Novel insights into autophagy in gastrointestinal pathologies,mechanisms in metabolic dysfunction-associated fatty liver disease and acute liver failure

In this editorial,we comment on three articles published in a recent issue of World Journal of Gastroenterology.There is a pressing need for new research on autophagy's role in gastrointestinal(GI)disorders,and also novel insights into some liver conditions,such as metabolic dysfunction-associated fatty liver disease(MAFLD)and acute liver failure(ALF).Despite advancements,understanding autophagy's intricate mechanisms and implications in these diseases remains incomplete.Moreover,MAFLD's pathogenesis,encompassing hepatic steatosis and metabolic dysregulation,require further elucidation.Similarly,the mechanisms underlying ALF,a severe hepatic dysfunction,are poorly understood.Innovative studies exploring the interplay between autophagy and GI disorders,as well as defined mechanisms of MAFLD and ALF,are crucial for identifying therapeutic targets and enhancing diagnostic and treatment strategies to mitigate the global burden of these diseases.

Comparing gastrointestinal dysfunction score and acute gastrointestinal injury grade for predicting short-term mortality in critically ill patients

BACKGROUND The prognosis of critically ill patients is closely linked to their gastrointestinal(GI)function.The acute GI injury(AGI)grading system,established in 2012,is extensively utilized to evaluate GI dysfunction and forecast outcomes in clinical settings.In 2021,the GI dysfunction score(GIDS)was developed,building on the AGI grading system,to enhance the accuracy of GI dysfunction severity assessment,improve prognostic predictions,reduce subjectivity,and increase reproducibility.AIM To compare the predictive capabilities of GIDS and the AGI grading system for 28-day mortality in critically ill patients.METHODS A retrospective study was conducted at the general intensive care unit(ICU)of a regional university hospital.All data were collected during the first week of ICU admission.The primary outcome was 28-day mortality.Multivariable logistic regression analyzed whether GIDS and AGI grade were independent risk factors for 28-day mortality.The predictive abilities of GIDS and AGI grade were compared using the receiver operating characteristic curve,with DeLong’s test assessing differences between the curves’areas.RESULTS The incidence of AGI in the first week of ICU admission was 92.13%.There were 85 deaths(47.75%)within 28 days of ICU admission.There was no initial 24-hour difference in GIDS between the non-survival and survival groups.Both GIDS(OR 2.01,95%CI:1.25-3.24;P=0.004)and AGI grade(OR 1.94,95%CI:1.12-3.38;P=0.019)were independent predictors of 28-day mortality.No significant difference was found between the predictive accuracy of GIDS and AGI grade for 28-day mortality during the first week of ICU admission(Z=-0.26,P=0.794).CONCLUSION GIDS within the first 24 hours was an unreliable predictor of 28-day mortality.The predictive accuracy for 28-day mortality from both systems during the first week was comparable.

Prognostic factors associated with gastrointestinal dysfunction after gastrointestinal tumor surgery:A meta-analysis

BACKGROUND Explore the risk factors of gastrointestinal dysfunction after gastrointestinal tumor surgery and to provide evidence for the prevention and intervention of gastrointestinal dysfunction in patients with gastrointestinal tumor surgery.AIM To investigate the potential risk factors for gastrointestinal dysfunction following gastrointestinal tumor surgery and to present information supporting the prevention and management of gastrointestinal dysfunction in surgery patients.METHODS Systematically searched the relevant literature from PubMed,Web of Science,Cochrane Library,Embase,CNKI,China Biomedical Database,Wanfang Database,and Weipu Chinese Journal Database self-established until October 1,2022.Review Manager 5.3 software was used for meta-analysis after two researchers independently screened literature,extracted data,and evaluated the risk of bias in the included studies.RESULTS A total of 23 pieces of literature were included,the quality of which was medium or above,and the total sample size was 43878.The results of meta-analysis showed that the patients were male(OR=1.58,95%CI:1.25-2.01,P=0.002)and≥60 years old(OR=2.60,95%CI:1.76-2.87,P<0.001),physical index≥25.3 kg/m2(OR=1.6,95%CI:1.00-1.12,P=0.040),smoking history(OR=1.89,95%CI:1.31-2.73,P<0.001),chronic obstructive pulmonary disease(OR=1.49,95%CI:1.22-1.83,P<0.001),enterostomy(OR=1.47,95%CI:1.26-1.70,P<0.001),history of abdominal surgery(OR=2.90,95%CI:1.67-5.03,P<0.001),surgical site(OR=1.2,95%CI:1.40-2.62,P<0.001),operation method(OR=1.68,95%CI:1.08-2.62,P=0.020),operation duration(OR=2.65,95%CI:1.92-3.67,P<0.001),abdominal adhesion grade(OR=2.52,95%CI:1.90-3.56,P<0.001),postoperative opioid history(OR=5.35,95%CI:3.29-8.71,P<0.001),tumor TNM staging(OR=2.58,95%CI:1.84-3.62,P<0.001),postoperative blood transfusion(OR=2.92,95%CI:0.88-9.73,P=0.010)is a risk factor for postoperative gastrointestinal dysfunction in patients with gastrointestinal tumors.CONCLUSION There are many factors affecting gastrointestinal dysfunction in gastrointestinal patients after surgery.Clinical staff should identify relevant risk factors early and implement targeted intervention measures on the basis of personalized assessment to improve the clinical prognosis of patients.

Clinical Evaluation of Enteral Nutrition+Probiotics in the Treatment of Gastrointestinal Dysfunction After Severe Traumatic Brain Injury

Objective:To evaluate the therapeutic effect of enteral nutrition+probiotics in patients with gastrointestinal dysfunction after severe craniocerebral injury.Methods:From September 2018 to February 2023,80 patients(20-82 years old)with gastrointestinal dysfunction who were admitted to the Intensive Care Unit at the Third People’s Hospital of Xining were included in the study.Their primary condition was severe craniocerebral injury,and all of them received conventional symptomatic treatment.Group A received enteral nutrition+probiotic therapy,whereas group B received enteral nutrition only.The differences in the following indicators were compared before and after treatment:nutritional and biochemical indicators,gastrointestinal function indicators,Glasgow Coma Scale(GCS),Sequential Organ Failure Assessment(SOFA),APACHE II score,serum procalcitonin(PCT),neutrophil(N)ratio,and C reactive protein(CRP).Result:The nutritional and biochemical indicators in group A were higher than those in group B,P<0.05;the time to first passage of flatus,time to first passage of stool,and bowel sound recovery time in group A were shorter than those in group B,P<0.05;the GCS of group A was higher than that of group B,P<0.05;the SOFA and APACHEⅡscores of group A were not different from those of group B,P>0.05;and the PCT,N ratio,and CRP levels of group A were lower than those of group B,P<0.05.Conclusion:In patients with gastrointestinal dysfunction after severe craniocerebral injury,enteral nutrition+probiotic therapy is highly effective and feasible,as it can optimize various nutritional indicators,shorten the gastrointestinal function recovery time,and reduce the body’s stress response.

Observation on the Nursing Effect of Ginger Moxibustion on Gastrointestinal Symptoms in Patients with Heart Failure Due to Yang Qi Deficiency

Objective:To evaluate the nursing measures and effects of ginger moxibustion in the treatment of heart failure(yang qi deficiency type)with gastrointestinal symptoms.Methods:86 patients with heart failure(yang qi deficiency type)accompanied by gastrointestinal symptoms who were admitted to the hospital between January 2023 and January 2024 were selected and divided into 43 cases in each group by random number table grouping;Group I implemented integrated care,while Group II adopted conventional care.The indicators of care were compared between the two groups.Results:After the nursing care,the digestive symptom scores of Group I were lower than those of Group I,and the psychological scores were lower than those of Group II(P<0.05).Conclusion:Ginger moxibustion can improve gastrointestinal symptoms and enhance the psychological health of patients with heart failure(yang qi deficiency type)with gastrointestinal symptoms.

Gastrointestinal dysfunction is associated with mortality in severe burn patients:a 10-year retrospective observational study from South China

Background:Data on severe and extensive burns in China are limited,as is data on the prevalence of a range of related gastrointestinal(GI)disorders[such as stress ulcers,delayed defecation,opioid-related bowel immotility,and abdominal compartment syndrome(ACS)].We present a multicentre analysis of coincident GI dysfunction and its effect on burn-related mortality.Methods:This retrospective analysis was conducted on patients with severe[≥20%total burn surface area(TBSA)]and extensive(>50%TBSA or>25%full-thickness TBSA)burns admitted to three university teaching institutions in China between January 1,2011 and December 31,2020.Both 30-and 90-day mortality were assessed by collating demographic data,burn causes,admission TBSA,%full-thickness TBSA,Baux score,Abbreviated Burn Severity Index(ABSI)score,and Sequential Organ Failure Assessment(SOFA)score,shock at admission and the presence of an inhalation injury.GI dysfunction included abdominal distension,nausea/vomiting,diarrhoea/constipation,GI ulcer/haemorrhage,paralytic ileus,feeding intolerance and ACS.Surgeries,length of intensive care unit(ICU)stay,pain control[in morphine milligram equivalents(MME)]and overall length of hospital stay(LOHS)were recorded.Results:We analyzed 328 patients[75.6%male,mean age:(41.6±13.6)years]with a median TBSA of 62.0%(41.0%–80.0%);256(78.0%)patients presented with extensive burns.The 90-day mortality was 23.2%(76/328),with 64(84.2%)of these deaths occurring within 30 d and 25(32.9%)occurring within 7 d.GI dysfunction was experienced by 45.4%of patients and had a significant effect on 90-day mortality[odds ratio(OR)=14.070,95%confidence interval(CI)5.886–38.290,P<0.001].Multivariate analysis showed that GI dysfunction was associated with admission SOFA score and%full-thickness TBSA.Overall,88.2%(67/76)of deceased patients had GI dysfunction[hazard ratio(HR)for death of GI dysfunction=5.951],with a survival advantage for functional disorders(diarrhoea,constipation,or nausea/vomiting)over GI ulcer/haemorrhage(P<0.001).Conclusion:Patients with severe burns have an unfavourable prognosis,as nearly one-fifth died within 90 d.Half of our patients had comorbidities related to GI dysfunction,among which GI ulcers and haemorrhages were independently correlated with 90-day mortality.More attention should be given to severe burn patients with GI dysfunction.

Mechanisms of gastrointestinal barrier dysfunction in COVID-19 patients

Coronavirus disease 2019(COVID-19)caused by the novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has become a major global public health event,resulting in a significant social and economic burden.Although COVID-19 was initially characterized as an upper respiratory and pulmonary infection,recent evidence suggests that it is a complex disease including gastrointestinal symptoms,such as diarrhea,nausea,and vomiting.Moreover,it remains unclear whether the gastrointestinal symptoms are caused by direct infection of the gastrointestinal tract by SARS-CoV-2 or are the result of systemic immune activation and subsequent dysregulation of homeostatic mechanisms.This review provides a brief overview of the mechanisms by which SARS-CoV-2 disrupts the integrity of the gastrointestinal barrier including the mechanical barrier,chemical barrier,microbial barrier,and immune barrier.

COVID-19-induced gastrointestinal autonomic dysfunction:A systematic review

BACKGROUND It is common for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection to occur in the gastrointestinal tract,which can present itself as an initial symptom.The severity of coronavirus disease 2019(COVID-19)is often reflected in the prevalence of gastrointestinal symptoms.COVID-19 can damage the nerve supply to the digestive system,leading to gastrointestinal autonomic dysfunction.There is still much to learn about how COVID-19 affects the autonomic nervous system and the gastrointestinal tract.AIM To thoroughly explore the epidemiology and clinical aspects of COVID-19-induced gastrointestinal autonomic dysfunction,including its manifestations,potential mechanisms,diagnosis,differential diagnosis,impact on quality of life,prognosis,and management and prevention strategies.METHODS We conducted a thorough systematic search across various databases and performed an extensive literature review.Our review encompassed 113 studies published in English from January 2000 to April 18,2023.RESULTS According to most of the literature,gastrointestinal autonomic dysfunction can seriously affect a patient's quality of life and ultimate prognosis.Numerous factors can influence gastrointestinal autonomic nervous functions.Studies have shown that SARS-CoV-2 has a well-documented affinity for both neural and gastrointestinal tissues,and the virus can produce various gastrointestinal symptoms by reaching neural tissues through different pathways.These symptoms include anorexia,dysgeusia,heartburn,belching,chest pain,regurgitation,vomiting,epigastric burn,diarrhea,abdominal pain,bloating,irregular bowel movements,and constipation.Diarrhea is the most prevalent symptom,followed by anorexia,nausea,vomiting,and abdominal pain.Although COVID-19 vaccination may rarely induce autonomic dysfunction and gastrointestinal symptoms,COVID-19-induced autonomic effects significantly impact the patient's condition,general health,prognosis,and quality of life.Early diagnosis and proper recognition are crucial for improving outcomes.It is important to consider the differential diagnosis,as these symptoms may be induced by diseases other than COVID-19-induced autonomic dysfunction.Treating this dysfunction can be a challenging task.CONCLUSION To ensure the best possible outcomes for COVID-19 patients,it is essential to take a multidisciplinary approach involving providing supportive care,treating the underlying infection,managing dysfunction,monitoring for complications,and offering nutritional support.Close monitoring of the patient's condition is crucial,and prompt intervention should be taken if necessary.Furthermore,conducting thorough research on the gastrointestinal autonomic dysfunction caused by COVID-19 is vital to manage it effectively.

Heart failure with preserved ejection fraction and the first law of thermodynamics

In heart failure with preserved ejection fraction,significant left ventricular diastolic abnormalities are present,despite a normal systolic ejection fraction.This article will consider whether this is consistent with the law of conservation of energy,also know as the first law of thermodynamics.

Study on the occurrence and influencing factors of gastrointestinal symptoms in hemodialysis patients with uremia

BACKGROUND Gastrointestinal symptoms are common in patients with uremia undergoing hemodialysis,and these symptoms seriously affect patients'prognosis.AIM To assess the occurrence and factors influencing gastrointestinal symptoms in patients with uremia undergoing hemodialysis.METHODS We retrospectively selected 98 patients with uremia who underwent regular hemo-dialysis treatment in the blood purification center of our hospital from December 2022 to December 2023.The gastrointestinal symptoms and scores of each dimension were evaluated using the Gastrointestinal Symptom Grading Scale(GSRS).Patients were divided into gastrointestinal symptoms and no gastrointestinal symptom groups according to whether they had gastrointestinal symptoms.The factors that may affect gastrointestinal symptoms were identified by single-factor analysis.Multiple logistic regression analysis was performed to identify independent risk factors for gastrointestinal symptoms.RESULTS Gastrointestinal symptoms included indigestion,constipation,reflux,diarrhea,abdominal pain,and eating disorders,and the total average GSRS score was 1.35±0.47.This study showed that age,number of tablets,dialysis time,glucocorticoid,parathyroid hormone(PTH),combined diabetes mellitus and C-reactive protein(CRP)were independent risk factors for gastrointestinal symptoms in patients with uremia undergoing hemodialysis,whereas body mass index(BMI),hemoglobin(Hb),and urea clearance index were independent protective factors(P<0.05).CONCLUSION Gastrointestinal symptoms are mostly mild in patients with uremia undergoing hemodialysis,most commonly including dyspepsia,eating disorders,and gastroesophageal reflux.The independent influencing factors mainly include the BMI,age,number of pills taken,dialysis time,urea clearance index,Hb,use of glucocorticoids,and thyroid hormone level.PTH,CRP,and diabetes are clinically related factors influencing the occurrence of gastrointestinal symptoms,and targeted prevention can be performed.

Heart failure and left ventricular dysfunction in older patients with chronic kidney disease: the China Hypertension Survey (2012‒2015)

Background Heart failure(HF)is a leading cause of hospitalization and mortality for older chronic kidney disease(CKD)patients.However,the epidemiological data is scarce.We aimed to determine the prevalence of left ventricular(LV)dysfunction and HF,and to explore the risk factors for HF among those patients.Methods This is a cross-sectional analysis of the China Hypertension Survey conducted between October 2012 and December 2015.A total of 5,808 participants aged≥65 years were included in the analysis.Self-reported history of HF and any other cardiovascular diseases was acquired.2-D and Doppler echocardiography were used to assess LV dysfunction.CKD was defined as either estimated glomerular filtration rate(eGFR)<60 mL/min per 1.73 m2 or urinary albumin to creatinine ratio(ACR)≥30 mg/g.Results Among CKD patients aged≥65 years,the weighted prevalence of HF,heart failure with preserved ejection fraction(HFpEF),heart failure with mid-range ejection fraction(HFmrEF),and heart failure with reduced ejection fraction(HFrEF)was 4.8%,2.5%,0.8%,and 1.7%,respectively.The weighted prevalence of HF was 5.0%in patients with eGFR<60 mL/min per 1.73 m2,and was 5.9%in patients with ACR≥30 mg/g.The prevalence of LV systolic dysfunction was 3.1%,and while it was 8.9%for moderate/severe diastolic dysfunction.Multivariate analysis showed that smoking was significantly associated with the risk of HF.Furthermore,age,smoking,and residents in rural areas were significantly associated with a risk of LV diastolic dysfunction.Conclusions The prevalence of HF and LV dysfunction was high in older patients with CKD,suggesting that particular strategies will be required.

Sunitinib for Taiwan Residents patients with gastrointestinal stromal tumor after imatinib treatment failure or intolerance

AIM:To report preliminary results of the efficacy and safety of sunitinib in the management of Taiwan Residents gastrointestinal stromal tumors (GIST) patients facing imatinib mesylate (IM) intolerance or failure.METHODS:Between 2001 and May 2010,199 Taiwan Residents patients with metastatic GIST were treated at Chang Gung Memorial Hospital.Among them,23 (11.6%) patients receiving sunitinib were investigated.RESULTS:Sixteen male and 7 female patients with a median age of 59 years (range:24-83 years) received sunitinib.Twenty-two GIST patients changed to sunitinib because of IM failure and 1 because of intolerance.The median duration of sunitinib administration was 6.0 mo (range:2-29 mo).The clinical benefit was 65.2% [2 complete response (CR),4 partial response (PR),and 9 stationary disease (SD);15/23].In 12 patients harboring mutations of the kit gene at exon 11,the clinical benefit rate (CR,PR,and SD) was 75.0% and 6 patients with tumors containing kit exon 9 mutations had a clinical benefit of 50.0% (not significant,P=0.344).The progression free survival (PFS) and overall survival (OS) did not differ between patients whose GISTs had wild type,KIT exon 9,or KIT exon 11 mutations.Hand-foot syndrome was the most common cause of grade Ⅲ adverse effect (26.1%),followed by anemia (17.4%),and neutropenia (13.0%).During the median 7.5-mo follow-up after sunitinib use,the median PFS and OS of these 23 GIST patients after sunitinib treatment were 8.4 and 14.1 mo,respectively.CONCLUSION:Sunitinib appears to be an effective treatment for Taiwan Residents with IM-resistant/intolerant GISTs and induced a sustained clinical benefit in more than 50% of Taiwan Residents advanced GIST patients.

Effects of exercise training on diastolic and systolic dysfunction in patients with chronic heart failure

BACKGROUND Chronic heart failure(CHF)is a complex syndrome characterized by a progressive reduction of the left ventricular(LV)contractility,low exercise tolerance,and increased mortality and morbidity.Diastolic dysfunction(DD)of the LV,is a keystone in the pathophysiology of CHF and plays a major role in the progression of most cardiac diseases.Also,it is well estimated that exercise training induces several beneficial effects on patients with CHF.AIM To evaluate the impact of a cardiac rehabilitation program on the DD and LV ejection fraction(EF)in patients with CHF.METHODS Thirty-two stable patients with CHF(age:56±10 years,EF:32%±8%,88%men)participated in an exercise rehabilitation program.They were randomly assigned to aerobic exercise(AER)or combined aerobic and strength training(COM),based on age and peak oxygen uptake,as stratified randomization criteria.Before and after the program,they underwent a symptom-limited maximal cardiopulmonary exercise testing(CPET)and serial echocardiography evaluation to evaluate peak oxygen uptake(VO2peak),peak workload(Wpeak),DD grade,right ventricular systolic pressure(RVSP),and EF.RESULTS The whole cohort improved VO2peak,and Wpeak,as well as DD grade(P<0.05).Overall,9 patients(28.1%)improved DD grade,while 23(71.9%)remained at the same DD grade;this was a significant difference,considering DD grade at baseline(P<0.05).In addition,the whole cohort improved RVSP and EF(P<0.05).Not any between-group differences were observed in the variables assessed(P>0.05).CONCLUSION Exercise rehabilitation improves indices of diastolic and systolic dysfunction.Exercise protocol was not observed to affect outcomes.These results need to be further investigated in larger samples.

Beta-blocker therapy in elderly patients with renal dysfunction and heart failure

OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with ejection fraction≤35%and glomerular filtration rate(GFR)≤60 m L/min per 1.73 m^2.We analyzed the relationship between treatment with BB and mortality or cardiovascular events.The mean age of our population was 82.6±4.1 years.Mean ejection fraction was 27.9%±6.5%.GFR was 60-45 m L/min per 1.73 m^2 in 50.3%of patients,45-30 m L/min per 1.73 m^2 in 37.4%,and<30 m L/min per 1.73 m^2 in 12.3%.At the conclusion of follow-up,67.4%of patients were receiving BB.The median follow-up was28.04(IR:19.41-36.67)months.During the study period,211 patients(54.1%)died and 257(65.9%)had a major cardiovascular event(death or hospitalization for heart failure).BB use was significantly associated with a reduced risk of death(HR=0.51,95%CI:0.35-0.74;P<0.001).Patients receiving BB consistently showed a reduced risk of death across the different stages of CKD:stage IIIa(GFR=30-45 m L/min per 1.73 m^2;HR=0.47,95%CI:0.26-0.86,P<0.0001),stage IIIb(GFR 30-45 m L/min per 1.73 m^2;HR=0.55,95%CI:0.26-1.06,P=0.007),and stages IV and V(GFR<30 m L/min per 1.73 m~2;HR=0.29,95%CI:0.11-0.76;P=0.047).CONCLUSIONS The use of BB in elderly patients with HFr EF and renal impairment was associated with a better prognosis.Use of BB should be encouraged when possible.

Left and right ventricular diastolic dysfunction and diastolic heart failure: does one lead to the other?

Background and Objective Diastolic dysfunction of the left ventricle is a mechanical abnormality diagnosed primarily by echocardiogram, and can be distinguished into three separate degrees based on the severity of reduction in passive compliance and active myocardial relaxation. Methods A literature search was performed for basic science studies, clinical studies and major practice guidelines on the subject of diastolic dysfunction and diastolic heart failure. Important findings were analyzed and correlated with regard to clinical relevance. Results Left ventricular diastolic dysfunction appears to compromise exercise tolerance and is believed to contribute to the pathophysiology in patients with diastolic heart failure. In the clinical setting, however, oftentimes no clear distinction is made between echocardiographically diagnosed diastolic dysfunction and diastolic heart failure, and adequate treatment recommendations are sparse and aimed to prevent worsening and progression of clinical symptoms. To date, there is a lack of high powered trials assessing the possible progression rate from echocardiographically diagnosed diastolic dysfunction to the clinical diagnosis of diastolic heart failure. Furthermore, there are no solid indices to assess the degree of severity of diastolic dysfunction or its progression. Pure right ventricular diastolic dysfunction appears to be even less understood and under-recognized, although it may play a role in the development of both right and left heart failure. Currently there are few but interesting data on the possible interaction between ventricles with diastolic dysfunction and the overall affect on the development of heart failure. Conclusions The timeline and progression of diastolic dysfunction to diastolic heart failure have not been well established and warrant further investigation.

Predictive factors for liver dysfunction and failure after hepatectomy:Analysis of 467 patients with hepatocellular carcinoma

Objective： The aim of our study was to analyze hepatic dysfunction and failure after hepatocellular carcinoma （HCC） resection and relationship of clinical and pathological factors. Methods： Clinical and pathological data of 467 HCC patients was retrospectively reviewed, who underwent liver resection from January 2002 to December 2008 in the Affiliated Hospital of Medical College, Qingdao University, and the post-resectional liver dysfunction and failure risk factors were analyzed by univariate and multivariate analysis. Results： The morbidity of post-resectional liver dysfunction and failure was 1.7% and 2.1%. The post-resectional liver dysfunction and failure after HCC hepatectomy into the statistical analysis： univariate analysis revealed preoperative platelet level （〈 100 × 10^9）, serum albumin level （〈 35 g/L）, serum gamma-Glutamyl transferase （〉 64 U/L）, Child-Pugh classification （B）, MELD score （≥ 9）, intraoperative bleeding （-〉 1000 mL）, blood transfusion were positive factors, multivariate analysis （Logistic） revealed that preoperative platelet level （0.983, 95% CI = 0.971-0.995） and intraoperative blood transfusion （3.145, 95% CI = 1.027-12.028） were independent risk factors for post-resectional liver dysfunction and failure. Conclusion： Prevented liver failure and liver dysfunction occurring after liver resection, it is the key to accurate preoperative assessment of liver function and the patient＇s reserved liver functional, precise hepatectomy and reasonable blockage of hepatic inflow.

Burden, Type, and Associated Factors of Thyroid Dysfunction in Patients with Heart Failure in Sub-Saharan Africa: A Cross-Sectional Study

Background: Various thyroid abnormalities have been reported during heart failure (HF). The present study aimed to evaluate the burden, type, and associated factors of thyroid disorders in Cameroonian patients with heart failure. Materials and Methods: We conducted a cross-sectional study from January to May 2020, involving volunteer adults followed for heart failure at the Yaoundé Central Hospital. Those receiving treatment that could cause thyroid dysfunction were excluded. Thyroid hormone levels (TSH, free T3, and free T4) were measured by enzyme-linked immunosorbent assay. Results: A total of 63 patients (30 women;47.6%) were included. The median age was 65 (IQR: 56 - 70) years. The main etiology of heart failure was hypertension (52.4%) followed by valvular heart disease (14.3%). Thyroid dysfunction was seen in 38 (60.3%, [95% CI: 47.2 - 72.4]) patients, of which 30 (79%) had hypothyroidism and 8 (21%) had hyperthyroidism. The most frequent thyroid dysfunction was Low T3 syndrome in 27% (95% CI: 16.6 - 39.7) of the study population followed sub-clinical hypothyroidism in 19.1% (95% CI: 10.3 - 30.9) of patients. Patients with HF and reduced ejection fraction (HFrEF) were more likely to have hypothyroidism than those with preserved ejection fraction (OR: 3.5, [95% CI: 1.2 - 9.9], p = 0.016). Also, patients with more than one hospital admission in the past 12 months were more likely to have hypothyroidism (OR: 5.3, [95% CI: 1.3 - 21.5], p = 0.013). Conclusion: The burden of thyroid dysfunction was high in this group of patients with HF. These were mainly low T3 syndrome and sub-clinical hypothyroidism. These were associated with heart failure with reduced ejection fraction and those with more than one hospitalization within the past 12-months.

Understanding heart failure in the elderly with respect to diastolic dysfunction and role for natriuretic peptides

The current issue of the Journal of Geriatric Cardiology contains an interesting paper by Dr. Yixin Song and colleagues raising important issues in the diagnosis and management of heart failure in elderly patients. Readers of this journal are in all likelihood aware that the epidemic of heart failure is of great impact medically and economically worldwide.

Effect of self-made exhaust plaster on patients with gastrointestinal dysfunction after gynecological operation

Objective:To explore the effect of self-made exhaust patch(SMEP)on gastrointestinal dysfunction after gynecological operation.Methods:A total of 200 patients with gynecological operation in the gynecological ward of Shandong Changle People's Hospital were randomly divided into the control group(n=100)and the treatment group(n=100).The recovery time of bowel sounds,the time of first anal exhaust,the duration of abdominal distention,the duration of abdominal pain,the incidence of abdominal distention and abdominal pain and linical efficacy of SMEP were observed.Results:Compared with the control group,the recovery time of gastrointestinal function and the first anal exhaust time in the treatment group were shorter;the duration of abdominal distention and abdominal pain in the treatment group were shorter than those in the control group(P<0.05);Cure rate of abdominal distention in the treatment is 62.5%and cure rate of abdominal pain in the treatment is 60%within 72 hours after operation,which is higher than that in the control group(44.%,45.9%).Conclusion:The results showed that the self-made exhaust patch can improve the clinical symptoms of patients after gynecological abdominal surgery,and the self-made exhaust patch had a significant effect on gastrointestinal dysfunction after gynecological surgery,which was worthy of clinical promotion.

A randomized placebo-controlled trial of Chinese medicine acupoint application on gastrointestinal dysfunction after appendectomy

Background:Gastrointestinal dysfunction is one of the common complications of appendectomy,which seriously affects the postoperative recovery and clinical prognosis.Through traditional Chinese medicine acupoint application is suggested for managing postoperative gastrointestinal dysfunction,supporting evidence is weak.Here,the prospective randomized placebo-controlled study was designed to provide high-level evidence regarding whether traditional Chinese medicine acupoint application is effective on the gastrointestinal dysfunction after appendectomy.Methods:A total of 60 patients who underwent appendectomy in Dongfang Hospital Beijing University of Chinese Medicine(Beijing,China)from November 2016 to December 2017 were selected as study objects and randomly divided into control group(n=30)and observation group(n=30).Based on routine postoperative care,the acupoints Zusanli(ST36)and Yongquan(KI1)were selected.The control group was given acupoint application of traditional Chinese medicine placebo and the observation group was given acupoint application of clinical empirical Chinese medicine called Wentongliqi prescription.The course of treatment was performed on the 1st,2nd,and 3rd days after appendectomy,once a day and 4 hours each time.The primary outcome includes the time until the recovery time of bowel sounds(h),the first postoperative flatus(h)and first bowel movement time(h)on the 1st,2nd,and 3rd days after appendectomy.The secondary outcome includes clinical symptom score,life ability score and adverse reactions were observed and recorded on the 1st,2nd,and 3rd days after appendectomy.Results:After treatment,the recovery time of intestinal sound in the observation group was earlier than that in the control group(P<0.05).However,there were no significant difference between the two groups in first anal exhaust time and first bowel movement time,clinical symptom scores and life ability scores between the two groups before and after treatment(P>0.05).Conclusion:Acupoint application therapy has limited effect on the recovery of gastrointestinal dysfunction after appendectomy.Further study with large sample size is needed to confirm its therapeutic effects.