Accurate diagnosis of severe coronary stenosis based on resting magnetocardiography: a prospective, single-center, cross-sectional analysis

OBJECTIVE To evalu ate the role of resting magnetocardiography in identifying seve re coronary artery stenosis in patients with suspected coronary artery disease.METHODS A total of 513 patients with angina symptoms were included and divided into two groups based on the extent of coronary artery disease determined by angiography:the non-severe coronary stenusis group(<70% stenosis) and the severe coronary stenosis group(≥70% stenosis).The diagnostic model was constructed using magnetic field map(MFM) parameters,either individually or in combination with clinical indicators.The performance of the models was evaluated using receiver operating characteristic curves,accuracy,sensitivity,specificity,positive predictive value(PPV) and ne gative predictive value(NPV).Calibration plots and decision curve analysis were performed to investigate the clinical utility and performance of the models,respectively.RESULTS In the severe coronary stenosis group,QR_MCTDd,S_MDp,and TT_(MA)C_(50) were significantly higher than those in the non-severe coronary stenosis group(10,46±10.66 vs,5.11±6.07,P <0.001;7.2±8.64 vs.4.68±6.95,P=0.003;0.32±57.29 vs.0.26±57.29,P <0.001).While,QR_MV_(amp),R_(MA),and T_(MA) in the severe coronary stenosis group were lower(0.23±0.16 vs.0.28±0.16,P<0.001;55.06±48.68 vs.59.24±53.01,P<0.001;51.67±39.32 vs. 60.45±51.33,P <0.001).Seven MFM parameters were integrated into the model,resulting in an area under the curve of 0.810(95% CI:0.765-0.855).The sensitivity,specificity,PPV,NPV,and accurecy were 71.7%,80.4%,93.3%,42.8 %,and 73.5%;respectevely.The combined model exhibited an area under the curve of 0.845(95% CI:0.798-0.892).The sensitivity,specificity,PPV,NPV,and accuracy were 84.3%,73.8%,92.6%,54.6%,and 82.1%;respectively.Calibration curves demonstrate d excellent agreement between the nomogram prediction and actual observation.The decision curve analysis showed that the c ombine d model provided greater net benefit compared to the magnetocardingraphy model.CONCLUSIONS The novel quantitative MFM parameters,whether used individually or in combination with clinical indicators,have been shown to effectively pre dict the risk of severe coronary stenosis in patients presenting with angina-like symptoms.Magnetocardiography,an emerging non-invasive diagnostic tool,warrants further exploration for its potential in diagnosing coronary heart disease.

Management of regional citrate anticoagulation for continuous renal replacement therapy:guideline recommendations from Chinese emergency medical doctor consensus

Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT.Regional citrate anticoagulation(RCA)has been shown to potentially be safer and more effective,and is now recommended as the preferred anticoagulant method for CRRT.However,there is still a lack of unified standards for RCA management in the world,and there are many problems in using this method in clinical practice.The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association(CMDA)organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues,including the advantages and disadvantages of RCA in CRRT anticoagulation,the principle of RCA,parameter settings for RCA,monitoring of RCA(mainly metabolic acid-base disorders),and special issues during RCA.Based on the latest available research evidence as well as the paneled experts'clinical experience,considering the generalizability,suitability,and potential resource utilization,while also balancing clinical advantages and disadvantages,a total of 16 guideline recommendations were formed from the experts'consensus.

Bariatric surgery and diabetes:Current challenges and perspectives

Diabetes mellitus(DM)and obesity have become public issues of global concern.Bariatric surgery for the treatment of obesity combined with type 2 DM has been shown to be a safe and effective approach;however,there are limited studies that have systematically addressed the challenges of surgical treatment of obesity combined with DM.In this review,we summarize and answer the most pressing questions in the field of surgical treatment of obesity-associated DM.I believe that our insights will be of great help to clinicians in their daily practice.

Mesenchymal stromal cells modulate unfolded protein response and preserve β-cell mass in type 1 diabetes

Introduction:Transplantation of mesenchymal stromal cells(MSCs)is a promising therapy for type 1 diabetes(T1D).However,whether the infused MSCs affect the endoplasmic reticulum stress or subsequent unfolded protein response inβcells remains unclear.Methods:To investigate this,we induced early-onset T1D in non-obese diabetic mice using streptozotocin.Subsequently,T1D mice were randomly assigned to receive either MSCs or phosphate-buffered saline.We observed the in vivo homing of MSCs and assessed their effectiveness by analyzing blood glucose levels,body weight,histopathology,pancreatic protein expression,and serum levels of cytokines,proinsulin,and C-peptide.Results:Infused MSCs were found in the lungs,liver,spleen,and pancreas of T1D mice.They exhibited various effects,including reducing blood glucose levels,regulating immunity,inhibiting inflammation,increasingβ-cell areas,and reducing the expression of key proteins in the unfolded protein response pathway.Fasting serum proinsulin and C-peptide levels were significantly higher in the MSCs treatment group than in the T1D model group.However,there was no significant difference in the biomarker ofβ-cell endoplasmic reticulum stress,the ratio of fasting serum proinsulin to C-peptide,between the two groups.Conclusion:Ourfindings reveal that MSCs infusion does not alleviate endoplasmic reticulum stress inβcells directly but modulates the unfolded protein response pathway to preserveβ-cell mass and function in T1D mice.

Conversion therapy for unresectable hepatocellular carcinoma:Advances and challenges

Recently,the World Journal of Gastrointestinal Oncology published an article entitled“Pathologically successful conversion hepatectomy for advanced giant hepatocellular carcinoma after multidisciplinary therapy:A case report and review of the literature”,in which the authors shared their successful experience with complete surgical resection after multidisciplinary conversion therapy.The study by Chu et al demonstrates the great challenges that the advanced hepatocellular carcinoma(HCC)poses to surgical oncology,reveals the complexity of conversion therapy for unresectable HCC,emphasizes the important role of a multidisciplinary management model in conversion therapy,and enriches our understanding of the dynamics of personalized treatment for different patients.At present,conversion therapy is a hot research topic in the treatment of unresectable HCC,which has brought new hope to many patients with moderately advanced HCC.However,there are still many urgent problems to be solved in conversion therapy.Here,we would like to further discuss the advances and challenges of conversion therapy for unresectable HCC with the authors and the general readers.

Identification of Early Warning Signals of Infectious Diseases in Hospitals by Integrating Clinical Treatment and Disease Prevention

The global incidence of infectious diseases has increased in recent years,posing a significant threat to human health.Hospitals typically serve as frontline institutions for detecting infectious diseases.However,accurately identifying warning signals of infectious diseases in a timely manner,especially emerging infectious diseases,can be challenging.Consequently,there is a pressing need to integrate treatment and disease prevention data to conduct comprehensive analyses aimed at preventing and controlling infectious diseases within hospitals.This paper examines the role of medical data in the early identification of infectious diseases,explores early warning technologies for infectious disease recognition,and assesses monitoring and early warning mechanisms for infectious diseases.We propose that hospitals adopt novel multidimensional early warning technologies to mine and analyze medical data from various systems,in compliance with national strategies to integrate clinical treatment and disease prevention.Furthermore,hospitals should establish institution-specific,clinical-based early warning models for infectious diseases to actively monitor early signals and enhance preparedness for infectious disease prevention and control.

Malignant melanoma:An important differential diagnosis for clear cell sarcoma of the gastrointestinal tract

A case report by Liu et al describes the characteristics of metastatic clear cell sarcoma(CCS)of the pancreas and provides valuable therapeutic insights for this rare malignancy.This case is interesting because of its rarity,suggesting that the pancreas may be a potential target organ for CCS,either primary or metastatic.At the same time,the authors also emphasize the importance of regular postoperative follow-up for timely detection of recurrent lesions,as CCS is characterized by a high degree of malignancy and a high rate of recurrent metastases.Considering that CCS of the gastrointestinal tract is easily confused with malignant melanoma(MM)of the gastrointestinal tract,here we compare the clinical features,histopathological and immunohistochemical characteristics,diagnosis,treatment,and prognosis of CCS and MM of the gastrointestinal tract,hoping to provide a reference for clinical work.

Effi cacy of partial and complete resuscitative endovascular balloon occlusion of the aorta in the hemorrhagic shock model of liver injury

BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBOA)can alleviate ischemic burden;however,its security and eff ectiveness prior to operative hemorrhage control remains unknown.Hence,we aimed to estimate the effi cacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun.METHODS:Twenty Landrace pigs were randomized into control(no aortic occlusion)(n=5),intervention with complete REBOA(cREBOA)(n=5),continuous pREBOA(C-pREBOA)(n=5),and sequential pREBOA(S-pREBOA)(n=5)groups.In the cREBOA and C-pREBOA groups,the balloon was inflated for 60 min.The hemodynamic and laboratory values were compared at various observation time points.Tissue samples immediately after animal euthanasia from the myocardium,liver,kidneys,and duodenum were collected for histological assessment using hematoxylin and eosin staining.RESULTS:Compared with the control group,the survival rate of the REBOA groups was prominently improved(all P<0.05).The total volume of blood loss was markedly lower in the cREBOA group(493.14±127.31 mL)compared with other groups(P<0.01).The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups(P<0.05).At 120 min,the S-pREBOA group showed higher alanine aminotransferase(P<0.05)but lower blood urea nitrogen compared with the cREBOA group(P<0.05).CONCLUSION:In this trauma model with liver injury,a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure,despite persistent hemorrhage.Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures,and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.

Plasma metabolites and risk of myocardial infarction:a bidirectional Mendelian randomization study

BACKGROUND Myocardial infarction(MI)is a critical cardiovascular event with multifaceted etiology,involving several genetic and environmental factors.It is essential to understand the function of plasma metabolites in the development of MI and unravel its complex pathogenesis.METHODS This study employed a bidirectional Mendelian randomization(MR)approach to investigate the causal relationships between plasma metabolites and MI risk.We used genetic instruments as proxies for plasma metabolites and MI and conducted MR analyses in both directions to assess the impact of metabolites on MI risk and vice versa.In addition,the large-scale genome-wide association studies datasets was used to identify genetic variants associated with plasma metabolite(1400 metabolites)and MI(20,917 individuals with MI and 440,906 individuals without MI)susceptibility.Inverse variance weighted was the primary method for estimating causal effects.MR estimates are expressed as beta coefficients or odds ratio(OR)with 95%CI.RESULTS We identified 14 plasma metabolites associated with the occurrence of MI(P<0.05),among which 8 plasma metabolites[propionylglycine levels(OR=0.922,95%CI:0.881–0.965,P<0.001),gamma-glutamylglycine levels(OR=0.903,95%CI:0.861–0.948,P<0.001),hexadecanedioate(C16-DC)levels(OR=0.941,95%CI:0.911–0.973,P<0.001),pentose acid levels(OR=0.923,95%CI:0.877–0.972,P=0.002),X-24546 levels(OR=0.936,95%CI:0.902–0.971,P<0.001),glycine levels(OR=0.936,95%CI:0.909–0.964,P<0.001),glycine to serine ratio(OR=0.930,95%CI:0.888–0.974,P=0.002),and mannose to trans-4-hydroxyproline ratio(OR=0.912,95%CI:0.869–0.958,P<0.001)]were correlated with a decreased risk of MI,whereas the remaining 6 plasma metabolites[1-palmitoyl-2-arachidonoyl-GPE(16:0/20:4)levels(OR=1.051,95%CI:1.018–1.084,P=0.002),behenoyl dihydrosphingomyelin(d18:0/22:0)levels(OR=1.076,95%CI:1.027–1.128,P=0.002),1-stearoyl-2-docosahexaenoyl-GPE(18:0/22:6)levels(OR=1.067,95%CI:1.027–1.109,P=0.001),alpha-ketobutyrate levels(OR=1.108,95%CI:1.041–1.180,P=0.001),5-acetylamino-6-formylamino-3-methyluracil levels(OR=1.047,95%CI:1.019–1.076,P<0.001),and N-acetylputrescine to(N(1)+N(8))-acetylspermidine ratio(OR=1.045,95%CI:1.018–1.073,P<0.001)]were associated with an increased risk of MI.Furthermore,we also observed that the mentioned relationships were unaffected by horizontal pleiotropy(P>0.05).On the contrary,MI did not lead to significant alterations in the levels of the aforementioned 14 plasma metabolites(P>0.05 for each comparison).CONCLUSIONS Our bidirectional MR study identified 14 plasma metabolites associated with the occurrence of MI,among which 13 plasma metabolites have not been reported previously.These findings provide valuable insights for the early diagnosis of MI and potential therapeutic targets.

Supramolecular self-assembled nanoparticles for targeted therapy of myocardial infarction by enhancing cardiomyocyte mitophagy

Myocardial infarction accompanied by diabetes mellitus is accepted as the most seri-ous type of coronary heart disease,and among the current treatment strategies,the precise delivery of protective drugs for inhibiting cardiomyocyte apoptosis is still a challenge.In this study,we developed a biodegradable nanoparticles-based delivery system with excellent macrophage escape,cardiac targeting,and drug release prop-erties to achieve targeted therapy of myocardial infarction.Specifically,a copolymer of p(DMA–MPC–CD)combining self-adhesion,hydration lubrication,and targeting peptide binding site was successfully prepared by free radical copolymerization,and it was self-assembled on the surface of melatonin-loaded dendritic mesoporous silica nanoparticles(bMSNs)following the integration of adamantane-modified cardiac homing peptide(CHP)based on supramolecular host–guest interaction.Importantly,a hydration layer formed around the zwitterionic phosphorylcholine groups of the multifunctional nanoparticles,which was confirmed by the enhancement in hydra-tion lubrication and reduction in coefficient of friction,prevented the nanoparticles from phagocytosis by the macrophages.The in vivo bioluminescence imaging test indicated that the nanoparticles were endowed with satisfied cardiac targeting capa-bility,and the in vivo mice study demonstrated that the intravenous injection of drug-loaded nanoparticles(namely bMSNs–Mel@PDMC–CHP)effectively reduced cardiomyocyte apoptosis,alleviated myocardial interstitialfibrosis,and enhanced cardiac function.

Clinicopathological Features and Long-Term Prognostic Role of Human Epidermal Growth Factor Receptor-2 Low Expression in Chinese Patients with Early Breast Cancer:A Single-Institution Study

Objective This study aimed to comprehensively analyze and compare the clinicopathological features and prognosis of Chinese patients with human epidermal growth factor receptor 2(HER2)-low early breast cancer(BC)and HER2-IHC0 BC.Methods Patients diagnosed with HER2-negative BC(N=999)at our institution between January2011 and December 2015 formed our study population.Clinicopathological characteristics,association between estrogen receptor(ER)expression and HER2-low,and evolution of HER2 immunohistochemical(IHC)score were assessed.Kaplan-Meier method and log-rank test were used to compare the long-term survival outcomes(5-year follow-up)between the HER2-IHC0 and HER2-low groups.Results HER2-low BC group tended to demonstrate high expression of ER and more progesterone receptor(PgR)positivity than HER2-IHC0 BC group(P<0.001).The rate of HER2-low status increased with increasing ER expression levels(Mantel-Haenszelχ^(2)test,P<0.001,Pearson’s R=0.159,P<0.001).Survival analysis revealed a significantly longer overall survival(OS)in HER2-low BC group than in HER2-IHC0 group(P=0.007)in the whole cohort and the hormone receptor(HR)-negative group.There were no significant differences between the two groups in terms of disease-free survival(DFS).The discordance rate of HER2 IHC scores between primary and metastatic sites was 36.84%.Conclusion HER2-low BC may not be regarded as a unique BC group in this population-based study due to similar clinicopathological features and prognostic roles.

Diagnosis of Coronary Artery Disease by Acoustic Analysis of Turbulent Murmur Caused by Coronary Artery Stenosis:A Single Center Study from China

Aim:Intracoronary murmur results from turbulent flow due to coronary artery narrowing.This study evaluated the diagnostic performance of a method for acoustic analysis of turbulent murmur caused by coronary artery stenosis in coronary artery disease(CAD)in Chinese populations.Method:Patients admitted to the cardiovascular department of the Sixth Medical Center of the Chinese People’s Liberation Army General Hospital between September 2021 and June 2022 for elective coronary angiography were prospectively enrolled.A digital electronic stethoscope was used to record heart sounds before angiography.Quantitative coronary angiography(QCA)served as the“gold standard”for CAD diagnosis to evaluate the diagnostic performance of the acoustic analysis method for CAD.Results:A total of 452 patients had complete QCA and heart sound data.The final interpretation results of the acoustic analysis method indicated 310 disease cases and 142 normal results.Increasing the cut-off values of coronary artery diameter stenosis from 30%to 50%,70%,and 90%increased the sensitivity and NPV of the acoustic analysis method;the sensitivity was 75.6%,81.9%,83.3%,and 85.7%,respectively;the NPV was 33.1%,57.0%,69.7%,and 88.0%,respectively;the specificity and PPV decreased(specificity of 75.8%,70.4%,51.0%,and 37.5%,respectively;PPV of 95.2%,89.0%,69.4%,and 32.9%,respectively);and the AUC values were 0.757,0.762,0.672,and 0.616,respectively.The sensitivity of the acoustic analysis method for one-vessel disease was 86.6%when the cut-off value was 50%.The sensitivity for identifying left anterior descending coronary artery lesions was best,at 90.7%.The sensitivity for identifying isolated coronary artery branch lesions was 66.7%,whereas the sensitivity for identifying three-vessel disease in multi-vessel coronary artery lesions was better,at 82.9%.Conclusion:Acoustic analysis of turbulent murmur caused by coronary artery stenosis for diagnosis of CAD may have favorable performance in the Chinese population.This method has good performance in CAD diagnosis with a cut-off coronary artery diameter for stenosis of 50%.

Piezo1 suppression reduces demyelination after intracerebral hemorrhage

Piezo1 is a mechanically-gated calcium channel.Recent studies have shown that Piezo1,a mechanically-gated calcium channel,can attenuate both psychosineand lipopolysaccharide-induced demyelination.Because oligodendrocyte damage and demyelination occur in intracerebral hemorrhage,in this study,we investigated the role of Piezo1 in intracerebral hemorrhage.We established a mouse model of cerebral hemorrhage by injecting autologous blood into the right basal ganglia and found that Piezo1 was largely expressed soon(within 48 hours)after intracerebral hemorrhage,primarily in oligodendrocytes.Intraperitoneal injection of Dooku1 to inhibit Piezo1 resulted in marked alleviation of brain edema,myelin sheath loss,and degeneration in injured tissue,a substantial reduction in oligodendrocyte apoptosis,and a significant improvement in neurological function.In addition,we found that Dooku1-mediated Piezo1 suppression reduced intracellular endoplasmic reticulum stress and cell apoptosis through the PERK-ATF4-CHOP and inositol-requiring enzyme 1 signaling pathway.These findings suggest that Piezo1 is a potential therapeutic target for intracerebral hemorrhage,as its suppression reduces intracellular endoplasmic reticulum stress and cell apoptosis and protects the myelin sheath,thereby improving neuronal function after intracerebral hemorrhage.

The first attempt for closure of the patent foramen ovale under guidance of teleoperation ultrasonic robot:a case report

Patent foramen ovale(PFO)is a remnant of normal fetal anatomy,which occurs in about 20%–25%of cases.Patients with PFO are at increased risk for migraine,acute limb ischemia secondary to emboli and cryptogenic(no other identifiable cause)stroke.The traditional approach has been to use a fluoroscopically guided blocking device,but this is contraindicated in patients with severe allergies to contrast media or inability to undergo angiography.With the advancements in technology,ultrasonic robotic systems have become available for medical procedures.In the current study,we reported a case of using the ultrasonic robotic teleoperation system to achieve closure of PFO at the Chinese PLA General Hospital,Beijing,China.

Predictive validation of existing bleeding and thromboembolic scores in elderly patients with comorbid atrial fibrillation and acute coronary syndrome

BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation(AF)and acute coron-ary syndrome(ACS)has not been reported.The present study compared the predictive performance of existing risk scores in patients.these METHODS A total of 1252 elderly patients with AF and ACS comorbidities(≥65 years old)were consecutively enrolled from January 2015 to December 2019.All patients were followed up for one year.The predictive performance of risk scores in predict-bleeding and thromboembolic events was calculated and compared.ing RESULTS During the 1-year follow-up,183(14.6%)patients had thromboembolic events,198(15.8%)patients had BARC class≥2 bleeding events,and 61(4.9%)patients had BARC class≥3 bleeding events.For the BARC class≥3 bleeding events,discrimina-tion of the existing risk scores was low to moderate,PRECISE-DAPT(C-statistic:0.638,95%CI:0.611-0.665),ATRIA(C-statistic:0.615,95%CI:0.587-0.642),PARIS-MB(C-statistic:0.612,95%CI:0.584-0.639),HAS-BLED(C-statistic:0.597,95%CI:0.569-0.624)and CRUSADE(C-statistic:0.595,95%CI:0.567-0.622).However,the calibration was good.PRECISE-DAPT showed a higher in-tegrated discrimination improvement(IDI)than PARIS-MB,HAS-BLED,ATRIA,and CRUSADE(P<0.05)and the best decision curve analysis(DCA).For thromboembolic events,the discrimination of GRACE(C-statistic:0.636,95%CI:0.608-0.662)was higher than CHA2DS2-VASc(C-statistic:0.612,95%CI:0.584-0.639),OPT-CAD(C-statistic:0.602,95%CI:0.574-0.629)and PARIS-CTE(C-statistic:0.595,95%CI:0.567-0.622).The calibration was good.Compared to OPT-CAD and PARIS-CTE,the IDI of the GRACE score slightly improved(P<0.05).However,NRI analysis showed no significant difference.DCA showed that the clinical practic-of thromboembolic risk scores was similar.ability CONCLUSIONS The discrimination and calibration of existing risk scores in predicting 1-year thromboembolic and bleeding events were unsatisfactory in elderly patients with comorbid AF and ACS.PRECISE-DAPT showed higher IDI and DCA than other risk scores in predicting BARC class≥3 bleeding events.The GRACE score showed a slight advantage in predicting throm-botic events.

Correlation between COVID-19 vaccination and diabetes mellitus:A systematic review

BACKGROUND Coronavirus disease 2019(COVID-19)is one of the current global public health threats and vaccination is the most effective tool to reduce the spread and decrease the severity of COVID-19.Diabetes is one of the important chronic diseases threatening human health and is a common comorbidity of COVID-19.What is the impact of diabetes on the immunization effect of COVID-19 vaccination?Conversely,does vaccination against COVID-19 exacerbate the severity of pre-existing diseases in patients with diabetes?There are limited and conflicting data on the interrelationship between diabetes and COVID-19 vaccination.AIM To explore the clinical factors and possible mechanisms underlying the interaction between COVID-19 vaccination and diabetes.METHODS We conducted a comprehensive search of PubMed,MEDLINE,EMBASE,and Reference Citation Analysis(https://www.referencecitationanalysis.com)online datab-ases,and medRxiv and bioRxiv gray literature using the keywords"SARSCoV-2","COVID-19","vaccine","vaccination","antibody",and"diabetes"individually or in combination,with a cut-off date of December 2,2022.We followed inclusion and exclusion criteria and after excluding duplicate publications,studies with quantifiable evidence were included in the full-text review,plus three manually searched publications,resulting in 54 studies being included in this review.RESULTS A total of 54 studies were included,from 17 countries.There were no randomized controlled studies.The largest sample size was 350963.The youngest of the included samples was 5 years old and the oldest was 98 years old.The included population included the general population and also some special populations with pediatric diabetes,hemodialysis,solid organ transplantation,and autoimmune diseases.The earliest study began in November 2020.Thirty studies discussed the effect of diabetes on vaccination,with the majority indicating that diabetes reduces the response to COVID-19 vaccination.The other 24 studies were on the effect of vaccination on diabetes,which included 18 case reports/series.Most of the studies concluded that COVID-19 vaccination had a risk of causing elevated blood glucose.A total of 12 of the 54 included studies indicated a"no effect"relationship between diabetes and vaccination.CONCLUSION There is a complex relationship between vaccination and diabetes with a bidirectional effect.Vaccination may contribute to the risk of worsening blood glucose in diabetic patients and diabetic patients may have a lower antibody response after vaccination than the general population.

Expert consensus on the diagnosis and treatment of heat stroke in China

Heat stroke(HS)is a fatal disease caused by thermal damage in the body,and it has a very high mortality rate.In 2015,the People’s Liberation Army Professional Committee of Critical Care Medicine published the first expert consensus on HS in China,Expert consensus on standardized diagnosis and treatment for heat stroke.With an increased understanding of HS and new issues that emerged during the HS treatment in China in recent years,the 2015 consensus no longer meet the requirements for HS prevention and treatment.It is necessary to update the consensus to include the latest research evidence and establish a new consensus that has broader coverage,is more practical and is more in line with China’s national conditions.This new expert consensus includes new concept of HS,recommendations for laboratory tests and auxiliary examinations,new understanding of diagnosis and differential diagnosis,On-site emergency treatment and In-hospital treatment,translocation of HS patients and prevention of HS.

Impact of B-mode-ultrasound-guided transhepatic and transperitoneal cholecystostomy tube placement on laparoscopic cholecystectomy

BACKGROUND B-mode-ultrasound-guided percutaneous cholecystostomy(PC)may be performed by a transhepatic or transperitoneal approach,called percutaneous transhepatic gallbladder drainage(PHGD)and percutaneous transperitoneal gallbladder drainage(PPGD),respectively.We compared the impact of PC related to the route of catheter placement on subsequent laparoscopic cholecystectomy(LC).AIM To compare the impact of PC related to the route of catheter placement on subsequent LC.METHODS We retrospectively studied 103 patients with acute calculous cholecystitis who underwent scheduled LC after PC between January 2010 and January 2019.Group I included 58 patients who underwent scheduled LC after PHGD.Group II included 45 patients who underwent scheduled LC after PPGD.Clinical outcomes were analyzed according to each group.RESULTS Baseline demographic characteristics did not differ significantly between both groups(P>0.05).Both PHGD and PPGD were able to quickly resolve cholecystitis sepsis.Group I showed significantly higher efficacy than group II in terms of lower pain score during puncture(3.1 vs 4.5;P=0.001)and at 12 h follow-up(1.5 vs 2.2;P=0.001),lower rate of fever within 24 h after PC(13.8%vs 42.2%;P=0.001),shorted operation duration(118.3 vs 139.6 min;P=0.001),lower amount of intraoperative bleeding(72.1 vs 109.4 mL;P=0.001)and shorter length of hospital stay(14.3 d vs 18.0 d;P=0.001).However,group II had significantly lower rate of local bleeding at the PC site(2.2%vs 20.7%;P=0.005)and lower rate of severe adhesion(33.5%vs 55.2%;P=0.048).No significant differences were noted between both groups regarding the conversion rate to laparotomy,rate of subtotal cholecystectomy,complications and pathology.CONCLUSION B-mode-ultrasound-guided PHGD is superior to PPGD followed by LC for treatment of acute calculous cholecystitis,with shorter operating time,minimal amount of intraoperative bleeding and short length of hospital stay.

Evaluation of short-term effects of drug-loaded microspheres and traditional transcatheter arterial chemoembolization in the treatment of advanced liver cancer

BACKGROUND Liver cancer is a malignant tumor with high morbidity and mortality.Transcatheter arterial chemoembolization(TACE)is the main method for surgically unresectable liver cancer.In recent years,drug-loaded microspheres have been gradually applied in TACE technology.There are some controversies about the therapeutic effects of drug-loaded microspheres TACE(D-TACE)and traditional TACE.AIM To explore the short-term efficacy of D-TACE and traditional TACE in the treatment of advanced liver cancer.METHODS The clinical data of 73 patients with advanced liver cancer admitted to the First and Sixth Medical Centers of Chinese PLA General Hospital from January 2017 to October 2019 were retrospectively analyzed.Among them,15 patients were treated with D-TACE,and 58 patients were treated with traditional TACE.Clinical baseline characteristics,perioperative laboratory indices,postoperative adverse reactions and postoperative complications were compared between the two groups.RESULTS There was no statistical difference between the two groups for the postoperative response:The highest postoperative body temperature of the drug-loaded microsphere group was 38.0±0.9℃and the postoperative highest body temperature of the traditional TACE group was 38.3±0.7℃(t=-1.414,P=0.162).For the 24 h postoperative nausea and vomiting after surgery in terms of scoring and postoperative pain scores,the traditional TACE group was higher than the drugloaded microsphere group(χ2=14.33,P=0.014;χ2=32.967,P=0.000)and the two groups had significant statistical differences.The disease control rate at 3 mo after treatment in the drugloaded microsphere group was 60%and the disease control rate at 3 mo after treatment in the traditional TACE group was 75.9%(χ2=4.091,P=0.252).There was no statistical difference between the two groups of data.During the follow-up period,the number of interventional treatments received was once in the drug-loaded microsphere group and the traditional TACE group received an average of 1.48 treatments(χ2=10.444 P=0.005).There was a statistical difference between the two groups.CONCLUSION Compared with traditional TACE,D-TACE may have some advantages in the treatment of advanced hepatocellular carcinoma with a large tumor load in the short term,but the long-term clinical efficacy needs additional follow-up studies.In addition,compared with the traditional group,the patients in the drug-loaded microsphere group had better subjective tolerance and could reduce the number of interventional treatments.Therefore,D-TACE is worthy of clinical promotion.

Correlation between COVID-19 and hepatitis B:A systematic review

BACKGROUND There is growing evidence that patients with coronavirus disease 2019(COVID-19)frequently present with liver impairment.Hepatitis B virus(HBV)remains a major public health threat in current society.Both severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and HBV can cause liver damage,and current findings on whether HBV infection increases disease severity in COVID-19 patients are inconsistent,and whether SARS-CoV-2 infection accelerates hepatitis B progression or leads to a worse prognosis in hepatitis B patients has not been adequately elucidated.AIM To explore the complex relationship between COVID-19 and hepatitis B in order to inform the research and management of patients co-infected with SARS-CoV-2 and HBV.METHODS An experienced information specialist searched the literature in the following online databases:PubMed,China National Knowledge Infrastructure,Google Scholar,Scopus,Wiley,Web of Science,Cochrane,and ScienceDirect.The literature published from December 2019 to September 1,2022 was included in the search.We also searched medRxiv and bioRxiv for gray literature and manually scanned references of included articles.Articles reporting studies conducted in humans discussing hepatitis B and COVID-19 were included.We excluded duplicate publications.News reports,reports,and other gray literature were included if they contained quantifiable evidence(case reports,findings,and qualitative analysis).Some topics that included HBV or COVID-19 samples but did not have quantitative evidence were excluded from the review.RESULTS A total of 57 studies were eligible and included in this review.They were from 11 countries,of which 33(57.9%)were from China.Forty-two of the 57 studies reported abnormalities in liver enzymes,three mainly reported abnormalities in blood parameters,four indicated no significant liver function alterations,and another eight studies did not provide data on changes in liver function.Fifty-seven studies were retrospective and the total number of co-infections was 1932,the largest sample size was 7723,and the largest number of co-infections was 353.Most of the studies suggested an interaction between hepatitis B and COVID-19,while 12 studies clearly indicated no interaction between hepatitis B and COVID-19.Six of the 57 studies clearly reported HBV activation.Six studies were related to liver transplant patients.CONCLUSION There is some association between COVID-19 and hepatitis B.Future high-quality randomized trials are needed to further elucidate the interaction between COVID-19 and hepatitis B.