OBJECTIVES: To develop a risk prediction model for the transformation of chronic atrophic gastritis to high-grade intraepithelial neoplasia (HGIN) based on traditional Chinese medicine (TCM) syndrome patterns. METHODS: Clinical data of 201 chronic atrophic gastritis patients who visited the Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine and Dong'erhuan Branch between January 2022 and March 2023 were retrospectively analyzed, including 32 patients with HGIN (HGIN group) and 169 patients with moderate and severe chronic atrophic gastritis (non-HGIN group). The information of demographic characteristics, dietary habits, lifestyle factors, social and psychosocial factors, family history of tumors, medical history and comorbidities, long-term medication, endoscopic findings, histopathological examination results, as well as TCM syndrome types were collected. Potential HGIN risk factors were screened using LASSO regression, and the significant risk factors for establishing an HGIN risk prediction model were identified using logistic regression analysis. The final model was visually presented using a nomogram, and its diagnostic performance was evaluated through receiver operating characteristic curve analysis. RESULTS: Spleen-stomach Qi deficiency was the most common TCM syndrome in both HGIN and non-HGIN groups. LASSO-logistic regression model analysis showed that heavy alcohol consumption (X1), syndrome of static blood in stomach collaterals (X2), low-grade intraepithelial neoplasia (X3), high-salt diet (X4), and age (X5) were independent risk factors related to the occurrence of HGIN, and the predictive model was ln［P/(1－P)］=2.159X1+2.230X2+1.664X3+2.070X4+0.122X5- 11.096. The model demonstrated good discriminative ability, calibration, and goodness-of-fit, with area under the curve values of 0.940 and 0.891 in the training and validation sets, respectively. CONCLUSIONS The TCM syndrome of static blood in stomach collaterals shows correlation with the transformation from chronic atrophic gastritis to HGIN. The HGIN prediction model based on TCM syndrome patterns developed in the study demonstrates potential value in clinical application.
Humans ; Gastritis, Atrophic/diagnosis* ; Medicine, Chinese Traditional ; Retrospective Studies ; Female ; Male ; Middle Aged ; Stomach Neoplasms/diagnosis* ; Adult ; Risk Factors ; Carcinoma in Situ/diagnosis* ; Aged ; Nomograms ; Chronic Disease ; Logistic Models

Objective To observe impact factors of average glandular dose(AGD)of full field digital mammography(FFDM)and digital breast tomosynthesis(DBT)under breast Combo mode.Methods Totally 169 subjects who received FFDM and DBT under Combo mode were collected retrospectively.The breast compression thickness,tube voltage,tube current and AGD of FFDM and DBT exposure at cranio-caudal(CC)and mediolateral oblique(MLO)positions of bilateral breast were recorded.FFDM or DBT exposure conditions and AGD among different breast compression thickness and breast types were compared,and their correlations were analyzed.The impacts of breast compression thickness and breast density on AGD of FFDM or DBT were observed.Results There were significant differences in tube voltage,tube current and AGD of FFDM or DBT among different breast compression thicknesses(all P＜0.001).With the increase of breast compression thickness,tube voltage,tube current and AGD of FFDM or DBT all increased(all P＜0.001).There were statistical differences in breast compression thickness,tube voltage,tube current and AGD of FFDM or DBT among different types breast(all P＜0.001).Hierarchical analysis showed that,when breast compression thickness was＜50 mm,50-59 mm and＞59 mm respectively,statistical differences in AGDFFDM and AGDDBT among different breast types at CC or MLO positions were found(all P＜0.001).Under the same breast compression thickness,tube current,AGDFFDM and AGDDBT of FFDM or DBT all increased with the increase of breast density(all P＜0.001),while tube voltage of FFDM or DBT had no obvious change(all P＞0.05).Breast compression thickness and breast density were both independent factors of AGD of FFDM or DBT(all P＜0.001).Conclusion Under breast Combo mode,breast compression thickness and gland density both had impacts on AGD of FFDM or DBT,and the former had more significant impact on AGD.

Objective To observe impact factors of average glandular dose(AGD)of full field digital mammography(FFDM)and digital breast tomosynthesis(DBT)under breast Combo mode.Methods Totally 169 subjects who received FFDM and DBT under Combo mode were collected retrospectively.The breast compression thickness,tube voltage,tube current and AGD of FFDM and DBT exposure at cranio-caudal(CC)and mediolateral oblique(MLO)positions of bilateral breast were recorded.FFDM or DBT exposure conditions and AGD among different breast compression thickness and breast types were compared,and their correlations were analyzed.The impacts of breast compression thickness and breast density on AGD of FFDM or DBT were observed.Results There were significant differences in tube voltage,tube current and AGD of FFDM or DBT among different breast compression thicknesses(all P＜0.001).With the increase of breast compression thickness,tube voltage,tube current and AGD of FFDM or DBT all increased(all P＜0.001).There were statistical differences in breast compression thickness,tube voltage,tube current and AGD of FFDM or DBT among different types breast(all P＜0.001).Hierarchical analysis showed that,when breast compression thickness was＜50 mm,50-59 mm and＞59 mm respectively,statistical differences in AGDFFDM and AGDDBT among different breast types at CC or MLO positions were found(all P＜0.001).Under the same breast compression thickness,tube current,AGDFFDM and AGDDBT of FFDM or DBT all increased with the increase of breast density(all P＜0.001),while tube voltage of FFDM or DBT had no obvious change(all P＞0.05).Breast compression thickness and breast density were both independent factors of AGD of FFDM or DBT(all P＜0.001).Conclusion Under breast Combo mode,breast compression thickness and gland density both had impacts on AGD of FFDM or DBT,and the former had more significant impact on AGD.

Objective:To investigate the clinical characteristics of abdominal infection related secondary hemorrhage and partition of intra-abdominal infection after pancreaticoduodenectomy (PD).Methods:The retrospective and descriptive study was conducted. The clinical data of 25 patients with abdominal infection related secondary hemorrhage after PD who were admitted to The First Affiliated Hospital of Xi ′an Jiaotong University from January 2009 to December 2017 were collected. There were 18 males and 7 females, aged (63±11)years. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3). Count data were described as absolute numbers. Results:(1) Clinical charac-teristics of abdominal infection related secondary hemorrhage after PD. Of 25 patients, there were 21 cases diagnosed with pancreatic fistula, 2 cases with negative for amylase test in abdominal drainage fluid, and 2 cases with unknown conditions of pancreatic fistula. There were 16 cases with sentinel hemorrhage and 9 cases without sentinel hemorrhage. Of 25 patients, 10 cases were evaluated as grade A bleeding, 10 cases were evaluated as grade B bleeding, and 5 cases were evaluated as grade C bleeding. The types of pathogenic microorganisms cultured in the peritoneal drainage fluid of 25 patients included 7 cases of simple Gram positive (G +) bacteria, 6 cases of simple Gram negative (G -) bacteria, 8 cases of both G + bacteria and G - bacteria, 1 case of G + bacteria and fungi, and 3 cases of G + bacteria, G - bacteria and fungi. There were 3 cases cultured with carbapenem-resistant Acinetobacter baumannii. There were 17 patients with fluid accumulation in the D region confirmed by abdominal computered tomography, including 2 cases of simple fluid accumulation in the D region and 15 cases of fluid accumulation in the D region and other regions. Of 25 patients, 12 cases underwent simple conservative medical treatment, 8 cases underwent digital subtraction angiography (DSA) hemostasis, 2 cases underwent DSA combined with surgical hemostasis, 1 case underwent endoscopic hemostasis, 1 case underwent surgical hemostasis, and 1 case underwent endoscopic + DSA hemostasis. Of 25 patients, 5 patients died. (2) Treatment methods and clinical outcomes of patients with abdo-minal infection in different regions of the partition of intra-abdominal infection. Of the 17 patients with clear regions of the partition of intra-abdominal infection, there were 6 cases with D region combined with ≤ 1 other region of the partition of intra-abdominal infection who did not receive surgical treatment survived, there were 11 cases with D region combined with ≥2 other regions of the partition of intra-abdominal infection who mainly received DSA or combined treatment, including 8 cases survived and 3 cases dead. Conclusions:The abdominal infection related secondary hemorrhage after pancreaticoduodenectomy is mainly due to D region of the partition of intra-abdominal infection, and the pathogen mainly presents as mixed infection and multi-drug-resistant bacterial infection. When the spread of infected lesions leads to D region combined with ≥2 other regions of the partition of intra-abdominal infection, the intervention measures are significantly upgraded, and the risk of patient death increases.

It was previously believed that hepatic portal venous gas (HPVG) was an "ominous sign" or "death sign", and once it appeared, the disease progressed rapidly with a high mortality rate which required immediate surgical treatment. However, with the continuous progress of medical technology, researchers have gained a deeper understanding that various causes can lead to HPVG, not all of which required surgical treatment, and the prognosis was not poor. Unfortunately, there is no guideline or consensus on the diagnosis and treatment of HPVG to guide clinical management and standardize diagnostic and therapeutic behaviors. Therefore, the authors review previous literatures with combined clinical diagnosis and treatment experience to conduct profound discussion on the epidemiological features, etiology, pathogenesis, imaging features, treatment strategies, and progno-sis of HPVG, and develop corresponding diagnosis and treatment procedures with the aims to help clinicians to improve diagnostic and therapeutic outcomes and prognosis of patients.

Objective:To investigate the clinical characteristics of abdominal infection related secondary hemorrhage and partition of intra-abdominal infection after pancreaticoduodenectomy (PD).Methods:The retrospective and descriptive study was conducted. The clinical data of 25 patients with abdominal infection related secondary hemorrhage after PD who were admitted to The First Affiliated Hospital of Xi ′an Jiaotong University from January 2009 to December 2017 were collected. There were 18 males and 7 females, aged (63±11)years. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3). Count data were described as absolute numbers. Results:(1) Clinical charac-teristics of abdominal infection related secondary hemorrhage after PD. Of 25 patients, there were 21 cases diagnosed with pancreatic fistula, 2 cases with negative for amylase test in abdominal drainage fluid, and 2 cases with unknown conditions of pancreatic fistula. There were 16 cases with sentinel hemorrhage and 9 cases without sentinel hemorrhage. Of 25 patients, 10 cases were evaluated as grade A bleeding, 10 cases were evaluated as grade B bleeding, and 5 cases were evaluated as grade C bleeding. The types of pathogenic microorganisms cultured in the peritoneal drainage fluid of 25 patients included 7 cases of simple Gram positive (G +) bacteria, 6 cases of simple Gram negative (G -) bacteria, 8 cases of both G + bacteria and G - bacteria, 1 case of G + bacteria and fungi, and 3 cases of G + bacteria, G - bacteria and fungi. There were 3 cases cultured with carbapenem-resistant Acinetobacter baumannii. There were 17 patients with fluid accumulation in the D region confirmed by abdominal computered tomography, including 2 cases of simple fluid accumulation in the D region and 15 cases of fluid accumulation in the D region and other regions. Of 25 patients, 12 cases underwent simple conservative medical treatment, 8 cases underwent digital subtraction angiography (DSA) hemostasis, 2 cases underwent DSA combined with surgical hemostasis, 1 case underwent endoscopic hemostasis, 1 case underwent surgical hemostasis, and 1 case underwent endoscopic + DSA hemostasis. Of 25 patients, 5 patients died. (2) Treatment methods and clinical outcomes of patients with abdo-minal infection in different regions of the partition of intra-abdominal infection. Of the 17 patients with clear regions of the partition of intra-abdominal infection, there were 6 cases with D region combined with ≤ 1 other region of the partition of intra-abdominal infection who did not receive surgical treatment survived, there were 11 cases with D region combined with ≥2 other regions of the partition of intra-abdominal infection who mainly received DSA or combined treatment, including 8 cases survived and 3 cases dead. Conclusions:The abdominal infection related secondary hemorrhage after pancreaticoduodenectomy is mainly due to D region of the partition of intra-abdominal infection, and the pathogen mainly presents as mixed infection and multi-drug-resistant bacterial infection. When the spread of infected lesions leads to D region combined with ≥2 other regions of the partition of intra-abdominal infection, the intervention measures are significantly upgraded, and the risk of patient death increases.

It was previously believed that hepatic portal venous gas (HPVG) was an "ominous sign" or "death sign", and once it appeared, the disease progressed rapidly with a high mortality rate which required immediate surgical treatment. However, with the continuous progress of medical technology, researchers have gained a deeper understanding that various causes can lead to HPVG, not all of which required surgical treatment, and the prognosis was not poor. Unfortunately, there is no guideline or consensus on the diagnosis and treatment of HPVG to guide clinical management and standardize diagnostic and therapeutic behaviors. Therefore, the authors review previous literatures with combined clinical diagnosis and treatment experience to conduct profound discussion on the epidemiological features, etiology, pathogenesis, imaging features, treatment strategies, and progno-sis of HPVG, and develop corresponding diagnosis and treatment procedures with the aims to help clinicians to improve diagnostic and therapeutic outcomes and prognosis of patients.

Objective:To analyze the clincial characteristics and laboratory findings of patients with neurobrucellosis (NB).Methods:Using retrospective analysis, clinical diagnosed patients with NB from June 2016 to February 2019 in Heilongjiang Agricultural Reclamation Bureau General Hospital were selected to analyze the general characteristics, clinical symptoms, laboratory examination results [white blood cell (WBC), hemoglobin(Hb), c-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein (TP), albumin (ALB), cerebrospinal fluid routine and biochemical, serum tube agglutination test (SAT), blood culture and cerebrospinal fluid culture of Brucella] , diagnosis and treatment effect. Results:A total of 25 patients were diagnosed with NB, including 19 males and 6 females, with an average age of (41.7 ± 14.2) years old, ranged from 11 to 70 years old. The main clinical symptoms were fever, headache, joint pain, vomiting and sweating, which accounted for 92.0% (23/25), 88.0% (22/25), 76.0% (19/25), 64.0% (16/25), and 64.0% (16/25), respectively. Positive neck ankylosis and mumbness of lowerlimbs were both 9 cases (36.0%), and mental disorders were 7 cases (28.0%). In 25 patients with NB, the WBC increased in 5 cases (20.0%), Hb decreased in 4 cases (16.0%), CRP increased in 13 cases (52.0%), ALT and AST both increased in 6 cases (24.0%), TP decreased in 21 cases (84.0%); SAT was positive in 25 cases (100.0%), cerebrospinal fluid SAT positive in 7 cases (28.0%); and blood culture was positive in 2 cases (8.0%). Cerebrospinal fluid changes were mainly manifested in 14 cases (56.0%) of chloride reduction, 13 cases (52.0%) of gluose reduction and 19 cases (76.0%) of protein increase. In 25 patients with NB, 17 cases were treated with doxycycline + rifampicin + ceftriaxone, 7 cases with etimicin + rifampicin + ceftriaxone, and 1 case with doxycycline + rifampicin + piperacillin sulbactam. After 6 to 12 months follow-up, 21 cases recovered well, whereas mild sequelae were observed in 4 patients.Conclusion:Clinical features of NB are hetorogeneous, and nerurological symptoms and cerebrospinal fluid examination are of great value in the diagnosis of NB.

Objective:To investigate the clinical characteristics and influencing factors of mortality in patients with intra-abdominal candidiasis (IAC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 203 IAC patients who were admitted to 7 medical centers from June 2018 to June 2020 were collected, including 54 cases in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, 31 cases in Fujian Medical University Union Hospital, 25 cases in Beijing Hospital, 25 cases in the First Affiliated Hospital of Xi'an Jiaotong University, 24 cases in China-Japan Friendship Hospital, 22 cases in General Hospital of Eastern Theater Command of Chinese PLA and 22 cases in Chongqing University Cancer Hospital. There were 130 males and 73 females, aged (64±15)years. Observation indicators: (1) candida infection and treatment of IAC patients; (2) analysis of influencing factors for mortality of IAC patients. 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(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate and multivariate analyses were performed by Logistic regression model. Results:(1) Candida infection and treatment of IAC patients: 134 cases of candida albicans were cultured in the initial abdominal drainage fluid or intraoperative abdominal specimens of 203 patients, and 49 cases were treated with fluconazole. Of 69 cases infected with non candida albicans, 13 cases were treated with fluconazole. The resistance rate of candida albicans to fluconazole was 5.91%(12/203). Of 203 patients, there were 68 cases with infections shock, 53 cases with renal failure, 84 cases with respiratory failure and 63 cases with multiple organ failure, respectively. There were 148 of 203 patients admitted to intensive care unit for 9 days(range, 3-20 days), and the total hospital stay was 28 days(range, 17-50 days). Of 203 patients, 86 cases were cured and discharged, 50 cases were improved and transferred to local hospitals, 32 cases gave up treatment and discharged automatically, 19 cases died, 16 cases had no follow-up data. The mortality was 25.12%(51/203). (2) Analysis of influencing factors for mortality of IAC patients. Results of univariate analysis showed that acute physiology and chronic health evaluation score, sequential organ failure assessment score, the Cr, bilirubin, albumin, procalcitonin, and PLT on the first day of candida positive culture, of the lowest value in a week and the highest in a week, heart disease, diabetes, infections shock, renal failure, respiratory failure, multiple organ failure, anti-fungal therapy were the related factors for mortality of IAC patients ( t=-2.322, Z=-2.550, -2.262, -4.361, t=2.085, Z=-3.734, -5.226, -2.394, -5.542, t=3.462, Z=-4.957, -5.632, 3.670, -5.805, t=3.966, Z=-3.734, -5.727, χ2=4.071, 4.638, 27.353, 18.818, 13.199, 26.251, 13.388, P<0.05). Multivariate analysis showed that the bilirubin, procalcitonin on the first day of candida positive culture and infections shock were independent risk factors for mortality of IAC patients ( odds ratio=1.021, 1.022, 6.864, 95% confidence interval as 1.010-1.033, 1.001-1.044, 1.858-25.353, P<0.05). Conclusions:The common fungus of IAC was candida albicans, and fluconazole can be used as the initial empirical treatment. The prognosis of patients with abdominal candidiasis is poor. Bilirubin, procalcitonin on the first day of candida positive culture and infections shock are indepen-dent risk factors for mortality of IAC patients.

SARS-CoV-2 can cause multiple organ injuries in some susceptible people in a short time, which seriously threatens the health and safety of people, and intensive care and multiple extracorporeal organ support are important means of treatment. Although many experts’ consensus and clinical guidelines have been published, a series of clinical problemsstill exist during the treatment procedure, and no consensushas not been reached until now. Therefore,in this paper wemake some reflections and explorations to provide experience and help for clinicians.