BACKGROUND Chronic liver disease is a growing global health problem,leading to hepatic decompensation characterized by an array of clinical and biochemical complic-ations.Several scoring systems have been introduced i...BACKGROUND Chronic liver disease is a growing global health problem,leading to hepatic decompensation characterized by an array of clinical and biochemical complic-ations.Several scoring systems have been introduced in assessing the severity of hepatic decompensation with the most frequent ones are Child-Pugh score,model of end-stage liver disease(MELD)score,and MELD-Na score.Anemia is frequently observed in cirrhotic patients and is linked to worsened clinical outcomes.Although studies have explored anemia in liver disease,few have investigated the correlation of hemoglobin level with the severity of hepatic decompensation.AIM To determine the relationship between hemoglobin levels and the severity of decompensated liver disease and comparing the strength of this correlation using the Child-Pugh,MELD,and MELD-Na scores.METHODS This cross-sectional study was conducted at a tertiary care hospital with 652 decompensated liver disease patients enrolled in the study.Data was collected on demographics,clinical history,and laboratory findings,including hemoglobin levels,bilirubin,albumin,prothrombin time(international normalized ratio),sodium,and creatinine.The Child-Pugh,MELD,and MELD-Na scores were calculated.Statistical analysis was performed using Statistical Package for the Social Sciences version 26,and correlations between hemoglobin levels and severity scores were assessed using Spearman's correlation coefficient.RESULTS The study included 405 males(62.1%)and 247 females(37.9%)with an average age of 58.8 years.Significant inverse correlations were found between hemoglobin levels and Child-Pugh,MELD,and MELD-Na scores(P<0.01),with the MELD scoring system being the strongest correlator among all.One-way analysis of variance revealed significant differences in hemoglobin levels across the severity groups of each scoring system(P=0.001).Tukey's post hoc analysis confirmed significant internal differences among each severity group.CONCLUSION Understanding the correlation between hemoglobin and liver disease severity can improve patient management by offering insights into prognosis and guiding treatment decisions.展开更多
In this article,we discussed the article by Zeng et al,published in a recent issue of the World Journal of Gastroenterology.The publication represents a significant advancement in the prognostic evaluation of rectal n...In this article,we discussed the article by Zeng et al,published in a recent issue of the World Journal of Gastroenterology.The publication represents a significant advancement in the prognostic evaluation of rectal neuroendocrine neoplasms.The GATIS score is a single nomogram model that incorporates five key progno-stic factors:Tumor grade;T stage;tumor size;age;and the prognostic nutritional index.This innovation optimizes the prognostic process,delivering more accurate predictions of overall survival and progression-free survival compared to tradi-tional TNM staging and World Health Organization classification systems.The findings of the study were based on a retrospective analysis spanning 12 years and involving 1408 patients from 17 reference centers in China.In this editorial,we specifically examined the strengths and limitations of the study,the clinical implications of the GATIS score,and the questions arising from its conclusions.展开更多
BACKGROUND Post-hepatectomy liver failure(PHLF)after liver resection is one of the main complications causing postoperative death in patients with hepatocellular carcinoma(HCC).It is crucial to help clinicians identif...BACKGROUND Post-hepatectomy liver failure(PHLF)after liver resection is one of the main complications causing postoperative death in patients with hepatocellular carcinoma(HCC).It is crucial to help clinicians identify potential high-risk PHLF patients as early as possible through preoperative evaluation.AIM To identify risk factors for PHLF and develop a prediction model.METHODS This study included 248 patients with HCC at The Second Affiliated Hospital of Air Force Medical University between January 2014 and December 2023;these patients were divided into a training group(n=164)and a validation group(n=84)via random sampling.The independent variables for the occurrence of PHLF were identified by univariate and multivariate analyses and visualized as nomograms.Ultimately,comparisons were made with traditional models via receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).RESULTS In this study,portal vein width[odds ratio(OR)=1.603,95%CI:1.288-1.994,P≤0.001],the preoperative neutrophil-to-lymphocyte ratio(NLR)(OR=1.495,95%CI:1.126-1.984,P=0.005),and the albumin-bilirubin(ALBI)score(OR=8.868,95%CI:2.144-36.678,P=0.003)were independent risk factors for PHLF.A nomogram prediction model was developed using these factors.ROC and DCA analyses revealed that the predictive efficacy and clinical value of this model were better than those of traditional models.CONCLUSION A new Nomogram model for predicting PHLF in HCC patients was successfully established based on portal vein width,the NLR,and the ALBI score,which outperforms the traditional model.展开更多
BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences b...BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences between CSP and traditional endoscopic mucosal resection(EMR)for the treatment of intestinal polyps.AIM To compare the efficacy-cost of EMR and CSP in the treatment of intestinal polyps.METHODS A total of 100 patients with intestinal polyps were included in the retrospective data of our hospital from April 2022 to May 2023.According to the treatment methods,they were divided into EMR(n=46)group and CSP(n=54)group.The baseline data of the two groups were balanced by 1:1 propensity score matching(PSM),and the cost-effectiveness analysis was performed on the two groups after matching.The recurrence rate of the two groups of patients was followed up for 1 year,and they were divided into recurrence group and non-recurrence group according to whether they recurred.Multivariate logistic regression analysis was used to screen out the influencing factors affecting the recurrence of intestinal polyps after endoscopic resection.RESULTS Significant disparities were observed in the number of polyps and smoking background between the two groups before PSM(P<0.05).Following PSM,the number of polyps and smoking history were well balanced between the EMR and CSP groups.The direct cost incurred by the CSP group was markedly higher than that incurred by the EMR group.Concurrently,the cost-effectiveness ratio in the CSP group was substantially reduced when juxtaposed with that in the EMR group(P<0.05).Upon completion of the 1-year follow-up,the rate of recurrence after endoscopic intestinal polypectomy was 38.00%.Multivariate methods revealed that age≥60 years,male sex,number of polyps≥3,and pathological type of adenoma were risk factors for recurrence after endoscopic intestinal polypectomy(all P<0.05).CONCLUSION CSP was more cost-effective for the treatment of intestinal polyps.An age≥60 years,male sex,having a number of polyps≥3,and pathological type of adenoma are independent influencing factors for recurrence.展开更多
BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in...BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in patients with hepatocellular carcinoma(HCC)who underwent laparoscopic hepatectomy during and after surgery.METHODS We retrospectively collected the clinicopathological data of 107 patients who successfully underwent laparoscopic hepatectomy at Zhongshan Hospital(Xiamen),Fudan University from June 2022 to June 2023.Whether using the ICG fluorescence imaging technique,we divided them into the ICG and non-ICG groups.To eliminate statistical bias,a 1:1 propensity score matching analysis was conducted.The comparison of perioperative outcomes,including inflammationrelated markers and progression-free survival,was analyzed statistically.RESULTS Intraoperatively,the ICG group exhibited lower blood loss,a shorter surgical time,lower hepatic inflow occlusion(HIO)frequency,and a shorter total HIO time.Postoperatively,the participation of ICG resulted in a shorter duration of hospitalization(6.5 vs 7.6 days,P=0.03)and postoperative inflammatory response attenuation(lower neutrophil-lymphocyte ratio on the first day after surgery and platelet-lymphocyte ratio on the third day,P<0.05).Although the differences were not significant,the levels of all inflammation-related markers were lower in the ICG group.The rates of postoperative complications and the survival analyses,including progression-free and overall survivals showed no significant difference between the groups.CONCLUSION The involvement of ICG fluorescence imaging may lead to improved perioperative outcomes,especially postoperative inflammatory response attenuation,and ultimately improve HCC patients’recovery after surgery.展开更多
目的 探究NIHSS/DWI-ASPECTS不匹配对大脑中动脉供血区脑梗死早期神经功能恶化的预测价值。方法 回顾性收集2017年3月~2018年5月因大脑中动脉供血区脑梗死在安徽医科大学第二附属医院神经内科住院的患者。收集其临床资料,根据入院时和住...目的 探究NIHSS/DWI-ASPECTS不匹配对大脑中动脉供血区脑梗死早期神经功能恶化的预测价值。方法 回顾性收集2017年3月~2018年5月因大脑中动脉供血区脑梗死在安徽医科大学第二附属医院神经内科住院的患者。收集其临床资料,根据入院时和住院72 h NIHSS评分,评估早期神经功能恶化(early neurological deterioration,END),将患者分为END组和非END组。所有患者在入院48 h内完成头部MRI检查,并行DWI-Alberta 卒中项目早期CT评分(DWI-ASPECTS),NIHSS/DWI-ASPECTS不匹配(NIHSS/DWI-ASPECTS Mismatch,NDM)定义为 NIHSS评分≥8且DWI-ASPECTS≥8,应用多变量Logistic回归分析NDM与大脑中动脉供血区脑梗死END的相关性。结果 共收集94例大脑中动脉供血区脑梗死患者,男性52例(55.3%),年龄(65.4±11.0)岁。符合END患者31例(33%)。NIHSS/DWI-ASPECTS不匹配(NDM)病例18例(19.1%),其中END组14例(45%),非END组4例(6.5%)。END组年龄大、NIHSS高、DWI-ASPECTS低、NDM患者比例显著高于非END组( P ≤0.05或 P ≤0.01)。多变量Logistic回归分析显示,在校正混杂因素后,DWI-ASPECTS(优势比0.637,95%置信区间0.409~0.994, P =0.047)和NDM(优势比13.175,95%置信区间1.539~112.824, P =0.019)是大脑中动脉供血区脑梗死END的预测因素。结论 NIHSS/DWI-ASPECTS不匹配对大脑中动脉供血区脑梗死早期神经功能恶化具有一定的预测价值。展开更多
本文全面解读了中医药团体标准评价体系(System of Consortium Standards Rating and Evaluation of Traditional Chinese Medicine,SCORE-TCM)。SCORE-TCM是结合定性与定量评价,全面评估中医药团体标准在制定主体、文本编写、技术内容...本文全面解读了中医药团体标准评价体系(System of Consortium Standards Rating and Evaluation of Traditional Chinese Medicine,SCORE-TCM)。SCORE-TCM是结合定性与定量评价,全面评估中医药团体标准在制定主体、文本编写、技术内容、推广应用和实施效益等几方面特征的综合评价工具。文中详述了SCORE-TCM的构建目的、定义和构建过程,解释了评价指标体系中的各项指标,并对每项指标的评价材料进行介绍。本文旨在帮助中医药团体标准的制定者、第三方评价机构和其他相关方更好地理解SCORE-TCM各评价条目的含义,更有效地运用于中医药团体标准的自评价或第三方评价,SCORE-TCM将为《中医药团体标准管理办法》的贯彻实施,以及中医药团体标准的高质量发展提供技术支持。展开更多
The albumin-bilirubin(ALBI)score,which was proposed to assess the prognosis of patients with hepatocellular carcinoma,has gradually been extended to other liver diseases in recent years,including primary biliary chola...The albumin-bilirubin(ALBI)score,which was proposed to assess the prognosis of patients with hepatocellular carcinoma,has gradually been extended to other liver diseases in recent years,including primary biliary cholangitis,liver cirrhosis,hepatitis,liver transplantation,and liver injury.The ALBI score is often compared with classical scores such as the Child-Pugh and model for end-stage liver disease scores or other noninvasive prediction models.It is widely employed because of its immunity to subjective evaluation indicators and ease of obtaining detection indicators.An increasing number of studies have confirmed that it is highly accurate for assessing the prognosis of patients with chronic liver disease;additionally,it has demonstrated good predictive performance for outcomes beyond survival in patients with liver diseases,such as decompensation events.This article presents a review of the application of ALBI scores in various non-malignant liver diseases.展开更多
文摘BACKGROUND Chronic liver disease is a growing global health problem,leading to hepatic decompensation characterized by an array of clinical and biochemical complic-ations.Several scoring systems have been introduced in assessing the severity of hepatic decompensation with the most frequent ones are Child-Pugh score,model of end-stage liver disease(MELD)score,and MELD-Na score.Anemia is frequently observed in cirrhotic patients and is linked to worsened clinical outcomes.Although studies have explored anemia in liver disease,few have investigated the correlation of hemoglobin level with the severity of hepatic decompensation.AIM To determine the relationship between hemoglobin levels and the severity of decompensated liver disease and comparing the strength of this correlation using the Child-Pugh,MELD,and MELD-Na scores.METHODS This cross-sectional study was conducted at a tertiary care hospital with 652 decompensated liver disease patients enrolled in the study.Data was collected on demographics,clinical history,and laboratory findings,including hemoglobin levels,bilirubin,albumin,prothrombin time(international normalized ratio),sodium,and creatinine.The Child-Pugh,MELD,and MELD-Na scores were calculated.Statistical analysis was performed using Statistical Package for the Social Sciences version 26,and correlations between hemoglobin levels and severity scores were assessed using Spearman's correlation coefficient.RESULTS The study included 405 males(62.1%)and 247 females(37.9%)with an average age of 58.8 years.Significant inverse correlations were found between hemoglobin levels and Child-Pugh,MELD,and MELD-Na scores(P<0.01),with the MELD scoring system being the strongest correlator among all.One-way analysis of variance revealed significant differences in hemoglobin levels across the severity groups of each scoring system(P=0.001).Tukey's post hoc analysis confirmed significant internal differences among each severity group.CONCLUSION Understanding the correlation between hemoglobin and liver disease severity can improve patient management by offering insights into prognosis and guiding treatment decisions.
文摘In this article,we discussed the article by Zeng et al,published in a recent issue of the World Journal of Gastroenterology.The publication represents a significant advancement in the prognostic evaluation of rectal neuroendocrine neoplasms.The GATIS score is a single nomogram model that incorporates five key progno-stic factors:Tumor grade;T stage;tumor size;age;and the prognostic nutritional index.This innovation optimizes the prognostic process,delivering more accurate predictions of overall survival and progression-free survival compared to tradi-tional TNM staging and World Health Organization classification systems.The findings of the study were based on a retrospective analysis spanning 12 years and involving 1408 patients from 17 reference centers in China.In this editorial,we specifically examined the strengths and limitations of the study,the clinical implications of the GATIS score,and the questions arising from its conclusions.
基金Supported by Shaanxi Provincial Social Development Fund,No.2024SF-YBXM-140.
文摘BACKGROUND Post-hepatectomy liver failure(PHLF)after liver resection is one of the main complications causing postoperative death in patients with hepatocellular carcinoma(HCC).It is crucial to help clinicians identify potential high-risk PHLF patients as early as possible through preoperative evaluation.AIM To identify risk factors for PHLF and develop a prediction model.METHODS This study included 248 patients with HCC at The Second Affiliated Hospital of Air Force Medical University between January 2014 and December 2023;these patients were divided into a training group(n=164)and a validation group(n=84)via random sampling.The independent variables for the occurrence of PHLF were identified by univariate and multivariate analyses and visualized as nomograms.Ultimately,comparisons were made with traditional models via receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).RESULTS In this study,portal vein width[odds ratio(OR)=1.603,95%CI:1.288-1.994,P≤0.001],the preoperative neutrophil-to-lymphocyte ratio(NLR)(OR=1.495,95%CI:1.126-1.984,P=0.005),and the albumin-bilirubin(ALBI)score(OR=8.868,95%CI:2.144-36.678,P=0.003)were independent risk factors for PHLF.A nomogram prediction model was developed using these factors.ROC and DCA analyses revealed that the predictive efficacy and clinical value of this model were better than those of traditional models.CONCLUSION A new Nomogram model for predicting PHLF in HCC patients was successfully established based on portal vein width,the NLR,and the ALBI score,which outperforms the traditional model.
文摘BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences between CSP and traditional endoscopic mucosal resection(EMR)for the treatment of intestinal polyps.AIM To compare the efficacy-cost of EMR and CSP in the treatment of intestinal polyps.METHODS A total of 100 patients with intestinal polyps were included in the retrospective data of our hospital from April 2022 to May 2023.According to the treatment methods,they were divided into EMR(n=46)group and CSP(n=54)group.The baseline data of the two groups were balanced by 1:1 propensity score matching(PSM),and the cost-effectiveness analysis was performed on the two groups after matching.The recurrence rate of the two groups of patients was followed up for 1 year,and they were divided into recurrence group and non-recurrence group according to whether they recurred.Multivariate logistic regression analysis was used to screen out the influencing factors affecting the recurrence of intestinal polyps after endoscopic resection.RESULTS Significant disparities were observed in the number of polyps and smoking background between the two groups before PSM(P<0.05).Following PSM,the number of polyps and smoking history were well balanced between the EMR and CSP groups.The direct cost incurred by the CSP group was markedly higher than that incurred by the EMR group.Concurrently,the cost-effectiveness ratio in the CSP group was substantially reduced when juxtaposed with that in the EMR group(P<0.05).Upon completion of the 1-year follow-up,the rate of recurrence after endoscopic intestinal polypectomy was 38.00%.Multivariate methods revealed that age≥60 years,male sex,number of polyps≥3,and pathological type of adenoma were risk factors for recurrence after endoscopic intestinal polypectomy(all P<0.05).CONCLUSION CSP was more cost-effective for the treatment of intestinal polyps.An age≥60 years,male sex,having a number of polyps≥3,and pathological type of adenoma are independent influencing factors for recurrence.
基金Supported by the Incubation Project of Zhongshan Hospital(Xiamen),Fudan University,No.2019ZSXMYS15the Clinical Research Center for Precision Medicine of Abdominal Tumor of Fujian Province+1 种基金the Key Clinical Specialty Discipline Construction Program of Fujian ProvinceXiamen Medical and Health Guidance Project,No.3502Z20244ZD1103.
文摘BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in patients with hepatocellular carcinoma(HCC)who underwent laparoscopic hepatectomy during and after surgery.METHODS We retrospectively collected the clinicopathological data of 107 patients who successfully underwent laparoscopic hepatectomy at Zhongshan Hospital(Xiamen),Fudan University from June 2022 to June 2023.Whether using the ICG fluorescence imaging technique,we divided them into the ICG and non-ICG groups.To eliminate statistical bias,a 1:1 propensity score matching analysis was conducted.The comparison of perioperative outcomes,including inflammationrelated markers and progression-free survival,was analyzed statistically.RESULTS Intraoperatively,the ICG group exhibited lower blood loss,a shorter surgical time,lower hepatic inflow occlusion(HIO)frequency,and a shorter total HIO time.Postoperatively,the participation of ICG resulted in a shorter duration of hospitalization(6.5 vs 7.6 days,P=0.03)and postoperative inflammatory response attenuation(lower neutrophil-lymphocyte ratio on the first day after surgery and platelet-lymphocyte ratio on the third day,P<0.05).Although the differences were not significant,the levels of all inflammation-related markers were lower in the ICG group.The rates of postoperative complications and the survival analyses,including progression-free and overall survivals showed no significant difference between the groups.CONCLUSION The involvement of ICG fluorescence imaging may lead to improved perioperative outcomes,especially postoperative inflammatory response attenuation,and ultimately improve HCC patients’recovery after surgery.
文摘目的 探究NIHSS/DWI-ASPECTS不匹配对大脑中动脉供血区脑梗死早期神经功能恶化的预测价值。方法 回顾性收集2017年3月~2018年5月因大脑中动脉供血区脑梗死在安徽医科大学第二附属医院神经内科住院的患者。收集其临床资料,根据入院时和住院72 h NIHSS评分,评估早期神经功能恶化(early neurological deterioration,END),将患者分为END组和非END组。所有患者在入院48 h内完成头部MRI检查,并行DWI-Alberta 卒中项目早期CT评分(DWI-ASPECTS),NIHSS/DWI-ASPECTS不匹配(NIHSS/DWI-ASPECTS Mismatch,NDM)定义为 NIHSS评分≥8且DWI-ASPECTS≥8,应用多变量Logistic回归分析NDM与大脑中动脉供血区脑梗死END的相关性。结果 共收集94例大脑中动脉供血区脑梗死患者,男性52例(55.3%),年龄(65.4±11.0)岁。符合END患者31例(33%)。NIHSS/DWI-ASPECTS不匹配(NDM)病例18例(19.1%),其中END组14例(45%),非END组4例(6.5%)。END组年龄大、NIHSS高、DWI-ASPECTS低、NDM患者比例显著高于非END组( P ≤0.05或 P ≤0.01)。多变量Logistic回归分析显示,在校正混杂因素后,DWI-ASPECTS(优势比0.637,95%置信区间0.409~0.994, P =0.047)和NDM(优势比13.175,95%置信区间1.539~112.824, P =0.019)是大脑中动脉供血区脑梗死END的预测因素。结论 NIHSS/DWI-ASPECTS不匹配对大脑中动脉供血区脑梗死早期神经功能恶化具有一定的预测价值。
文摘本文全面解读了中医药团体标准评价体系(System of Consortium Standards Rating and Evaluation of Traditional Chinese Medicine,SCORE-TCM)。SCORE-TCM是结合定性与定量评价,全面评估中医药团体标准在制定主体、文本编写、技术内容、推广应用和实施效益等几方面特征的综合评价工具。文中详述了SCORE-TCM的构建目的、定义和构建过程,解释了评价指标体系中的各项指标,并对每项指标的评价材料进行介绍。本文旨在帮助中医药团体标准的制定者、第三方评价机构和其他相关方更好地理解SCORE-TCM各评价条目的含义,更有效地运用于中医药团体标准的自评价或第三方评价,SCORE-TCM将为《中医药团体标准管理办法》的贯彻实施,以及中医药团体标准的高质量发展提供技术支持。
文摘The albumin-bilirubin(ALBI)score,which was proposed to assess the prognosis of patients with hepatocellular carcinoma,has gradually been extended to other liver diseases in recent years,including primary biliary cholangitis,liver cirrhosis,hepatitis,liver transplantation,and liver injury.The ALBI score is often compared with classical scores such as the Child-Pugh and model for end-stage liver disease scores or other noninvasive prediction models.It is widely employed because of its immunity to subjective evaluation indicators and ease of obtaining detection indicators.An increasing number of studies have confirmed that it is highly accurate for assessing the prognosis of patients with chronic liver disease;additionally,it has demonstrated good predictive performance for outcomes beyond survival in patients with liver diseases,such as decompensation events.This article presents a review of the application of ALBI scores in various non-malignant liver diseases.
