Objective To explore the predictive value of immune inflammation combined with liver function hematological indicators for the metastasis of colorectal cancer.Methods A retrospective analysis of clinical data of 133 patients with colorectal cancer was conducted.The patients were divided into three groups based on disease progression after 24 months of postoperative follow-up:non-metastasis group(n=38),liver metastasis group(n=43),and non-liver distant metastasis group(n=52).The immune inflammatory markers and liver function hematological indicators of progression-free survival were analyzed.Nomogram prediction models were constructed using univariate and multivariate logistic regression analyses to identify risk factors for metastasis of colorectal cancer.The accuracy of the nomogram was validated using receiver operating characteristic(ROC)curve and calibration curve,and the clinical predictive efficacy was evaluated through decision curve and clinical impact curve.Results Univariate and multivariate logistic regression analyses showed that pan-immune-inflammatory value(PIV),prognostic nutritional index(PNI),and bile acid(BA)were independent predictors of colorectal cancer metastasis.The area under the ROC curve of the combined prediction of metastasis was 0.84;neutrophil/lymphocyte ratio(NLR)and BA were independent predictors of liver metastasis from colorectal cancer.The area under the ROC curve of the combined prediction of liver metastasis was 0.83;PIV and PNI were independent predictive factors for the occurrence of non-liver distant metastasis from colorectal cancer.The area under the ROC curve for the combined prediction of non-liver distant metastasis was 0.83.The calibration curve,decision curve,and clinical impact curve showed that the three models had good accuracy and net benefit value.Conclusion The nomogram constructed based on immune inflammation and liver function hematological indicators can predict the metastasis of patients with colorectal cancer and has high predictive efficacy and clinical application prospects.

Objective:To systematically evaluate the risk of hypotension induced by sodium-glucose transporter 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus.Methods:Randomized controlled trials of SGLT2 inhibitors in the treatment of type 2 diabetes mellitus, in which hypotension were evaluated as an outcome indicator of adverse events, were collected by searching relevant databases at home and abroad (up to February 15, 2023). Cochrane risk of bias assessment tool was used to evaluate the quality of the included studies. Stata 15.1 software was used to conduct Bayesian network meta-analysis, including drawing the network evidence plot, the league map of pairwise comparison, and the surface under the cumulative ranking curve (SUCRA) for hypotension risk under different interventions of SGLT2 inhibitors, and ranking the risks of hypotension induced by different interventions of SGLT2 inhibitors. The effect sizes were expressed by relative risk ( RR) and its 95% confidence interval ( CI). Results:A total of 20 studies were included in the analysis, involving 22 525 patients with 15 260 in the trial group and 7 265 in the control group. Drugs that used in the trial group included dapagliflozin (in 1 517 patients), canagliflozin (in 6 053 patients), and ertugliflozin (in 7 690 patients); drugs that used in the control group included glimepiride (in 482 patients) and placebo (in 6 783 patients). The results of the network meta-analysis showed that the risk of hypotension was higher after treatment with 300 mg of canagliflozin, compared with those with 5 mg and 15 mg of ertugliflozin, and placebo ( RR=2.13, 95% CI: 1.31-3.47; RR=2.21, 95% CI: 1.35-3.61; RR=2.49, 95% CI: 1.62-3.82; all P<0.05); the risk of hypotension was higher after treatment with 100 mg of canagliflozin, compared with placebo ( RR=1.61, 95% CI: 1.04-2.50, P<0.05); the differences in comparison between any other 2 interventions with SGLT2 inhibitors were not statistically significant. According to the relative risks for hypotension of different interventions with SGLT2 inhibitors in the results of SUCRA, interventions were ranked as ertugliflozin 5 mg, placebo, dapagliflozin 2.5 mg, ertugliflozin 10 mg, ertugliflozin 15 mg, canagliflozin 50 mg, canagliflozin 100 mg, dapagliflozin 5 mg, dapagliflozin 10 mg, canagliflozin 150 mg, and canagliflozin 300 mg. Conclusions:Different treatment regimens with SGLT2 inhibitors had different risks of hypotension in patients with type 2 diabetes. The risk of hypotension caused by ertugliflozin is lower, especially at the dose of 5 mg. The risk of hypotension caused by canagliflozin is higher, especially at relatively high doses.

Objective:To systematically evaluate the risk of hypotension induced by sodium-glucose transporter 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus.Methods:Randomized controlled trials of SGLT2 inhibitors in the treatment of type 2 diabetes mellitus, in which hypotension were evaluated as an outcome indicator of adverse events, were collected by searching relevant databases at home and abroad (up to February 15, 2023). Cochrane risk of bias assessment tool was used to evaluate the quality of the included studies. Stata 15.1 software was used to conduct Bayesian network meta-analysis, including drawing the network evidence plot, the league map of pairwise comparison, and the surface under the cumulative ranking curve (SUCRA) for hypotension risk under different interventions of SGLT2 inhibitors, and ranking the risks of hypotension induced by different interventions of SGLT2 inhibitors. The effect sizes were expressed by relative risk ( RR) and its 95% confidence interval ( CI). Results:A total of 20 studies were included in the analysis, involving 22 525 patients with 15 260 in the trial group and 7 265 in the control group. Drugs that used in the trial group included dapagliflozin (in 1 517 patients), canagliflozin (in 6 053 patients), and ertugliflozin (in 7 690 patients); drugs that used in the control group included glimepiride (in 482 patients) and placebo (in 6 783 patients). The results of the network meta-analysis showed that the risk of hypotension was higher after treatment with 300 mg of canagliflozin, compared with those with 5 mg and 15 mg of ertugliflozin, and placebo ( RR=2.13, 95% CI: 1.31-3.47; RR=2.21, 95% CI: 1.35-3.61; RR=2.49, 95% CI: 1.62-3.82; all P<0.05); the risk of hypotension was higher after treatment with 100 mg of canagliflozin, compared with placebo ( RR=1.61, 95% CI: 1.04-2.50, P<0.05); the differences in comparison between any other 2 interventions with SGLT2 inhibitors were not statistically significant. According to the relative risks for hypotension of different interventions with SGLT2 inhibitors in the results of SUCRA, interventions were ranked as ertugliflozin 5 mg, placebo, dapagliflozin 2.5 mg, ertugliflozin 10 mg, ertugliflozin 15 mg, canagliflozin 50 mg, canagliflozin 100 mg, dapagliflozin 5 mg, dapagliflozin 10 mg, canagliflozin 150 mg, and canagliflozin 300 mg. Conclusions:Different treatment regimens with SGLT2 inhibitors had different risks of hypotension in patients with type 2 diabetes. The risk of hypotension caused by ertugliflozin is lower, especially at the dose of 5 mg. The risk of hypotension caused by canagliflozin is higher, especially at relatively high doses.

Objective:To investigate the effects of dexmedetomidine on vital signs during recovery from general anesthesia in gynecological patients undergoing general anesthesia surgery and analysis of risk factors for complications.Methods:A total of 80 gynecological patients undergoing general anesthesia surgery who received treatment in Lishui People's Hospital from March 2021 to March 2022 were included in this study. They were randomly divided into an observation group and a control group ( n = 40/group). All patients were subjected to general anesthesia. The observation group was infused with 0.5 μg/kg dexmedetomidine intravenously 15 minutes before induction of anesthesia and then infused with dexmedetomidine at a rate of 0.2 μg/kg per hour until 20-30 minutes before the end of the operation. The control group was identically given 0.9% normal saline. The recovery quality, vital signs before surgery and during recovery from general anesthesia (systolic blood pressure, diastolic blood pressure, heart rate, body temperature), and complications during recovery from general anesthesia were compared between the two groups. These patients were divided into a complication group and a non-complication group according to whether there were complications during recovery from general anesthesia. Univariate and multivariate Logistic regression analyses were performed to analyze the high-risk factors for complications occurring during recovery from general anesthesia in gynecological patients undergoing general anesthesia surgery. Results:The time to awaken, time to recover spontaneous respiration, and time to extubation in the observation group were significantly shorter than those in the control group ( t = 3.74, 2.97, 2.56, all P < 0.05). Systolic blood pressure, diastolic blood pressure, and heart rate measured during recovery from general anesthesia were significantly lower in the observation group compared with the control group ( t = 5.71, 4.53, 4.53, all P < 0.001). Body temperature ( t = 4.40, P < 0.001) and the incidence of complications ( χ2 = 5.69, P < 0.05) were significantly lower in the observation group compared with the control group. These patients were divided into complication ( n = 22) and non-complication ( n = 58) groups according to whether they had complications during recovery from general anesthesia. Univariate and multivariate logistic regression analyses showed that American Association of Anesthesiologists grade II, presence of underlying diseases, abnormal leukocyte count, and no use of dexmedetomidine were the risk factors for postoperative complications in gynecological patients undergoing general anesthesia surgery ( OR = 2.38, 2.86, 2.17, 3.60, all P < 0.05). Conclusion:Dexmedetomidine can improve awakening quality and vital signs and reduce complications during recovery from general anesthesia. American Association of Anesthesiologists grade, underlying disease, abnormal white blood cell count, and no use of dexmedetomidine are the risk factors for complications occurring during recovery from general anesthesia in gynecological patients undergoing general anesthesia surgery.

Objective:To systematically evaluate the risks of gastrointestinal reactions induced by sodium-glucose transporter 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus.Methods:Randomized controlled trials of SGLT2 inhibitors in the treatment of type 2 diabetes mellitus, in which gastrointestinal reactions were evaluated as one of outcome indicators, were collected by searching relevant databases at home and abroad (up to December 30, 2022). Cochrane risk of bias assessment tool was used to evaluate the quality of the included studies. Stata 15.1 software was used to conduct Bayesian network meta-analysis, including drawing the network evidence plot, the league map of pairwise comparison, and the surface under the cumulative ranking curve (SUCRA) for gastrointestinal reaction risks with different interventions of SGLT2 inhibitors, and ranking the risks of gastrointestinal reaction of different interventions of SGLT2 inhibitors. The effect sizes of gastrointestinal reaction were expressed by relative risk ( RR) and its 95% confidence interval ( CI). Results:A total of 15 studies were included in the analysis, involving 5 540 patients with 3 949 in the SGLT2 inhibitor treatment group and 1 591 in the control group. Drugs that used in the treatment group included dapagliflozin (in 1 872 patients), canagliflozin (in 1 100 patients), empagliflozin (in 649 patients), ertugliflozin (in 219 patients), ipragliflozin (in 61 patients), and licogliflozin (in 48 patients). All patients in the control group were treated with placebo. The results of the network meta-analysis showed that the risk of gastrointestinal reactions was higher after treatment with 10 mg of ertugliflozin, compared with those with 50 mg and 100 mg of canagliflozin ( RR=1.37, 95% CI: 1.02-3.48; RR=2.98, 95% CI: 1.19-4.09; all P<0.05). There was no statistically significant difference in comparison between other interventions with SGLT2 inhibitors. According to the results of SUCRA on the relative risks for gastrointestinal reactions of different interventions with SGLT2 inhibitors, interventions were ranked as licogliflozin 50 mg, ertugliflozin 25 mg, ertugliflozin 10 mg, empagliflozin 25 mg, ipragliflozin 100 mg, ipragliflozin 300 mg, ipragliflozin 200 mg, ertugliflozin 5 mg, licogliflozin 10 mg, ipragliflozin 50 mg, empagliflozin 10 mg, licogliflozin 2.5 mg, dapagliflozin 20 mg, dapagliflozin 10 mg, empagliflozin 5 mg, ertugliflozin 1 mg, dapagliflozin 5 mg, placebo, canagliflozin 300 mg, canagliflozin 200 mg, dapagliflozin 2.5 mg, dapagliflozin 1 mg, canagliflozin 100 mg, canagliflozin 50 mg. Conclusions:Different SGLT2 inhibitor treatment regimens lead to different risks of gastrointestinal reactions in patients with type 2 diabetes. The risk of gastrointestinal reactions caused by canagliflozin is low, especially under the dose of 50 mg. Licogliflozin and ertugliflozin have greater possibility to cause gastrointestinal reactions, especially when they were used at high doses.

Objective:To systematically evaluate the risks of gastrointestinal reactions induced by sodium-glucose transporter 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus.Methods:Randomized controlled trials of SGLT2 inhibitors in the treatment of type 2 diabetes mellitus, in which gastrointestinal reactions were evaluated as one of outcome indicators, were collected by searching relevant databases at home and abroad (up to December 30, 2022). Cochrane risk of bias assessment tool was used to evaluate the quality of the included studies. Stata 15.1 software was used to conduct Bayesian network meta-analysis, including drawing the network evidence plot, the league map of pairwise comparison, and the surface under the cumulative ranking curve (SUCRA) for gastrointestinal reaction risks with different interventions of SGLT2 inhibitors, and ranking the risks of gastrointestinal reaction of different interventions of SGLT2 inhibitors. The effect sizes of gastrointestinal reaction were expressed by relative risk ( RR) and its 95% confidence interval ( CI). Results:A total of 15 studies were included in the analysis, involving 5 540 patients with 3 949 in the SGLT2 inhibitor treatment group and 1 591 in the control group. Drugs that used in the treatment group included dapagliflozin (in 1 872 patients), canagliflozin (in 1 100 patients), empagliflozin (in 649 patients), ertugliflozin (in 219 patients), ipragliflozin (in 61 patients), and licogliflozin (in 48 patients). All patients in the control group were treated with placebo. The results of the network meta-analysis showed that the risk of gastrointestinal reactions was higher after treatment with 10 mg of ertugliflozin, compared with those with 50 mg and 100 mg of canagliflozin ( RR=1.37, 95% CI: 1.02-3.48; RR=2.98, 95% CI: 1.19-4.09; all P<0.05). There was no statistically significant difference in comparison between other interventions with SGLT2 inhibitors. According to the results of SUCRA on the relative risks for gastrointestinal reactions of different interventions with SGLT2 inhibitors, interventions were ranked as licogliflozin 50 mg, ertugliflozin 25 mg, ertugliflozin 10 mg, empagliflozin 25 mg, ipragliflozin 100 mg, ipragliflozin 300 mg, ipragliflozin 200 mg, ertugliflozin 5 mg, licogliflozin 10 mg, ipragliflozin 50 mg, empagliflozin 10 mg, licogliflozin 2.5 mg, dapagliflozin 20 mg, dapagliflozin 10 mg, empagliflozin 5 mg, ertugliflozin 1 mg, dapagliflozin 5 mg, placebo, canagliflozin 300 mg, canagliflozin 200 mg, dapagliflozin 2.5 mg, dapagliflozin 1 mg, canagliflozin 100 mg, canagliflozin 50 mg. Conclusions:Different SGLT2 inhibitor treatment regimens lead to different risks of gastrointestinal reactions in patients with type 2 diabetes. The risk of gastrointestinal reactions caused by canagliflozin is low, especially under the dose of 50 mg. Licogliflozin and ertugliflozin have greater possibility to cause gastrointestinal reactions, especially when they were used at high doses.