Systemic immune-inflammation index,neutrophilto-lymphocyte ratio,and platelet-to-lymphocyte ratio in patients with type 2 diabetes at different stages of diabetic retinopathy

AIM:To investigate systemic immune-inflammation index(SII),neutrophil-to-lymphocyte ratio(NLR),and plateletto-lymphocyte ratio(PLR)levels in patients with type 2 diabetes at different stages of diabetic retinopathy(DR).METHODS:This retrospective study included 141 patients with type 2 diabetes mellitus(DM):45 without diabetic retinopathy(NDR),47 with non-proliferative diabetic retinopathy(NPDR),and 49 with proliferative diabetic retinopathy(PDR).Complete blood counts were obtained,and NLR,PLR,and SII were calculated.The study analysed the ability of inflammatory markers to predict DR using receiver operating characteristic(ROC)curves.The relationships between DR stages and SII,PLR,and NLP were assessed using multivariate logistic regression.RESULTS:The average NLR,PLR,and SII were higher in the PDR group than in the NPDR group(P=0.011,0.043,0.009,respectively);higher in the NPDR group than in the NDR group(P<0.001 for all);and higher in the PDR group than in the NDR group(P<0.001 for all).In the ROC curve analysis,the NLR,PLR,and SII were significant predictors of DR(P<0.001 for all).The highest area under the curve(AUC)was for the PLR(0.929 for PLR,0.925 for SII,and 0.821 for NLR).Multivariate regression analysis indicated that NLR,PLR,and SII were statistically significantly positive and independent predictors for the DR stages in patients with DM[odds ratio(OR)=1.122,95%confidence interval(CI):0.200–2.043,P<0.05;OR=0.038,95%CI:0.018–0.058,P<0.05;OR=0.007,95%CI:0.001–0.01,P<0.05,respectively).CONCLUSION:The NLR,PLR,and SII may be used as predictors of DR.

Prognostic significance of systemic immune-inflammation index in patients with intrahepatic cholangiocarcinoma undergoing hepatic resection

BACKGROUND The prognosis of intrahepatic cholangiocarcinoma(ICC)patients following surgical resection remains poor.It is necessary to investigate effective biomarkers or prognostic models for ICC patients.AIM To investigate the prognostic effect of systemic immune-inflammation index(SII)to predict long-term outcomes in ICC patients with undergoing hepatic resection.METHODS Consecutive ICC patients who underwent initial hepatectomy with curative intent from January 2009 to September 2017 were retrospectively reviewed.Receiver-operating characteristic(ROC)curves were used to determine the optimal cut-off values of SII.Kaplan-Meier curves and Cox proportional hazards regression were performed to evaluate the discriminative ability of preoperative SII in predicting overall survival(OS)and recurrence-free survival(RFS).RESULTS A total of 530 patients were included and randomly divided into derivation(n=265)and validation cohort(n=265).The optimal cut-off value for SII was 450.Ata median follow-up of 18 mo(range,1-115.4 mo),317(59.8%)patients died and381(71.9%)patients experienced tumor relapse.Low SII level was associated with better OS and RFS(both P<0.05).Multivariate analyses identified multiple tumors,node invasion and high SII level as independent risk factors for OS,while multiple tumors,node invasion and high SII level were identified as independent risk factors for RFS.Validation cohort confirmed the findings of derivation cohort.CONCLUSION The present study demonstrated the feasibility of preoperative SII as a prognostic indicator for ICC.Patients with increased SII level were associated with worse OS and earlier tumor recurrence.Elevated SII level was an independent risk factor for OS and RFS in patients with ICC after hepatectomy.In the future,the SII could help stratifying patients with ICC,thus guiding therapeutic choices,especially in immunotherapy.

Effective immune-inflammation index for ulcerative colitis and activity assessments

BACKGROUND The inverse association between systemic immune-inammation index(SII)and overall survival in tumors has been studied.AIM To evaluate the hematological indexes for assessing the activity of ulcerative colitis(UC).METHODS In this case-control study,172 UC patients and healthy participants were included.Comparisons were made among groups of white blood cells,hemoglobin,platelets,neutrophils,lymphocytes,monocytes,SII,neutrophil-tolymphocyte ratio(NLR),and platelet-to-lymphocyte ratio(PLR).The relationship with hematological inflammation was verified by Spearman correlation analyses.The efficiency of SII,NLR,and PLR for distinguishing between UC and severe disease status was assessed by the receiver operator curve and logistic regression analyses.RESULTS The values of SII,NLR,and PLR were higher in UC patients than in controls(P<0.001)and were positively correlated with the Mayo endoscopic score,extent,Degree of Ulcerative Colitis Burden of Luminal Inflammation(DUBLIN)score,and Ulcerative Colitis Endoscopic Index of Severity(UCEIS).The cut-off NLR value of 562.22 predicted UC with a sensitivity of 79.65%and a specificity of 76.16%.Logistic regression analysis revealed that patients with SII and NLR levels above the median had a significantly higher risk of UC(P<0.05).Risk factors independently associated with DUBLIN≥3 included SII≥1776.80[odds ratio(OR)=11.53,P=0.027]and NLR value of 2.67-4.23(OR=2.96,P=0.047)on multivariate analysis.Compared with the first quartile,SII≥1776.80 was an independent predictor of UCEIS≥5(OR=18.46,P=0.012).CONCLUSION SII has a certain value in confirming UC and identifying its activity.

Effects of Early-stage Phased Rehabilitation Training on Acute Respiratory Distress Syndrome:A Systematic Review and Meta-analysis

[Objectives]To systematically evaluate the effects of early-stage phased rehabilitation training on the oxygenation index,ICU length of stay,duration of mechanical ventilation,and occurrence of complications(ventilator-associated pneumonia,pressure ulcers,delirium)in ARDS patients,thus contributing evidence for the clinical application of early-stage phased rehabilitation training.[Methods]The China National Knowledge Infrastructure(CNKI),Wanfang,and other databases were searched.Literature screening,data extraction,and systematic analysis of the included studies were performed using Revman software.[Results]Thirteen randomized controlled trials involving a total of 860 patients were included in this review.The results of the meta-analysis showed that compared to the traditional rehabilitation training group,the early-stage phased rehabilitation training group demonstrated a significant increase in the oxygenation index of ARDS patients[SMD=1.18,95%CI(1.01,1.35),P<0.01],with statistically significant differences.Furthermore,there were significant reductions in ICU length of stay[SMD=-0.70,95%CI(-0.90,-0.50),P<0.01],duration of mechanical ventilation[SMD=-1.15,95%CI(-1.36,-0.94),P<0.01],and occurrence of complications[OR=0.16,95%CI(0.10,0.26),P<0.01],all of which were statistically significant.[Conclusions]Early-stage phased pulmonary rehabilitation training for ARDS patients effectively improves the oxygenation index,shortens ICU length of stay and duration of mechanical ventilation,and reduces complications.These findings support the clinical application and promotion of early-stage phased rehabilitation training.

Actuality and underlying mechanisms of systemic immuneinflammation index and geriatric nutritional risk index prognostic value in hepatocellular carcinoma

This editorial contains comments on the article“Correlation between preoperative systemic immune inflammation index,nutritional risk index,and prognosis of radical resection of liver cancer”in a recent issue of the World Journal of Gastrointestinal Surgery.It pointed out the actuality and importance of the article and focused primarily on the underlying mechanisms making the systemic immuneinflammation index(SII)and geriatric nutritional risk index(GNRI)prediction features valuable.There are few publications on both SII and GNRI together in hepatocellular carcinoma(HCC)and patient prognosis after radical surgery.Neutrophils release cytokines,chemokines,and enzymes,degrade extracellular matrix,reduce cell adhesion,and create conditions for tumor cell invasion.Neutrophils promote the adhesion of tumor cells to endothelial cells,through physical anchoring.That results in the migration of tumor cells.Pro-angiogenic factors from platelets enhance tumor angiogenesis to meet tumor cell supply needs.Platelets can form a protective film on the surface of tumor cells.This allows avoiding blood flow damage as well as immune system attack.It also induces the epithelial-mesenchymal transformation of tumor cells that is critical for invasiveness.High SII is also associated with macro-and microvascular invasion and increased numbers of circulating tumor cells.A high GNRI was associated with significantly better progression-free and overall survival.HCC patients are a very special population that requires increased attention.SII and GNRI have significant survival prediction value in both palliative treatment and radical surgery settings.The underlying mechanisms of their possible predictive properties lie in the field of essential cancer features.Those features provide tumor nutrition,growth,and distribution throughout the body,such as vascular invasion.On the other hand,they are tied to the possibility of patients to resist tumor progression and development of complications in both postoperative and cancer-related settings.The article is of considerable interest.It would be helpful to continue the study follow-up to 2 years and longer.External validation of the data is needed.

Systematic reviews and meta-analyses: Why are they clinically significant?

This review aims to clarify the clinical significance of systematic reviews and meta-analyses by illustrating several classical examples.Firstly,systematic reviews can provide the highest level of evidence for clinical decisions.Secondly,systematic reviews can propose unresolved issues and future directions.Thirdly,systematic reviews can avoid harm to the human body.Fourthly,systematic reviews can prevent a waste of resources.Generally speaking,clinical researchers should be encouraged to perform systematic reviews and metaanalyses.

The Systemic Immune Inflammatory Index Predicts No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention in Older Patients with STEMI

Purpose:Coronary no-reflow phenomenon(NRP),a common adverse complication in patients with ST-segment eleva-tion myocardial infarction(STEMI)treated by percutaneous coronary intervention(PCI),is associated with poor patient prognosis.In this study,the correlation between the systemic immune-inflammation index(SII)and NRP in older patients with STEMI was studied,to provide a basis for early identification of high-risk patients and improve their prognosis.Materials and methods:Between January 2017 and June 2020,578 older patients with acute STEMI admitted to the Department of Cardiology of Hebei General Hospital for direct PCI treatment were selected for this retrospective study.Patients were divided into an NRP group and normal-flow group according to whether NRP occurred during the operation.Clinical data and the examination indexes of the two groups were collected.Logistic regression was used to analyze the independent predictors of NRP,and the receiver operating characteristic curve was used to further analyze the ability of SII to predict NRP in older patients with STEMI.Results:Multivariate logistic analysis indicated that hypertension(OR=2.048,95%CI:1.252–3.352,P=0.004),lymphocyte count(OR=0.571,95%CI:0.368–0.885,P=0.012),platelet count(OR=1.009,95%CI:1.005–1.013,P<0.001),hemoglobin(OR=1.015,95%CI:1.003–1.028,P=0.018),multivessel disease(OR=2.237,95%CI:1.407–3.558,P=0.001),and SII≥1814(OR=3.799,95%CI:2.190–6.593,P<0.001)were independent predictors of NRP after primary PCI in older patients with STEMI.Receiver operating characteristic curve analysis demonstrated that SII had a high predictive value for NRP(AUC=0.738;95%CI:0.686–0.790),with the best cut-off value of 1814,a sensitivity of 52.85%and a specificity of 85.71%.Conclusion:For older patients with STEMI undergoing primary PCI,SII is a valid predictor of NRP.

社会保障质量与经济高质量发展协调性研究:脱钩与耦合视角

社会保障与经济高质量发展是实现共同富裕的重要行动途径。从系统论视角分析社会保障与经济两大系统的学理关系,并基于中国省级面板数据对社会保障质量与经济高质量发展指数分别进行综合测度,利用脱钩理论与耦合协调度分析两者之间的动态关系。研究发现:(1)社会保障质量与经济高质量发展指数均呈现逐年递增趋势,但两者在整体上呈现脱钩、负脱钩与连结波动特征,主流脱钩状态呈现“递进恶化”,各省份经济高质量发展主要表现出低效扩张型趋势;(2)两系统的耦合度与耦合协调度虽均呈逐年上升趋势,但仍处于较低的协调状态;(3)异质性分析中,社会保障与经济高质量发展的系统耦合协调度在东部地区从勉强协调转向初级协调,中部地区从濒临失调向勉强协调演进,西部地区从轻度失调转向濒临失调。总之,做大蛋糕是社会保障稳定运行的物质基础,分好蛋糕是社会保障有效运行的保证。

学术评价中TOPSIS方法系统误差产生机制研究

[目的/意义]TOPSIS评价方法作为一种非常重要的评价手段在学术评价中得到广泛的应用,但其系统误差问题一直没有得到关注。[方法/过程]文章将误差理论引入TOPSIS指标体系评价中,在理论分析的基础上,对TOPSIS系统误差的产生机制、检验方法、改进措施进行了深度分析,并以优秀环境科学技术期刊为例进行了相关说明。[结果/结论]研究发现,TOPSIS评价方法系统误差的产生因素是多方面的,包括评价指标选取、TOPSIS方法自身问题、标准化方法选择、权重设置、结果公布等环节;应综合采取措施以降低TOPSIS学术评价的系统误差;实际权重合理性是TOPSIS评价方法系统误差的重要检验方法,系统误差较大的情况要慎重选用该评价方法。

系统性金融风险对宏观经济运行的非线性影响研究

为了探究系统性金融风险对宏观经济的影响,该研究采用了CRITIC法和因子分析法,构建系统性金融风险指数和宏观经济韧性水平指数。通过MS-VAR模型探讨了不同区制状态下金融风险对宏观经济的非线性效应。研究发现,系统性金融风险对宏观经济存在时变影响,短期内对宏观经济造成负向冲击,但长期来看反而会提高经济韧性。研究结果还表明,系统性金融风险对宏观经济具有明显的时变特征,实时采取预防和控制措施,有序处置突出风险,有助于促进经济实现高质量发展。研究通过将经济韧性作为宏观经济抵御风险和冲击的评价指标,为宏观经济的发展提供了一个新的研究视角,同时为宏观经济抵御风险、促进经济的高质量发展提供了有力指导。

系统护理在功能性子宫出血患者干预中的应用效果观察

目的分析功能性子宫出血患者干预中系统护理的应用价值。方法选取100例功能性子宫出血患者,按照人院顺序分为两组,每组50例。对照组予以常规护理,观察组予以系统护理,对比两组护理效果。结果干预后观察组患者焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均明显低于对照组,差异具有统计学意义(P<0.05)。干预后观察组患者血红蛋白(Hb)、血清白蛋白(ALB)及前白蛋白(PA)指标均显著高于对照组,差异具有统计学意义(P<0.05)。结论对功能性子宫出血患者实施系统护理具有显著优势,可以有效改善患者身体功能,促使患者尽快康复,具有临床应用与推广价值。

Prognostic value of systemic immune.inflammation index in patients with gastric cancer

Background:Inflammation-based indexes have been used to predict survival and recurrence in cancer patients.Systemic immune-inflammation index(Sll) was reported to be associated with prognosis in some malignant tumors.In the present study,we aimed to explore the association between Sll and the prognosis of patients with gastric cancer.Methods:We retrospectively analyzed data from 444 gastric cancer patients who underwent gastrectomy at the First Affiliated Hospital of Sun Yat-sen University between January 1994 and December 2005.Preoperative Sll was calculated.The Chi square test or Fisher's exact test was used to determine the relationship between preoperative Sll and clinicopathologic characteristics.Overall survival(OS) rates were estimated using the Kaplan-Meier method,and the effect of Sll on OS was analyzed using the Cox proportional hazards model.Receiver operating characteristic(ROC)curves were used to compare the predictive ability of Sll,NLR,and PLR.Results:Sll equal to or higher than 660 was significantly associated with old age,large tumor size,unfavorable Borrmann classification,advanced tumor invasion,lymph node metastasis,distant metastasis,advanced TNM stage,and high carcino-embryonic antigen level,high neutrophil-lymphocyte ratio,and high platelet-lymphocyte ratio(all P<0.05).High Sll was significantly associated with unfavorable prognosis(P<0.001) and Sll was an independent predictor for OS(P=0.015).Subgroups analysis further showed significant associations between high Sll and short OS in stage Ⅰ,Ⅱ,Ⅲ subgroups(all P<0.05).Sll was superior to NLR and PLR for predicting OS in patients with gastric cancer.Conclusion:Preoperative Sll level is an independent prognostic factor for OS in patients with gastric cancer.

煤矿系统性安全风险评价指标体系及应用

针对当前我国煤矿事故时有发生,煤炭行业受内外部因素风险影响突出等问题,提出了煤矿系统性安全风险定义,分别阐述了煤矿系统性安全风险的特点、触发因素和传导机制。构建了煤矿系统性安全风险指标体系,涵盖1个一级指标、5个二级指标、25个三级指标,建立了煤矿系统性安全风险指数模型,并应用该模型对我国23个产煤省(区)2021年度煤矿系统性安全风险进行了分级分析研判。结果表明:一季度、四季度煤矿系统性安全风险指数高,分别为0.3926和0.3959,高于全国平均水平,主要是受企业普遍复工复产、抢工期赶进度、冬季供暖用煤量增加等因素影响,煤矿系统性安全风险呈现上升趋势;贵州、云南、陕西和河南4省煤矿系统性安全风险高,需重点加强对上述时段以及上述省份的煤矿安全监管,防范煤矿重特大事故发生。

基于MBISAP评分和PNI、SII的列线图模型对急性胰腺炎患者预后的预测价值

目的探讨急性胰腺炎的预后因素,建立列线图模型预测急性胰腺炎患者的生存率。方法选取2021年2月—2022年5月在徐州医科大学附属医院诊断为急性胰腺炎的398例患者为内部验证组并进行回顾性分析,另外选取150例患者进行外部验证。将内部验证组患者分为死亡组和生存组。采用多因素Logistic回归分析进行预后营养指数(PNI)、全身免疫炎症指数(SII)、改良客观性急性胰腺炎严重程度床边指数评分(MBISAP评分)的列线图构建和校准曲线绘制并进行验证,计算净重新分类指数(NRI)、综合判别改善指数(IDI)评价预测效能。绘制Kaplan-Meier曲线。结果与生存组相比,死亡组血尿素、中性粒细胞计数、SII评分、MBISAP评分及合并胸腔积液、全身炎症反应综合征(SIRS)的比例均升高(P<0.05),白蛋白、PNI评分降低(P<0.05)。多因素预后分析提示MBISAP、PNI、SII是急性胰腺炎的独立预后因素。列线图模型评分的危险分层提示高危组(总分>67分)患者的28 d病死率更高(P<0.05)。结论基于MBISAP评分、PNI、SII构建了一个可靠的列线图模型,对急性胰腺炎患者具有较好的预后预测和危险分层价值。

系统化护理干预在乙肝肝硬化合并糖尿病患者中的应用研究

目的探讨系统化护理干预在乙肝肝硬化合并糖尿病患者中的应用效果。方法选取南京中医药大学附属南京医院2020年6月—2022年6月接收的82例乙肝肝硬化合并糖尿病患者为研究对象,根据入院先后顺序分为对照组(给予常规护理干预)与干预组(给予系统化护理干预),各41例。观察两组的血糖指标变化,比较两组的并发症发生率及护理满意率。结果干预后,干预组的FPG、2 hPG指标均显著低于对照组,差异有统计学意义(P<0.05);干预组的低血糖及感染发生率分别为4.88%、2.44%,显著低于对照组的21.95%、24.39%,差异有统计学意义(P<0.05);干预组的护理满意率为97.56%,显著高于对照组的78.05%,差异有统计学意义(P<0.05)。结论对乙肝肝硬化合并糖尿病患者给予系统化护理干预,有助于改善患者血糖水平,预防患者低血糖及感染的发生,提高患者护理满意率。

益生菌对妊娠期糖尿病影响的系统评价

目的:系统评价益生菌对妊娠期妇女糖尿病(GDM)的影响。方法:计算机检索PubMed、EMbase、Cochrane图书馆临床对照试验资料库、CBM、CNKI、维普和万方数据库,检索时间均从建库至2021年10月,手工检索相关文献。收集评价使用益生菌预防妊娠期妇女糖尿病和治疗妊娠期糖尿病的随机对照试验(RCT)。对符合纳入标准的临床研究进行质量评价和资料提取后,采取RevMan 5.1软件进行Meta分析。结果:共纳入8个RCT,包含1 149例患者,其中预防GDM的RCT 4项(802例患者);治疗GDM的RCT 4项(347例患者)。Meta分析结果表明,在预防GDM方面,与对照组(安慰剂)比较,使用益生菌能有效降低妊娠期糖尿病的发生率[RR=0.48,95%CI(0.31,0.74),P=0.001],而在妊娠期空腹血清胰岛素、空腹血糖和胰岛素抵抗指数均无统计学差异;在治疗GDM方面,与对照组(安慰剂)比较,使用益生菌能有效改善胰岛素抵抗指数[RR=-0.65,95%CI(-1.18,-0.11),P=0.02],降低空腹血清胰岛素[RR=-2.94,95%CI(-5.69,-0.20),P=0.04]水平,而在空腹血糖方面差异无统计学意义。结论:预防性使用益生菌能有效降低妊娠期糖尿病的发生率;使用益生菌治疗GDM能有效改善GDM患者胰岛素抵抗指数,降低空腹血清胰岛素。

Development and validation of a novel nomogram for predicting overall survival in gastric cancer based on inflammatory markers

BACKGROUND Nearly 66%of occurrences of gastric cancer(GC),which has the second-highest death rate of all cancers,arise in developing countries.In several cancers,the predictive significance of inflammatory markers has been established.AIM To identify clinical characteristics and develop a specific nomogram to determine overall survival for GC patients.METHODS Nine hundred and four GC patients treated at the First Affiliated Hospital of Anhui Medical University between January 2010 and January 2013 were recruited.Prognostic risk variables were screened for Cox analysis.The C index,receiver operator characteristic(ROC)curve,and decision curve analysis were used to evaluate the nomogram.RESULTS Tumor node metastasis stage,carcinoembryonic antigen,systemic immuneinflammation index,and age were identified as independent predictive variables by multivariate analysis.Systemic immune-inflammation index value was superior to that of other inflammatory indicators.The ROC indicated the nomogram had a higher area under the curve than other factors,and its C-index for assessing the validation and training groups of GC patients was extremely reliable.CONCLUSIONWe created a novel nomogram to forecast the prognosis of GC patients following curativegastrectomy based on blood markers and other characteristics. Both surgeons and patients canbenefit significantly from this new scoring system.

临床教师教学能力评价指标体系的系统评价

目的系统评价国内外临床教师教学能力评价指标体系相关文献,为制定规范化、全面化的临床教师教学能力评价指标体系提供参考依据。方法系统检索中国知网、万方数据库、PubMed、Web of Science等数据库中关于临床教师教学能力评价指标体系相关文献,利用Ekman质量评价工具进行质量评价,采用汇集性整合方法对研究结果进行归纳整合。结果共纳入10篇文献,以中文文献为主(8篇),共含10个指标体系或量表。文献质量评价结果显示高质量文献1篇,其他均为中等质量。归纳出教学基本素质、教学实施能力、教学研究能力、教学基本能力、临床带教能力、教学管理能力及教学评价能力7项一级指标,27项二级指标,75项三级指标。结论本研究分类汇总了现有的临床教师教学能力评价指标体系,为后续构建全面的、科学的、客观的与标准的临床教师教学能力评价体系提供参考依据。

系统性护理模式在小儿喘息性支气管炎中的应用效果研究

目的浅析小儿喘息性支气管炎患者采用系统性护理模式的效果与安全性。方法选取2020年1月至2022年12月在抚州市乐安县人民医院收治的小儿喘息性支气管炎患者60例,对照组采用常规护理;观察组采用系统性护理模式,对比两组临床疗效。结果观察组治疗总有效率高于对照组(P<0.05);此外,在临床症状的改善用时上,观察组短于对照组(P<0.05)。在肺功能指标的评价中,观察组的改善效果优于对照组(P<0.05)。护理满意度评价中,观察组家属对护理人员的工作满意度评价高于对照组(P<0.05)。结论小儿喘息性支气管炎患者实施系统性护理模式的效果显著,有助于改善患者的肺功能指标,帮助患者早日康复,为临床诊治疾病提供可行方案。