Objective To investigate the clinical significance of neutrophil-to-lymphocyte ratio(NLR),systemic immune-inflammatory index(SII),systemic inflammation response index(SIRI),and aggregate index of systemic inflammation(AISI)in chronic kidney disease(CKD)patients complicated with heart failure.Methods This study enrolled 190 CKD patients complicated with heart failure(case group)and 30 CKD patients without heart failure(control group)who treated in the outpatient and inpatient departments of Wenling Hospital of Traditional Chinese Medicine from January 2022 to December 2024.Differences in NLR,SII,SIRI,and AISI between the two groups were compared,and the relationship between these inflammatory markers and traditional Chinese medicine(TCM)syndrome types in CKD patients complicated with heart failure was analyzed.Logistic regression analysis and receiver operating characteristic(ROC)curve were used for evaluating the predictive efficacy of NLR,SII,SIRI,and AISI for illness severity of CKD complicated with heart failure.Results(1)The levels of NLR,SII,SIRI,and AISI in the case group were significantly higher than those in the control group(P＜0.01).(2)In CKD patients complicated with heart failure,NLR,SII,SIRI,and AISI were positively correlated with N-terminal pro-brain natriuretic peptide(NT-proBNP)levels(P＜0.01).(3)Among the CKD patients complicated with heart failure of fundamentally deficiency syndromes,spleen-kidney yang deficiency syndrome was the most prevalent,followed by spleen-kidney qi-yin deficiency syndrome,spleen-kidney qi deficiency syndrome,and yin-yang deficiency syndrome.Among the CKD patients complicated with heart failure of incidentally excess syndromes,blood stasis syndrome was the most common,followed by damp-heat syndrome,urinary toxin retention syndrome,and water-damp syndrome.(4)In CKD patients complicated with heart failure of fundamentally deficiency syndromes,NLR,SII,SIRI,and AISI levels ranked in the decreasing sequence in the syndromes of yin-yang deficiency,spleen-kidney yang deficiency,spleen-kidney qi-yin deficiency,and spleen-kidney qi deficiency;in the patients with incidentally excess syndromes,the levels ranked in the decreasing sequence in urinary toxin retention,damp-heat syndrome,blood stasis syndrome,and water-damp syndrome(P＜0.05).(5)Multivariate logistic regression identified NLR,SII,SIRI,and AISI as independent risk factors for illness severity of CKD complicated with heart failure(P＜0.01).(6)ROC curve analysis demonstrated high values of NLR,SII,SIRI,and AISI in differentiating illness severity of CKD complicated with heart failure(P＜0.01).Conclusion Inflammatory markers of NLR,SII,SIRI,and AISI exhibit significant correlation with illness severity of CKD complicated with heart failure,suggesting their potentiality as biological markers for TCM syndrome differentiation and disease progression assessment in this population.

Objective To investigate the correlation between insulin resistance markers[triglyceride-glucose(TyG)index],inflammatory indicators[neutrophil-to-lymphocyte ratio(NLR),C-reactive protein(CRP)],and traditional Chinese medicine(TCM)syndromes in patients with diabetic kidney disease(DKD)complicated by carotid atherosclerosis(CAS).Methods This retrospective study enrolled 300 DKD patients with CAS(case group)and 30 DKD patients without CAS(control group).Differences in TyG index,NLR,and CRP levels were compared between groups.The relationships between these markers and carotid intima-media thickness(IMT)/plaque area were analyzed,along with their variations across TCM syndromes.Logistic regression and receiver operating characteristic(ROC)curve analyses were performed to evaluate the predictive value of TyG index,NLR,and CRP for plaque stability and prognosis.Results(1)The TyG index,NLR,and CRP levels in patients with DKD and CAS were significantly higher than those in patients with DKD alone(P＜0.01).(2)The TyG index,NLR,and CRP were significantly positively correlated with IMT and plaque area(P＜0.01).(3)In patients with DKD combined with CAS,the TyG index,NLR,and CRP levels in those with unstable plaques were significantly higher than those with stable plaques(P＜0.01).(4)Among the distribution of TCM syndromes in patients with DKD combined with CAS,the qi and yin deficiency syndrome had the highest proportion(33.33％),followed by spleen and kidney yang deficiency syndrome(28.67％),yin and yang deficiency syndrome(22.00％),and turbid toxin and stasis obstruction syndrome(16.00％).(5)Among patients with DKD and CAS,the TyG index,NLR,and CRP levels in patients with different TCM syndromes decreased in the following order:turbid toxin and stasis obstruction syndrome,yin and yang deficiency syndrome,spleen-kidney yang deficiency syndrome,and qi and yin deficiency syndrome.(6)Logistic regression analysis results showed that TyG index,NLR,and CRP levels were closely associated with plaque stability in patients with DKD combined with CAS(P＜0.05 or P＜0.01).(7)ROC analysis showed that these markers have high prognostic value in DKD-CAS(P＜0.01).Conclusion TyG index,NLR,and CRP may serve as potential biomarkers for TCM syndrome differentiation and prognosis assessment in DKD-CAS.

Objective To study the effect of intra-aortic balloon pump(IABP)in the therapy of ST-segment-elevation myocardial infarction(STEMI)patients complicated with ventricular septal rupture(VSR).Methods A retrospective analysis was performed on 35 STEMI patients complicated with VSR.Those patients were admitted in Yan'an Hospital Affiliated to Kunming Medical University from January 2019 to June 2023.Patients were divided into the combine-treated group(20 cases)and the drug-treated group(15 cases)according to the therapeutic strategies.The combine-treated group received IABP implantation and drug therapy,and the drug-treated group only received drug therapy.The clinical characteristics,hemodynamic and cardiac function improvement and mortality were evaluated.Hemodynamic and cardiac function improvement were compared between the two groups.Results There were no statistically significant differences in age,male proportion and size of VSR between the two groups(P>0.05).In the combine-treated group,the average heart rate,the average arterial blood pressure,central venous pressure,the LVEF value of cardiac ultrasound,pleural effusion,B-Line of lung,the level of B-type natriuretic peptide(BNP),the level of serum creatinine and the level of serum lactic acid were improved at 72 h after IABP use(all P<0.05).All these indicators got worse in the drug-treated group.The mortality rate of the combine-treated group was markedly lower than that of the drug-treated group(P<0.05).The mortality rate of patients who received IABP implantation within 72 h after VSR was lower than that of patients who received IABP implantation beyond 72 h after VSR.Conclusion For patients with AMI complicated with VSR,implantation of IABP can significantly improve hemodynamics,cardiac function and reduce mortality.

Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.

Objective To develop an evidence-based practice program for ICU eye care and evaluate its application effect using Stetler model of research utilization.Methods The systematic search was carried out in domestic and foreign guid elines,systematic reviews,evidence summaries,expert consensuses on eye care for ICU patients.The quality of the included literature was evaluated and the evidence was summarized.The evidence based on expert advice,clinical context and stakeholder opinions was screened.According to Stetler model of research utilization,the evidence translation/application was formulated from 3 aspects,including method,level and type of evidence application,and the evidence translation was implemented using a stepwise trial design.Five ICUs in a tertiary hospital in Zhejiang Province were selected,and the order of enrollment of each ICU was determined by computer-generated random numbers from April to september,2022.In the first month,all ICUs were in pre-evidence-based practice period,and in the second month,an ICU was trained and entered the evidence-based practice period.Until the 6th month,all ICUs entered the evidence-based practice period.Then the rate of ocular symptoms and implementation rate of eye care measures were compared before and after EBP.Results A total of 1 540 patients were included.With regard to the implementation rate of eye care measures,the rate of lubricant use and suspected ocular infection management in patients at high risk for ocular complications in evidence-based practice period was significantly higher compared with pre-evidence-based practice period(P＜0.001),and no statistically significant difference was found in the rate of eyelid closure.The incidence of conjunctival exposure,subconjunctival hemorrhage,conjunctival congestion,and ocular discharge in non-neurology critical care patients decreased compared with pre-evidence-based practice period(P＜0.05),and the incidence of conjunctival edema and conjunctival congestion in NICU patients decreased compared with pre-evidence-based practice period as the intervention continued(P＜0.001).Conclusion Evidence-based practice in eye care for ICU patients using Stetler model of research utilization can standardize the practice of eye care for ICU patients and improve the quality of care.

Objective:To investigate the thyroid function status and levothyroxine ( L-T 4) replacement therapy strategy in pregnant women after 131I treatment of hyperthyroidism. Methods:From January 2005 to December 2019, 88 patients (age: (27.3±3.7) years) who received 131I treatment in Nanjing Drum Tower Hospital were retrospectively analyzed. They became pregnant at least half a year after 131I treatment with normal thyroid function and delivered successfully. Thyroid stimulating hormone (TSH), free triiodothyronine (FT 3) and free thyroxine (FT 4) were respectively detected at 1-3 months before pregnancy, 4-7, 8-12, 13-22, 23-28, ≥29 weeks of pregnancy, and 6 weeks, 3 months, 6 months of postpartum. According to the 2011 American Thyroid Association guidelines, L-T 4 replacement therapy was performed to maintain normal thyroid function. Repeated measures analysis of variance and the least significant difference t test were used to analyze data. Results:There were significant differences in TSH, FT 3, FT 4 and L-T 4 among different time periods before pregnancy, pregnancy and postpartum ( F values: 5.94, 3.32, 3.49, 9.63, all P<0.05). In order to maintain normal thyroid function in each period of pregnancy, the doses of L-T 4 replacement therapy were increased to (82.33±35.06) μg and (100.75±36.77) μg at 4-7, 8-12 weeks of pregnancy compared with the dose ((64.52±34.32) μg) before pregnancy ( t values: 7.33, 10.44, both P<0.001). The doses of L-T 4 were increased slowly after 13 weeks of pregnancy. In the third trimester (≥29 weeks), the dose was 76.69% higher than that before pregnancy. There were significant changes of TSH, FT 3 and FT 4 at 6 weeks of postpartum compared with those in the third trimester (TSH: (1.21±1.08) vs (2.99±1.42) mU/L, FT 3: (5.23±1.07) vs (3.90±0.55) pmol/L, FT 4: (21.29±4.96) vs (15.37±2.29) pmol/L, t values: -2.48, 6.05, 5.88, P values: 0.017, <0.001, <0.001). Compared with that in the third trimester, the dose of L-T 4 was decreased significantly at 6 weeks of postpartum ( t=-6.85, P<0.001), but doses of L-T 4 at 6 weeks, 3 months and 6 months of postpartum were still higher than that before pregnancy ( t values: 4.67-4.71, all P<0.001). Conclusions:TSH, FT 3 and FT 4 should be regularly monitored at 1-3 months before pregnancy, gestation period and 6 weeks of postpartum in pregnant women after 131I treatment of hyperthyroidism. The dose of L-T 4 should be adjust to the serum TSH level as soon as possible.

BACKGROUND: The burden of esophageal cancer varies across different regions of the world. The aim of this study is to analyze the current burden of esophageal cancer in 185 countries in 2022 and to project the trends up to the year 2050. METHODS: We extracted data on primary esophageal cancer cases and deaths from the GLOBOCAN 2022 database, which includes data from 185 countries. Age-standardized incidence rates (ASIR) and mortality rates (ASMR) per 100,000 person-years were calculated by stratifying by Human Development Index (HDI) levels and regions. Considering changes in population size and age structure, we assumed that the risks of incidence and mortality remain constant at the levels of 2022 to forecast the number of new cases and deaths from esophageal cancer globally by 2050. RESULTS: In 2022, an estimated 511,054 people were diagnosed with esophageal cancer globally, and 445,391 died from the disease. The global ASIR and ASMR for esophageal cancer were 5.00 and 4.30 per 100,000, respectively. The highest rates were observed in East Africa (7.60 for incidence, 7.20 for mortality per 100,000), East Asia (7.60 for incidence, 5.90 for mortality per 100,000), Southern Africa (6.30 for incidence, 5.90 for mortality per 100,000), and South Central Asia (5.80 for incidence, 5.50 for mortality per 100,000). Among the 185 countries worldwide, esophageal cancer was among the top five causes of cancer incidence in 18 countries and among the top five causes of cancer mortality in 25 countries. In 2022, China had 224,012 new cases and 187,467 deaths from esophageal cancer, accounting for approximately 43.8% and 42.1% of the global total, respectively, which is higher than the proportion of China's population to the global population (17.9%). ASIR was 8.30 per 100,000, and ASMR was 6.70 per 100,000. The highest burden of esophageal cancer was in high HDI countries, with new cases and deaths accounting for 51.3% and 50.0% of the global total, respectively. The ASIR and ASMR were highest in the high HDI group (6.10 and 5.10 per 100,000, respectively), also exceeding the global averages. There was a trend of decreasing mortality to incidence ratio with increasing HDI, but no correlation was observed between HDI and ASIR or ASMR. In all regions worldwide, the incidence and mortality rates were higher in males than in females (with a male-to-female ASR ratio ranging from 1.10 to 28.7). Compared to 2022, it is projected that by 2050, the number of new esophageal cancer cases will increase by approximately 80.5%, and deaths will increase by 85.4% due to population growth and aging. CONCLUSIONS The burden of esophageal cancer remains heavy. Adopting a healthy lifestyle, including reducing tobacco and alcohol intake, avoiding moldy foods, and increasing intake of fresh fruits and vegetables, can help reduce the risk of stomach and esophageal cancer. In addition, the development and implementation of evidence-based and effective public health policies are critical to reducing the global disease burden of esophageal cancer.
Esophageal Neoplasms/mortality* ; Humans ; Male ; Incidence ; Female ; Middle Aged ; Global Health ; Aged ; Adult

Emerging SARS-CoV-2 variants have made COVID-19 convalescents susceptible to re-infection and have raised concern about the efficacy of inactivated vaccination in neutralization against emerging variants and antigen-specific B cell response. To this end, a study on a long-term cohort of 208 participants who have recovered from COVID-19 was conducted, and the participants were followed up at 3.3 (Visit 1), 9.2 (Visit 2), and 18.5 (Visit 3) months after SARS-CoV-2 infection. They were classified into three groups (no-vaccination (n = 54), one-dose (n = 62), and two-dose (n = 92) groups) on the basis of the administration of inactivated vaccination. The neutralizing antibody (NAb) titers against the wild-type virus continued to decrease in the no-vaccination group, but they rose significantly in the one-dose and two-dose groups, with the highest NAb titers being observed in the two-dose group at Visit 3. The NAb titers against the Delta variant for the no-vaccination, one-dose, and two-dose groups decreased by 3.3, 1.9, and 2.3 folds relative to the wild-type virus, respectively, and those against the Omicron variant decreased by 7.0, 4.0, and 3.8 folds, respectively. Similarly, the responses of SARS-CoV-2 RBD-specific B cells and memory B cells were boosted by the second vaccine dose. Results showed that the convalescents benefited from the administration of the inactivated vaccine (one or two doses), which enhanced neutralization against highly mutated SARS-CoV-2 variants and memory B cell responses. Two doses of inactivated vaccine among COVID-19 convalescents are therefore recommended for the prevention of the COVID-19 pandemic, and vaccination guidelines and policies need to be updated.