Objective:To explore the real-life experiences of patients six months after laparoscopic sleeve gastrectomy (LSG), aiming to provide a reference for developing intervention plans.Methods:This was a descriptive phenomenological study. Purposeful sampling and maximum variation sampling were used to select 24 patients who underwent LSG at the Affiliated Hospital of Zunyi Medical University from February to August 2023. Semi-structured in-depth interviews were conducted, and the Colaizzi 7-step analysis method was applied to inductively extract and refine the themes.Results:A total of six main themes and ten sub-themes were identified through analysis. The main themes were: desires to improve postoperative physical symptoms (gastrointestinal symptoms, hair loss, neurological symptoms, and general symptoms) ; perception of subjective emotions (anxiety, regret, fear, and confidence) ; decreased social adaptability (decline in work ability, impaired social skills) ; general low compliance; desire for professional guidance; and postoperative benefit finding.Conclusions:Six months after LSG, patients primarily experienced physical symptom disturbances, poor psychological states, decreased social adaptability, low compliance, and a desire for professional guidance. However, they also recognized various benefits of the surgery. Healthcare providers should strengthen dynamic symptom assessments and management, guide patients psychologically, enhance social support, and actively improve follow-up and continuous care to help patients improve self-coping abilities and weight loss outcomes.

Objective:To evaluate the predictive efficacy of different comorbidity indices for hospitalization due to acute exacerbations in chronic obstructive pulmonary disease (COPD) patients with comorbidities (CO-COPD).Methods:This retrospective cohort study included 259 stable COPD patients with comorbidities from Beijing Tongren Hospital, Capital Medical University, between October 2021 and September 2023, all with ≥1-year follow-up. Patients were categorized into hospitalized ( n=75) and non-hospitalized ( n=184) groups based on acute exacerbation events. Clinical characteristics, comorbidities, and comorbidity indices, including Charlson Comorbidity Index (CCI), COPD-specific Comorbidity Test (COTE), and comorbidities in chronic obstructive lung disease index (COMCOLD) were compared between two goups. Risk facors of hospitalization due to acute exacerbations were analyzed by Cox regression. Modified indices were developed by incorporating additional respiratory comorbidities (asthma, bronchiectasis, lung cancer) weighted by hazard ratios (HRs) from Cox reguression. The predictive performance of different comorbidity indices for hospitalization was assessed by receiver operating characteristic (ROC) curves. Results:Hospitalized patients exhibited lower BMI, FEV 1% predicted, and FEV 1/FVC (all P<0.05), alongside higher modified British Medical Research Coucil (mMRC) scores and COPD assessment test (CAT) scores, eosinophil counts, and Global Initiative for Chronic Obstructive Lung Disease, (GOLD)severity ( t=3.73, Z=-3.43, Z=-2.43, Z=-11.10, Z=-11.32, Z=-1.80, χ2=17.62, all P<0.05); and also higher use rates of inhaled corticosteroid (ICS) and systemic oral corticosteroid (OCS) ( χ2=5.48, 7.15, all P<0.05). The comorbidities of asthma, bronchiectasis, lung cancer, hypertension, coronary atherosclerotic heart disease, anxiety and depression in hospitalized group were significantly higher ( χ2=22.49, 18.30, 15.63, 5.10, 4.68, 7.46, 5.16, all P<0.05), along with the increased CCI and COTE index ( P<0.05). Comorbid asthma, bronchiectasis, and lung cancer were independent risk factors for hospitalization ( HR=1.841, 2.924, and 2.076, respectively; all P<0.05). Original CCI and COTE showed moderate predictive value ( AUC=0.609 and 0.655), while modified CCI, COTE, and COMCOLD demonstrated improved performance ( AUC=0.730, 0.760, and 0.713, respectively). At optimal cutoffs (modified CCI>3.5, COTE>4.5, COMCOLD>6.5), sensitivities were 61.3%, 76.0%, and 58.7%, with specificities of 70.1%, 61.4%, and 72.3%. Age-stratified analysis revealed enhanced predictive utility of modified indices across age groups. Conclusions:CCI, COTE, and COMCOLD provide modest predictive value for hospitalization in CO-COPD. Modified indices incorporating respiratory comorbidities significantly improve risk stratification, offering clinical utility for identifying high-risk patients in primary care settings.

Objective:To retrieve, screen, and synthesize the best available evidence related to perioperative blood glucose management in patients undergoing bariatric and metabolic surgery.Methods:Relevantliterature on perioperative blood glucose management in bariatric and metabolic surgery patients was retrieved from Chinese and English databases using a top-down strategy based on the "6S" evidence-based model. The search period was from database inception to June 30, 2024. Two evidence-based trained researchers independently screened the literature according to inclusion criteria, assessed methodological quality, and extracted and synthesized the evidence.Results:Fourteen articles were eventually included, comprising five clinical practice guidelines, four expert consensus, two systematic reviews, one evidence summary, and two randomized controlled trials. Eighteen pieces of best evidence were synthesized across seven dimensions: principles of glycemic management, target blood glucose levels, management of hypoglycemic agents, very-low-calorie diet intervention, treatment of postoperative hypoglycemia treatment, self-monitoring of blood glucose, and follow-up and guidance.Conclusions:The best evidence extracted in this study is scientifically sound and clinically applicable, providing evidence-based support and decision-making guidance for perioperative blood glucose management in patients undergoing bariatric and metabolic surgery. However, clinical practitioners need to apply it selectively in the context of hospital and departmental realities when applying it in practice.

Objective:To explore the real-life experiences of patients six months after laparoscopic sleeve gastrectomy (LSG), aiming to provide a reference for developing intervention plans.Methods:This was a descriptive phenomenological study. Purposeful sampling and maximum variation sampling were used to select 24 patients who underwent LSG at the Affiliated Hospital of Zunyi Medical University from February to August 2023. Semi-structured in-depth interviews were conducted, and the Colaizzi 7-step analysis method was applied to inductively extract and refine the themes.Results:A total of six main themes and ten sub-themes were identified through analysis. The main themes were: desires to improve postoperative physical symptoms (gastrointestinal symptoms, hair loss, neurological symptoms, and general symptoms) ; perception of subjective emotions (anxiety, regret, fear, and confidence) ; decreased social adaptability (decline in work ability, impaired social skills) ; general low compliance; desire for professional guidance; and postoperative benefit finding.Conclusions:Six months after LSG, patients primarily experienced physical symptom disturbances, poor psychological states, decreased social adaptability, low compliance, and a desire for professional guidance. However, they also recognized various benefits of the surgery. Healthcare providers should strengthen dynamic symptom assessments and management, guide patients psychologically, enhance social support, and actively improve follow-up and continuous care to help patients improve self-coping abilities and weight loss outcomes.

Objective:To retrieve, screen, and synthesize the best available evidence related to perioperative blood glucose management in patients undergoing bariatric and metabolic surgery.Methods:Relevantliterature on perioperative blood glucose management in bariatric and metabolic surgery patients was retrieved from Chinese and English databases using a top-down strategy based on the "6S" evidence-based model. The search period was from database inception to June 30, 2024. Two evidence-based trained researchers independently screened the literature according to inclusion criteria, assessed methodological quality, and extracted and synthesized the evidence.Results:Fourteen articles were eventually included, comprising five clinical practice guidelines, four expert consensus, two systematic reviews, one evidence summary, and two randomized controlled trials. Eighteen pieces of best evidence were synthesized across seven dimensions: principles of glycemic management, target blood glucose levels, management of hypoglycemic agents, very-low-calorie diet intervention, treatment of postoperative hypoglycemia treatment, self-monitoring of blood glucose, and follow-up and guidance.Conclusions:The best evidence extracted in this study is scientifically sound and clinically applicable, providing evidence-based support and decision-making guidance for perioperative blood glucose management in patients undergoing bariatric and metabolic surgery. However, clinical practitioners need to apply it selectively in the context of hospital and departmental realities when applying it in practice.

Objective:To evaluate the predictive efficacy of different comorbidity indices for hospitalization due to acute exacerbations in chronic obstructive pulmonary disease (COPD) patients with comorbidities (CO-COPD).Methods:This retrospective cohort study included 259 stable COPD patients with comorbidities from Beijing Tongren Hospital, Capital Medical University, between October 2021 and September 2023, all with ≥1-year follow-up. Patients were categorized into hospitalized ( n=75) and non-hospitalized ( n=184) groups based on acute exacerbation events. Clinical characteristics, comorbidities, and comorbidity indices, including Charlson Comorbidity Index (CCI), COPD-specific Comorbidity Test (COTE), and comorbidities in chronic obstructive lung disease index (COMCOLD) were compared between two goups. Risk facors of hospitalization due to acute exacerbations were analyzed by Cox regression. Modified indices were developed by incorporating additional respiratory comorbidities (asthma, bronchiectasis, lung cancer) weighted by hazard ratios (HRs) from Cox reguression. The predictive performance of different comorbidity indices for hospitalization was assessed by receiver operating characteristic (ROC) curves. Results:Hospitalized patients exhibited lower BMI, FEV 1% predicted, and FEV 1/FVC (all P<0.05), alongside higher modified British Medical Research Coucil (mMRC) scores and COPD assessment test (CAT) scores, eosinophil counts, and Global Initiative for Chronic Obstructive Lung Disease, (GOLD)severity ( t=3.73, Z=-3.43, Z=-2.43, Z=-11.10, Z=-11.32, Z=-1.80, χ2=17.62, all P<0.05); and also higher use rates of inhaled corticosteroid (ICS) and systemic oral corticosteroid (OCS) ( χ2=5.48, 7.15, all P<0.05). The comorbidities of asthma, bronchiectasis, lung cancer, hypertension, coronary atherosclerotic heart disease, anxiety and depression in hospitalized group were significantly higher ( χ2=22.49, 18.30, 15.63, 5.10, 4.68, 7.46, 5.16, all P<0.05), along with the increased CCI and COTE index ( P<0.05). Comorbid asthma, bronchiectasis, and lung cancer were independent risk factors for hospitalization ( HR=1.841, 2.924, and 2.076, respectively; all P<0.05). Original CCI and COTE showed moderate predictive value ( AUC=0.609 and 0.655), while modified CCI, COTE, and COMCOLD demonstrated improved performance ( AUC=0.730, 0.760, and 0.713, respectively). At optimal cutoffs (modified CCI>3.5, COTE>4.5, COMCOLD>6.5), sensitivities were 61.3%, 76.0%, and 58.7%, with specificities of 70.1%, 61.4%, and 72.3%. Age-stratified analysis revealed enhanced predictive utility of modified indices across age groups. Conclusions:CCI, COTE, and COMCOLD provide modest predictive value for hospitalization in CO-COPD. Modified indices incorporating respiratory comorbidities significantly improve risk stratification, offering clinical utility for identifying high-risk patients in primary care settings.

Objective:To investigate the clinical features of patients with chronic obstructive pulmonary disease (COPD) and serum-positive specific IgE (SIgE).Methods:This study was a retrospective cohort study. A total of 105 stable COPD patients with allergic features and completed serum SIgE testing were included, and all of them were from Capital Medical University, Beijing Tong Ren Hospital from September 2022 to October 2023. Those with at least one positive result of SIgE testing were classified as positive SIgE COPD group, and those with negative SIgE were classified as negative SIgE COPD group. There were 32 cases (30.5%) in the positive SIgE COPD group and 73 cases (69.5%) in the negative SIgE COPD group. Differences in laboratory tests, pulmonary function, chronic obstructive pulmonary symptom scores, incidence of severe acute exacerbation events in the past year, and drug therapy were compared between the two groups. The risk factors for positive SIgE COPD were analyzed, and the best predictive value for the diagnosis of positive SIgE COPD was analyzed using the area under the curve (AUC) of receiver operating characteristic (ROC).Results:Compared with the negative SIgE COPD group, the percentage of positive SIgE COPD group with rhinitis, sinusitis, sinusitis with nasal polyps, eczema, and a history of drug or food allergy were higher (all P<0.05) and the percentage of those who had quit smoking were higher ( P<0.05); the percentage of IgE above normal thresholds, the level of IgE, the percentage of peripheral blood eosinophil (EOS%), the count of EOS, and fractional exhaled nitric oxide (FeNO) were higher (all P<0.05), and the percentage of those who had severe and above severe Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) pulmonary function classification were higher, while the percentage of forced expiratory volume in one second (FEV 1% predicted), 25% maximal expiratory flow (MEF 25%) and MEF 75/25% were lower, and FEV 1/FVC was higher (all P<0.05). The positive SIgE COPD group had higher modified British medical research council (mMRC) scores and COPD assessment test (CAT) scores, and a higher incidence of severe acute exacerbation events over the past year (all P<0.05), and the use of short-acting β 2 receptor agonists (SABA) or short-acting muscarinic antagonist (SAMA), inhaled corticosteroid (ICS), theophylline and oral hormone therapy were more frequent (all P<0.05). EOS% ( OR=1.252, 95% CI: 1.039-1.508) was a risk factor for SIgE positivity in COPD ( P<0.05), and having quit smoking ( OR=0.385, 95% CI: 0.197-0.751) was a protective factor ( P<0.05). The AUC value of the ROC curve of EOS%>2.5% for the diagnosis of SIgE positivity was 0.647 (95% CI: 0.543-0.752), with a sensitivity and specificity of 52.8% and 73.1%, respectively. Conclusions:Positive SIgE COPD has sever clinical symptoms, high risk of acute exacerbation and deficiencies in treatment. The elevate of EOS% is a risk factor for the development of positive SIgE in COPD patients; positive SIgE COPD meets the diagnostic criteria for allergic COPD phenotype, and EOS% over 2.5% is suggestive of the clinical detection of allergic COPD phenotype.

Hemorrhagic shock (HS) is one of the leading causes of death among young adults worldwide. Multiple organ dysfunction in HS is caused by an imbalance between tissue oxygen supply and demand, which is closely related to the poor prognosis of patient. Mitochondrial dysfunction is one of the key mechanisms contributing to multiple organ dysfunction in HS, while mitochondrial quality control regulates mitochondrial function through a series of processes, including mitochondrial biogenesis, mitochondrial dynamics, mitophagy, mitochondrial-derived vesicles, and mitochondrial protein homeostasis. Modulating mitochondrial quality control can improve organ dysfunction. This review aims to summarize the effects of mitochondrial dysfunction on organ function in HS and discuss the potential mechanisms of mitochondrial quality control, providing insights into the injury mechanisms underlying HS and guiding clinical management.

Objective:To investigate the efficacy and safety of peritoneal dialysis (PD) in end-stage renal disease (ESRD) patients with liver cirrhosis (LC).Methods:Clinical data of PD patients receiving regular treatment followed up for≥6 months, and aged≥18 years in the Third Affiliated Hospital of Hebei Medical University Peritoneal Dialysis Center from January 1, 2013 to March 31, 2020 were retrospectively collected. The patients were divided into LC-PD group and non-LC-PD group according to whether they had LC or not. Propensity score matching (PSM) was used to match the LC-PD group and the non-LC-PD group with 1∶4 ratio. The baseline clinical data, dialysis adequacy, peritonitis and clinical outcomes between the two groups were compared. Kaplan-Meier survival curve and Log-rank test were used to compare the survival rate and technical survival rate between the two groups.Results:A total of 241 PD patients were included in this study. After PSM, 13 cases in LC-PD group and 52 cases in non-LC-PD group were included. Compared with non-LC-PD group, patients in LC-PD group had lower baseline urine volume ( Z=-3.546, P<0.001) and serum albumin ( Z=-2.609, P=0.009). At the follow-up of 3, 6, 12 and 24 months, total serum protein ( t=-3.319, P=0.002), serum albumin ( t=-4.019, P<0.001), triglyceride ( Z=-2.263, P=0.024), and serum phosphorus ( Z=-2.173, P=0.030) in the LC-PD group were lower than those in non-LC-PD group. During the follow-up period of 2 years, the patients in the LC-PD group had significantly higher serum albumin than baseline values ( χ2=16.901, P=0.001), and there was no statistically significant difference between the two groups ( χ2=0.155, P=0.694). The decline rate of residual kidney Kt/V in the LC-PD group was slower than that in the non-LC-PD group ( χ2=44.589, P<0.001). The incidence of peritonitis in LC-PD group was higher than that in the non-LC-PD group, with a statistically significant difference (0.59/patient-year vs 0.20/patient-year, Z=-2.135, P=0.033). The composition ratio of pathogenic bacteria in both groups was mainly gram-positive bacteria (10/25 vs 11/30) and proportion of Streptococcus in LC-PD group was higher than that in non-LC-PD group (4/10 vs 0/11, P=0.035). The proportion of Escherichia coli in the first peritonitis was higher than that in LC-PD group (4/9 vs 1/22, P=0.017). The Kaplan-Meier survival curve results showed no statistically significant difference in survival rate (Log-rank χ2=0.491, P=0.484) and technical survival rate (Log-rank χ2=0.408, P=0.523) between the two groups. Conclusions:PD is a safe and effective treatment mode for ESRD patients with LC, and the survival rate and technical survival rate are comparable to those patients without LC. The incidence of peritonitis in patients with LC-PD in our dialysis center is higher than that in the non-LC-PD patients, and gram-positive bacterial infections are the mainstay, suggesting that attention should be paid to strengthening patient management and training.

Objective:To explore the independent risk factors that predict 10-year mortality in patients with stable chronic obstructive pulmonary disease(COPD).Methods:The baseline data from a prospective cohort study were analyzed and long-term follow-up were performed. Patients with confirmed diagnosis of stable COPD were consecutively enrolled in the outpatient clinic from January 2010 to December 2010, and were followed up until December 31, 2020. Cox regression analysis was used to determine the independent risk factors for all-cause mortality and mortality from respiratory causes in stable COPD patients.Results:A total of 182 stable COPD patients were enrolled and followed up for a median of 89 months. The 10-year mortality was 51.1%(93/182), and 9 patients died within one year. The leading cause of death was respiratory disorder, followed by cardiovascular and cerebrovascular diseases. The risk factors independently associated with all-cause mortality included old age( HR=1.936,95% CI: 1.610~2.328, P<0.01), increased baseline COPD Assessment Test(CAT)( HR=1.331,95% CI: 1.049-1.689, P=0.02) and the increased CAT in one year( HR=1.314,95% CI: 1.197-1.420, P<0.01). The risk factors independently associated with respiratory cause mortality included increased baseline CAT( HR=1.719,95% CI: 1.026-2.880, P=0.04), emphysema index(LAA%)( HR=1.062,95% CI: 1.007-1.120, P=0.03), and one year inecreased CAT( HR=1.342,95% CI: 1.198-1.505, P<0.01)was a protective factor. Conclusions:Old age, baseline CAT, one year increased in CAT and LAA% were independent influencing factors for 10-year mortality of stable COPD patients.