Development and validation of a nomogram model for predicting the risk of gallstone recurrence after gallbladder-preserving surgery

Background:The high incidence of gallstone recurrence was a major concern for laparoscopic gallbladderpreserving surgery.This study aimed to investigate the risk factors for gallstone recurrence after gallbladder-preserving surgery and to establish an individualized nomogram model to predict the risk of gallstone recurrence.Methods:The clinicopathological and follow-up data of 183 patients who were initially diagnosed with gallstones and treated with gallbladder-preserving surgery at our hospital from January 2012 to January 2019 were retrospectively collected.The independent predictive factors for gallstone recurrence following gallbladder-preserving surgery were identified by multivariate logistic regression analysis.A nomogram model for the prediction of gallstone recurrence was constructed based on the selected variables.The C-index,receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the predictive power of the nomogram model for gallstone recurrence.Results:During the follow-up period,a total of 65 patients experienced gallstone recurrence,and the recurrence rate was 35.5%.Multivariate logistic regression analysis revealed that the course of gallstones>2 years[odds ratio(OR)=2.567,95%confidence interval(CI):1.270-5.187,P=0.009],symptomatic gallstones(OR=2.589,95%CI:1.059-6.329,P=0.037),multiple gallstones(OR=2.436,95%CI:1.133-5.237,P=0.023),history of acute cholecystitis(OR=2.778,95%CI:1.178-6.549,P=0.020)and a greasy diet(OR=2.319,95%CI:1.186-4.535,P=0.014)were independent risk factors for gallstone recurrence after gallbladder-preserving surgery.A nomogram model for predicting the recurrence of gallstones was established based on the above five variables.The results showed that the C-index of the nomogram model was 0.692,suggesting it was valuable to predict gallstone recurrence.Moreover,the calibration curve showed good consistency between the predicted probability and actual probability.Conclusions:The nomogram model for the prediction of gallstone recurrence might help clinicians develop a proper treatment strategy for patients with gallstones.Gallbladder-preserving surgery should be cautiously considered for patients with high recurrence risks.

雷诺数和侧风对S型垂直轴风力机气动特性的影响

相较于工作在郊外良好风场的大型风力机,小型风力机易受城市风环境如低风速、高湍流度以及时变风速风向的影响。采用数值模拟手段研究了雷诺数和来流倾角对小型S型垂直轴风力机气动性能的影响。研究结果表明:S型风力机的气动性能对雷诺数不敏感,功率系数几乎不随雷诺数变化;侧风导致S型风力机的气动性能变差,静扭矩系数和功率系数降低,并且随着侧风来流倾角的增大,气动性能越差,侧风影响的流动机理一方面是来流倾角降低了水平速度分量,另一个方面是竖直速度分量减小了前进叶片的压力差,增加回转叶片的压力差,进一步加剧了气动性能的恶化。

Development and validation of a predictive model for the assessment of potassium-lowering treatment among hyperkalemia patients

BACKGROUND:Hyperkalemia is common among patients in emergency department and is associated with mortality.While,there is a lack of good evaluation and prediction methods for the effi cacy of potassium-lowering treatment,making the drug dosage adjustment quite diffi cult.We aimed to develop a predictive model to provide early forecasting of treating eff ects for hyperkalemia patients.METHODS:Around 80%of hyperkalemia patients(n=818)were randomly selected as the training dataset and the remaining 20%(n=196)as the validating dataset.According to the serum potassium(K+)levels after the fi rst round of potassium-lowering treatment,patients were classifi ed into the eff ective and ineff ective groups.Multivariate logistic regression analyses were performed to develop a prediction model.The receiver operating characteristic(ROC)curve and calibration curve analysis were used for model validation.RESULTS:In the training dataset,429 patients had favorable eff ects after treatment(eff ective group),and 389 had poor therapeutic outcomes(ineff ective group).Patients in the ineff ective group had a higher percentage of renal disease(P=0.007),peripheral edema(P<0.001),oliguria(P=0.001),or higher initial serum K+level(P<0.001).The percentage of insulin usage was higher in the effective group than in the ineff ective group(P=0.005).After multivariate logistic regression analysis,we found age,peripheral edema,oliguria,history of kidney transplantation,end-stage renal disease,insulin,and initial serum K+were all independently associated with favorable treatment eff ects.CONCLUSION:The predictive model could provide early forecasting of therapeutic outcomes for hyperkalemia patients after drug treatment,which could help clinicians to identify hyperkalemia patients with high risk and adjust the dosage of medication for potassium-lowering.

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.

Value of arterial blood lactate and early lactate clearance in evaluating the prognosis in patients with COPD merged with respiratory failure

Objective:To explore the value of arterial blood lactate and early lactate clearance in evaluating the prognosis in patients with COPD merged with respiratory failure.Methods:A total of 78 patients with COPD merged with respiratory failure were included in the study. The arterial blood lactate level 1 d before treatment and 6 h after treatment was detected. The early lactate clearance was evaluated. The patients were divided into the severe elevation group, mild elevation group, and normal control group according to the blood lactate level. APACHEⅡ score, 28 d death rate, and other clinical related indicators in the three groups were compared. According to the early lactate clearance, the patients were divided into the high lactate clearance group and low lactate clearance group. The arterial blood lactate level, APACHEⅡ score, death rate, and arterial blood gas indicators in the two groups were compared. The multiple-factor analysis of prognosis was performed.Results:With the increasing of blood lactate concentration before treatment, APACHEⅡ score, mechanical ventilation time, ventilation rate, hospitalization time, and death rate were gradually elevated, and the comparison among the three groups was not statistically significant. When compared with before treatment, the arterial blood lactate level, APACHEⅡ score, and PaCO2 in the high lactate clearance group were significantly reduced, but PaO2 and pH were significantly elevated, while PaO2 in the low lactate clearance group was significantly elevated. The death rate in the high lactate clearance group was significantly lower than that in the low lactate clearance group. The early lactate clearance was a factor in protecting the prognosis in patients with COPD merged with respiratory failure.Conclusions:The arterial blood lactate level and early lactate clearance can affect the prognosis in patients with COPD merged with respiratory failure. Dynamic monitoring of early blood lactate level can better evaluate the disease severity degree and prognosis.

A Review of Compression, Ventilation, Defibrillation, Drug Treatment, and Targeted Temperature Management in Cardiopulmonary Resuscitation

Objective：Important studies of cardiopulmonary resuscitation （CPR） techniques influence the development of new guidelines.We systematically reviewed the efficacy of some important studies of CPR.Data Sources：The data analyzed in this review are mainly from articles included in PubMed and EMBAS E,published from 1964 to 2014.Study Selection：Original articles and critical reviews about CPR techniques were selected for review.Results：The survival rate after out-of-hospital cardiac arrest （OHCA） is improving.This improvement is associated with the performance of uninterrupted chest compressions and simple airway management procedures during bystander CPR.Real-time feedback devices can be used to improve the quality of CPR.The recommended dose,timing,and indications for adrenaline （epinephrine） use may change.The appropriate target temperature for targeted temperature management is still unclear.Conclusions：New studies over the past 5 years have evaluated various aspects of CPR in OHCA.Some of these studies were high-quality randomized controlled trials,which may help to improve the scientific understanding of resuscitation techniques and result in changes to CPR guidelines.

Therapeutic effects of the extract of Sancao Formula, a Chinese herbal compound, on imiquimod-induced psoriasis via cysteine-rich protein 61

Objective: Psoriasis is a common chronic inflammatory skin disease that is prone to recurrence, and the proinflammatory factor, cysteine-rich protein 61(Cyr61), is important in its pathophysiology. Long-term clinical practice has shown that Sancao Formula(SC), a Chinese herbal compound, is effective in the treatment of psoriasis, but the precise mechanism remains unknown. In this study, we investigate the mechanism by which SC extract alleviates imiquimod(IMQ)-induced psoriasis.Methods: The expression of Cyr61 in psoriatic lesions and normal healthy skin was detected using immunohistochemical analysis to investigate the biological role of Cyr61 in models of psoriatic inflammation. A psoriatic mouse model was established by topical application of IMQ, and the effect of topical application of SC extract was evaluated using the psoriasis area and severity index(PASI) score,hematoxylin-eosin staining, and histopathological features of the skin. Next, a HaCaT cell inflammation model was established using interferon-γ(IFN-γ), and the effect of SC extract on the mRNA and protein levels of Cyr61 and intercellular cell adhesion molecule-1(ICAM-1) was confirmed using Western blot and quantitative real-time polymerase chain reaction analyses.Results: Immunohistochemical staining showed that the expression of Cyr61 in psoriatic lesions was higher than that in normal skin samples(78.26% vs 41.18%, P < 0.05), and the number of Cyr61-positive cells in psoriatic lesions was also significantly higher than in normal skin(18.66 ± 2.51 vs4.33 ± 1.52, P < 0.05). Treatment in mice with IMQ-induced psoriasis showed that SC extract could significantly improve the inflammatory phenotype, PASI score(10.875 ± 0.744 vs 3.875 ± 0.582, P < 0.05),and pathological features compared with those in IMQ model group;SC treatment was also associated with decreased levels of Cyr61 and ICAM-1. In the IFN-γ-induced inflammatory cell model, the mRNA and protein levels of Cyr61 and ICAM-1 were upregulated, while the SC extract downregulated the levels of Cyr61 and ICAM-1.Conclusion: The results provide a theoretical basis for the involvement of Cyr61 in the pathogenesis of psoriasis, and suggest that SC should be used to target Cyr61 for the prevention of psoriasis recurrence.

一例罕见的间接传播人狂犬病(英文)

本文回顾性报告了一例较为罕见的间接传播人狂犬病患者的得病经过和救治过程,对其中的特殊之处进行分析和思考。本病例提供的一线临床实践资料,有助于提高对该疾病的认识以及制定更为科学、合理的狂犬病防治方案。该狂犬病患者无动物咬伤或接触动物体液等相关病史,而是通过其有少许皮损的拇指接触到被狗咬伤者的血液(可能被狗唾液污染)而感染狂犬病病毒,即间接的接触传播。因而,对于这类患者,临床上也应及时接种狂犬病疫苗或给予抗狂犬病免疫球蛋白。