BACKGROUND:This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores(EWSs)and three shock indices in early sepsis prediction in the emergency department(ED).METHODS:We per...BACKGROUND:This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores(EWSs)and three shock indices in early sepsis prediction in the emergency department(ED).METHODS:We performed a retrospective study on consecutive adult patients with an infection over 3 months in a public ED in Hong Kong.The primary outcome was sepsis(Sepsis-3 definition)within 48 h of ED presentation.Using c-statistics and the DeLong test,we compared 11 EWSs,including the National Early Warning Score 2(NEWS2),Modified Early Warning Score,and Worthing Physiological Scoring System(WPS),etc.,and three shock indices(the shock index[SI],modified shock index[MSI],and diastolic shock index[DSI]),with Systemic Inflammatory Response Syndrome(SIRS)and quick Sequential Organ Failure Assessment(qSOFA)in predicting the primary outcome,intensive care unit admission,and mortality at different time points.RESULTS:We analyzed 601 patients,of whom 166(27.6%)developed sepsis.NEWS2 had the highest point estimate(area under the receiver operating characteristic curve[AUROC]0.75,95%CI 0.70-0.79)and was significantly better than SIRS,qSOFA,other EWSs and shock indices,except WPS,at predicting the primary outcome.However,the pooled sensitivity and specificity of NEWS2≥5 for the prediction of sepsis were 0.45(95%CI 0.37-0.52)and 0.88(95%CI 0.85-0.91),respectively.The discriminatory performance of all EWSs and shock indices declined when used to predict mortality at a more remote time point.CONCLUSION:NEWS2 compared favorably with other EWSs and shock indices in early sepsis prediction but its low sensitivity at the usual cut-off point requires further modification for sepsis screening.展开更多
For ulcerative colitis(UC),the variability in inflammatory activity along the colon poses a challenge in management.The focus on achieving endoscopic healing in UC is evident,where the UC Endoscopic Index of Severity ...For ulcerative colitis(UC),the variability in inflammatory activity along the colon poses a challenge in management.The focus on achieving endoscopic healing in UC is evident,where the UC Endoscopic Index of Severity and Mayo Endoscopic Subscore are commonly used for evaluation.However,these indices primarily consider the most severely affected region.Liu et al recent study validates the Toronto Inflammatory Bowel Disease Global Endoscopic Reporting(TIGER)score offering a comprehensive assessment of inflammatory activity across diverse segments of the colon and rectum and a reliable index correlating strongly with UC Endoscopic Index of Severity and moderately with Mayo Endoscopic Subscore(MES).Despite recommendation,certain aspects warrant further invest-igation.Fecal calprotectin,an intermediate target,correlates with TIGER and should be explored.Determining TIGER scores defining endoscopic remission and response,evaluating agreement with histological activity,and assessing inter-endoscopist agreement for TIGER require scrutiny.Exploring the correlation between TIGER and intestinal ultrasound,akin to MES,adds value.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
BACKGROUND Bone metastasis has various negative impacts.Activities of daily living(ADL)and quality of life(QOL)can be significantly decreased,survival may be impacted,and medical expenses may increase.It is estimated ...BACKGROUND Bone metastasis has various negative impacts.Activities of daily living(ADL)and quality of life(QOL)can be significantly decreased,survival may be impacted,and medical expenses may increase.It is estimated that at least 5%cancer patients might be suffering from bone metastases.In 2016,we published the Comprehensive Guidelines for the Diagnosis and Treatment of Bone Metastasis.Since then,the therapeutic outcomes for patients have gradually improved.As life expectancy is a major determinant of surgical intervention,the strategy should be modified if the prolongation of survival is to be achieved.AIM To monitor how bone metastasis treatment has changed before and after launch of our guidelines for bone metastasis.METHODS For advanced cancer patients with bone metastasis who visited the Department of Clinical Oncology at Akita University hospital between 2012 and 2023,parameters including the site and number of bone metastases,laboratory data,and survival time,were extracted from electronic medical records and the Katagiri score was calculated.The association with survival was determined for each factor.RESULTS Data from 136 patients were obtained.The 1-year survival rate for the poor prognosis group with a higher Katagiri score was 20.0%in this study,which was 6%and an apparent improvement from 2014 when the scoring system was developed.Other factors significantly affecting survival included five or more bone metastases than less(P=0.0080),and treatment with chemotherapy(P<0.001),bone modifying agents(P=0.0175)and immune checkpoint inhibitors(P=0.0128).In recent years,advances in various treatment methods have extended the survival period for patients with advanced cancer.It is necessary not only to simply extend survival time,but also to maintain ADL and improve QOL.CONCLUSION Various therapeutic interventions including surgical approach for bone metastasis,which is a disorder of locomotor organs,are increasingly required.Guidelines and scoring system for prognosis need to be revised promptly.展开更多
BACKGROUND Robotic surgery(RS)is gaining popularity;however,evidence for abdominoperineal resection(APR)of rectal cancer(RC)is scarce.AIM To compare the efficacy of RS and laparoscopic surgery(LS)in APR for RC.METHODS...BACKGROUND Robotic surgery(RS)is gaining popularity;however,evidence for abdominoperineal resection(APR)of rectal cancer(RC)is scarce.AIM To compare the efficacy of RS and laparoscopic surgery(LS)in APR for RC.METHODS We retrospectively identified patients with RC who underwent APR by RS or LS from April 2016 to June 2022.Data regarding short-term surgical outcomes were compared between the two groups.To reduce the effect of potential confounding factors,propensity score matching was used,with a 1:1 ratio between the RS and LS groups.A meta-analysis of seven trials was performed to compare the efficacy of robotic and laparoscopic APR for RC surgery.RESULTS Of 133 patients,after propensity score matching,there were 42 patients in each group.The postoperative complication rate was significantly lower in the RS group(17/42,40.5%)than in the LS group(27/42,64.3%)(P=0.029).There wasno significant difference in operative time(P=0.564),intraoperative transfusion(P=0.314),reoperation rate(P=0.314),lymph nodes harvested(P=0.309),or circumferential resection margin(CRM)positive rate(P=0.314)between the two groups.The meta-analysis showed patients in the RS group had fewer positive CRMs(P=0.04),lesser estimated blood loss(P<0.00001),shorter postoperative hospital stays(P=0.02),and fewer postoperative complications(P=0.002)than patients in the LS group.CONCLUSION Our study shows that RS is a safe and effective approach for APR in RC and offers better short-term outcomes than LS.展开更多
BACKGROUND Patients with ankylosing spondylitis(AS)frequently suffer from comorbid sleep disorders,exacerbating the burden of the disease and affecting their quality of life.AIM To investigate the clinical significanc...BACKGROUND Patients with ankylosing spondylitis(AS)frequently suffer from comorbid sleep disorders,exacerbating the burden of the disease and affecting their quality of life.AIM To investigate the clinical significance of serum inflammatory factors,health index and disease activity scores in patients with AS complicated by sleep disorders.METHODS A total of 106 AS patients with comorbid sleep disorders were included in the study.The patients were grouped into the desirable and undesirable prognosis groups in accordance with their clinical outcomes.The serum levels of inflammatory factors,including C-reactive protein,erythrocyte sedimentation rate,interleukin(IL)-6,tumour necrosis factor-αand IL-1β,were measured.Disease activity scores,such as the Bath AS functional index,Bath AS disease activity index,Bath AS metrology index and AS disease activity score,were assessed.The health index was obtained through the Short Form-36 questionnaire.RESULTS The study found significant associations amongst serum inflammatory factors,health index and disease activity scores in AS patients with comorbid sleep disorders.Positive correlations were found between serum inflammatory factors and disease activity scores,indicating the influence of heightened systemic inflammation on disease severity and functional impairment.Conversely,negative correlations were found between disease activity scores and health index parameters,highlighting the effect of disease activity on various aspects of healthrelated quality of life.Logistic regression analysis further confirmed the predictive value of these factors on patient outcomes,underscoring their potential utility in risk assessment and prognostication.CONCLUSION The findings demonstrate the intricate interplay amongst disease activity,systemic inflammation and patientreported health outcomes in AS patients complicated by sleep disorders.The results emphasise the need for comprehensive care strategies that address the diverse needs and challenges faced by these patients and underscore the potential relevance of serum inflammatory factors,health index and disease activity scores as prognostic markers in this patient population.展开更多
The treatment of hepatitis C has undergone a significant boom since the advent of direct acting antivirals (DAA). Indeed, the interferon-ribavirin combination that has been used to treat hepatitis C has a virological ...The treatment of hepatitis C has undergone a significant boom since the advent of direct acting antivirals (DAA). Indeed, the interferon-ribavirin combination that has been used to treat hepatitis C has a virological response in only 45% of cases with significant side effects. The advent of direct-acting antivirals has changed the prognosis of cirrhotic patients with hepatitis C. DAAs have ensured a sustained viral response in the majority of patients. Our work aims to see the evolution of hepatitis C patients at the cirrhosis stage under DAA. We conducted a retrospective study over 15 years (January 2009, January 2024) including all patients with post-viral cirrhosis C, whom we divided into two groups: group A, cirrhotic patients who received ribavirin and interferon, and group B, patients on DAA. From January 2009 to January 2024, we conducted a study of 182 patients with viral hepatitis C, including 102 cirrhotic patients. The mean age was 55 years. 66% of patients were initially treated with the ribavirin interferon combination, while 34% received direct-acting antivirals (DAAs). Since the introduction of DAAs, the most commonly used regimens have been sofosbuvir/daclatasvir with or without ribavirin and sofosbuvir/ledipasvir with or without ribavirin. Group A achieved sustained virological response (SVR) in 60% of cases, with notable side effects. In Group B, SVR was 98.18%, with improved tolerability and fewer side effects than previous treatments. Fifteen patients developed hepatocellular carcinoma (HCC), with a significantly lower mortality rate in those treated with DAAs compared with pegylated dual therapy (p: 0.001).展开更多
Objective: To evaluate the application value of neutrophils/lymphocytes (NLR), platelets/lymphocytes (PLR), lymphocytes/monocytes (LMR), HEART (history, electrocardiogram, age, risk factors, and troponin) score, and p...Objective: To evaluate the application value of neutrophils/lymphocytes (NLR), platelets/lymphocytes (PLR), lymphocytes/monocytes (LMR), HEART (history, electrocardiogram, age, risk factors, and troponin) score, and point-of- care testing (POCT) in the early warning and precise diagnosis of high-risk chest pain in emergency medicine. Methods: A total of 157 patients with acute chest pain who were admitted to the emergency department and chest pain treatment unit of our hospital between August 2022 and September 2023 were selected. Rapid testing of bedside myocardial markers (ultrasensitive troponin (hs-cTnI), myoglobin (MYO), creatine kinase isoenzyme (CK-MB), D-dimer (D-Dimer), and N-terminal B-type natriuretic peptide precursor (NT-proBNP)) was performed on the patients using a POCT device (ThermoKing BioMQ60proB). A HEART score was used to classify the patients into low (n = 53), intermediate (n = 59), and high-risk (n = 45) groups, and the NLR, PLR, and LMR were calculated. The NLR, PLR, and LMR values were compared among the three groups of patients, and the optimal cutoff values as well as sensitivity and specificity were determined based on receiver operating characteristic (ROC) analysis. Results: The HEART scores of patients in the low-risk, intermediate-risk, and high-risk groups were (2.72 ± 0.24), (4.75 ± 0.56), and (5.32 ± 0.73) respectively, and the differences were statistically significant (P < 0.05). Compared with the low-risk group, the intermediate-risk group and high-risk group had a significantly higher NLR and PLR, and a significantly lower LMR;the high-risk group had higher NLR and PLR and lower values of LMR as compared to the other two groups, and the difference was statistically significant (P < 0.05). The ROC curves suggested that the area under the curve, sensitivity, and specificity of the combined diagnosis of NLR, PLR, LMR, HEART score, and POCT were greater than those of LR, PLR, and LMR with HEART score and POCT alone. Conclusion: The combined application of NLR, PLR, LMR, HEART score, and POCT has significant application value in the early warning and precise diagnosis of emergency high-risk chest pain. It provides a more simple, easy-to-access, and efficient assessment index for the clinical prediction and treatment of emergency high- risk chest pain.展开更多
Objective:To explore the effect of nursing interventions based on self-efficacy theory guidance on psychological stress indicators in patients with hepatitis B cirrhosis.Methods:70 patients with hepatitis B cirrhosis ...Objective:To explore the effect of nursing interventions based on self-efficacy theory guidance on psychological stress indicators in patients with hepatitis B cirrhosis.Methods:70 patients with hepatitis B cirrhosis from October 2023 to May 2024 were selected and grouped by random number table.The observation group received nursing intervention based on self-efficacy theory,while the control group received routine nursing.The differences in psychological stress indicators,self-efficacy indicators,and nursing satisfaction were compared between the two groups.Results:Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HAMD)scores of the observation group were significantly lower than those of the control group(P<0.05);Chronic Disease Self-Efficacy Scale(CDSES)scores of the observation group were significantly higher than those of the control group(P<0.05);and nursing satisfaction scores of the observation group were significantly higher than those of the control group(P<0.05).Conclusion:Hepatitis B cirrhosis patients receiving nursing care based on self-efficacy theory can stimulate patients'self-efficacy,calm their emotions,and their overall satisfaction is high.展开更多
Aims: The present study aims to compare the assessment of work ability based on the use of the Work Ability Index (WAI) with another questionnaire base only on the use of WAI’s first item, termed as the “Work Abilit...Aims: The present study aims to compare the assessment of work ability based on the use of the Work Ability Index (WAI) with another questionnaire base only on the use of WAI’s first item, termed as the “Work Ability Score” (WAS). Study design: A cohort of 384 Spanish workers included in a Post COVID-19 condition or persistent COVID-19 multicenter research was utilized. Place and Duration of Study: This cohort was enlisted in four hospitals (Hospital Universitario 12 de Octubre, Madrid;Hospital Universitario Virgen Macarena, Sevilla, Andalucía;Hospital Universitario Gregorio Marañón, Madrid and Complejo Asistencial Universitario de Salamanca, Castilla y León), since 2021 until 2022. Methodology: 384 Spanish workers (176 men and 208 women;aged 20 to 70 years) with Post COVID-19 condition or persistent COVID-19 were included. Descriptive analysis of primary scores was conducted. Given the non-normal distribution of data, the Mann-Whitney and Kruskal-Wallis tests were employed. Spearman and Kendall correlations were employed to assess the relationship between WAI and WAS, also used weighted Kappa to estimate the degree agreement between WAI and WAS. Logistic regression models were utilized to study determinants influencing WAI and WAS, categorized as poor or moderate. Results: WAI had an average score of 32.98 (SD = 10.28), whereas WAS had an average of 5.95 (SD = 2.77). Significant differences were observed in both WAI and WAS across the same variables. Strong and statistically significant correlations were evident between WAI and WAS (rs = 0.83, p < 0.001). All the variables used in the logistic regression model (gender, the sector employment, and previous chronic diseases) were statistically significant in both questionnaires. Conclusion: WAS questionnaire could be used as a tool for reliable assessment of work ability among Spanish workers with Post COVID-19 condition or Persistent CO-VID-19.展开更多
Background: Spinal dysraphism represents a wide spectrum of congenital abnormalities of the spine. Myelomeningocele is considered the most common malformation and the most common we saw in our community, with its morb...Background: Spinal dysraphism represents a wide spectrum of congenital abnormalities of the spine. Myelomeningocele is considered the most common malformation and the most common we saw in our community, with its morbidity problems seen commonly in the postoperative period. ASQ-3<sup>TM</sup> Scores are the ages and stages questionnaire, third edition, and represent a tool to assess the development progress, especially in toddlers. Objectives: Evaluation of neurodevelopmental outcome among Sudanese toddlers with spinal dysraphism after surgical closure with or without a VP shunt using ASQ-3<sup>TM</sup> Scores. Methodology: This is a retrospective hospital-based study of 84 patients who underwent myelomeningocele repair at the National Center for Neurological Sciences (NCNS) during the period from 2017 up to 2019. Data were collected through a constructed questionnaire, including ASQ-3<sup>TM</sup> Scores. Data were processed and analyzed using the Statistical Package for Social Science (SPSS) computer program. Version 25. Results: 84 patients were included in this study;all patients were diagnosed with spinal dysraphism. Out of them, 51 (60.7%) were 2 years old, 33 (39.3%) were 3 years old, 45 (53.6%) were male, 45 (53.6%) of patients mothers attended ANC irregularly, and 54 (64.3%) their mothers didn’t receive folate supplements. 44 (52.3%) of patients underwent MMC repair only, while 40 (47.7%) underwent MMC repair and VP shunt. The commonest postoperative complication was infection, reported in 12 (14.3%) of patients, followed by VP shunt revision in 9 (10.7%) of patients. Neurological assessment showed that the majority of patients need further assessment with a professional, 57 (67.9%) of children don’t walk, run, or climb like other toddlers as their parent’s state;also, half of patients (42, 50%) had medical problems, and 27 (32.1%) of their parent’s state that they do not talk like other toddlers their age. There was a statistically significant association between post-operative complications and communication development, problem-solving development, and personal social development (P value = 0.05), and a statistically significant association was found between age at repair and neurological development (P value = 0.05). Conclusion: The majority of patients had motor deficiency (particularly gross motor) and poor personal and social skills. Age at repair and postoperative complications significantly influenced the neurological development.展开更多
BACKGROUND The albumin-bilirubin(ALBI)score is an index of liver function recently developed to assess prognosis in patients with hepatocellular carcinoma(HCC).It can detect small changes in liver dysfunction and has ...BACKGROUND The albumin-bilirubin(ALBI)score is an index of liver function recently developed to assess prognosis in patients with hepatocellular carcinoma(HCC).It can detect small changes in liver dysfunction and has been successfully applied to the prediction of survival in patients with non-malignant liver diseases of various etiologies.AIM To investigate the ALBI score for identifying decompensation risk at the 3-year follow-up in patients with compensated cirrhosis.METHODS One-hundred and twenty-three patients with compensated cirrhosis without HCC in King Chulalongkorn Memorial Hospital diagnosed by imaging were retrospectively enrolled from January 2016 to December 2020.A total of 113 patients(91.9%)had Child A cirrhosis with a median model for end-stage liver disease(MELD)score of less than 9.Baseline clinical and laboratory variables and decompensation events were collected.The ALBI score was calculated and validated to classify decompensation risk into low-,middle-,and high-risk groups using three ALBI grade ranges(ALBI grade 1:≤-2.60;grade 2:>-2.60 but≤-1.39;grade 3:>-1.39).Decompensation events were defined as ascites development,variceal bleeding,or grade 3 or 4 hepatic encephalopathy.RESULTS Among 123 cirrhotic patients enrolled,13.8%(n=17)developed decompensating events at a median time of 25[95%confidence interval(CI):17-31]mo.Median baseline ALBI score in compensated cirrhosis was significantly lower than that of patients who developed decompensation events[-2.768(-2.956 to-2.453)vs-2.007(-2.533 to-1.537);P=0.01].Analysis of decompensation risk at 3 years showed that ALBI score had a time-dependent area under the curve(tAUC)of 0.86(95%CI:0.78-0.92),which was significantly better than that of ALBI-Fibrosis-4(ALBI-FIB4)score(tAUC=0.77),MELD score(tAUC=0.66),Child-Pugh score(tAUC=0.65),and FIB-4 score(tAUC=0.48)(P<0.05 for all).The 3-year cumulative incidence of decompensation was 3.1%,22.6%,and 50%in the low-,middle-,and high-risk groups,respectively(P<0.001).The odds ratio for decompensation in patients of the high-risk group was 23.33(95%CI:3.88-140.12,P=0.001).CONCLUSION The ALBI score accurately identifies decompensation risk at the 3-year follow-up in patients with compensated cirrhosis.Those cirrhotic patients with a high-risk grade of ALBI score showed a 23 times greater odds of decompensation.展开更多
Background:Pediatric acute pancreatitis(AP)is rare but increasing.Severe AP is associated with higher morbidity and mortality.However,there are no universally accepted prognostic criteria for AP.Methods:This retrospec...Background:Pediatric acute pancreatitis(AP)is rare but increasing.Severe AP is associated with higher morbidity and mortality.However,there are no universally accepted prognostic criteria for AP.Methods:This retrospective study included children with AP admitted to an intensive care unit(ICU)of our tertiary pediatric center between January 2009 and December 2018.The severity of organ dysfunction in AP was assessed according to the modified Atlanta criteria using the Pediatric Sequential Organ Failure Assessment(p SOFA)and Computed Tomography Severity Index(CTSI).Results:Seventy acute episodes of AP were evaluated in 55 children with primary pancreatitis.In addition,secondary AP was diagnosed in 15 patients originally admitted to ICU for different indications.Mild AP[no organ dysfunction,normal computed tomography(CT)finding]was the most prevalent(64/85 episodes in 49 children),followed by moderate AP(15 children;p SOFA 2-9 points,CTSI 3-4 points on admission).Severe AP(p SOFA 4-17 points,CTSI 6-10 points)was diagnosed in 6 children with traumatic or secondary AP.The most frequent etiologies of primary AP episodes were idiopathic(39%)and biliary(31%).Children with idiopathic AP had frequent relapses and comorbidities.Hereditary AP was typically mild,but presented with high pancreatic enzyme levels and recurrence rates.Admission at ICU and an interval without enteral nutrition(EN)were relatively short in drug-induced AP and relatively long in secondary and traumatic AP.Endoscopic retrograde cholangiopancreatography(ERCP)was performed in 13 patients with biliary AP and in 4 patients with traumatic AP.No AP-related death was observed.Conclusion:p SOFA score accurately reflects the severity and prognosis of AP in children.展开更多
BACKGROUND The hemoglobin,albumin,lymphocyte,and platelet(HALP)score,derived from a composite evaluation of markers reflecting the tumor-inflammation relationship and nutritional status,has been substantiated as a not...BACKGROUND The hemoglobin,albumin,lymphocyte,and platelet(HALP)score,derived from a composite evaluation of markers reflecting the tumor-inflammation relationship and nutritional status,has been substantiated as a noteworthy prognostic determinant for diverse malignancies.AIM To investigate how the HALP score relates to prognosis in patients with metastatic gastric cancer.METHODS The cutoff values for the HALP score,neutrophil/lymphocyte ratio,and platelet/lymphocyte ratio were determined using receiver operating characteristic analysis.Low HALP scores were defined as those less than 24.79 and high HALP scores as those greater than 24.79.RESULTS The study cohort comprised 147 patients and 110 of them(74.8%)were male.The patients'median age was 63(22-89)years.The median overall survival was significantly superior in the patients with high HALP scores than in those with low HALP scores(10.4 mo vs 7.5 mo,respectively;P<0.001)CONCLUSION The HALP score was found to be a prognostic factor in patients with metastatic gastric cancer.展开更多
Background: Minimally invasive surgery is becoming increasingly popular in the field of pancreatic surgery. However, there are few studies of robotic distal pancreatectomy(RDP) for pancreatic ductal adenocarcinoma(PDA...Background: Minimally invasive surgery is becoming increasingly popular in the field of pancreatic surgery. However, there are few studies of robotic distal pancreatectomy(RDP) for pancreatic ductal adenocarcinoma(PDAC). This study aimed to investigate the efficacy and feasibility of RDP for PDAC. Methods: Patients who underwent RDP or laparoscopic distal pancreatectomy(LDP) for PDAC between January 2015 and September 2020 were reviewed. Propensity score matching analyses were performed. Results: Of the 335 patients included in the study, 24 underwent RDP and 311 underwent LDP. A total of 21 RDP patients were matched 1:1 with LDP patients. RDP was associated with longer operative time(209.7 vs. 163.2 min;P = 0.003), lower open conversion rate(0% vs. 4.8%;P < 0.001), higher cost(15 722 vs. 12 699 dollars;P = 0.003), and a higher rate of achievement of an R0 resection margin(90.5% vs. 61.9%;P = 0.042). However, postoperative pancreatic fistula grade B or C showed no significant intergroup difference(9.5% vs. 9.5%). The median disease-free survival(34.5 vs. 17.3 months;P = 0.588) and overall survival(37.7 vs. 21.9 months;P = 0.171) were comparable between the groups. Conclusions: RDP is associated with longer operative time, a higher cost of surgery, and a higher likelihood of achieving R0 margins than LDP.展开更多
BACKGROUND Upper gastrointestinal(GI)bleeding is a life-threatening condition with high mortality rates.AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes:In-hosp...BACKGROUND Upper gastrointestinal(GI)bleeding is a life-threatening condition with high mortality rates.AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes:In-hospital mortality,intervention(endoscopic or surgical)and length of admission(≥7 d).METHODS We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021.We calculated and compared the area under the receiver operating characteristics curves(AUROCs)of Glasgow-Blatchford score(GBS),pre-endoscopic Rockall score(PERS),albumin,international normalized ratio,altered mental status,systolic blood pressure,age older than 65(AIMS65)and age,blood tests and comorbidities(ABC),including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts.We subsequently analyzed through a logistic binary regression model,if addition of lactate increased the score performance.RESULTS All scores had discriminative ability in predicting in-hospital mortality irrespective of study group.AIMS65 score had the best performance in the variceal bleeding group(AUROC=0.772;P<0.001),and ABC score(AUROC=0.775;P<0.001)in the non-variceal bleeding group.However,ABC score,at a cut-off value of 5.5,was the best predictor(AUROC=0.770,P=0.001)of inhospital mortality in both populations.PERS score was a good predictor for endoscopic treatment(AUC=0.604;P=0.046)in the variceal population,while GBS score,(AUROC=0.722;P=0.024),outperformed the other scores in predicting surgical intervention.Addition of lactate to AIMS65 score,increases by 5-fold the probability of in-hospital mortality(P<0.05)and by 12-fold if added to GBS score(P<0.003).No score proved to be a good predictor for length of admission.CONCLUSION ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population.PERS and GBS should be used to determine need for endoscopic and surgical intervention,respectively.Lactate can be used as an additional tool to risk scores for predicting inhospital mortality.展开更多
基金supported by the Health and Medical Research Fund of the Food and Health Bureau of the Hong Kong Special Administrative Region(Project No.19201161)Seed Fund from the University of Hong Kong.
文摘BACKGROUND:This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores(EWSs)and three shock indices in early sepsis prediction in the emergency department(ED).METHODS:We performed a retrospective study on consecutive adult patients with an infection over 3 months in a public ED in Hong Kong.The primary outcome was sepsis(Sepsis-3 definition)within 48 h of ED presentation.Using c-statistics and the DeLong test,we compared 11 EWSs,including the National Early Warning Score 2(NEWS2),Modified Early Warning Score,and Worthing Physiological Scoring System(WPS),etc.,and three shock indices(the shock index[SI],modified shock index[MSI],and diastolic shock index[DSI]),with Systemic Inflammatory Response Syndrome(SIRS)and quick Sequential Organ Failure Assessment(qSOFA)in predicting the primary outcome,intensive care unit admission,and mortality at different time points.RESULTS:We analyzed 601 patients,of whom 166(27.6%)developed sepsis.NEWS2 had the highest point estimate(area under the receiver operating characteristic curve[AUROC]0.75,95%CI 0.70-0.79)and was significantly better than SIRS,qSOFA,other EWSs and shock indices,except WPS,at predicting the primary outcome.However,the pooled sensitivity and specificity of NEWS2≥5 for the prediction of sepsis were 0.45(95%CI 0.37-0.52)and 0.88(95%CI 0.85-0.91),respectively.The discriminatory performance of all EWSs and shock indices declined when used to predict mortality at a more remote time point.CONCLUSION:NEWS2 compared favorably with other EWSs and shock indices in early sepsis prediction but its low sensitivity at the usual cut-off point requires further modification for sepsis screening.
文摘For ulcerative colitis(UC),the variability in inflammatory activity along the colon poses a challenge in management.The focus on achieving endoscopic healing in UC is evident,where the UC Endoscopic Index of Severity and Mayo Endoscopic Subscore are commonly used for evaluation.However,these indices primarily consider the most severely affected region.Liu et al recent study validates the Toronto Inflammatory Bowel Disease Global Endoscopic Reporting(TIGER)score offering a comprehensive assessment of inflammatory activity across diverse segments of the colon and rectum and a reliable index correlating strongly with UC Endoscopic Index of Severity and moderately with Mayo Endoscopic Subscore(MES).Despite recommendation,certain aspects warrant further invest-igation.Fecal calprotectin,an intermediate target,correlates with TIGER and should be explored.Determining TIGER scores defining endoscopic remission and response,evaluating agreement with histological activity,and assessing inter-endoscopist agreement for TIGER require scrutiny.Exploring the correlation between TIGER and intestinal ultrasound,akin to MES,adds value.
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.
文摘BACKGROUND Bone metastasis has various negative impacts.Activities of daily living(ADL)and quality of life(QOL)can be significantly decreased,survival may be impacted,and medical expenses may increase.It is estimated that at least 5%cancer patients might be suffering from bone metastases.In 2016,we published the Comprehensive Guidelines for the Diagnosis and Treatment of Bone Metastasis.Since then,the therapeutic outcomes for patients have gradually improved.As life expectancy is a major determinant of surgical intervention,the strategy should be modified if the prolongation of survival is to be achieved.AIM To monitor how bone metastasis treatment has changed before and after launch of our guidelines for bone metastasis.METHODS For advanced cancer patients with bone metastasis who visited the Department of Clinical Oncology at Akita University hospital between 2012 and 2023,parameters including the site and number of bone metastases,laboratory data,and survival time,were extracted from electronic medical records and the Katagiri score was calculated.The association with survival was determined for each factor.RESULTS Data from 136 patients were obtained.The 1-year survival rate for the poor prognosis group with a higher Katagiri score was 20.0%in this study,which was 6%and an apparent improvement from 2014 when the scoring system was developed.Other factors significantly affecting survival included five or more bone metastases than less(P=0.0080),and treatment with chemotherapy(P<0.001),bone modifying agents(P=0.0175)and immune checkpoint inhibitors(P=0.0128).In recent years,advances in various treatment methods have extended the survival period for patients with advanced cancer.It is necessary not only to simply extend survival time,but also to maintain ADL and improve QOL.CONCLUSION Various therapeutic interventions including surgical approach for bone metastasis,which is a disorder of locomotor organs,are increasingly required.Guidelines and scoring system for prognosis need to be revised promptly.
文摘BACKGROUND Robotic surgery(RS)is gaining popularity;however,evidence for abdominoperineal resection(APR)of rectal cancer(RC)is scarce.AIM To compare the efficacy of RS and laparoscopic surgery(LS)in APR for RC.METHODS We retrospectively identified patients with RC who underwent APR by RS or LS from April 2016 to June 2022.Data regarding short-term surgical outcomes were compared between the two groups.To reduce the effect of potential confounding factors,propensity score matching was used,with a 1:1 ratio between the RS and LS groups.A meta-analysis of seven trials was performed to compare the efficacy of robotic and laparoscopic APR for RC surgery.RESULTS Of 133 patients,after propensity score matching,there were 42 patients in each group.The postoperative complication rate was significantly lower in the RS group(17/42,40.5%)than in the LS group(27/42,64.3%)(P=0.029).There wasno significant difference in operative time(P=0.564),intraoperative transfusion(P=0.314),reoperation rate(P=0.314),lymph nodes harvested(P=0.309),or circumferential resection margin(CRM)positive rate(P=0.314)between the two groups.The meta-analysis showed patients in the RS group had fewer positive CRMs(P=0.04),lesser estimated blood loss(P<0.00001),shorter postoperative hospital stays(P=0.02),and fewer postoperative complications(P=0.002)than patients in the LS group.CONCLUSION Our study shows that RS is a safe and effective approach for APR in RC and offers better short-term outcomes than LS.
基金Supported by the Immuno Inflammatory Diseases Research Support Project,No.J202301E036.
文摘BACKGROUND Patients with ankylosing spondylitis(AS)frequently suffer from comorbid sleep disorders,exacerbating the burden of the disease and affecting their quality of life.AIM To investigate the clinical significance of serum inflammatory factors,health index and disease activity scores in patients with AS complicated by sleep disorders.METHODS A total of 106 AS patients with comorbid sleep disorders were included in the study.The patients were grouped into the desirable and undesirable prognosis groups in accordance with their clinical outcomes.The serum levels of inflammatory factors,including C-reactive protein,erythrocyte sedimentation rate,interleukin(IL)-6,tumour necrosis factor-αand IL-1β,were measured.Disease activity scores,such as the Bath AS functional index,Bath AS disease activity index,Bath AS metrology index and AS disease activity score,were assessed.The health index was obtained through the Short Form-36 questionnaire.RESULTS The study found significant associations amongst serum inflammatory factors,health index and disease activity scores in AS patients with comorbid sleep disorders.Positive correlations were found between serum inflammatory factors and disease activity scores,indicating the influence of heightened systemic inflammation on disease severity and functional impairment.Conversely,negative correlations were found between disease activity scores and health index parameters,highlighting the effect of disease activity on various aspects of healthrelated quality of life.Logistic regression analysis further confirmed the predictive value of these factors on patient outcomes,underscoring their potential utility in risk assessment and prognostication.CONCLUSION The findings demonstrate the intricate interplay amongst disease activity,systemic inflammation and patientreported health outcomes in AS patients complicated by sleep disorders.The results emphasise the need for comprehensive care strategies that address the diverse needs and challenges faced by these patients and underscore the potential relevance of serum inflammatory factors,health index and disease activity scores as prognostic markers in this patient population.
文摘The treatment of hepatitis C has undergone a significant boom since the advent of direct acting antivirals (DAA). Indeed, the interferon-ribavirin combination that has been used to treat hepatitis C has a virological response in only 45% of cases with significant side effects. The advent of direct-acting antivirals has changed the prognosis of cirrhotic patients with hepatitis C. DAAs have ensured a sustained viral response in the majority of patients. Our work aims to see the evolution of hepatitis C patients at the cirrhosis stage under DAA. We conducted a retrospective study over 15 years (January 2009, January 2024) including all patients with post-viral cirrhosis C, whom we divided into two groups: group A, cirrhotic patients who received ribavirin and interferon, and group B, patients on DAA. From January 2009 to January 2024, we conducted a study of 182 patients with viral hepatitis C, including 102 cirrhotic patients. The mean age was 55 years. 66% of patients were initially treated with the ribavirin interferon combination, while 34% received direct-acting antivirals (DAAs). Since the introduction of DAAs, the most commonly used regimens have been sofosbuvir/daclatasvir with or without ribavirin and sofosbuvir/ledipasvir with or without ribavirin. Group A achieved sustained virological response (SVR) in 60% of cases, with notable side effects. In Group B, SVR was 98.18%, with improved tolerability and fewer side effects than previous treatments. Fifteen patients developed hepatocellular carcinoma (HCC), with a significantly lower mortality rate in those treated with DAAs compared with pegylated dual therapy (p: 0.001).
文摘Objective: To evaluate the application value of neutrophils/lymphocytes (NLR), platelets/lymphocytes (PLR), lymphocytes/monocytes (LMR), HEART (history, electrocardiogram, age, risk factors, and troponin) score, and point-of- care testing (POCT) in the early warning and precise diagnosis of high-risk chest pain in emergency medicine. Methods: A total of 157 patients with acute chest pain who were admitted to the emergency department and chest pain treatment unit of our hospital between August 2022 and September 2023 were selected. Rapid testing of bedside myocardial markers (ultrasensitive troponin (hs-cTnI), myoglobin (MYO), creatine kinase isoenzyme (CK-MB), D-dimer (D-Dimer), and N-terminal B-type natriuretic peptide precursor (NT-proBNP)) was performed on the patients using a POCT device (ThermoKing BioMQ60proB). A HEART score was used to classify the patients into low (n = 53), intermediate (n = 59), and high-risk (n = 45) groups, and the NLR, PLR, and LMR were calculated. The NLR, PLR, and LMR values were compared among the three groups of patients, and the optimal cutoff values as well as sensitivity and specificity were determined based on receiver operating characteristic (ROC) analysis. Results: The HEART scores of patients in the low-risk, intermediate-risk, and high-risk groups were (2.72 ± 0.24), (4.75 ± 0.56), and (5.32 ± 0.73) respectively, and the differences were statistically significant (P < 0.05). Compared with the low-risk group, the intermediate-risk group and high-risk group had a significantly higher NLR and PLR, and a significantly lower LMR;the high-risk group had higher NLR and PLR and lower values of LMR as compared to the other two groups, and the difference was statistically significant (P < 0.05). The ROC curves suggested that the area under the curve, sensitivity, and specificity of the combined diagnosis of NLR, PLR, LMR, HEART score, and POCT were greater than those of LR, PLR, and LMR with HEART score and POCT alone. Conclusion: The combined application of NLR, PLR, LMR, HEART score, and POCT has significant application value in the early warning and precise diagnosis of emergency high-risk chest pain. It provides a more simple, easy-to-access, and efficient assessment index for the clinical prediction and treatment of emergency high- risk chest pain.
文摘Objective:To explore the effect of nursing interventions based on self-efficacy theory guidance on psychological stress indicators in patients with hepatitis B cirrhosis.Methods:70 patients with hepatitis B cirrhosis from October 2023 to May 2024 were selected and grouped by random number table.The observation group received nursing intervention based on self-efficacy theory,while the control group received routine nursing.The differences in psychological stress indicators,self-efficacy indicators,and nursing satisfaction were compared between the two groups.Results:Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HAMD)scores of the observation group were significantly lower than those of the control group(P<0.05);Chronic Disease Self-Efficacy Scale(CDSES)scores of the observation group were significantly higher than those of the control group(P<0.05);and nursing satisfaction scores of the observation group were significantly higher than those of the control group(P<0.05).Conclusion:Hepatitis B cirrhosis patients receiving nursing care based on self-efficacy theory can stimulate patients'self-efficacy,calm their emotions,and their overall satisfaction is high.
文摘Aims: The present study aims to compare the assessment of work ability based on the use of the Work Ability Index (WAI) with another questionnaire base only on the use of WAI’s first item, termed as the “Work Ability Score” (WAS). Study design: A cohort of 384 Spanish workers included in a Post COVID-19 condition or persistent COVID-19 multicenter research was utilized. Place and Duration of Study: This cohort was enlisted in four hospitals (Hospital Universitario 12 de Octubre, Madrid;Hospital Universitario Virgen Macarena, Sevilla, Andalucía;Hospital Universitario Gregorio Marañón, Madrid and Complejo Asistencial Universitario de Salamanca, Castilla y León), since 2021 until 2022. Methodology: 384 Spanish workers (176 men and 208 women;aged 20 to 70 years) with Post COVID-19 condition or persistent COVID-19 were included. Descriptive analysis of primary scores was conducted. Given the non-normal distribution of data, the Mann-Whitney and Kruskal-Wallis tests were employed. Spearman and Kendall correlations were employed to assess the relationship between WAI and WAS, also used weighted Kappa to estimate the degree agreement between WAI and WAS. Logistic regression models were utilized to study determinants influencing WAI and WAS, categorized as poor or moderate. Results: WAI had an average score of 32.98 (SD = 10.28), whereas WAS had an average of 5.95 (SD = 2.77). Significant differences were observed in both WAI and WAS across the same variables. Strong and statistically significant correlations were evident between WAI and WAS (rs = 0.83, p < 0.001). All the variables used in the logistic regression model (gender, the sector employment, and previous chronic diseases) were statistically significant in both questionnaires. Conclusion: WAS questionnaire could be used as a tool for reliable assessment of work ability among Spanish workers with Post COVID-19 condition or Persistent CO-VID-19.
文摘Background: Spinal dysraphism represents a wide spectrum of congenital abnormalities of the spine. Myelomeningocele is considered the most common malformation and the most common we saw in our community, with its morbidity problems seen commonly in the postoperative period. ASQ-3<sup>TM</sup> Scores are the ages and stages questionnaire, third edition, and represent a tool to assess the development progress, especially in toddlers. Objectives: Evaluation of neurodevelopmental outcome among Sudanese toddlers with spinal dysraphism after surgical closure with or without a VP shunt using ASQ-3<sup>TM</sup> Scores. Methodology: This is a retrospective hospital-based study of 84 patients who underwent myelomeningocele repair at the National Center for Neurological Sciences (NCNS) during the period from 2017 up to 2019. Data were collected through a constructed questionnaire, including ASQ-3<sup>TM</sup> Scores. Data were processed and analyzed using the Statistical Package for Social Science (SPSS) computer program. Version 25. Results: 84 patients were included in this study;all patients were diagnosed with spinal dysraphism. Out of them, 51 (60.7%) were 2 years old, 33 (39.3%) were 3 years old, 45 (53.6%) were male, 45 (53.6%) of patients mothers attended ANC irregularly, and 54 (64.3%) their mothers didn’t receive folate supplements. 44 (52.3%) of patients underwent MMC repair only, while 40 (47.7%) underwent MMC repair and VP shunt. The commonest postoperative complication was infection, reported in 12 (14.3%) of patients, followed by VP shunt revision in 9 (10.7%) of patients. Neurological assessment showed that the majority of patients need further assessment with a professional, 57 (67.9%) of children don’t walk, run, or climb like other toddlers as their parent’s state;also, half of patients (42, 50%) had medical problems, and 27 (32.1%) of their parent’s state that they do not talk like other toddlers their age. There was a statistically significant association between post-operative complications and communication development, problem-solving development, and personal social development (P value = 0.05), and a statistically significant association was found between age at repair and neurological development (P value = 0.05). Conclusion: The majority of patients had motor deficiency (particularly gross motor) and poor personal and social skills. Age at repair and postoperative complications significantly influenced the neurological development.
文摘BACKGROUND The albumin-bilirubin(ALBI)score is an index of liver function recently developed to assess prognosis in patients with hepatocellular carcinoma(HCC).It can detect small changes in liver dysfunction and has been successfully applied to the prediction of survival in patients with non-malignant liver diseases of various etiologies.AIM To investigate the ALBI score for identifying decompensation risk at the 3-year follow-up in patients with compensated cirrhosis.METHODS One-hundred and twenty-three patients with compensated cirrhosis without HCC in King Chulalongkorn Memorial Hospital diagnosed by imaging were retrospectively enrolled from January 2016 to December 2020.A total of 113 patients(91.9%)had Child A cirrhosis with a median model for end-stage liver disease(MELD)score of less than 9.Baseline clinical and laboratory variables and decompensation events were collected.The ALBI score was calculated and validated to classify decompensation risk into low-,middle-,and high-risk groups using three ALBI grade ranges(ALBI grade 1:≤-2.60;grade 2:>-2.60 but≤-1.39;grade 3:>-1.39).Decompensation events were defined as ascites development,variceal bleeding,or grade 3 or 4 hepatic encephalopathy.RESULTS Among 123 cirrhotic patients enrolled,13.8%(n=17)developed decompensating events at a median time of 25[95%confidence interval(CI):17-31]mo.Median baseline ALBI score in compensated cirrhosis was significantly lower than that of patients who developed decompensation events[-2.768(-2.956 to-2.453)vs-2.007(-2.533 to-1.537);P=0.01].Analysis of decompensation risk at 3 years showed that ALBI score had a time-dependent area under the curve(tAUC)of 0.86(95%CI:0.78-0.92),which was significantly better than that of ALBI-Fibrosis-4(ALBI-FIB4)score(tAUC=0.77),MELD score(tAUC=0.66),Child-Pugh score(tAUC=0.65),and FIB-4 score(tAUC=0.48)(P<0.05 for all).The 3-year cumulative incidence of decompensation was 3.1%,22.6%,and 50%in the low-,middle-,and high-risk groups,respectively(P<0.001).The odds ratio for decompensation in patients of the high-risk group was 23.33(95%CI:3.88-140.12,P=0.001).CONCLUSION The ALBI score accurately identifies decompensation risk at the 3-year follow-up in patients with compensated cirrhosis.Those cirrhotic patients with a high-risk grade of ALBI score showed a 23 times greater odds of decompensation.
基金supported by grants from the European Regional Development Fund-Project ENOCH(CZ.02.1.01/0.0/0.0/16_019/0000868)the Ministry of Health,Czech Republic-conceptual development of research organization(MH DRO,grant FNOL,0098892)。
文摘Background:Pediatric acute pancreatitis(AP)is rare but increasing.Severe AP is associated with higher morbidity and mortality.However,there are no universally accepted prognostic criteria for AP.Methods:This retrospective study included children with AP admitted to an intensive care unit(ICU)of our tertiary pediatric center between January 2009 and December 2018.The severity of organ dysfunction in AP was assessed according to the modified Atlanta criteria using the Pediatric Sequential Organ Failure Assessment(p SOFA)and Computed Tomography Severity Index(CTSI).Results:Seventy acute episodes of AP were evaluated in 55 children with primary pancreatitis.In addition,secondary AP was diagnosed in 15 patients originally admitted to ICU for different indications.Mild AP[no organ dysfunction,normal computed tomography(CT)finding]was the most prevalent(64/85 episodes in 49 children),followed by moderate AP(15 children;p SOFA 2-9 points,CTSI 3-4 points on admission).Severe AP(p SOFA 4-17 points,CTSI 6-10 points)was diagnosed in 6 children with traumatic or secondary AP.The most frequent etiologies of primary AP episodes were idiopathic(39%)and biliary(31%).Children with idiopathic AP had frequent relapses and comorbidities.Hereditary AP was typically mild,but presented with high pancreatic enzyme levels and recurrence rates.Admission at ICU and an interval without enteral nutrition(EN)were relatively short in drug-induced AP and relatively long in secondary and traumatic AP.Endoscopic retrograde cholangiopancreatography(ERCP)was performed in 13 patients with biliary AP and in 4 patients with traumatic AP.No AP-related death was observed.Conclusion:p SOFA score accurately reflects the severity and prognosis of AP in children.
文摘BACKGROUND The hemoglobin,albumin,lymphocyte,and platelet(HALP)score,derived from a composite evaluation of markers reflecting the tumor-inflammation relationship and nutritional status,has been substantiated as a noteworthy prognostic determinant for diverse malignancies.AIM To investigate how the HALP score relates to prognosis in patients with metastatic gastric cancer.METHODS The cutoff values for the HALP score,neutrophil/lymphocyte ratio,and platelet/lymphocyte ratio were determined using receiver operating characteristic analysis.Low HALP scores were defined as those less than 24.79 and high HALP scores as those greater than 24.79.RESULTS The study cohort comprised 147 patients and 110 of them(74.8%)were male.The patients'median age was 63(22-89)years.The median overall survival was significantly superior in the patients with high HALP scores than in those with low HALP scores(10.4 mo vs 7.5 mo,respectively;P<0.001)CONCLUSION The HALP score was found to be a prognostic factor in patients with metastatic gastric cancer.
文摘Background: Minimally invasive surgery is becoming increasingly popular in the field of pancreatic surgery. However, there are few studies of robotic distal pancreatectomy(RDP) for pancreatic ductal adenocarcinoma(PDAC). This study aimed to investigate the efficacy and feasibility of RDP for PDAC. Methods: Patients who underwent RDP or laparoscopic distal pancreatectomy(LDP) for PDAC between January 2015 and September 2020 were reviewed. Propensity score matching analyses were performed. Results: Of the 335 patients included in the study, 24 underwent RDP and 311 underwent LDP. A total of 21 RDP patients were matched 1:1 with LDP patients. RDP was associated with longer operative time(209.7 vs. 163.2 min;P = 0.003), lower open conversion rate(0% vs. 4.8%;P < 0.001), higher cost(15 722 vs. 12 699 dollars;P = 0.003), and a higher rate of achievement of an R0 resection margin(90.5% vs. 61.9%;P = 0.042). However, postoperative pancreatic fistula grade B or C showed no significant intergroup difference(9.5% vs. 9.5%). The median disease-free survival(34.5 vs. 17.3 months;P = 0.588) and overall survival(37.7 vs. 21.9 months;P = 0.171) were comparable between the groups. Conclusions: RDP is associated with longer operative time, a higher cost of surgery, and a higher likelihood of achieving R0 margins than LDP.
文摘BACKGROUND Upper gastrointestinal(GI)bleeding is a life-threatening condition with high mortality rates.AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes:In-hospital mortality,intervention(endoscopic or surgical)and length of admission(≥7 d).METHODS We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021.We calculated and compared the area under the receiver operating characteristics curves(AUROCs)of Glasgow-Blatchford score(GBS),pre-endoscopic Rockall score(PERS),albumin,international normalized ratio,altered mental status,systolic blood pressure,age older than 65(AIMS65)and age,blood tests and comorbidities(ABC),including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts.We subsequently analyzed through a logistic binary regression model,if addition of lactate increased the score performance.RESULTS All scores had discriminative ability in predicting in-hospital mortality irrespective of study group.AIMS65 score had the best performance in the variceal bleeding group(AUROC=0.772;P<0.001),and ABC score(AUROC=0.775;P<0.001)in the non-variceal bleeding group.However,ABC score,at a cut-off value of 5.5,was the best predictor(AUROC=0.770,P=0.001)of inhospital mortality in both populations.PERS score was a good predictor for endoscopic treatment(AUC=0.604;P=0.046)in the variceal population,while GBS score,(AUROC=0.722;P=0.024),outperformed the other scores in predicting surgical intervention.Addition of lactate to AIMS65 score,increases by 5-fold the probability of in-hospital mortality(P<0.05)and by 12-fold if added to GBS score(P<0.003).No score proved to be a good predictor for length of admission.CONCLUSION ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population.PERS and GBS should be used to determine need for endoscopic and surgical intervention,respectively.Lactate can be used as an additional tool to risk scores for predicting inhospital mortality.