ObjectiveTo investigate the performance of fibrosis-4 （FIB-4） versus aspartate aminotransferase-to-platelet ratio index （APRI） in predicting advanced liver fibrosis and disease progression in patients with chronic HBV infection. MethodsA total of 497 patients with chronic HBV infection who underwent liver biopsy in The First Affiliated Hospital of Guangxi Medical University from February 2013 to December 2022 were enrolled， among whom 404 were enrolled in a retrospective study and 75 were enrolled in a prospective study. Related indicators were collected， including demographic features （sex and age）， biochemical indices （alanine aminotransferase ［ALT］ and aspartate aminotransferase ［AST］）， and platelet count， and FIB-4 and APRI were calculated. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups； the chi-square test was used for comparison of categorical data between groups. The area under the ROC curve （AUC） was used to assess the ability of APRI and FIB-4 in evaluating liver fibrosis degree and disease progression in patients with chronic HBV infection. ResultsIn the retrospective analysis， compared with the FIB-4<2.67 group， the FIB-4≥2.67 group had a significantly higher proportion of the patients who were diagnosed with liver cirrhosis or hepatocellular carcinoma （66.19% vs 47.54%， χ²=12.75， P<0.001）. The medians of FIB-4 and APRI increased significantly with liver fibrosis degree from F0 to F4 （H=42.5 and 35.9， both P<0.001）. As for the fibrosis stage of F0-F4， the median of FIB-4 was significantly higher than that of APRI in the patients with the same fibrosis stage （H=59.71， P<0.001）. FIB-4 and APRI had a similar AUC for predicting stage F3 fibrosis （0.67 vs 0.65， Z=0.71， P=0.480）， while FIB-4 had a higher AUC for predicting stage F4 fibrosis than APRI （0.72 vs 0.64， Z=10.50， P<0.001）. In the prospective study cohort， FIB-4 and APRI showed an increasing trend over time in predicting disease progression （chronic hepatitis B to liver cirrhosis）， with an AUC of 0.718 （95% confidence interval ［CI］： 0.476‍ ‍—‍ ‍0.760） and 0.555 （95%CI： 0.408‍ ‍—‍ ‍0.703）， respectively， and FIB-4 had a significantly higher accuracy than APRI in predicting disease progression （χ²=12.44， P<0.001）. ConclusionFIB-4 and APRI can be used to evaluate advanced liver fibrosis （F3 and F4） and predict disease progression， and FIB-4 is superior to APRI in certain aspects.

Critically ill patients are at high risk for hospital acquired infections, which can significantly increase the mortality rate and treatment costs for these patients. Therefore, in the process of treating the primary disease, strict prevention and control of new hospital infections is an essential component of the treatment for critically ill patients. The treatment of critically ill patients involves multiple steps and requires a concerted effort from various aspects such as theory, management, education, standards, and supervision to achieve effective prevention and control of hospital infections. However, there is currently a lack of unified understanding and standards for hospital infection prevention and control. To address this, in March 2024, a group of experts in critical care medicine, infectious diseases, and hospital infection from China discussed the current situation and issues of hospital infection control in the intensive care unit together. Based on a review of the latest evidence-based medical evidence from both domestic and international sources, 2024 Expert Consensus on Hospital Acquired Infection Control Principles in the Department of Critical Care Medicine was formed, aiming to provide a basis for the development of hospital infection prevention and control strategies in the field of critical care medicine.

Objective:To assess respondents' understanding of the items in the Neck Dissection Impairment Index (NDII) through cognitive interviews and to revise the items accordingly.Methods:Totally 30 postoperative neck dissection patients returning for follow-up at Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University from November 2023 to February 2024, were selected by purposive sampling for two rounds of cognitive interviews. Based on the interview results, the Chinese version of the NDII was revised.Results:The Chinese version of the NDII included ten items. The first round of interviews identified issues such as "incomplete expression, abstract language, and written form, " leading to revisions of five items. The second round of interviews showed that all respondents understood the revised items, and no new suggestions for modification were made.Conclusions:Cognitive interviews can improve respondents' comprehension of the Chinese version of the NDII, identify cognitive biases caused by cultural differences and improper linguistic expressions during the translation process, and enhance the understanding and acceptance of the scale's content among the target population.

Objective To evaluate the types and imaging features of early and late complications after liver transplantation.Methods A retro-spective analysis was conducted on the complications imaging data from 124 patients after liver transplantation.The CT and MRI characteristics of these complications was analyzed,categorized based on their occurrence time and type.Results The postoperative complications in the total 124 patients included vascular complication in 85 patients,biliary complication in 78 patients,and parenchy-mal complication in 21 patients.Additionally,the simple and complex complications were exhibited in 43 and 81 patients.Early vas-cular complication accounted for 69.8％,especially 21 cases(91.3％)were with early hepatic artery thrombosis.Bile leakage in 9 cases occurred in the early postoperative period,whereas biliary stenosis in 43 cases and biliary stones in 23 cases were observed in the late postoperative period.All ischemic infarction in 13 cases occurred in the early postoperative period.Among the 10 cases of liver abscess,8 cases were secondary to ischemic necrosis of liver parenchyma,and other 2 cases were secondary to suppurative cholangitis.Addi-tionally,6 cases of liver tumor recurrence were all detected in the late postoperative period.Conclusion The types of complications occurring after liver transplantation vary over time,and CT and MRI can be used to detect and evaluate postoperative complications.

Objective:We aimed to develop a novel visualized model based on nomogram to predict postoperative overall survival.Methods:This was a multicenter, retrospective, observational cohort study, including participants with histologically confirmed gastric and colorectal cancer who underwent radical surgery from 11 medical centers in China from August 1, 2015 to June 30, 2018. Baseline characteristics, histopathological data and nutritional status, as assessed using Nutrition Risk Screening 2002 (NRS 2002) score and the scored Patient-Generated Subjective Global Assessment, were collected. The least absolute shrinkage and selection operator regression and Cox regression were used to identify variables to be included in the predictive model. Internal and external validations were performed.Results:There were 681 and 127 patients in the training and validation cohorts, respectively. A total of 188 deaths were observed over a median follow-up period of 59 (range: 58 to 60) months. Two independent predictors of NRS 2002 and Tumor-Node-Metastasis (TNM) stage were identified and incorporated into the prediction nomogram model together with the factor of age. The model's concordance index for 1-, 3- and 5-year overall survival was 0.696, 0.724, and 0.738 in the training cohort and 0.801, 0.812, and 0.793 in the validation cohort, respectively.Conclusions:In this study, a new nomogram prediction model based on NRS 2002 score was developed and validated for predicting the overall postoperative survival of patients with gastric colorectal cancer. This model has good differentiation, calibration and clinical practicability in predicting the long-term survival rate of patients with gastrointestinal cancer after radical surgery.

Humans ; Critical Illness ; Multiple Organ Failure/etiology*

Objective:To summarize the echocardiographic features and outcomes in fetuses with congenital ventricular outpouching (CVO).Methods:This retrospective study enrolled ten fetuses diagnosed with CVO by fetal echocardiography in the Affiliated Hospital of Qingdao University and Qingdao Women and Children's Hospital from January 2015 to April 2022. Clinical data were analyzed, including echocardiographic features, other intracardiac and extracardiac malformations, karyotypes, and pregnancy outcomes. Data were analyzed by descriptive statistics.Results:All ten cases were single, including eight ventricular diverticula and two ventricular aneurysms. Five cases had the anomaly in the left ventricular and the other five in the right. Five cases were isolated malformations, and the other five were complicated by other intra- or extracardiac malformations. A pathogenic copy number variation was detected in one case. Three pregnancies were terminated, and one was lost to follow-up. The other six fetuses were born alive and showed no obvious clinical symptoms or abnormalities in growth and development during 3-70 months of follow-up. The right ventricular diverticulum spontaneously disappeared in one case. One case with the right ventricular aneurysm was also diagnosed with noncompaction of the left ventricular myocardium by echocardiography at six months.Conclusions:Fetal CVO presents with typical echocardiographic features and can be diagnosed prenatally. Regular follow-up during pregnancy is recommended to observe the sizes of outpouchings and the occurrence of complications in fetuses with CVO after excluding other structural and chromosomal abnormalities to avoid unnecessary termination. Attention should also be paid to postnatal follow-up.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

Acute respiratory and circulatory disorders are the most common critical syndromes, the essence of which is damage to the organs/systems of the heart and lungs. These comprise the essential manifestation of disease and injury progression to the severe stage. Its development involves the following components: individual specificity, primary disease strike, dysregulation of the host′s response, and systemic disorders. Admission for acute respiratory and circulatory disorders is a clinical challenge. Based on a previously proposed flow, a critical care ultrasound-based stepwise approach (PIEPEAR) as a standard procedure to manage patients with acute cardiorespiratory compromise and practical experience in recent years, a modified seven-step analysis and treatment process has been developed to help guide clinicians with rational thinking and standardized treatment when faced with acute respiratory and circulatory disorders. The process consists of seven steps: problem-based clinical analysis, intentional information acquisition, evaluation of core disorder based on critical care ultrasound, pathophysiology and host response phenotype identification, etiology diagnosis, act treatment through pathophysiology-host response and etiology, and re-check. The modified seven-step approach is guided by a “modular analysis” style of thinking and visual monitoring. This approach can strengthen the identification of clinical problems and facilitate a three-in-one analysis. It focuses on pathophysiological disorders, body reactions, and primary causes to more accurately understand the condition′s key points, and make treatment more straight forward, to finally achieve the aim of “comprehensive cognition and refined treatment”.

Objective:To summarize the prenatal ultrasound features and prognosis of fetal goiter.Methods:The prenatal ultrasound findings and clinical data of five cases of fetal goiter in the Affiliated Hospital of Qingdao University from August 2018 to October 2022 were retrospectively analyzed regarding the sonographic features, concomitant signs, and prognosis using descriptive statistical method.Results:The five cases were first diagnosed as fetal goiter at 25-35 weeks of gestation, with all of them showing hypoechoic or medium echoic masses in the fetal anterior neck area. One case exhibited a central blood flow signal, early appearance of the distal femoral ossification center, tachycardia, increased cardiothoracic ratio during pregnancy, and developed postnatal hyperthyroidism. Three cases showed peripheral blood flow signals and had postnatal hypothyroidism, one of which had delayed appearance of distal femoral ossification center and increased cardiothoracic ratio. One case showed a peripheral blood flow signal with normal thyroid function after birth. Among the five cases, tracheal compression and polyhydramnios were found in one case; neck hyperextension was found in three cases. After treatment, the size of goiters did not change or shrunk in three cases and increased with the gestations in one case. One case did not receive any prenatal treatment and was born through cesarean section due to late detection and increased cardiothoracic ratio. Two cases underwent cesarean section at 35 gestational weeks, one had full-term cesarean section, and two delivered vaginally at term. Hyperthyroidism in one neonate was caused by excessively elevated maternal thyrotropin receptor antibody. Three cases of hypothyroidism occurred due to maternal antithyroid medication whose thyroid function recovered after supplementation of thyroxine. The thyroid function was normal in the rest of the baby. During the follow-up from 9 months to 4 years and 11 months old, no abnormalities in the intellectual and motor development of the five children were found.Conclusions:Fetal goiter often exhibits hypochoic or medium echoic mass in the anterior neck during prenatal ultrasonography. The fetal thyroid function could be evaluated according to different blood flow patterns and the presence of the ossification center. The prognosis of fetal goiter is good after active prenatal treatment.