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.

Objective To explore the effect of endoscopic surgery via trans-axilloareolar sternocleidomastoid intermuscular approach for unilateral thyroid cancer.Methods A total of 116 patients with unilateral thyroid cancer admitted to our hospital from January 2020 to March 2023 were selected,and all of them underwent unilateral thyroidectomy+isthmus resection+central lymph node dissection under endoscopy.The patients were divided into the observation group and the control group according to random number table method,with 58 cases in each group.Patients in the observation group received the trans-axilloareolar sternocleidomastoid intermuscular approach,and patients in the control group received subclavian approach.The surgical-related indicators,stress indicators[adrenocorticotropic hormone(ACTH),norepinephrine(NE),cortisol(Cor)]before and after surgery,parathyroid hormone(PTH),blood calcium level,postoperative incision aesthetics satisfaction,and occurrence of complications were compared between the two groups.Results There was no statistically significant difference in the operation time,intraoperative blood loss,or postoperative drainage volume of patients between the two groups(P>0.05).The dissection number of lymph nodes in the central region of patients in the observation group was greater than that in the control group(P<0.05).In the two groups,the levels of NE,Cor,and ACTH 1 day and 3 days after surgery were higher than those before surgery(P<0.05),and the levels of NE,Cor and ACTH 1 day after surgery were higher than those 3 days after surgery(P<0.05);the levels of NE,Cor and ACTH 1 day and 3 days after surgery of patients in the observation group were lower than those in the control group(P<0.05).In the two groups,the levels of PTH and serum calcium 1 day and 3 days after surgery were lower than those before surgery(P<0.05),and the levels of PTH and serum calcium 3 days after surgery were lower than those 1 day after surgery(P<0.05),while there were no significant differences in the levels of PTH or serum calcium 1 day and 3 days after surgery between the two groups(P>0.05).The satisfaction of postoperative incision aesthetics in the observation group(100%)was higher than that in the control group(72.41%),with statistically significant difference(P<0.05).No statistically significant difference was found in the incidence of complications between the two groups(P>0.05).Conclusion Endoscopic surgery via trans-axilloareolar sternocleidomastoid intermuscular approach is safe and feasible for unilateral thyroid cancer,which has a mild stress response and inconspicuous incisions,with high satisfaction of incision aesthetics for patients.

PURPOSE: The rate of complications among patients undergoing surgery has increased due to infection with SARS-CoV-2 and other variants of concern. However, Omicron has shown decreased pathogenicity, raising questions about the risk of postoperative complications among patients who are infected with this variant. This study aimed to investigate complications and related factors among patients with recent Omicron infection prior to undergoing orthopedic surgery. METHODS: A historical control study was conducted. Data were collected from all patients who underwent surgery during 2 distinct periods: (1) between Dec 12, 2022 and Jan 31, 2023 (COVID-19 positive group), (2) between Dec 12, 2021 and Jan 31, 2022 (COVID-19 negative control group). The patients were at least 18 years old. Patients who received conservative treatment after admission or had high-risk diseases or special circumstances (use of anticoagulants before surgery) were excluded from the study. The study outcomes were the total complication rate and related factors. Binary logistic regression analysis was used to identify related factors, and odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the impact of COVID-19 infection on complications. RESULTS: In the analysis, a total of 847 patients who underwent surgery were included, with 275 of these patients testing positive for COVID-19 and 572 testing negative. The COVID-19-positive group had a significantly higher rate of total complications (11.27%) than the control group (4.90%, p < 0.001). After adjusting for relevant factors, the OR was 3.08 (95% CI: 1.45-6.53). Patients who were diagnosed with COVID-19 at 3-4 weeks (OR = 0.20 (95% CI: 0.06-0.59), p = 0.005), 5-6 weeks (OR = 0.16 (95% CI: 0.04-0.59), p = 0.010), or ≥7 weeks (OR = 0.26 (95% CI: 0.06-1.02), p = 0.069) prior to surgery had a lower risk of complications than those who were diagnosed at 0-2 weeks prior to surgery. Seven factors (age, indications for surgery, time of operation, time of COVID-19 diagnosis prior to surgery, C-reactive protein levels, alanine transaminase levels, and aspartate aminotransferase levels) were found to be associated with complications; thus, these factors were used to create a nomogram. CONCLUSION Omicron continues to be a significant factor in the incidence of postoperative complications among patients undergoing orthopedic surgery. By identifying the factors associated with these complications, we can determine the optimal surgical timing, provide more accurate prognostic information, and offer appropriate consultation for orthopedic surgery patients who have been infected with Omicron.
Humans ; COVID-19/complications* ; Male ; Female ; Middle Aged ; Postoperative Complications/epidemiology* ; SARS-CoV-2 ; Orthopedic Procedures/adverse effects* ; Aged ; Nomograms ; Adult ; Retrospective Studies ; Risk Factors

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.

Objective To explore the effect of endoscopic surgery via trans-axilloareolar sternocleidomastoid intermuscular approach for unilateral thyroid cancer.Methods A total of 116 patients with unilateral thyroid cancer admitted to our hospital from January 2020 to March 2023 were selected,and all of them underwent unilateral thyroidectomy+isthmus resection+central lymph node dissection under endoscopy.The patients were divided into the observation group and the control group according to random number table method,with 58 cases in each group.Patients in the observation group received the trans-axilloareolar sternocleidomastoid intermuscular approach,and patients in the control group received subclavian approach.The surgical-related indicators,stress indicators[adrenocorticotropic hormone(ACTH),norepinephrine(NE),cortisol(Cor)]before and after surgery,parathyroid hormone(PTH),blood calcium level,postoperative incision aesthetics satisfaction,and occurrence of complications were compared between the two groups.Results There was no statistically significant difference in the operation time,intraoperative blood loss,or postoperative drainage volume of patients between the two groups(P>0.05).The dissection number of lymph nodes in the central region of patients in the observation group was greater than that in the control group(P<0.05).In the two groups,the levels of NE,Cor,and ACTH 1 day and 3 days after surgery were higher than those before surgery(P<0.05),and the levels of NE,Cor and ACTH 1 day after surgery were higher than those 3 days after surgery(P<0.05);the levels of NE,Cor and ACTH 1 day and 3 days after surgery of patients in the observation group were lower than those in the control group(P<0.05).In the two groups,the levels of PTH and serum calcium 1 day and 3 days after surgery were lower than those before surgery(P<0.05),and the levels of PTH and serum calcium 3 days after surgery were lower than those 1 day after surgery(P<0.05),while there were no significant differences in the levels of PTH or serum calcium 1 day and 3 days after surgery between the two groups(P>0.05).The satisfaction of postoperative incision aesthetics in the observation group(100%)was higher than that in the control group(72.41%),with statistically significant difference(P<0.05).No statistically significant difference was found in the incidence of complications between the two groups(P>0.05).Conclusion Endoscopic surgery via trans-axilloareolar sternocleidomastoid intermuscular approach is safe and feasible for unilateral thyroid cancer,which has a mild stress response and inconspicuous incisions,with high satisfaction of incision aesthetics for patients.

Objective:To investigate the efficacy and safety of the conditioning regimen BeEAM(bendamustine+et-oposide+cytarabine+melphalan)in autologous stem cell transplantation(ASCT)for patients with malignant lymphoma.Methods:The clinical data of 20 patients with malignant lymphoma who underwent ASCT after conditioning with BeEAM regimen from January 2021 to December 2022 in the First Affiliated Hospital of Bengbu Medical University were collected,and the clinical characteristics before transplantation,conditioning-related toxicity,hematopoietic reconstitution after transplantation,and therapeutic effects were analyzed.67 patients with malignant lymphoma who did not undergo ASCT during the same period were selected as the control group,and the 1-year progression-free survival(PFS)rate and overall-survival(OS)rate between the ASCT group and the non-ASCT group were compared.Results:15 cases achieved complete remission(CR)and 5 cases achieved partial remission(PR)before transplantation in ASCT group.During the conditioning process of patients in the ASCT group,14 cases experienced gastrointestinal adverse reactions,13 cases experienced neutropenic fever,10 cases experienced oral mucositis,2 cases experienced abnormal liver function,and only 1 case experienced acute renal injury.All the adverse reactions resolved after symptomatic treatment.After transplantation,19 cases achieved hematopoietic reconstitution,and only one case had poor platelet engraftment.The median time of peripheral white blood cell(WBC)engraftment was 9(9-16)days,and the median time of platelet engraftment was 12(10-23)days.By the end of follow-up,there were no transplant-related deaths.The 1-year PFS rates in the ASCT group and the non-ASCT group were 94.4％and 68.5％,respectively;The 1-year OS rates were 94.4％and 83.5％,respectively.The median PFS and OS time for both groups were not reached.The PFS in the ASCT group was significantly better than that in the non-ASCT group(P＜0.05),and there was no significant difference in OS between the two groups(P＞0.05).Conclusion:BeEAM regimen is safe and effective as a conditioning treatment for ASCT in patients with malignant lymphoma,with tolerable adverse reactions,controllable non-hematological toxicity,smooth hematopoietic reconstitution,and considerable short-term efficacy.However,further follow-up is required to evaluate its long-term efficacy.

Linezolid,a fully synthetic oxazolidinone antibiotic,is mainly used to treat severe infections caused by Gram-positive drug-resistant bacteria.In recent years,with the rise in drug-resistant bacteria,the clinical utilization rate of linezolid and the incidence of linezolid-related adverse reactions in the hematological system and metabolic system have increased.The main adverse reactions include thrombocytopenia,anemia and lactic acidosis.Studies have shown that the causes of adverse reactions in linezolid-induced hematological system and metabolic system are diverse,and the mechanisms are not fully elucidated.In this review,the pharmacokinetic characteristics,mechanism of adverse reactions,risk factors,as well as preventive measures and individualized drug administration strategies of linezolid in vivo were discussed based on literature reports at home and abroad,aiming to provide references for clinical prevention and treatment of linezolid-related adverse reactions of hematological system and metabolic system.

AIM To identify the in vivo metabolites of Cynanchum auriculatum Royle ex Wight extract in functional dyspepsia rats by UHPLC Q-Exactive Plus Orbitrap HRMS.METHODS The rat models for functional dyspepsia were established.The analysis was performed on a 40℃ thermostatic Hypersil GOLD C18 column(2.1 mm×100 mm,1.9 μm),with the mobile phase comprising of water(containing 0.1％formic acid)-acetonitrile(containing 0.1％formic acid)flowing at 0.3 mL/min in a gradient elution manner,and electrospray ionization source was adopted in positive and negative ion scanning.RESULTS Total 4 prototypes(baishouwubenzophenone,deacylmetaplexigenin,qingyangshengenin,syringic)and 110 metabolites were identified,12 of which were common metabolites in feces and urine,56 of which were unique metabolites in urine,42 of which were unique metabolites in feces.The metabolic pathway of prototypes contained phase Ⅰ metabolism(reduction,oxidization,etc.),phase Ⅱ metabolism(sulfonation,glucuronidation,etc.)and phase Ⅰ,Ⅱ composite reactions.CONCLUSION This effective and comprehensive method can lay the theoretical foundation for further discovery of potential active metabolites in C.auriculatum.

Purpose: Patients with advanced biliary tract cancer (BTC) have a poor survival. We aim to evaluate the efficacy and safety of nab-paclitaxel plus gemcitabine and cisplatin regimen in Chinese advanced BTC patients. Materials and Methods: Eligible patients with locally advanced or metastatic BTC administrated intravenous 100 mg/m2 nab-paclitaxel, 800 mg/m2 gemcitabine, and 25 mg/m2 cisplatin every 3 weeks. The primary endpoint was progression-free survival (PFS). The secondary endpoints included overall survival (OS) and adverse events, while exploratory endpoint was the association of biomarkers with efficacy. Results: After the median follow-up of 25.0 months, the median PFS and OS of 34 enrolled patients were 7.1 months (95% confidence interval [CI], 5.4 to 13.7) and 16.4 months (95% CI, 10.9 to 23.6), respectively. The most common treatment-related adverse events at ≥ 3 grade were neutropenia (26.5%) and leukopenia (26.5%). Survival analyses demonstrated that carcinoembryonic antigen (CEA) levels could monitor patients’ survival outcomes. A significant increase in the number of infiltrating CD4+ cells (p=0.008) and a decrease in programmed death-1–positive (PD-1+) cells (p=0.032) were observed in the response patients. Conclusion In advanced BTC patients, nab-paclitaxel plus gemcitabine and cisplatin regimen showed therapeutic potential. Potential prognostic factors of CEA levels, number of CD4+ cells and PD-1+ cells may help us maximize the efficacy benefit.