【Objective】 To analyze the independent influencing factors of repeated extracorporeal shock wave lithotripsy (ESWL) in the treatment of upper urinary calculi (UUC), based on which a nomogram model was established to predict the efficacy. 【Methods】 Clinical and imaging data of 203 patients receiving repeated ESWL during Jan.2020 and Dec.2022 were collected, including 117 cases in the successful group and 86 cases in the unsuccessful group.The patients’ age and sex, stone volume (SV), surface area (SA), skin-to-site distance (SSD), maximum CT value, mean stone density (MSD), and stone heterogeneity index (SHI) were compared between the two groups.The independent predictors were analyzed with logistic regression and the meaningful variables (P<0.05) were used to establish a nomogram.The efficacy of the model was evaluated using receiver operating characteristic (ROC) curve and decreasing curve analysis (DCA).Internal validation was also performed. 【Results】 Stepwise regression showed that SV, SSD, MSD and SHI were independent influencing factors (P<0.05).The area under the ROC curve (AUC), optimal threshold, sensitivity and specificity were 0.793 (95%CI: 0.674-0.911), 0.619, 77.1% and 74.0%, respectively.The DCA curve was above two extreme curves.Hosmer-Lemeshow test and calibration curve showed that the nomogram had a good fitting degree (χ²=5.526, P=0.489), and the correction C-index was 0.746. 【Conclusion】 SV, SSD, MSD and SHI are independent predictors of the efficacy of repeated ESWL in the treatment of UUC.The nomogram established based on the above indicators has good predictive efficiency and clinical applicability.

Objective:To evaluate the diagnostic accuracy of a noninvasive physiological parameter-based early sepsis screening model for elderly patients in comparison to the systemic inflammatory response syndrome(SIRS)and quick sequential organ failure assessment(qSOFA)scores.Methods:A retrospective study was conducted using data from the Medical Information Mart for Intensive Care Ⅳ(MIMIC-Ⅳ)database.The study focused on patients who were admitted to the intensive care unit(ICU)within 24 hours and were categorized into septic and non-septic groups based on the presence or absence of sepsis.Baseline data and patient outcomes were recorded.Additionally, the SIRS score and qSOFA scores within 24 hours of ICU admission were calculated.Physiological parameters that showed statistical significance in the univariate analysis included respiratory rate, heart rate, level of consciousness, body temperature, systolic blood pressure, and urine output.These parameters were then included in Logistic regression models.The specificity and sensitivity of the regression model for sepsis screening were calculated, and receiver operating characteristic(ROC)curves were plotted.The areas under the ROC curves(AUCs)of the screening model, SIRS, and qSOFA scoring systems were compared.Results:A total of 53 150 ICU hospitalization records were screened, and 23 681 patients with infection or suspected infection within 24 hours were included.Among them, 18 277 patients had sepsis.The 28-day mortality rate for septic patients was higher compared to non-septic patients(13.5% vs.5.1%, χ2=285.131, P<0.001).The baseline data within 24 hours showed significant differences between the two groups in terms of heart rate, respiratory rate, body temperature, state of consciousness, 24-hour urine output, and systolic blood pressure(all P<0.001).These variables were included in the regression equation: ∑β iX i=2.055+ 0.285(temperature: 0/1)+ 0.172(respiratory rate: 0/1)+ 0.073(heart rate: 0/1)+ 1.204(mental status: 0/1)-0.022(systolic blood pressure)+ 0.227(classification of urine output: 0/1/2), P=1/[1+ EXP(-∑β iX i)].The regression model diagnosed sepsis ROC area in young and middle-aged patients as 0.726(95% CI: 0.718 to 0.735), which was significantly higher than the SIRS score(0.585, 95% CI: 0.576 to 0.595)and the qSOFA score(0.676, 95% CI: 0.667 to 0.685)(both P<0.001).In elderly patients, the regression model diagnosed sepsis ROC area as 0.671(95% CI: 0.663 to 0.679), which was also significantly higher than the SIRS score(0.572, 95% CI: 0.563 to 0.580)and the qSOFA score(0.631, 95% CI: 0.623 to 0.639)(both P<0.001). Conclusions:The early sepsis diagnosis model, which utilizes noninvasive physiological parameters, has shown higher accuracy when compared to the SIRS and qSOFA scores.However, it is important to note that its accuracy is lower in elderly patients as compared to young and middle-aged patients.This indicates the necessity for further optimization of the model in order to improve its performance in diagnosing sepsis in the elderly.

Objective:To explore the predictive value of the prognostic nutritional index (PNI) in concurrently infected patients with acute-on-chronic liver failure (ACLF).Methods:220 cases with ACLF diagnosed and treated at the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2016 were selected. Patients were divided into an infection and non-infection group according to whether they had co-infections during the course of the disease. Clinical data differences were compared between the two groups of patients. Binary logistic regression analysis was used to screen out influencing factors related to co-infection. The receiver operating characteristic curve was used to evaluate the predictive value of PNI for ACLF co-infection. The measurement data between groups were compared using the independent sample t-test and the Mann-Whitney U rank sum test. The enumeration data were analyzed using the Fisher exact probability test or the Pearson χ2 test. The Pearson method was performed for correlation analysis. The independent risk factors for liver failure associated with co-infection were analyzed by multivariate logistic analysis. Results:There were statistically significant differences in ascites, hepatorenal syndrome, PNI score, and albumin between the infection and the non-infection group ( P ?

ObjectiveTo investigate the influencing factors for the prognosis of patients with acute－on－chronic liver failure （ACLF）， and to establish a short－term prognostic model. MethodsA retrospective analysis was performed for the baseline clinical data of 247 patients with ACLF who were hospitalized in Department of Infectious Diseases， The First Affiliated Hospital of Xi’an Jiaotong University， from January 2011 to December 2016， and the patients were divided into survival group and death group. The two groups were compared to identify the influencing factors for prognosis； a prognostic model was established， and the receiver operating characteristic （ROC） curve was used to assess its predictive efficacy and determine the optimal cut－off value. The independent－samples t test was used for comparison of normally distributed continuous data between groups， and the Mann－Whitney U rank sum test was used for comparison of non－normally distributed continuous data between groups； the Fisher’s exact test or the Pearson’s chi－square test was used for comparison of categorical data between groups. The univariate and multivariate logistic regression analyses were used to investigate the independent risk factors for 28－ and 90－day prognosis， and the Kaplan－Meier method was used to plot the 28－day survival curves. ResultsA total of 220 patients with ACLF were included based on the inclusion and exclusion criteria； there were 148 patients in the 28－day survival group and 72 patients in the 28－day death group， with a 28－day transplantation－free survival rate of 67.27%； there were 115 patients in the 90－day survival group and 105 patients in the 90－day death group， with a 90－day transplantation－free survival rate of 52.27%. The logistic regression analysis showed that female sex （odds ratio ［OR］=2.149， P=0.030）， high Model for End－Stage Liver Disease （MELD） score （OR=1.120， P<0.001）， and low lymphocyte count （OR=0.411， P=0.002） were independent risk factors for 28－day prognosis， and an LS－MELD model for 28－day prognosis was established as Logit （28－day prognosis）=－3.432+0.765×sex－0.890×lymphocyte count×10^－9+0.113×MELD（1 for male sex and 2 for female sex）. The ROC curve analysis showed that this model had an optimal cut－off value of 0.35， and then the patients were divided into low LS－MELD group （≤0.35） and high LS－MELD group （>0.35）； the low LS－MELD group had a significantly higher 28－day survival rate than the high LS－MELD group （P<0.001）. ConclusionPeripheral blood lymphocyte count combined with sex and MELD score has a certain value in predicting the short－term prognosis of ALCF patients.

Objective:To explore the efficacy and safety of adalimumab (ADA) in Chinese Takayasu arteritis (TAK) patients.Methods:This study prospectively included ten refractory active TAK patients. The clinical, laboratory and imaging data of these patients before and after ADA treatment were collected and compared. Statistical analysis was carried out with the statistical product and service solutions (SPSS) program V.24.0. We performed univariate analysis by Wilcoxon-Mann-Whitney test for numerical data according to normality. The P value <0.05 was interpreted as statistically significant. Results:Ten TAK patients recruited in this study were all female, with a median age of 27.5 [25.0, 36.0] years. Fever or fatigue (6/10, 60%), neck pain (6/10, 60%), and limb claudication (4/10, 40%) were the most common clinical manifestations. The most common pattern of vascular involvement was Numano type V (7/10, 70%). The serum erythrocyte sedimentation rate (ESR) [22.0(4.5, 37.5) mm/1 h vs 7.0(4.5, 31.0) mm/1 h, Z=-2.04, P=0.042] and IL-6 level [12.3(3.6, 57.7) ng/L vs 2.8(2.0, 24.0) ng/L, Z=-2.19, P=0.028] reduced significantly after ADA treatment. The thickness of the common carotid artery intima decreased from 2.7(2.2, 4.0) mm to 2.3(1.6, 3.4) mm after ADA treatment ( Z=-1.99, P=0.046). The lumen diameter of the common carotid artery increased from 0.31(0.20, 0.42) cm to 0.37(0.29, 0.43) cm ( Z=-2.02, P=0.043). The glucocorticoid dosage was reduced from [11.2(6.9, 15.0) mg to 10.0(5.0, 13.1) mg, Z=-1.89, P=0.059]. In the 10 patients, 6 patients (60%) reached complete response, 2 patients (20%) reached the partial response, and the total effective rate was 80%(8/10). Pneumonia in one TAK patient was recorded. Conclusion:The results of this study suggest, that ADA can be used for refractory active TAK patients, and is safe.

Objective To assess the prognostic accuracy of the quick Sequential Organ Failure Assessment (qSOFA) score for septic shock of adults with soft tissue infections.The clinical characteristics of these patients were analyzed to provide reference for their multidisciplinary treatment.Methods A retrospective study was conducted.The patients with soft tissue infections admitted to the General Surgery Department of Beijing Hospital and the Burn and Plastic Surgery Department of Fourth Medical Center of PLA General Hospital from January 2012 to December 2018 were enrolled and patients combined with other infections were excluded.Patients were divided into the septic shock group and the non-septic group according to whether septic shock occurred during hospitalization.The baseline data,non-operative management and prognosis were compared between the two groups with Fisher's exact test.The sensitivity,specificity,positive predictive value,negative predictive value and the area under the receiver operating characteristic curve (AUC) of the qSOFA for diagnosis of sepsis and septic shock were calculated.Patients were also divided into four groups according to the etiology of soft tissue infection.The pathogens,surgical treatment and morbidity of septic shock among the four groups were also compared.Results A total of 192 patients were enrolled,including 28 (14.6％) patients with septic shock.Compared with the non-septic shock group,there were more proportion of patients with qSOFA ≥ 2 (60.7％ vs 18.3％,P=0.001) within 24 h of diagnosis of infection,and higher morbidity of sepsis (82.1％ vs 32.9％,P＜0.01)within 48 h of diagnosis of infection in the septic shock group.At the cut-off value of qSOFA ≥ 2,the sensitivity,specificity,positive predictive value,negative predictive value and the AUC were 60.7％,81.7％,36.2％,92.4％ and 0.767 (95％CI:0.665-0.869,P＜0.01) respectively for diagnosis of septic shock.The morbidity of septic shock (36.4％) and 28-day mortality (13.6％) in patients with necrotizing fasciitis were higher than those in patients with other causes (both P＜0.05).The most common pathogens were methicillin-sensitive Staphylococcus (6.8％),methicillin-resistant Staphylococcus (6.2％),Enterobacter (5.7％) and Enterococcus (5.2％).Conclusions qSOFA ≥ 2 can be used as a rapid septic shock screening tool for adults with soft tissue infection.Early diagnosis of sepsis,thorough debridement and effective antibiotic treatment are essential for these patients.

The original version of this article unfortunately contained some mistakes.

Objective: To evaluate the effectiveness of health belief model-based health education intervention in improving blood pressure control of patients with hypertension in community settings. Methods: From September 2016 to September 2017, 400 newly diagnosed patients with hypertension were recruited from 6 community healthcare centers with comparable population size and health services in the Shunyi District of Beijing. All community healthcare centers were randomly assigned to the intervention group (206 patients) and the control group (194 patients). Patients in the intervention group received 3 lectures (20-30 min for each) of health belief model-based health education. Patients in the control group received usual care. The basic characteristics, health beliefs, and health literacy were collected, and blood pressure was measured before and after the intervention, respectively. The difference-in-difference model was used to analyze the change of blood pressure and the influencing factors between two groups before and after the intervention. Results: A total of 134 patients in the intervention group and 129 patients in the control group completed the study. After adjusting for the age, gender, family income, medical insurance, chronic diseases and family history, the score of perceived barriers was increased by 1.65 (P=0.016), and perceived seriousness was decreased by 0.73 (P=0.018). The systolic blood pressure of patients was decreased by 7.37 mmHg (1 mmHg=0.133 kPa, P=0.001) and diastolic blood pressure was decreased by 4.07 mmHg (P=0.014), respectively. The β (95%CI) values were -7.37 (-11.88,-2.86) and -4.07 (-7.30, -0.84). The perceived susceptibility and self-efficacy had a significant influence on the blood pressure of patients (P<0.05). Conclusion Health belief model-based health education intervention could significantly improve the blood pressure control of patients with hypertension in the community settings.

To assess the diagnosis accuracy of the quick sequential organ failure assessment (qSOFA) score for adult sepsis patient with soft tissue infection, and to assess the prognostic accuracy of the qSOFA score for septic shock. Methods A retrospective study was conducted. The patients with soft tissue infection admitted to the general surgery department of Beijing Hospital and the burns and plastic surgery department of Fourth Medical Center of PLA General Hospital from January 2012 to December 2018 were enrolled. Patients were divided into the sepsis group and the non-sepsis group according to whether sepsis occurred within 48 hours after diagnosis of infection. The baseline data, prognosis, and qSOFA, the change of sequential organ failure assessment (ΔSOFA), systemic inflammatory response syndrome (SIRS) scores were compared between the two groups, and the receiver operating characteristic (ROC) curves were also drawn to assess the diagnosis accuracy of the qSOFA and SIRS scores for adult sepsis patients with soft tissue infection and to assess the prognostic accuracy of the qSOFA, ΔSOFA and SIRS scores for septic shock of these patients. Results 192 patients were included in the study. Sepsis occurred in 79 patients (41.1%) within 48 hours after diagnosis of infection. Septic shock occurred in 28 patients (14.6%) during 28-day hospitalization and 6 patients (3.1%) died. Compared with non-sepsis group, more proportion of necrotizing fasciitis, septic shock and patients received mechanical ventilation (21.5% vs. 4.4%, 31.6% vs. 2.7%, 16.5% vs. 4.4%, all P < 0.01), with higher mortality (7.6% vs. 0%, P = 0.003) in sepsis group. ROC curve analysis showed that when the cut-off value of qSOFA ≥ 2, the sensitivity, specificity, positive predictive value, negative predictive value and area under ROC curve (AUC) were 48.1%, 92.0%, 80.8%, 71.7% and 0.824 [95% confidence interval (95%CI) = 0.764-0.884, P < 0.01] respectively for diagnosis of sepsis caused by soft tissue infection. When the cut-off value of SIRS score ≥ 3, the sensitivity, specificity, positive predictive value, negative predictive value and AUC were 89.8%, 48.6%, 55.0%, 87.3% and 0.721 (95%CI = 0.677-0.765, P < 0.01) respectively for diagnosis of sepsis caused by soft tissue infection. All scores of qSOFA ≥ 2, ΔSOFA ≥ 2 and SIRS score ≥3 could be used to predict septic shock (all P < 0.01). The AUC of ΔSOFA, qSOFA and SIRS scores were 0.767 (95%CI = 0.665-0.869), 0.840 (95%CI = 0.757-0.923) and 0.716 (95%CI = 0.596-0.835) respectively. Conclusions qSOFA ≥ 2 can be used as a rapid sepsis screening tool for adult patients with soft tissue infection. It is suggested that qSOFA or SIRS scores can be used to predict septic shock of adult patients with soft tissue infection initially.

Objective To observe the dynamic characteristics of hepatitis B core antibody (anti-HBc) titers in chronic hepatitis B (CHB) patients treated with interferon and to explore the predictive value of anti-HBc for response to interferon.Methods The clinical information of the patients diagnosed with CHB in Department of Infectious Diseases , the First Affiliated Hospital of Xi′an Jiaotong University from October 2011 to October 2014 were collected.HBV DNA, liver function and HBV serological markers of CHB patients were tested dynamically during and after interferon treatment.The dynamic characteristics of anti-HBc titers in patients with different virological responses were analyzed.The predictive values of anti-HBc titer for the efficacy of interferon treatment of CHB patients were analyzed by binary logistic regression .Results Of the 42 CHB patients aging(30.8 ±10.1) years old, 34 patients were hepatitis B e antigen (HBeAg) positive and 8 were negative.All patients completed 48-week interferon treatment and 24-week follow-up after the end of treatment. Among them, 28.6%( 12/42), 26.2%( 11/42 ) and 45.2%( 19/42 ) of patients achieved sustained virological response (SVR), virological relapse ( VR) and non-response ( NR), respectively.Patients with different virological response presented various characteristics of anti -HBc titers.Compared with NR group, the anti-HBc titers at baseline and week 12 were significantly higher in SVR group (at baseline: [4.93 ±0.30] vs [4.70 ±0.33] lg IU/mL, t ＝2.147, P ＝0.013; at week 12: [4.83 ± 0.23] vs [4.44 ± 0.41] lg IU/mL, t＝3.032, P＝0.007).The anti-HBc titers in SVR group at week 12 and week 24 were significantly higher than those in VR group (at week 12: [4.83 ±0.23] vs [4.67 ±0.51] lg IU/mL, t＝2.400, P＝0.039; at week 24: [4.73 ±0.21] vs [4.55 ±0.50] lg IU/mL, t＝2.542, P＝0.039).By multivariate logistic regression analysis, the anti-HBc titer at baseline was the independent predictive factor for SVR in CHB patients treated with interferon (OR＝6.000, 95%CI: 1.118 -20.486, P＝0.037).The area under receiver operating characteristics curve was 0.753 and the optimal cutoff value of anti-HBc titer for the response to interferons in CHB patients was 5.03 lg IU/mL, with positive predictive value of 64.3%and negative predictive value of 89.3%.Conclusions Dynamic pattern of anti-HBc titers is correlated with different virological responses in CHB patients treated with interferon , and the baseline anti-HBc titer is the independent predictive factor for SVR.