Renal and perinephric abscesses in West China Hospital:10-year retrospective-descriptive study

AIM： To elucidate the clinical, radiological and laboratory pro？les of renal abscess （RA） and perinephric abscess （PNA）, along with related treatment and outcome.METHODS： Ninety-eight patients diagnosed with RA or PNA using the primary discharge diagnoses identi？ed from the International Statistical Classification of Diseases and Related Health Problems Tenth Edition （ICD-10） codes （RA： N15.101, PNA： N15.102） between September 2004 and December 2014 in West China Hospital were selected. Medical records including patients’ characteristics, symptoms and signs, high-risk factors, radiological features, causative microorganisms and antibiotic-resistance pro？les, treatment approaches, and clinical outcomes were collected and analyzed.RESULTS： The mean age of the patients was 46.49 years with a male to female ratio of 41：57. Lumbar pain （76.5%） and fever （53.1%） were the most common symptoms. Other symptoms and signs included chills （28.6%）, anorexia and vomiting （25.5%）, lethargy （10.2%）, abdominal pain （11.2%）, fank mass （12.2%）, fank ？stula （2.0%）, gross hematuria （7.1%）, frequency （14.3%）, dysuria （9.2%）, pyuria （5.1%） and weight loss （1.0%）. Painful percussion of the costovertebral angle （87.8%） was the most common physical ？nding. The main predisposing factors were lithiasis （48.0%）, diabetes mellitus （33.7%） followed by history of urological surgery （16.3%）, urinary tract infections （14.3%）, renal function impairment （13.3%）, liver cirrhosis （2.0%）, neurogenic bladder （1.0%）, renal cyst （1.0%）, hydronephrosis （1.0%）, chronic hepatitis B （1.0%）, post-discectomy （1.0%） and post-colectomy （1.0%）. Ultrasound （US） and computed tomography were the most valuable diagnostic tools and US was recommended as the initial diagnostic imaging choice.Escherichia coli （51.4%）, Staphylococcus aureus （10.0%） and Klebsiella pneumoniae （8.6%） were the main causative microorganisms. Intravenous antibiotic therapy was necessary while intervention including surgical and nonsurgical approaches were reserved for larger abscesses, multiple abscesses, PNAs and non-responders. CONCLUSION： Heightened alertness, prompt diagnosis, and especially proper antibiotics in conjunction with interventional approaches allow a promising clinical outcome of renal and perinephric abscesses.

Management of an endoscopy center during the outbreak of COVID-19:Experience from West China Hospital

Since the outbreak of the coronavirus disease 2019(COVID-19),various measures have been taken to protect against the infection.As droplet and contact transmission are the main routes of COVID-19 infection,endoscopy centers are considered to be high-risk areas for exposure to COVID-19.We have undertaken several countermeasures in our endoscopic center during the pandemic,and have gained significant experience in terms of prevention and control of COVID-19.We here present our experience and strategies adopted for preventing hospital infection in our endoscopy center during the COVID-19 pandemic.We describe our management of the environment,endoscope,patients,and medical staff,and our self-made masks.

Management strategies in a thoracic surgery ward during COVID-19 pandemic: Experience from West China Hospital

The coronavirus disease 2019 was first reported in Wuhan in December 2019 and then spread rapidly throughout the world.On March 11,2020,the World Health Organization declared coronavirus disease 2019 a pandemic.In response to the pandemic,the management division of West China Hospital oversaw the implementation of hospital-wide emergency measures.In accordance with these measures,the hospital's thoracic surgery ward implemented a new management system by reformulating staff training plans,patient admission procedures,and other systems for managing the ward and protecting perioperative patients.Overall,the ward was successful in restoring normal working order,protecting all staff from occupational exposures,and ensuring the safety of inpatients and their families.

Influencing factors of self-management ability among dry eye patients in west China

AIM:To investigate the current situation and influencing factors of self-management ability in dry eye patients in west China.METHODS:A total of 265 patients clinically diagnosed with dry eye received a convenience survey questionnaire at West China Hospital of Sichuan University.All participants completed the rating scale of health self-management skill for adults(AHSMSRS),Huaxi Emotional-Distress Index(HEI),e-health literacy scale(e-HEALS)and Brief Illness Perception Questionnaire(Brief-IPQ).A generalized linear model was employed to establish a multivariate linear model with demographic data,psychological state,e-HEALS,and illness perception as independent variables and health selfmanagement skill score as the dependent variable.RESULTS:The mean score for health self-management skill was 165.58±15.79.Multivariate analysis revealed that advanced age,better illness perception and improved psychological state were associated with better health selfmanagement ability among dry eye patients.Furthermore,the health self-management ability of patients with a disease duration less than 1y was found to be higher compared to those with a disease duration exceeding 1y.CONCLUSION:The health self-management ability of dry eye patients in west China is relatively high.Age,duration of disease,illness perception and psychological state are the influencing factors on the health selfmanagement ability of dry eye patients.

Epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China:a hospital-based retrospective study

Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.

Challenges for rear hospital care of Wenchuan Earthquake casualties： experience from West China Hospital

To review the challenges and countermeasures in the hospital care for Wenchuan earthquake casualties and draw lessons for the protective response in the future. Medical records and laboratory findings of the victims admitted in West China Hospital （WCH） were retro- spectively analyzed. Related data were compared between beforemath and aftermath of the earthquake and between WCH and frontier county hospitals. One thousand and thirty-one earthquake survivors were hospitalized, 1 358 victims underwent surgery and 142 victims were transferred to intensive care unit. The incidence of infection, crush syndrome and multiple organ dysfunction syndrome （MODS） was 39.6%, 20,7% and 2.3% respectively. Wound classification showed that the incidence of extremity damage was 72%, while the incidence of chest trauma, abdominal trauma and brain trauma was less than 10% respectively. Isolating rates of environmental pathogens were increased in the aftermath of earthquake, and the spectrum of the pathogens and related antibiotic sensitivities were quite different from those in the beforemath of earthquake. The social economic and population conditions in the earthquake-stricken areas affected the composition of the victims and the geographic features restricted the efficiency of rescue. Trauma-induced MODS, crush syndrome and severe infections all constituted the dilemma for the hospital care, to resolve whether the multidiscipline team work was proved to be an optimizing choice. For a more effective disaster protective response in the future, the study on rescue plan and the ladder therapies for massive casualties should be potentiated.

Recommended psychological crisis intervention response to the 2019 novel coronavirus pneumonia outbreak in China:a model of West China Hospital

The novel coronavirus pneumonia(COVID-19)epidemic has brought serious social psychological impact to the Chinese people,especially those quarantined and thus with limited access to face-to-face communication and traditional social psychological interventions.To better deal with the urgent psychological problems of people involved in the COVID-19 epidemic,we developed a new psychological crisis intervention model by utilizing internet technology.This new model,one of West China Hospital,integrates physicians,psychiatrists,psychologists and social workers into Internet platforms to carry out psychological intervention to patients,their families and medical staff.We hope this model will make a sound basis for developing a more comprehensive psychological crisis intervention response system that is applicable for urgent social and psychological problems.

Translational Medicine Center of West China Hospital

Biotherapy Translational Medicine Center of West China Hospital, Sichuan University is one of the research centers in West China Hospital, which is located in High Tech Zone, Chengdu. It includes several core facilities, such as State Key Laboratory of Biotherapy/one of the National Research and Development （R＆D） Platforms for Novel Drugs,

Influencing factors of fear of falling among glaucoma patients in west China:a cross-sectional study

AIM:To investigate the current situation and influencing factors of fear of falling in glaucoma patients in western China.METHODS:In this cross-sectional study,glaucoma patients treated in the Ophthalmology Department of West China Hospital of Sichuan University were conducted to investigate the demographic data,visual acuity,visual field,activities of daily living,risk of falling,fear of falling and psychological states.Generalized linear model was used for multivariate analysis with fear of falling as dependent variable and other factors as independent variables.RESULTS:The mean score of the Chinese version modified Fall Efficacy Scale(MFES)was 7.52±2.09 points.Univariate analysis and multivariate analysis showed that the history of falls within one year,visual acuity,visual field,risk of falling,activities of daily living and psychological states had statistically difference on fear of falling(P<0.05).CONCLUSION:Glaucoma patients in west China have relatively high risk of fear of falling.History of falling within 1y,severe visual function impairment,high risk of falling,incapable of independence of daily living,and abnormal psychological state are risk factors of fear of falling among glaucoma patients.

Transcatheter aortic valve implantation： preliminary experience in West China Hospital

Transcatheter aortic valve implantation （TAVI） is a promising alternative, to surgical aortic vane replacement for patients with symptomatic severe aortic stenosis （AS） who were deemed at a high surgical risk. This novel technique has kept evolving rapidly throughout the world in the past decade, but was not introduced to China until recently. Here we report our clinical experience in TAVI based on the largest cohort of Chinese patients in a single center.

Prediction model establishment and validation for enteral nutrition aspiration during hospitalization in patients with acute pancreatitis

BACKGROUND Acute pancreatitis(AP)is a disease caused by abnormal activation of pancreatic enzymes and can lead to self-digestion of pancreatic tissues and dysfunction of other organs.Enteral nutrition plays a vital role in the treatment of AP because it can meet the nutritional needs of patients,promote the recovery of intestinal function,and maintain the barrier and immune functions of the intestine.However,the risk of aspiration during enteral nutrition is high;once aspiration occurs,it may cause serious complications,such as aspiration pneumonia,and suffocation,posing a threat to the patient’s life.This study aims to establish and validate a prediction model for enteral nutrition aspiration during hospitalization in patients with AP.AIM To establish and validate a predictive model for enteral nutrition aspiration during hospitalization in patients with AP.METHODS A retrospective review was conducted on 200 patients with AP admitted to Chengdu Shangjin Nanfu Hospital,West China Hospital of Sichuan University from January 2020 to February 2024.Clinical data were collected from the electronic medical record system.Patients were randomly divided into a validation group(n=40)and a modeling group(n=160)in a 1:4 ratio,matched with 200 patients from the same time period.The modeling group was further categorized into an aspiration group(n=25)and a non-aspiration group(n=175)based on the occurrence of enteral nutrition aspiration during hospitalization.Univariate and multivariate logistic regression analyses were performed to identify factors influencing enteral nutrition aspiration in patients with AP during hospitalization.A prediction model for enteral nutrition aspiration during hospitalization was constructed,and calibration curves were used for validation.Receiver operating characteristic curve analysis was conducted to evaluate the predictive value of the model.RESULTS There was no statistically significant difference in general data between the validation and modeling groups(P>0.05).The comparison of age,gender,body mass index,smoking history,hypertension history,and diabetes history showed no statistically significant difference between the two groups(P>0.05).However,patient position,consciousness status,nutritional risk,Acute Physiology and Chronic Health Evaluation(APACHE-II)score,and length of nasogastric tube placement showed statistically significant differences(P<0.05)between the two groups.Multivariate logistic regression analysis showed that patient position,consciousness status,nutritional risk,APACHE-II score,and length of nasogastric tube placement were independent factors influencing enteral nutrition aspiration in patients with AP during hospitalization(P<0.05).These factors were incorporated into the prediction model,which showed good consistency between the predicted and actual risks,as indicated by calibration curves with slopes close to 1 in the training and validation sets.Receiver operating characteristic analysis revealed an area under the curve(AUC)of 0.926(95%CI:0.8889-0.9675)in the training set.The optimal cutoff value is 0.73,with a sensitivity of 88.4 and specificity of 85.2.In the validation set,the AUC of the model for predicting enteral nutrition aspiration in patients with AP patients during hospitalization was 0.902,with a standard error of 0.040(95%CI:0.8284-0.9858),and the best cutoff value was 0.73,with a sensitivity of 91.9 and specificity of 81.8.CONCLUSION A prediction model for enteral nutrition aspiration during hospitalization in patients with AP was established and demonstrated high predictive value.Further clinical application of the model is warranted.

Projecting the Dynamic Trends of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome:Modeling the Epidemic in Sichuan Province, China

Objective Our study aimed to provide a comprehensive overview of the current status and dynamic trends of the human immunodeficiency virus(HIV)prevalence in Sichuan,the second most heavily affected province in China,and to explore future interventions.Methods The epidemiological,behavioral,and population census data from multiple sources were analyzed to extract inputs for an acquired immunodeficiency syndrome(AIDS)epidemic model(AEM).Baseline curves,derived from historical trends in HIV prevalence,were used,and the AEM was employed to examine future intervention scenarios.Results In 2015,the modeled data suggested an adult HIV prevalence of 0.191%in Sichuan,with an estimated 128,766 people living with HIV/AIDS and 16,983 individuals with newly diagnosed infections.Considering current high-risk behaviors,the model predicts an increase in the adult prevalence to 0.306%by 2025,projecting an estimated 212,168 people living with HIV/AIDS and 16,555 individuals with newly diagnosed infections.Conclusion Heterosexual transmission will likely emerge as the primary mode of AIDS transmission in Sichuan.Furthermore,we anticipate a stabilization in the incidence of AIDS with a concurrent increase in prevalence.Implementing comprehensive intervention measures aimed at high-risk groups could effectively alleviate the spread of AIDS in Sichuan.

Do smart city policies improve energy efficiency?Evidence from China

To address air pollution and offer a convenient and comfortable living environment,the Chinese government launched a smart city pilot(SCP)project in 2012,accompanied by a comprehensive set of environmental and energy-related laws and regulations.Although academic interest in smart cities has surged,there remains a notable gap in empirical research exploring the economic,environmental,and energy effects of such initiatives.Taking 232 prefecture-level cities from 2003 to 2017 as research subjects,this study measures energy effi‐ciency by using energy consumption per unit of GDP and adopts a difference-in-differences(DID)analysis to investigate the impact of SCPs on energy efficiency.The empirical results indicate that SCPs improved energy efficiency by promoting urban technological innovation capabilities and green total factor productivity,and this effect was more pronounced in cities that were more dependent on traditional fossil fuel energy sources and had more developed fiscal and financial levels.Studying the impact of smart city construction on energy utilization efficiency in developing countries,such as China,is not only significantly enlightening for China’s green and low-carbon transition but also provides reference opinions for constructing smart cities and the path to enhancing energy efficiency in other developing countries.The findings provide valuable insights into the global development of smart cities,urban sustainability,and high-quality economic growth.

The Increase in Total Knee Replacement Surgery in China: A 10-Year Real-World Study

Total knee arthroplasty (TKR) is the most common and costly surgical procedure performed, and it is considered one of the most successful clinical interventions for patients suffering from severe knee osteoarthritis (OA). The incidence of TKR, including demographics, incidence rates, lengths of hospital stay, and costs, was estimated from 2010 to 2019 by analyzing data extracted from the Joint Surgery Department in our hospital, which included a total of 6770 patients. We calculated the TKR risk ratios to compare the rate of TKR between different covariables such as gender, age group, and primary diagnoses. The annual volume of TKR increased by fivefold (5.14%), with a higher incidence observed in the 60 to 69 age group constituting approximately 36% of cases. There has also been an increase in incidence among young people (<50), which now stands at 6.2%. The rate ratio (RR) per female vs. male was found to be 3.0 and the RR of OA vs. RA was 0.09. The mean average length of stay (ALOS) in the hospital decreased from 15 to just 5 days during this period. Additionally, the adjusted mean cost per patient increased significantly from ¥ 38261 ± 3630.63 to ¥ 53115.17 ± 2831.35. The majority of TKR recipients were over 60 years old with osteoarthritis being identified as the main causative agent. It is worth noting that women are more susceptible to knee arthritis and there is a concerning shift toward younger individuals being affected by this disease. Our results indicate a rise in in-hospital costs alongside a significant decline in hospital ALOS for TKR procedures. We predict an unprecedented rise in TKR incidence in the coming years due to population aging and improving economic conditions in China.

Clinical manifestation,lifestyle,and treatment patterns of chronic erosive gastritis:A multicenter real-world study in China

BACKGROUND Although chronic erosive gastritis(CEG)is common,its clinical characteristics have not been fully elucidated.The lack of consensus regarding its treatment has resulted in varied treatment regimens.AIM To explore the clinical characteristics,treatment patterns,and short-term outcomes in CEG patients in China.METHODS We recruited patients with chronic non-atrophic or mild-to-moderate atrophic gastritis with erosion based on endoscopy and pathology.Patients and treating physicians completed a questionnaire regarding history,endoscopic findings,and treatment plans as well as a follow-up questionnaire to investigate changes in symptoms after 4 wk of treatment.RESULTS Three thousand five hundred sixty-three patients from 42 centers across 24 cities in China were included.Epigastric pain(68.0%),abdominal distension(62.6%),and postprandial fullness(47.5%)were the most common presenting symptoms.Gastritis was classified as chronic non-atrophic in 69.9%of patients.Among those with erosive lesions,72.1%of patients had lesions in the antrum,51.0%had multiple lesions,and 67.3%had superficial flat lesions.In patients with epigastric pain,the combination of a mucosal protective agent(MPA)and proton pump inhibitor was more effective.For those with postprandial fullness,acid regurgitation,early satiety,or nausea,a MPA appeared more promising.CONCLUSION CEG is a multifactorial disease which is common in Asian patients and has non-specific symptoms.Gastroscopy may play a major role in its detection and diagnosis.Treatment should be individualized based on symptom profile.

Influence of sex on outcomes of liver transplantation for hepatocellular carcinoma:a multicenter cohort study in China

Objective:Sex-specific differences are observed in various liver diseases,but the influence of sex on the outcomes of hepatocellular carcinoma(HCC)after liver transplantation(LT)remains to be determined.This study is the first Chinese nationwide investigation of the role of sex in post-LT outcomes in patients with HCC.Methods:Data for recipients with HCC registered in the China Liver Transplant Registry between January 2015 and December 2020 were analyzed.The associations between donor,recipient,or donor-recipient transplant patterns by sex and the post-LT outcomes were studied with propensity score matching(PSM).The survival associated with different sex-based donor-recipient transplant patterns was further studied.Results:Among 3,769 patients enrolled in this study,the 1-,3-,and 5-year overall survival(OS)rates of patients with HCC after LT were 96.1%,86.4%,and 78.5%,respectively,in female recipients,and 95.8%,79.0%,and 70.7%,respectively,in male recipients after PSM(P=0.009).However,the OS was comparable between recipients with female donors and male donors.Multivariate analysis indicated that male recipient sex was a risk factor for post-LT survival(HR=1.381,P=0.046).Among the donor-recipient transplant patterns,the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival(P<0.05).Conclusions:Our findings highlighted that the post-LT outcomes of female recipients were significantly superior to those of male recipients,and the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival.Livers from male donors may provide the most benefit to female recipients.Our results indicate that sex should be considered as a critical factor in organ allocation.

Research on the development methodology for clinical practice guidelines for organic integration of traditional Chinese medicine and Western medicine

Integrated traditional Chinese medicine(TCM)and Western medicine(WM)is a new medical science grounded in the knowledge bases of both TCM and WM,which then forms a unique modern medical system in China.Integrated TCM and WM has a long history in China,and has made important achievements in the process of clinical diagnosis and treatment.However,the methodological defects in currently published clinical practice guidelines(CPGs)limit its development.The organic integration of TCM and WM is a deeper integration of TCM and WM.To realize the progression of"integration"to"organic integration",a targeted and standardized guideline development methodology is needed.Therefore,the purpose of this study is to establish a standardized development procedure for clinical practice guidelines for the organic integration of TCM and WM to promote the systematic integration of TCM and WM research results into clinical practice guidelines in order to achieve optimal results as the whole is greater than the sum of the parts.

Two‐decade endeavor on treatment of portal hypertension in West China Hospital

The global population of liver cirrhosis is growing,and China harbors a large number of liver cirrhosis patients throughout the world.Portal hypertension(PHT)not only is the aftermath of liver cirrhosis but also imposes a superimposed attack on the cirrhotic liver.It accounts for approximately one‐third of hospitalizations due to massive variceal bleeding,refractory ascites,and liver and extrahepatic organ failures in the Department of Gastroenterology,West China Hospital.The high shortterm mortality and long‐lasting torment of PHT in patients have been pushing us to try to improve the outcome of the disease since 2000.

Differences in brain-derived neurotrophic factor gene polymorphisms between acute ischemic stroke patients and healthy controls in the Han population of southwest China

Single-nucleotide polymorphisms in the brain-derived neurotrophic factor gene may affect the secretion and function of brain-derived neurotrophic factor, thereby affecting the occurrence, severity and prognosis of ischemic stroke. This case-control study included 778 patients (475 males and 303 females, mean age of 64.0 ± 12.6 years) in the acute phase of ischemic stroke and 865 control subjects (438 males and 427 females, mean age of 51.7 ± 14.7 years) from the Department of Neurology, Wes: China Hospital, Sichuan University, China between September 2011 and December 2014. The patients' severities of neurological defici:s in the acute phase were assessed using the National Institutes of Health Stroke Scale immediately after admission to hospital. The ischemic stroke patients were divided into different subtypes according to the Trial of Org 10172 in Acute Stroke Treatment classification. Early prognosis was evaluated using the Modified Rankin Scale when the patients were discharged. Genomic DNA was extracted from peripheral blood of participants. Genotyping of rs7124442 and rs6265 was performed using Kompetitive Allele Specific polymerase chain reaction genotyping technology. Our results demonstrated that patients who carried the C allele of the rs7124442 locus had a lower risk of poor prognosis than the T allele carriers (odds ratio [OR]= 0.67;95% confidence interval [CI]: 0.45-1.00;P = 0.048). The patients with the CC or TC genotype also exhibited lower risk than TT carriers (OR = 0.65;95% CI: 0.42-1.00;P = 0.049). The AA genotype at the rs6265 locus was associated with the occurrence of ischemic stroke in patients with large-artery atherosclerosis (OR = 0.5& 95% CI: 0.37-0.90;P = 0.015). We found that the C allele (CC and TC genotypes) at the rs7124442 locus may be protective for the prognosis of ischemic stroke. The AA genotype at the rs6265 locus is likely a protective factor against the occurrence of ischemic stroke in patients with large-artery atherosclerosis. The study protocol was approved by the Ethics Committee of West China Hospital of Sichuan University, China (approval ID number 2008,4]) on July 25, 2008.

Prophylaxis of chronic kidney disease after liver transplantation-experience from west China

AIM： TO evaluate the prophylaxis of chronic kidney dis- ease （CKD） after liver transplantation （LT） with low-dose calcineurin inhibitor （CNI） and mycophenolate mofetil （MMF）.