of circulating solutes compared to the expected baseline. Although patients may present with normal serum creatinine (Scr) levels, the incidence of ARC is high in intensive care unit (ICU) settings. ARC is associated with subtherapeutic exposure and treatment failure of renally cleared antibiotics. However, limited research exists on the incidence and risk factors of ARC in the ICU, and even fewer data are available specifically for neurological ICU (NICU). This study aims to determine the incidence and risk factors of ARC in neurocritically ill patients. METHODS: We retrospectively analyzed all available Scr data of neurocritical care patients admitted to the NICU of the Second Xiangya Hospital of Central South University between December 2020 and January 2023. Creatinine clearance (CrCl) was calculated using the Cockcroft-Gault equation. ARC was defined as a CrCl≥130 mL/(min·1.73 m²) sustained for more than 50% of the duration of the NICU stay. A total of 208 neurocritically ill patients were assigned into an ARC group (n=52) and a non-ARC (N-ARC) group (n=156). Clinical characteristics were compared between the 2 groups. Variables with P<0.05 in univariate analysis were included in binary Logistic regression to identify independent risk factors for ARC. RESULTS: The incidence of ARC among neurocritically ill patients was 25.00%. Of the 74 patients with normal CrCl, 20 (27.03%) gradually developed ARC during hospitalization. Compared with the N-ARC group, the patients of the ARC group were younger (P<0.001), with a higher proportion of females (P=0.048) and a lower admission mean arterial pressure (MAP) (P=0.034). Moreover, patients of the ARC group were commonly complicated with severe bacterial infections compared with the patients of the N-ARC group (P<0.001). In binary Logistic regression analysis, younger age (OR=0.903, 95% CI 0.872 to 0.935) and severe bacterial infections (OR=6.270, 95% CI 2.568 to 15.310) were significant predictors of ARC. CONCLUSIONS ARC is relatively common in the NICU. A considerable number of patients with initially normal renal function developed ARC during hospitalization. Younger age and concurrent severe bacterial infection are important risk factors of ARC in neurocritically ill patients.
Humans ; Risk Factors ; Female ; Male ; Retrospective Studies ; Creatinine/blood* ; Middle Aged ; Intensive Care Units ; Aged ; Adult ; Incidence ; Critical Illness ; Renal Elimination ; Kidney/metabolism*

Objective:To investigate the influencing factors for splenomegaly secondary to acute pancreatitis (AP) and construction of a nomogram prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 180 patients with AP who were admitted to Xuanwu Hospital of Capital Medical University from December 2017 to December 2021 were collected. There were 124 males and 56 females, aged (49±15) years. Among them, 60 AP patients who developed secondary splenomegaly were taken as the case group, including 48 males and 12 females, aged (47±13)years, and the rest of 120 cases of AP without secondary splenomegaly were taken as the control group, including 76 males and 44 females, aged (50±16)years. Observation indicators: (1) occurrence and clinical characteristics of splenomegaly secondary to AP; (2) influencing factors for splenomegaly secondary to AP; (3) construction and evaluation of a nomogram prediction model for splenomegaly secondary to AP. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was analyzed using the rank sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. The univariate analysis was performed using statistical methods appropriate to the data type. The optimal cut-off value was determined by the receiver operating characteristic curves. Multivariate analysis was conducted using the Logistic regression model with forward method. Based on the results of the multivariate analysis, a nomogram prediction model was constructed. The receiver operating characteristic curve was drawn, and the discrimination was evaluated using the area under curve. The consistency of the nomogram prediction model was evaluated using calibration curve, and its clinical benefit was evaluated using decision curve. Results:(1) Occurrence and clinical characteristics of splenomegaly secondary to AP. The first detection time of 60 patients with splenomegaly secondary to AP was 60(30,120)days after the onset of AP. Cases with persistent respiratory dysfunction, multiple organ failure, severity of illness as mild or moderately severe/severe, pancreatic and/or peripancreatic infection, surgery were 19, 17, 4, 56, 37, 32 for 60 patients with splenomegaly secondary to AP, versus 16, 19, 43, 77, 39, 29 for 120 patients without splenomegaly secondary to AP, respectively, showing significant differences in the above indicators between the two groups ( χ2=8.58, 3.91, 17.64, 13.95, 15.19, P<0.05). (2) Influencing factors for splenomegaly secondary to AP. Resuts of multivariate analysis showed that white blood cell count <5.775×10?/L within 24 hours of AP onset, revised computed tomography (CT) severity index >7 in 3-7 days after onset and the presence of local complications were independent risk factors influencing the splenomegaly secondary to AP ( odds ratio=3.85, 2.86, 6.40, 95% confidence interval as 1.68-8.85, 1.18-6.95, 1.56-26.35, P<0.05). (4) Construction and evaluation of a nomogram prediction model for splenomegaly secondary to AP. The nomogram prediction model was constructed based on white blood cell count within 24 hours of AP onset, revised CT severity index in 3-7 days after onset and local complications. The area under the receiver operating characteristic curve of the nomogram prediction model was 0.76 (95% confidence interval as 0.69-0.83, P<0.05), with a sensitivity of 0.87 and a specificity of 0.55. The calibration curve demonstrated consistency between the predicted rate from the nomogram prediction model and the actually observed rate. The decision curve analysis indicated that the nomogram prediction model had favorable clinical practicability. Conclusions:Patients with AP who develop secondary splenomegaly tend to have a higher severity of illness than those develop no secondary splenomegaly. White blood cell count <5.775×10?/L within 24 hours of AP onset, revised CT severity index >7 in 3-7 days after onset and presence of local complications are independent risk factors influencing splenomegaly secondary to AP, and its nomogram prediction model can predict incidence rate of splenomegaly secondary to AP.

Objective:To explore the predictive factors for adverse clinical outcomes in critically ill adult patients with autoimmune encephalitis by analyzing their clinical characteristics and prognosis.Methods:Clinical data of patients diagnosed with " confirmed" or " possible" autoimmune encephalitis who were hospitalized in the intensive care unit (ICU) of the Department of Neurology at the Second Xiangya Hospital of Central South University from January 2015 to December 2023 were retrospectively collected. The neurological function of patients at 3, 6, and 12 months of onset was followed up, and the modified Rankin Scale (mRS) at 12 months was used as an evaluation index for clinical prognosis; Further analysis was conducted on the relationship between clinical features, auxiliary examinations, and prognosis.Results:The 12-month survival rate of critically ill adult patients with autoimmune encephalitis in our center was 90.7%(117/129), and the 6-month poor prognosis rate was 28.7%(37/129). Univariate logistic regression analysis found that age of onset ( P<0.01), presence of tumors ( P<0.01), mechanical ventilation ( P<0.01), Glasgow Coma Scale (GCS) at ICU admission ( P<0.01), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score ( P<0.01), cerebrospinal fluid glucose ( P<0.01), cerebrospinal fluid protein level ( P=0.02), epileptic waves in electroencephalography (EEG) ( P=0.03), use of glucocorticoids ( P=0.04), and time interval between initiation of intravenous immunoglobulin (IVIG) and onset ( P=0.04) were associated with prognosis. The results of multiple logistic regression analysis showed that mechanical ventilation [ P=0.01, area under the curve (AUC)=0.72)], APACHE Ⅱ score ( P=0.04, AUC=0.68), cerebrospinal fluid protein content ( P=0.04, AUC=0.65), and the time interval between initiation of IVIG and onset ( P=0.02, AUC=0.64) were independent predictive factors for the prognosis of adult critical autoimmune encephalitis. The prognostic prediction model for adult critical autoimmune encephalitis established by combining these four indicators has a higher AUC (0.85). Conclusions:Mechanical ventilation, APACHE Ⅱ score, cerebrospinal fluid protein level, and the time interval between initiation of IVIG and onset are predictive factors for poor clinical outcomes in critically ill autoimmune encephalitis in adults; The prognostic prediction model for adult critical autoimmune encephalitis established by combining these four indicators can identify patients with poor prognosis early, which is beneficial for early comprehensive management and intervention treatment to improve patient prognosis.

Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy.Whether pregnancy-related or not,liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality.Thus,the European Association for the Study of the Liver invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations,based on the best available evidence,for the management of liver diseases in pregnancy for hepatologists,gastroenter-ologists,obstetric physicians,general physicians,training specialists and other healthcare professionals who provide care for this patient population.

This Practice Guidance intends to coalesce best practice recommendations for the identification of portal hypertension （PH）， for prevention of initial hepatic decompensation， for the management of acute variceal hemorrhage （AVH）， and for reduction of the risk of recurrent variceal hemorrhage in chronic liver disease. The most significant changes in the current Guidance relate to recognition of the concept of compensated advanced chronic liver disease， codification of methodology to use noninvasive assessments to identify clinically significant PH （CSPH）， and endorsement of a change in paradigm with the recommendation of early utilization of nonselective beta-blocker therapy when CSPH is identified. The updated guidance further explores potential future pharmacotherapy options for PH， clarifies the role of preemptive transjugular intrahepatic portosystemic shunt in AVH， discusses more recent data related to the management of cardiofundal varices， and addresses new topics such as portal hypertensive gastropathy and endoscopy prior to transesophageal echocardiography and antineoplastic therapy.

The seventy-two grid palm technique is an important theoretical source of traditional Chinese medicine hand diagnosis. Starting from the ecological medical model， we analyse the seventy-two grid palm technique， and believe that its diagnosis of human body integrates biological， ecological， psychological， social and other factors， and each factor is based on physiological and pathological theories， and its external social interpretation of the nature of the human body is inseparable from health state. It is proposed that the seventy-two grid palm technique should be integrated with the ecological and natural viewpoints based on the biomedical models or bio-psycho-social medical models， and the research should be conducted from the perspective of the ecological medical model， in order to promote the development of hand diagnosis.

Although there are several risk classification and management guidelines for invasive procedures in cirrhotic patients,consensus on the bleeding risks and hemostatic parameter thresholds has not been achieved.The purpose of this consensus is to establish an opinion on the bleeding risks associated with invasive procedures in cirrhotic patients,categorizing 80 procedures as"high risk"or"low risk".The consensus will also inform physicians of the acceptable laboratory thresholds for platelet count,international normalized ratio,fibrinogen,and activated partial thromboplastin time that experts consider acceptable before elective invasive procedures in patients with cirrhosis.This experience-based classification may help refine future research design and guide clinical decision-making for invasive procedures in cirrhotic patients.

Although there are several risk classification and management guidelines for invasive procedures in cirrhotic patients, consensus on the bleeding risks and hemostatic parameter thresholds has not been achieved. The purpose of this consensus is to establish an opinion on the bleeding risks associated with invasive procedures in cirrhotic patients, categorizing 80 procedures as " high risk" or " low risk". The consensus will also inform physicians of the acceptable laboratory thresholds for platelet count, international normalized ratio, fibrinogen, and activated partial thromboplastin time that experts consider acceptable before elective invasive procedures in patients with cirrhosis. This experience-based classification may help refine future research design and guide clinical decision-making for invasive procedures in cirrhotic patients.