Clinical manifestations,diagnosis and long-term prognosis of adult autoimmune enteropathy:Experience from Peking Union Medical College Hospital

BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis and prognosis.METHODS We retrospectively analyzed the clinical,endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023,whose diagnosis was based on the 2007 diagnostic criteria.RESULTS Diarrhea in AIE patients was characterized by secretory diarrhea.The common endoscopic manifestations were edema,villous blunting and mucosal hyperemia in the duodenum and ileum.Villous blunting(100%),deep crypt lymphocytic infiltration(67%),apoptotic bodies(50%),and mild intraepithelial lymphocytosis(69%)were observed in the duodenal biopsies.Moreover,there were other remarkable abnormalities,including reduced or absent goblet cells(duodenum 94%,ileum 62%),reduced or absent Paneth cells(duodenum 94%,ileum 69%)and neutrophil infiltration(duodenum 100%,ileum 69%).Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies.All patients received glucocorticoid therapy as the initial medication,of which 14/16 patients achieved a clinical response in 5(IQR:3-20)days.Immunosuppressants were administered to 9 patients with indications of steroid dependence(6/9),steroid refractory status(2/9),or intensified maintenance medication(1/9).During the median of 20.5 months of followup,2 patients died from multiple organ failure,and 1 was diagnosed with non-Hodgkin’s lymphoma.The cumulative relapse-free survival rates were 62.5%,55.6%and 37.0%at 6 months,12 months and 48 months,respectively.CONCLUSION Certain histopathological findings,including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies,might be potential diagnostic criteria for adult AIE.The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressant medications,which highlights the need for early diagnosis and novel medications.

Long-term outcomes after endoscopic removal of malignant colorectal polyps:Results from a 10-year cohort

BACKGROUND Choosing an optimal post-polypectomy management strategy of malignant colorectal polyps is challenging,and evidence regarding a surveillance-only strategy is limited.AIM To evaluate long-term outcomes after endoscopic removal of malignant colorectal polyps.METHODS A single-center retrospective cohort study was conducted to evaluate outcomes after endoscopic removal of malignant colorectal polyps between 2010 and 2020.Residual disease rate and nodal metastases after secondary surgery and local and distant recurrence rate for those with at least 1 year of follow-up were invest-igated.Event rates for categorical variables and means for continuous variables with 95%confidence intervals were calculated,and Fisher’s exact test and Mann-Whitney test were performed.Potential risk factors of adverse outcomes were RESULTS In total,135 lesions(mean size:22.1 mm;location:42%rectal)from 129 patients(mean age:67.7 years;56%male)were enrolled.The proportion of pedunculated and non-pedunculated lesions was similar,with en bloc resection in 82%and 47%of lesions,respectively.Tumor differentiation,distance from resection margins,depth of submucosal invasion,lymphovascular invasion,and budding were reported at 89.6%,45.2%,58.5%,31.9%,and 25.2%,respectively.Residual tumor was found in 10 patients,and nodal metastasis was found in 4 of 41 patients who underwent secondary surgical resection.Univariate analysis identified piecemeal resection as a risk factor for residual malignancy(odds ratio:1.74;P=0.042).At least 1 year of follow-up was available for 117 lesions from 111 patients(mean follow-up period:5.59 years).Overall,54%,30%,30%,11%,and 16%of patients presented at the 1-year,3-year,5-year,7-year,and 9-10-year surveillance examinations.Adverse outcomes occurred in 9.0%(local recurrence and dissemination in 4 patients and 9 patients,respectively),with no difference between patients undergoing secondary surgery and surveillance only.CONCLUSION Reporting of histological features and adherence to surveillance colonoscopy needs improvement.Long-term adverse outcome rates might be higher than previously reported,irrespective of whether secondary surgery was performed.

Does Smoking Weaken the Immune System: A Narrative Review

Smoking has a complex impact on the immune system, affecting both innate and adaptive immunity. It can exacerbate pathogenic immune responses and attenuate defensive immunity, leading to a higher susceptibility to infections and certain diseases. The chemicals in cigarette smoke, such as nicotine and carbon monoxide, can alter immune cell functions and inflammatory responses. Smoking can also have long-term effects on the immune system, with some changes persisting even after quitting [1]. According to a Penn Medicine Physician, the Medical Oncologist Dr. David Porter, “People who are smokers tend to get sicker from infections”, “It may be that smoking impacts the immune system’s ability to respond appropriately”. Thus, such individuals within smoking exposure history might be considered as immunocompromised due to the altered and weakened immune system. Cigarette smoking is a prevalent habit with far-reaching health implications. Among its many adverse effects, smoking significantly alters the immune system’s functionality [1].

Inhibition of the NF-κB Signaling Pathway Improves Cigarette Mainstream Smoke-Induced Lung Injury and Gut Microbiota Disturbance

Currently,cigarette smoke(CS)remains a major contributor to disease morbidity and mortality.CS can be divided into cigarette mainstream smoke(CMS)and side-stream smoke,depending on where it is produced by burning tobacco^([1]).CMS is inhaled by smokers from the filter end during cigarette combustion and is strongly associated with the development of several diseases^([2-4]).

Exploring the Impact of Alcohol Consumption and Smoking on Primary Open Angle Glaucoma: A Mendelian Randomization Study

Objective: Utilizing Mendelian Randomization, this study employs Single Nucleotide Polymorphisms (SNPs) as instrumental variables to explore the causal relationships between bibulosity, smoking, and Primary Open Angle Glaucoma (POAG). Methods: GWAS data for bibulosity, smoking, and POAG were obtained from the Social Science Genetic Association Consortium website and the IEU OpenGWAS Project website, respectively. Using a P-value threshold of −8, a linkage disequilibrium coefficient (r2) of 0.001, and a linkage disequilibrium region width of 10,000 kb, the data were aggregated, resulting in 6 SNPs for bibulosity and 253 SNPs for smoking. Three regression models, MR-Egger, Weighted Median Estimator (WME), and Random-Effects Inverse-Variance Weighted (IVW) were applied to analyze the causal impact of bibulosity and smoking on POAG. Results: The GWAS data for alcohol consumption and smoking were derived from European populations, while the GWAS data for Primary Open-Angle Glaucoma (POAG) were sourced from East Asian populations, with no gender restrictions. Analysis using three different regression models revealed that neither excessive alcohol consumption nor smoking significantly increased the risk of developing POAG. Specifically, the odds ratios with 95% confidence intervals for the alcohol consumption group were 0.854 (0.597 - 1.221) in MR-Egger regression, 0.922 (0.691 - 1.231) in WME regression, and 0.944 (0.711 - 1.252) in IVW regression. For the smoking group, the odds ratios were 1.146 (0.546 - 2.406) in MR-Egger regression, 0.850 (0.653 - 1.111) in WME regression, and 0.939 (0.780 - 1.131) in IVW regression. Given the significant heterogeneity in the SNPs associated with smoking, the focus was primarily on the results from the IVW regression model. Conclusion: Alcohol consumption and smoking are not significant risk factors for the development of POAG.

Small-scale fire tests in the underwater tunnel section model with new sidewall smoke extraction

The Shenzhen–Zhongshan Bridge is a 24‐km‐long bridge and tunnel system,including a 6.8-km-long super cross section subsea tunnel.To solve the smoke exhaust problem of a super large cross-section subsea tunnel,the tunnel has a new smoke exhaust system that combines a horizontal smoke exhaust cross section at the top and sidewall smoke exhaust holes.In order to evaluate the potential fire hazards of this type of tunnel,a 1:30 tunnel model was established and 140 smallscale experiments on underwater tunnel fires were conducted.By changing the fire power,fire location,and fan operation mode,different scenarios of submarine immersed tunnel fire were simulated and the related key parameters such as fire smoke diffusion behavior and smoke temperature distribution were studied.On this basis,the optimal smoke control strategy was proposed for different fire scenarios.The research results indicate that the new smoke exhaust system can fully utilize the smoke flow characteristics,significantly improve smoke exhaust efficiency,and increase available evacuation time,thus further enhancing the fire safety of super large cross-section subsea tunnels.

Tailoring Iron-Ion Release of Cellulose-Based Aerogel-Coated Iron Foam for Long-Term High-Power Microbial Fuel Cells

The presence of iron(Fe) has been found to favor power generation in microbial fuel cells(MFCs). To achieve long-term power production in MFCs, it is crucial to effectively tailor the release of Fe ions over extended operating periods. In this study, we developed a composite anode(A/IF) by coating iron foam with cellulose-based aerogel. The concentration of Fe ions in the anode solution of A/IF anode reaches 0.280 μg/mL(Fe^(2+) vs. Fe^(3+) = 61%:39%) after 720 h of aseptic primary cell operation. This value was significantly higher than that(0.198 μg/mL, Fe^(2+) vs. Fe^(3+) = 92%:8%) on uncoated iron foam(IF), indicating a continuous release of Fe ions over long-term operation. Notably, the resulting MFCs hybrid cell exhibited a 23% reduction in Fe ion concentration(compared to a 47% reduction for the IF anode) during the sixth testing cycle(600-720 h). It achieved a high-power density of 301 ± 55 mW/m^(2) at 720 h, which was 2.62 times higher than that of the IF anode during the same period. Furthermore, a sedimentary microbial fuel cell(SMFCs) was constructed in a marine environment, and the A/IF anode demonstrated a power density of 103 ± 3 mW/m^(2) at 3240 h, representing a 75% improvement over the IF anode. These findings elucidate the significant enhancement in long-term power production performance of MFCs achieved through effective tailoring of Fe ions release during operation.

An Improved YOLOv5s-Based Smoke Detection System for Outdoor Parking Lots

In the rapidly evolving urban landscape,outdoor parking lots have become an indispensable part of the city’s transportation system.The growth of parking lots has raised the likelihood of spontaneous vehicle combus-tion,a significant safety hazard,making smoke detection an essential preventative step.However,the complex environment of outdoor parking lots presents additional challenges for smoke detection,which necessitates the development of more advanced and reliable smoke detection technologies.This paper addresses this concern and presents a novel smoke detection technique designed for the demanding environment of outdoor parking lots.First,we develop a novel dataset to fill the gap,as there is a lack of publicly available data.This dataset encompasses a wide range of smoke and fire scenarios,enhanced with data augmentation to ensure robustness against diverse outdoor conditions.Second,we utilize an optimized YOLOv5s model,integrated with the Squeeze-and-Excitation Network(SENet)attention mechanism,to significantly improve detection accuracy while maintaining real-time processing capabilities.Third,this paper implements an outdoor smoke detection system that is capable of accurately localizing and alerting in real time,enhancing the effectiveness and reliability of emergency response.Experiments show that the system has a high accuracy in terms of detecting smoke incidents in outdoor scenarios.

The Prevalence of Smoking in Caribbean Towns and Correlation with Disease States: A Survey

Background: Smoking continues to be one of the most popular recreational practices despite its known harmful effects. Aim: The purpose of this survey was to assess the prevalence of smoking in the Caribbean and the correlation of smoking with the disease states of high blood pressure, diabetes and high cholesterol whose risk is known to be higher among smokers. Findings: Our study found a smoking prevalence of 22% in the population, similar to that reported by the World Health Organization (20%) and a positive correlation between smoking and diabetes. Conclusion: The survey shows that smoking numbers within the population are still high and that smoking increases the risk of certain disease states within smokers. Aggressive global efforts to reduce smoking should continue so as to minimize the negative impact of smoking on health.

Long-Term Performance and Microstructural Characterization of Dam Concrete in the Three Gorges Project

This study investigates the long-term performance of laboratory dam concrete in different curing environments over ten years and the microstructure of 17-year-old laboratory concrete and actual concrete cores drilled from the Three Gorges Dam.The mechanical properties of the laboratory dam concrete,whether cured in natural or standard environments,continued to improve over time.Furthermore,the laboratory dam concrete exhibited good resistance to diffusion and a refined microstructure after 17 years.However,curing and long-term exposure to the local natural environment reduced the frost resistance.Microstructural analyses of the laboratory concrete samples demonstrated that moderate-heat cement and fine fly ash(FA)particles were almost fully hydrated to form compact micro structures consisting of large quantities of homogeneous calcium(alumino)silicate hydrate(C-(A)-S-H)gels and a few crystals.No obvious interfacial transition zones were observed in the microstructure owing to the longterm pozzolanic reaction.This dense and homogenous microstructure was the crucial reason for the excellent long-term performance of the dam concrete.A high FA volume also played a significant role in the microstructural densification and performance growth of dam concrete at a later age.The concrete drilled from the dam surface exhibited a loose microstructure with higher microporosity,indicating that concrete directly exposed to the actual service environment suffered degradation caused by water and wind attacks.In this study,both macro-performance and microstructural analyses revealed that the application of moderate-heat cement and FA resulted in a dense and homogenous microstructure,which ensured the excellent long-term performance of concrete from the Three Gorges Dam after 17 years.Long-term exposure to an actual service environment may lead to microstructural degradation of the concrete surface.Therefore,the retained long-term dam concrete samples need to be further researched to better understand its microstructural evolution and development of its properties.

Soil bacterial and fungal communities resilience to long-term nitrogen addition in subtropical forests in China

Atmospheric nitrogen(N)deposition is predicted to increase,especially in the subtropics.However,the responses of soil microorganisms to long-term N addition at the molecular level in N-rich subtropical forests have not been clarified.A long-term nutrient addition experiment was conducted in a subtropical evergreen old-growth forest in China.The four treatments were:control,low N(50 kg N ha^(-1)a^(-1)),high N(100 kg N ha^(-1)a^(-1)),and combined N and phosphorus(P)(100 kg N ha^(-1)a^(-1)+50 kg P ha^(-1)a^(-1)).Metagenomic sequencing characterized diversity and composition of soil microbial communities and used to construct bacterial/fungal co-occurrence networks.Nutrient-treated soils were more acidic and had higher levels of dissolved organic carbon than controls.There were no significant differences in microbial diversity and community composition across treatments.The addition of nutrients increased the abundance of copiotrophic bacteria and potentially beneficial microorganisms(e.g.,Gemmatimonadetes,Chaetomium,and Aureobasidium).Low N addition increased microbiome network connectivity.Three rare fungi were identified as module hubs under nutrient addition,indicating that low abundance fungi were more sensitive to increased nutrients.The results indicate that the overall composition of microbial communities was stable but not static to long-term N addition.Our findings provide new insights that can aid predictions of the response of soil microbial communities to long-term N addition.

U-Net Inspired Deep Neural Network-Based Smoke Plume Detection in Satellite Images

Industrial activities, through the human-induced release of Green House Gas (GHG) emissions, have beenidentified as the primary cause of global warming. Accurate and quantitative monitoring of these emissions isessential for a comprehensive understanding of their impact on the Earth’s climate and for effectively enforcingemission regulations at a large scale. This work examines the feasibility of detecting and quantifying industrialsmoke plumes using freely accessible geo-satellite imagery. The existing systemhas so many lagging factors such aslimitations in accuracy, robustness, and efficiency and these factors hinder the effectiveness in supporting timelyresponse to industrial fires. In this work, the utilization of grayscale images is done instead of traditional colorimages for smoke plume detection. The dataset was trained through a ResNet-50 model for classification and aU-Net model for segmentation. The dataset consists of images gathered by European Space Agency’s Sentinel-2 satellite constellation from a selection of industrial sites. The acquired images predominantly capture scenesof industrial locations, some of which exhibit active smoke plume emissions. The performance of the abovementionedtechniques and models is represented by their accuracy and IOU (Intersection-over-Union) metric.The images are first trained on the basic RGB images where their respective classification using the ResNet-50model results in an accuracy of 94.4% and segmentation using the U-Net Model with an IOU metric of 0.5 andaccuracy of 94% which leads to the detection of exact patches where the smoke plume has occurred. This work hastrained the classification model on grayscale images achieving a good increase in accuracy of 96.4%.

Long-term thinning decreases the contribution of heterotrophic respiration to soil respiration in subalpine plantations

Interest in the dynamics of soil respiration(R_(S))in subalpine forest ecosystems is increasing due to their high soil carbon density and potential sensitivity to environmental changes.However,as a principal silvicultural practice,the long-term impacts of thinning on R_(S) and its heterotrophic and autotrophic respiration components(R_(h) and Ra,respectively)in subalpine plantations are poorly understood,espe-cially in winter.A 3-year field observation was carried out with consideration of winter CO_(2) efflux in middle-aged sub-alpine spruce plantations in northwestern China.A trench-ing method was used to explore the long-term impacts of thinning on Rs,Rn and R_(a).Seventeen years after thinning,mean annual Rs,Rn and R_(a) increased,while the contribu-tion of R_(h) to R_(s) decreased with thinning intensity.Thinning significantly decreased winter R,because of the reduction in R_(n) but had no significant effect on Ra.The temperature sensitivity(Q_(10))of R_(h) and R_(a) also increased with thinning intensity,with lower Q_(10) values for R_(h)(2.1-2.6)than for Ra(2.4-2.8).The results revealed the explanatory variables and pathways related to R_(n) and R_(a) dynamics.Thinning increased soil moisture and nitrate nitrogen(NO_(3)^(-)-N),and the enhanced nitrogen and water availability promoted R_(h) and R_(a) by improving fine root biomass and microbial activity.Our results highlight the positive roles of NO_(3)^(-)-N in stimulating R_(s) components following long-term thinning.Therefore,applications of nitrogen fertilizer are not recommended while thinning subalpine spruce plantations from the perspective of reducing soil CO_(2) emissions.The increased Q_(10) values of R_(s) components indicate that a large increase in soil CO_(2) emissions would be expected following thinning because of more pronounced climate warming in alpineregions.

A data and physical model dual-driven based trajectory estimator for long-term navigation

Long-term navigation ability based on consumer-level wearable inertial sensors plays an essential role towards various emerging fields, for instance, smart healthcare, emergency rescue, soldier positioning et al. The performance of existing long-term navigation algorithm is limited by the cumulative error of inertial sensors, disturbed local magnetic field, and complex motion modes of the pedestrian. This paper develops a robust data and physical model dual-driven based trajectory estimation(DPDD-TE) framework, which can be applied for long-term navigation tasks. A Bi-directional Long Short-Term Memory(Bi-LSTM) based quasi-static magnetic field(QSMF) detection algorithm is developed for extracting useful magnetic observation for heading calibration, and another Bi-LSTM is adopted for walking speed estimation by considering hybrid human motion information under a specific time period. In addition, a data and physical model dual-driven based multi-source fusion model is proposed to integrate basic INS mechanization and multi-level constraint and observations for maintaining accuracy under long-term navigation tasks, and enhanced by the magnetic and trajectory features assisted loop detection algorithm. Real-world experiments indicate that the proposed DPDD-TE outperforms than existing algorithms, and final estimated heading and positioning accuracy indexes reaches 5° and less than 2 m under the time period of 30 min, respectively.

RuO_(2)/CoMO_(2)O_(x) Catalyst with Low Ruthenium Loading for Long-Term Acidic Oxygen Evolution

We must urgently synthesize highly efficient and stable oxygen-evolution reaction(OER) catalysts for acidic media. Herein, we constructed a series of Ti mesh(TM)-supported RuO_(2)/CoMo_(y)O_(x) catalysts(RuO_(2)/CoMo_(y)O_(x)/TM) with heterogeneous structures. By optimizing the ratio of Co to Mo, RuO_(2)/CoMO_(2)O_(x)/TM with low Ru loading(0.079 mg/cm^(2)) achieves remarkable OER performance(η = 243 mV at 10 mA/cm^(2)) and high stability(300 h @ 10 mA/cm^(2)) in 0.5 mol/L H_(2)SO_(4) electrolyte. The activity of RuO_(2)/CoMo_yO_x/TM can be maintained for 50 h at 100 mA/cm^(2), and a water electrolyzer with RuO_(2)/CoMO_(2)O_(x)/TM as anode can operate for 40 h at 100 mA/cm~2, suggesting the remarkable OER durability of RuO_(2)/CoMo__(y)O__(x)/TM in acidic electrolyte. Owing to the heterogeneous interface between CoMO_(2)O_(x) and RuO_(2), the electronic structure of Ru atoms was optimized and electron-rich Ru was formed. With modulated electronic properties, the dissociation energy of H_(2)O is weakened, and the OER barrier is lowered. This study provides the design of low-cost noble metal catalysts with long-term stability in an acidic environment.

Imperative for long-term management and surveillance in Kawasaki disease

Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.

Optimism,Social Support,and Caregiving Burden among the Long-Term Caregivers:The Mediating Effect of Psychological Resilience

Background:As the elderly population grows,the demand for long-term care services is increasing.Despite significant investments in care quality and workforce training,long-term care workers often face challenges such as work fatigue,heavy workloads,and inadequate support.These issues can impact job satisfaction,mental health,and care quality,leading to staff turnover.This study examines how optimism,social support,and psychological resilience relate to caregiving burden,aiming to understand their effects on caregivers’well-being and performance to enhance the quality of long-term care services.Methods:The participants were 542 long-term care workers.Descriptive statistics,t-tests,one-way ANOVA,and hierarchical regression were used for data analysis.Results:(1)Optimism and social support were significantly and positively correlated with psychological resilience and significantly and negatively associated with caregiving burden.(2)Regarding differences in optimism,social support,psychological resilience,and caregiving burden among long-term care workers,females scored significantly higher than males in“social support;”married workers scored significantly higher than unmarried workers in“optimism,”“social support,”and“psychological resilience”;workers aged 45–65 scored significantly higher than those aged 25–45 in“optimism”;workers aged 25–45 scored significantly higher than those aged 45–65 in“caregiving burden”;social workers scored significantly higher than nursing staff in“optimism.”(3)Psychological resilience partially mediated the relationship between social support and caregiving burden concerning explanatory and predictive power.Conclusions:These findings suggest that optimism,social support,and psychological resilience are essential factors in reducing the caregiving burden among long-term care workers.The study highlights the importance of promoting psychological resilience and providing social support to alleviate the burden of caregiving.

Effect of long-term thermal exposure on microstructure of laser-welded UNS N10003 alloy

The evolution of the microstructure and tensile rupture mechanism of laser welds in UNS N10003 alloy exposed to 700℃are investigated.Fine M_(6)C carbides precipitate around the primary eutectic M_(6)C-carbides in the fusion zone after 100 h of exposure.During long-term thermal exposure,the size of the fine M_(6)C carbides increased.The eutectic M_(6)C-carbides in the as-welded fusion zone transformed into spherical M_(6)C carbides as the exposure time extends to 10000 h.Additionally,the spherical M_(6)C particles exhibit size coarsening with increasing exposure time.The tensile properties of the welded joints are not adversely affected by the evolution of eutectic M_(6)C-carbides and the coarsening of M_(6)C carbides.

Net Effect of Short-Term Smoking Cessation on Mental Health Changes:Inverse Probability of Treatment Weighting and Difference-in-Differences Method

Background:In response to the need for research clearly demonstrating the net effect of smoking cessation on mental health status,considering the causal relationship between smoking cessation and changes in mental health status,this study was undertaken.Thus,this study aimed to examine the net effect of short-term smoking cessation on five specific mental health metrics and the overall mental health status score.Methods:We used data from the first wave of the Korean Health Panel(KHP)Survey(2011–2013,2016–2018)and focused on men aged 19 years and older,to explore the effects of smoking cessation.We compared mental health status before and after cessation among current non-smokers who had quit smoking and continuous smokers.We ensured homogeneity between the two groups via inverse probability of treatment weighting(IPTW)and employed a difference-in-differences(DID)analysis to assess changes in mental health status.This study controlled for factors that could influence mental health and explored the net effect of short-term smoking cessation through difference-in-differences model using multiple regression analysis.Results:The results showed that short-term smoking cessation significantly alleviated mental and physical stress(p<0.1),reduced experiences of frustration(p<0.01),and improved the overall mental health status score(p<0.1).Conclusion:Thus,these results highlight a meaningful link between positive health behavior changes,such as smoking cessation,and enhanced mental health.Moreover,the application of temporal variables further improved the understanding of the causal relationship between health behaviors and mental health.

Development of a new Cox model for predicting long-term survival in hepatitis cirrhosis patients underwent transjugular intrahepatic portosystemic shunts

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)placement is a procedure that can effectively treat complications of portal hypertension,such as variceal bleeding and refractory ascites.However,there have been no specific studies on predicting long-term survival after TIPS placement.AIM To establish a model to predict long-term survival in patients with hepatitis cirrhosis after TIPS.METHODS A retrospective analysis was conducted on a cohort of 224 patients who un-derwent TIPS implantation.Through univariate and multivariate Cox regression analyses,various factors were examined for their ability to predict survival at 6 years after TIPS.Consequently,a composite score was formulated,encompassing the indication,shunt reasonability,portal venous pressure gradient(PPG)after TIPS,percentage decrease in portal venous pressure(PVP),indocyanine green retention rate at 15 min(ICGR15)and total bilirubin(Tbil)level.Furthermore,the performance of the newly developed Cox(NDC)model was evaluated in an in-ternal validation cohort and compared with that of a series of existing models.RESULTS The indication(variceal bleeding or ascites),shunt reasonability(reasonable or unreasonable),ICGR15,post-operative PPG,percentage of PVP decrease and Tbil were found to be independent factors affecting long-term survival after TIPS placement.The NDC model incorporated these parameters and successfully identified patients at high risk,exhibiting a notably elevated mortality rate following the TIPS procedure,as observed in both the training and validation cohorts.Additionally,in terms of predicting the long-term survival rate,the performance of the NDC model was significantly better than that of the other four models[Child-Pugh,model for end-stage liver disease(MELD),MELD-sodium and the Freiburg index of post-TIPS survival].CONCLUSION The NDC model can accurately predict long-term survival after the TIPS procedure in patients with hepatitis cirrhosis,help identify high-risk patients and guide follow-up management after TIPS implantation.