Objective:To evaluate the value of the skeletal muscle index (SMI) and psoas major muscle index(PMI) measured at the third lumbar vertebra(L3) level in the evaluation on nutritional status and prognosis of cirrhosis patients with ascites.Methods:The clinical data of 102 patients with cirrhosis and ascites treated in our department between September 2018 and September 2022 was analyzed retrospectively, the skeletal muscle and psoas muscle area at L3 level were measured, and L3-SMI and L3-PMI were calculated. According to L3-SMI, patients were divided into the sarcopenia group (62 cases) and the normal muscle mass group (40 cases). Differences between the two groups were compared in terms of L3-SMI, L3-PMI, body mass index (BMI), albumin, the rate of re-admissions and mortality during follow-up. The value of each index in nutritional assessment was also explored.Results:L3-SMI, L3-PMI, and albumin in the sarcopenia group were significantly lower than those in the normal muscle mass group, with statistical significance ( P<0.01).The BMI of the sarcopenia group was lower than that of the normal muscle mass group, but the difference was not significant ( P>0.05). L3-PMI showed better performance in nutritional assessment compared with albumin and BMI. The rate of re-admissions and the mortality rate in the sarcopenia group during the follow-up period were significantly higher compared with the normal muscle mass group ( P<0.05). Conclusion:L3-SMI and L3-PMI can effectively reflect the nutritional status of cirrhosis patients with ascites, and are promising indicators for prognosis prediction in cirrhosis patients with ascites.

Objective:To investigate changes and clinical significance of senescent cell proportion and senescence-associated cytokines in peripheral blood of patients with acute myeloid leukemia(AML)in different states.Methods:AML patients who were diagnosed and treated in the Second Hospital of Anhui Medical University were selected as research subjects(17 cases in newly diag-nosed group,16 cases in remission group,and 12 cases in relapse group),morphology of leukemia blasts and proportion of senescent cells in peripheral blood of patients in each group were observed by Regis and senescence specific β-galactosidase(SA-β-gal)staining,levels of senescence-associated cytokines IL-8,IL-1β,IL-6,IL-10 in peripheral blood of each group were detected by cytometric bead array(CBA),and differences and clinical significance among groups were compared.Results:Relapse group peripheral blood smear Regis staining showed that morphology of leukemia blasts increased significantly and proportion of SA-β-gal positive cells was significantly increased(P<0.01);levels of serum senescence-associated cytokines IL-8,IL-1β,IL-6 and IL-10 in relapse group were significantly increased(P<0.05);there was no correlation between serum senescence-associated cytokine levels and proportion of peripheral blood leukemia blasts(P>0.05);relapsed patients with higher IL-8 levels trend to have lower re-induction remission rates and worse overall survival after relapse(P<0.05);multivariate Cox regression analysis showed that IL-8 level was an indepen-dent risk factor for prognosis of relapsed patients(P<0.05).Conclusion:Increased proportion of senescent cells and significantly increased levels of senescence-associated cytokines IL-8,IL-1β,IL-6,IL-10 in peripheral blood of AML patients are closely related to disease recurrence,and relapsed patients with higher IL-8 level had poor prognosis.

Objective:To systematically review the effect of fracture liaison service (FLS) in elderly patients with fragile hip fractures, so as to provide reference for clinical decision-making.Methods:By combining subject terms and free terms, electronic searches were conducted on China National Knowledge Infrastructure, WanFang Data, VIP, China Biomedical Literature Database, PubMed, Embase, Cochrane Library and Web of Science. The included references were manually retrieved using the snowball method. The retrieval time was from the establishment of the database to March 1, 2023. Two researchers screened articles based on inclusion and exclusion criteria, extracted data, and evaluated the quality of articles, using RevMan5.4 software for statistical analysis.Results:A total of 15 articles were included, totaling 4 333 patients with fragile hip fractures, with a follow-up time of ≥3 months. Meta-analysis showed that FLS could improve patient medication compliance [ RR=2.32, 95% CI (1.74, 3.11) , P<0.01] and hip function [ SMD=1.20, 95% CI (0.93, 1.47) , P<0.01] , reduce mortality [ RR=0.70, 95% CI (0.58, 0.84) , P<0.01] and the occurrence of refractures [ RR=0.44, 95% CI (0.32, 0.61) , P<0.01] , with statistical differences. Conclusions:Compared with routine nursing for fragile hip fractures, FLS can improve medication compliance and hip function, decrease mortality and the occurrence of refractures in patients with fragile hip fractures.

Objective:To analyze the relationship between gait speed or grip strength and all-cause mortality in elderly inpatients over 75 years old, and to compare their predictive value for all-cause mortality.Methods:A prospective cohort study was conducted and enrolled elderly patients aged ≥75 years hospitalized from December 2016 to December 2019 at the Department of Integrated Medicine and Geriatrics, Fuxing Hospital, Capital Medical University.Gait speed(m/s)and grip strength(kg)were respectively measured via the 6-meter walk test and a dynamometer.The patients were followed up for more than 1 year after discharge, and the time of all-cause mortality was recorded.The Cox regression model was used to analyze the correlation between gait speed, grip strength or their combination and the risk of all-cause mortality.ROC curves were statistically analyzed using the DeLong test.Results:A total of 704 patients were enrolled, with an average age of(83.8±6.3)years; the median follow-up time was 33(24, 42)months.During the follow-up period, all-cause death occurred in 131 cases(18.6%).Compared with the high gait speed and high grip strength groups, the low gait speed and low grip strength groups had higher all-cause mortality(all P<0.05).The Cox regression model was used to analyze the relationships between gait speed, grip strength and all-cause mortality.The results showed that gait speed( HR=2.255, 95% CI: 1.462-3.477, P<0.001)and grip strength( HR=1.815, 95% CI: 1.232-2.673, P<0.001)were associated with the risk of all-cause mortality after adjustment for other factors; When gait speed slowed down and grip strength decreased, the risk of death reached the highest level( HR=3.156, 95% CI: 1.829-5.445, P<0.001).The AUC of the gait speed model(0.703, 95% CI: 0.667-0.736)was higher than the AUC of the grip strength model(0.648, 95% CI: 0.611-0.683), with a difference of 0.055(95% CI: 0.006-0.103, P=0.026). Conclusions:Decreased gait speed or grip strength is related to an increase of death risk.The risk of death is highest when the patient has both slowed gait speed and decreased grip strength.The predictive value of gait speed for death is better than grip strength.Together they can be used as simple, rapid and effective tools to predict all-cause mortality in this population.

Objective:To search, evaluate and summarize the evidence related to the maintenance of peripheral arterial duct flushing systems in children for clinical reference.Methods:Up To Date, BMJ, Nathional Institute for Health and Care Excellence(NICE), Chinese Medlive, Cochrane Library, Joanna Briggs Institute(JBI), CINAHL, METSTR, PubMed, Wanfang, CNKI, VIP were used to collect secondary evidence resources about management and maintenance of peripheral arterial duct flushing systems in children. After the quality evaluation of each type of literature, the evidence was extracted and summarized.Results:A total of 9 articles were included in the research. The 22 pieces of best evidence were obtained from 7 aspects, including basic requirements of children′s peripheral arterial duct flushing systems, arterial flushing method, flushing rate of injection pump system, flushing pressure of pressurized bag pump system, arterial flushing fluid, replacement and maintenance of children′s arterial catheter flushing system, and continuous improvement of arterial catheter maintenance.Conclusions:The best evidence for the establishment and maintenance of pediatric peripheral arterial duct flushing systems provides a basis for clinical decision, but practice testing is still needed.

BACKGROUND: The fetal growth charts in widest use in China were published by Hadlock >35 years ago and were established on data from several hundred of American pregnant women. After that, >100 fetal growth charts were published around the world. We attempted to assess the impact of applying the long-standing Hadlock charts and other charts in a Chinese population and to compare their ability to predict newborn small for gestational age (SGA). METHODS: For this retrospective observational study, we reviewed all pregnant women ( n  = 106,455) who booked prenatal care with ultrasound measurements for fetal biometry at the Shenzhen Maternity and Child Healthcare Hospital between 2012 and 2019. A fractional polynomial regression model was applied to generate Shenzhen fetal growth chart ranges for head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL). The differences between Shenzhen charts and published charts were quantified by calculating the Z -score. The impact of applying these published charts was quantified by calculating the proportions of fetuses with biometric measurements below the 3rd centile of these charts. The sensitivity and area under the receiver operating characteristic curves of published charts to predict neonatal SGA (birthweight <10th centile) were assessed. RESULTS: Following selection, 169,980 scans of fetal biometry contributed by 41,032 pregnancies with reliable gestational age were analyzed. When using Hadlock references (<3rd centile), the proportions of small heads and short femurs were as high as 8.9% and 6.6% in late gestation, respectively. The INTERGROWTH-21st standards matched those of our observed curves better than other charts, in particular for fat-free biometry (HC and FL). When using AC<10th centile, all of these references were poor at predicting neonatal SGA. CONCLUSIONS Applying long-standing Hadlock references could misclassify a large proportion of fetuses as SGA. INTERGROWTH-21st standard appears to be a safe option in China. For fat-based biometry, AC, a reference based on the Chinese population is needed. In addition, when applying published charts, particular care should be taken due to the discrepancy of measurement methods.
Infant, Newborn ; Child ; Female ; Pregnancy ; Humans ; Growth Charts ; Prenatal Care ; Ultrasonography, Prenatal/methods* ; Fetal Development ; Fetal Growth Retardation ; Gestational Age ; Fetus ; China ; Infant, Newborn, Diseases ; Observational Studies as Topic

Objective:To investigate the safety and clinical outcome of ultra-early oral nutrition after endoscopic treatment of gastroesophageal variceal bleeding in liver cirrhosis patients.Methods:Cirrhotic patients with gastroesophageal variceal bleeding who received endoscopic treatment at the Endoscopic Center of Beijing Haidian Hospital were retrospectively included from January 2018 to January 2022. The patients were divided into ultra-early oral nutrition group where patients would fast for 4 hours after endoscopic treatment and routine treatment group where patients would fast for at least 48 hours after operation and receive parenteral nutrition during fasting. The rebleeding, infection events (including pulmonary infection, urinary infection, spontaneous bacterial peritonitis, etc.), hospitalization duration and hospital readmission were recorded and compared between the two groups.Results:A total of 96 patients were enrolled, including 52 with ultra-early oral nutrition, 44 with routine treatment. There was no significant difference in age, gender, BMI, cause of liver cirrhosis, Child-Pugh score, LDRf classification of gastroesophageal varices and degree of esophageal varices between the two groups ( P > 0.05). All patients were followed up for 6 weeks and there was no significant difference in incidence of rebleeding (5.8% vs 4.5%, P > 0.999), peritonitis (1.9% vs 4.5%, P = 0.883), pulmonary infection (5.8% vs 11.4%, P = 0.537) and urinary infection (3.8% vs 2.3%, P > 0.999) between the two groups. The non-inferiority analysis suggested that the safety defined as free from rebleeding in ultra-early oral nutrition group was not inferior to that in routine treatment group ( P = 0.0018). The hospitalization duration in ultra-early oral nutrition group was significantly shorter than that in routine treatment group (6 days vs 9 days, P < 0.001). The hospital readmission rate within 6 weeks in the ultra-early oral nutrition group tended to be lower than that in the routine treatment group (3.8% vs 9.1%, P = 0.526). Conclusion:Ultra-early oral nutrition after endoscopic treatment of gastroesophageal variceal bleeding in liver cirrhosis patients shows similar rebleeding risk compared with current practice and can shorten hospitalization duration.

Objective:To preliminarily observe the clinical efficacy of microwave hyperthermia combined with intensity-modulated radiotherapy (IMRT) and chemotherapy for patients with locally advanced gastric cancer.Methods:Forty patients who could not been operated or refused operation were enrolled in this clinical trial, who were confirmed as locally advanced proximal or distal gastric cancer by gastroscopy pathology and imaging. Radiotherapy was delivered by IMRT technology for 5 times per week with a total dose of 46 to 56 Gy (median dose of 50 Gy) in 25 to 28 fractions. Synchronous hyperthermia was given at 42 to 44℃ twice a week, 45 min/time. S-1 or capecitabine-based synchronous chemotherapy was performed, d1-14/3 weeks. The symptom remission rate, adverse reactions, objective remission rate (complete and partial remission) and survival were observed.Results:A total of 40 patients, aged between 56 and 83 years (median age of 71 years), were enrolled in this study. The male-to-female ratio was 7: 1. Among them, 38 cases (95%) showed symptom remission. The most common adverse reactions were grade 1-2 gastrointestinal reactions and leukopenia. The objective remission rate was 87.5%, the 2-year progression-free survival and overall survival rates were 68.6% and 70.5%, respectively.Conclusion:Preliminary findings demonstrate that microwave hyperthermia combined with chemoradiotherapy achieve satisfactory outcomes and yield tolerable toxicity in patients with locally advanced gastric cancer.

Owing to its insidious onset, the diagnosis of ovarian cancer is usually delayed and followed with ascites, which results in a poor prognosis compared to other gynecological malignant tumors. Ascites, a pathological accumulation of fluid in the abdominal cavity, contains a variety of cellular and non-cellular components, which promotes tumor metastasis, leads to chemotherapy resistance, and seriously affects the quality of life and prognosis of patients. In this article, the basic characteristics and the recent progress of ascites in ovarian cancer are reviewed, so as to provide references for further research.

Objective:To explore the medication regularity and prescription rule of Chinese herbal medicine in the treatment of cardiac failure.Methods:The China Patent Publication Notice of the State Intellectual Property Office (http://epub.sipo.gov.cn/) was rearched and retrievedfor Chinese herbal medicine for the treatment of heart failure. The Traditional Chinese Medicine (TCM) inheritance support system (V 2.5) was used to input the prescription information and establish the database. The association rules, mutual information method, entropy clustering of complex systems and other data mining methods were used for commonly used drugs, combination rule and new prescription of core group.Results:A total of 101 prescriptions were included, involving 316 drugs. The frequency of commonly used drugs were Astragali Radix (59.41%), Poria (41.58%), Salviae Miltiorrhizae Radix et Rhizoma (40.59%), Descurainiae Semen Lepidii Semen (34.65%), Aconiti Lateralis Radix Praeparata (33.66%), and the medicinal properties were mainly warm, and the sweet taste. The main flavors weresweet, bitterness, and pungency, and the main sources of meridians belonged to liver, spleen, heart, lungs and kidneys. The most commonly used drug combinations contribute to supplement Qi, invigorate blood circulation and stasis, warm Yang, remove moisture. There were 12 core drug groups and 6 new prescriptions for heart failure. Conclusions:Analysis on formulas for heart failure shows that the prescriptions focus on supplementing qi and activating blood circulation, warming Yang reducing dampness, invigorating spleen, and nourishing Yin, dispel turbid, solid Yang. It can provide reference for clinical treatment to improve curative effect and standardize prescription medication.