Correlation of serum albumin level on postoperative day 2 with hospital length of stay in patients undergoing emergency surgery for perforated peptic ulcer

BACKGROUND Perforated peptic ulcer(PPU)is a common emergency surgical condition and a significant cause of morbidity and mortality worldwide.While advances in surgical techniques have improved outcomes for patients with PPU,many factors still affect postoperative hospital stay and overall prognosis.One potential factor is the serum albumin(SA)level,a widely utilized marker of nutritional status that has been associated with length of stay and complications in various surgical procedures.AIM To clarify the correlation of SA level on postoperative day 2 with hospital length of stay(HLOS)in patients undergoing emergency surgery for perforated peptic ulcer(PPU).METHODS We retrospectively collected and analyzed clinical baseline data,including blood routine and SA levels,of patients who underwent emergency PPU surgery and postoperative treatment at the Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University between December 2012 and September 2021.Patients were grouped according to HLOS with 7 d as the cut-off value,and relevant indicators were analyzed using SPSS 26.0.RESULTS Of the 37 patients undergoing emergency surgery for PPU referred to our department,33 had gastric and 4 had duodenal ulcer perforation.The median HLOS was 10 d.There were 8 patients in the≤7-d group(median HLOS:7 d)and 29 patients in the>7-d group(median HLOS:10 d).The≤7-d group had markedly higher SA on postoperative day 2 than the>7-d group(37.7 g/L vs 32.6g/L;P<0.05).The SA level on postoperative day 2 was a protective factor for patients with HLOS>7 d(Odds ratio=0.629,P=0.015).The cut-off of SA on postoperative day 2 was 30.6g/L,with an area under the curve of 0.86 and a negative predictive value of 100%for the prediction of HLOS≤7 d.CONCLUSION The SA level on postoperative day 2 was associated with the HLOS in patients undergoing emergency surgery for PPU.The pre-and post-operative albumin levels should be monitored,and infusion of human SA should be considered in a timely manner.

Application and Effect of Intelligent Disinfection Robot in Non-Negative Pressure Isolation Ward of Novel Coronavirus Pneumonia Designated Hospital

The application of intelligent disinfection robot in designated non-negative pressure isolation ward during the outbreak in novel coronavirus pneumonia. The construction and competition, disinfection mode of intelligent disinfection robot, the setting of disinfection point built on area and number of isolation ward, can be introduced below. Frequency can realize remote control when staff uses a table to give instruction and set disinfection mode, and then the intelligent disinfection robot returns automatically to the charging pile to charge when the instruction is completed. It can also autonomously move to sterilize without human participation, which makes man-machine separation and accurate disinfection come true. The chance of contact infection and exposure is decreased when an intelligent disinfection robot is used to sterilize the environment and object surface in an isolation ward, which can also reduce occupational exposure, achieve occupational protection of medical workers and ensure there is no hospital infection.

Infection Prevention Strategy in General Hospital under Regular Epidemic Prevention and Control

New coronavirus pneumonia spread rapidly all over the world in the first half of 2020, which is a new respiratory disease with strong infectiousness. At present, the epidemic situation in China has been effectively controlled, but the global epidemic situation remains grim, and the National Health Commission has instructed that the prevention and control of new coronavirus pneumonia should become normalized. As outposts for surveillance of public health events, hospitals are an important front in the fight against the epidemic. Therefore, it is very crucial to construct infection prevention and control system actively to contain the outbreak. This paper analyzes and summarizes the normal prevention and control management strategy of Infection Control Branch Management (hereinafter referred to as Hospital Infection-Control Dept) in a certain designated comprehensive third-grade hospital in Guangdong Province and transforms the prevention and control means in emergency state into measures for sustainable development, which also provides basis and reference for Hospital Infection-Control Dept of medical institutions to formulate prevention and control guidelines.

Fever Outpatient Service of General Hospital Applies “1 + 3 + 3” Emergency Management Mode to Deal with COVID-19 Pandemic

Purpose: To discuss the effect of “1 + 3 + 3” emergency management mode to deal with COVID-19 pandemic in fever outpatient service of general hospitals. Method: This paper analyzes and summarizes the problems encountered by fever outpatient service in dealing with the COVID-19 pandemic from three aspects of “One Team”, “Three-Key” Control and “Three Mosts”. Results: The application of “1 + 3 + 3” emergency management mode can effectively boost the orderliness and efficiency of fever outpatient service in dealing with COVID-19 pandemic. Conclusion: The “1 + 3 + 3” emergency management mode provides a new management mode and idea for dealing with COVID-19 pandemic, so the fever outpatient service of general hospitals can better improve the national overall anti-pandemic situation.

Study of the Effects of Lower Limb Muscle Strengthening Exercises on Hospitalized Pregnant Women on Bed Rest for Prevention of Miscarriage

Objective: Against a background of the two-child policy in China, the objective is to explore the effects of lower limb strengthening exercises on hospitalized pregnant women put on bed rest for prevention of miscarriage. Method: Sixty cases of pregnant women admitted to the Department of Obstetrics in one of the highest ranking hospitals in Guangzhou, China, during the period from November 2018 to December 2019 for the purpose of preventing miscarriage were selected. They were divided into an experimental group and a control group of 30 cases each. The control group was put under routine care while the intervention group conducted lower limb muscle strengthening exercise on top of the routine care. After the intervention, the conditions of lower limbs, the psychological states and the results of pregnancy for the two groups were compared. Results: After the intervention, the scores of the experimental group in anxiety, depression and postpartum depression were lower and leg circumferences were smaller compared to the control group. The difference is statistically significant (P < 0.05). The experimental group had longer gestation than the control group and was able to get out of bed earlier than the control group after delivery, with statistically significant difference (P < 0.05). Conclusion: Lower limb muscle strengthening exercises can effectively improve the physiological and psychological states of pregnant women hospitalized for prevention of miscarriage and promote their postpartum recovery.

Survey on the Readiness for Hospital Discharge and Its Influencing Factors among Patients with Cardiac Valve Replacement

Background: There are about 200,000 patients in China who need to undergo valve replacement surgery each year. With the promotion and application of the Fast-Track Surgery concept and the increase in hospital bed turnover rate, the average hospital stay of patients undergoing CVR surgery has been significantly shortened, and thus the patients are still in the recovery stage rather than fully recovered when they are discharged from the hospital. Good preparation for discharge can improve patients’ post-discharge self-care ability, reduce the risk of re-admission, and save medical resources. Objective: To describe the status of readiness for hospital discharge among postoperative patients that have undergone CVR, and to explore its influencing factors. Methods: The general information questionnaire, the Readiness for Hospital Discharge Scale and the Quality of discharge Teaching Scale were utilized to investigate 130 post-CVR patients admitted to the Cardiothoracic Surgery Department of a tertiary A-Class hospital in Guangzhou from July 2019 to October 2020. Results: The Readiness for Hospital Discharge Scale was at a moderate level with a total score of 163.88 ± 39.082, while the Quality of Discharge Teaching Scale was also at a moderate level with a total score of 194.09 ± 40.643. Multiple linear regression analysis revealed that the quality of discharge guidance, gender, and occupation were the influencing factors of CVR patient’s readiness for hospital discharge. These three variables jointly explained 45.8% of the total variation. Conclusion: The level of CVR patients’ readiness for hospital discharge is at a moderate level, and the quality of discharge guidance positively affects patients’ readiness for discharge. Therefore, in clinical work, attention should be paid to patient discharge guidance. Personalized health education should be implemented to improve the quality of patient guidance.

The Application of the “3 + 1” Mode in the COVID-19 Epidemic Prevention and Control at the Infection Ward of a Designated Comprehensive Hospital for COVID-19 Treatment

Objective: We assess the application effect of the “3 + 1” mode in the COVID-19 epidemic prevention and control at the infection ward of a designated comprehensive hospital for COVID-19 treatment. Method: Based on the features of the inpatients of the infection ward and their relatives, a “3 + 1” mode for the COVID-19 prevention and control is developed to conform to the demands for epidemic prevention and control and the overall prevention and control scheme of the whole hospital. Here, “3” stands for the epidemic prevention and control system, personnel management, and prevention and control measures;“1” stands for COVID-19 testing. Result: From March 1, 2020 to March 31, 2021, a total of 3056 patients were hospitalized in the three infection wards. Among them, 265 patients had a fever, and 113 patients had respiratory symptoms. None of them were infected with COVID-19. The participation rate of the test about the knowledge related to COVID-19 and the knowledge mastery rate were both 100% among the medical staff. None of the inpatients and their companions or the medical staff was diagnosed with COVID-19. Conclusion: Thus the “3 + 1” mode proves successful for avoiding nosocomial infection and the spread of the epidemic.

Application of Intelligent Equipment on Novel Coronavirus Pneumonia Designated Hospital

Objective: To explore the application of intelligent equipment in non-negative pressure isolation ward for COVID-2019 patients. Method: From February 1 to March 17, 2020, intelligent equipment, such as communication interaction system, intelligent disinfection robot, delivering robot, were used in non- negative pressure isolation ward of COVID-2019. With the help of communication interaction system to supervise the implementation of infection prevention and control, and observe the incorrect situation of pee use and personal behavior before and after the implementation. The disinfection robot and meal delivery robot were used in ward disinfection and life nursing combined with nursing practice. Result: Through the supervision of communication interaction system, the frequency of pee use and personal behavior was reduced. The frequency of bad articles before and after improvement was wearing protective clothing (2.80%/0.84%), taking off protective clothing (5.87%/0.84%), personal behavior observation (8.38%/1.90%), P < 0.01. The robot disinfected and delivered medicine for 912.5 h, saving 225 shifts of nursing staff. Conclusion: Intelligent equipment is a good option for infection control in isolation ward of COVID-2019. It can not only reduce the workload of health workers, but also the cross-infection.

Isolates of Cryptococcus Neoformans from Non-HIV and Non-Transplant Hospitalized Patients

A retrospective cross-sectional study for patients with confirmed Cryptococcus neoformans meningitis(CM)in non-HIV-infected and non-transplant hosts in two class-A tertiary hospitals in Guangzhou,China is reported.181 CM patients were enrolled during the study period,48%(87/181)of which died.Underlying diseases were risk factor associated with higher mortality,among which diabetes mellitus ranked first for the incidence of CM.The mortality was not related to antifungal drug susceptibility.All strains were considered susceptible to amphotericin B,although interpretative breakpoints for amphotericin B have not yet been established.According to the CLSI guidelines,most of the strains in our study were susceptible to voriconazole,fluconazole,fluorocytosine and dose-dependently susceptible to itraconazle.

A Cross-Sectional Study on Appetite, Nutritional Status and Nutritional Support of Hospitalized Patients

Objective: To understand the appetite and nutritional status of hospitalized patients in a tertiary A general hospital in Guangzhou, Guangdong Province. Methods: A cross-sectional survey of appetite and nutritional status assessment on inpatients in 44 wards of the hospital was conducted. Taking all “conscious patients hospitalized for more than 48 hours” in the hospital on November 25, 2020 as the survey subjects, the patients’ appetite, dietary intake, nutrition and nutritional support in the past week were investigated. Results: A total of 890 cases were investigated, among which 25 cases (2.81%) with missing data were excluded, and thus 865 investigated cases were considered effective. The incidence of nutritional risk was 28.67%, malnutrition 13.29%, external tube feeding nutrition 3.24%, parenteral nutrition 7.05%, and oral nutritional supplement 10.40%. The average score of appetite assessment was (6.99 ± 2.43) points. Among them, cases with appetite assessment scores < 5 points accounted for 15.84%, and 52 patient cases utilized appetite-improving drugs. Among the 137 patients with appetite scores < 5, only 7 patients utilized appetite-improving drugs. The patients’ dietary self-evaluation scores were averagely (4.08 ± 1.16) points, and the daily intake compliance rate of patients was 85.78%. Appetite assessment score was correlated with dietary intake score (r = 0.548) and daily intake compliance rate (r = 0.263) (p < 0.01). The differences in body weight, BMI, grip strength, albumin, and hemoglobin concentration of patients with different appetite states were statistically different (p < 0.01). Appetite was an influencing factor of weight change (β = −0.079, p = 0.023). The difference between the appetite assessment scores and the daily intake compliance rates of patients with different nutritional support methods was statistically significant (p < 0.05);the individualized diet group had the highest appetite assessment score (8.57 ± 1.70), while the parenteral nutrition group had the lowest appetite assessment score (4.90 ± 2.99);the individualized diet group had the highest daily intake rate of 100%, followed by the parenteral nutrition group with 96.72%, and the regular diet group had the lowest rate of 84.02%. Conclusion: The appetite of hospitalized patients is closely related to nutritional status, and therefore, attention should be paid to the appetite status and nutritional status of hospitalized patients. Inpatients with different nutritional support methods should be given individualized appetite and nutritional interventions.

Influencing factors of hospitalization costs for glaucoma patients under clinical pathway management

Background:To investigate and analyze the hospitalization costs of inpatients with primary acute angle closure glaucoma(PACG),and to explores the influencing factors of hospitalization cost and to provide reference for specialized hospitals to carry out clinical pathways.Methods:The first page diagnostic data of PACG patients’medical records were collected,and an Excel database was established according to the International Classification of Diseases(ICD-10)code.Statistical analysis of hospitalization data was performed using SPSS 17.0 software.Results:Hospitalization days and clinical pathway which affect the change of the hospitalization cost(P<0.001).Conclusions:Hospitalization day is an important factor affecting the hospitalization cost,reducing unnecessary hospitalization time can control the increase of hospitalization cost.

Aquaporin-4-IgG-seropositive neuromyelitis optica spectrum disorders:progress of experimental models based on disease pathogenesis

Neuromyelitis optica spectrum disorders are neuroinflammatory demyelinating disorders that lead to permanent visual loss and motor dysfunction.To date,no effective treatment exists as the exact causative mechanism remains unknown.Therefore,experimental models of neuromyelitis optica spectrum disorders are essential for exploring its pathogenesis and in screening for therapeutic targets.Since most patients with neuromyelitis optica spectrum disorders are seropositive for IgG autoantibodies against aquaporin-4,which is highly expressed on the membrane of astrocyte endfeet,most current experimental models are based on aquaporin-4-IgG that initially targets astrocytes.These experimental models have successfully simulated many pathological features of neuromyelitis optica spectrum disorders,such as aquaporin-4 loss,astrocytopathy,granulocyte and macrophage infiltration,complement activation,demyelination,and neuronal loss;however,they do not fully capture the pathological process of human neuromyelitis optica spectrum disorders.In this review,we summarize the currently known pathogenic mechanisms and the development of associated experimental models in vitro,ex vivo,and in vivo for neuromyelitis optica spectrum disorders,suggest potential pathogenic mechanisms for further investigation,and provide guidance on experimental model choices.In addition,this review summarizes the latest information on pathologies and therapies for neuromyelitis optica spectrum disorders based on experimental models of aquaporin-4-IgG-seropositive neuromyelitis optica spectrum disorders,offering further therapeutic targets and a theoretical basis for clinical trials.

Codelivery of anti-CD47 antibody and chlorin e6 using a dual pH-sensitive nanodrug for photodynamic immunotherapy of osteosarcoma

Osteosarcoma is a malignant tumor originating from bone tissue that progresses rapidly and has a poor patient prognosis.Immunotherapy has shown great potential in the treatment of osteosarcoma.However,the immunosuppressive microenvironment severely limits the efficacy of osteosarcoma treatment.The dual pH-sensitive nanocarrier has emerged as an effective antitumor drug delivery system that can selectively release drugs into the acidic tumor microenvironment.Here,we prepared a dual pH-sensitive nanocarrier,loaded with the photosensitizer Chlorin e6(Ce6)and CD47 monoclonal antibodies(aCD47),to deliver synergistic photodynamic and immunotherapy of osteosarcoma.On laser irradiation,Ce6 can generate reactive oxygen species(ROS)to kill cancer cells directly and induces immunogenic tumor cell death(ICD),which further facilitates the dendritic cell maturation induced by blockade of CD47 by aCD47.Moreover,both calreticulin released during ICD and CD47 blockade can accelerate phagocytosis of tumor cells by macrophages,promote antigen presentation,and eventually induce T lymphocyte-mediated antitumor immunity.Overall,the dual pH-sensitive nanodrug loaded with Ce6 and aCD47 showed excellent immune-activating and anti-tumor effects in osteosarcoma,which may lay the theoretical foundation for a novel combination model of osteosarcoma treatment.

Successful treatment of severe hepatic impairment in erythropoietic protoporphyria:A case report and review of literature

BACKGROUND Erythropoietic protoporphyria(EPP)is a rare genetic disorder stemming from ferrochelatase gene mutations,which leads to abnormal accumulation of protoporphyrin IX primarily in erythrocytes,skin,bone marrow and liver.Although porphyria-related severe liver damage is rare,its consequences can be severe with limited treatment options.CASE SUMMARY This case study highlights a successful intervention for a 35-year-old male with EPP-related liver impairment,employing a combination of red blood cell(RBC)exchange and therapeutic plasma exchange(TPE).The patient experienced significant symptom relief and a decrease in bilirubin levels following multiple PE sessions and an RBC exchange.CONCLUSION The findings suggest that this combined approach holds promise for managing severe hepatic impairment in EPP.

Large-scale loss-of-function perturbations reveal a comprehensive epigenetic regulatory network in breast cancer

Objective:Epigenetic abnormalities have a critical role in breast cancer by regulating gene expression;however,the intricate interrelationships and key roles of approximately 400 epigenetic regulators in breast cancer remain elusive.It is important to decipher the comprehensive epigenetic regulatory network in breast cancer cells to identify master epigenetic regulators and potential therapeutic targets.Methods:We employed high-throughput sequencing-based high-throughput screening(HTS^(2))to effectively detect changes in the expression of 2,986 genes following the knockdown of 400 epigenetic regulators.Then,bioinformatics analysis tools were used for the resulting gene expression signatures to investigate the epigenetic regulations in breast cancer.Results:Utilizing these gene expression signatures,we classified the epigenetic regulators into five distinct clusters,each characterized by specific functions.We discovered functional similarities between BAZ2B and SETMAR,as well as CLOCK and CBX3.Moreover,we observed that CLOCK functions in a manner opposite to that of HDAC8 in downstream gene regulation.Notably,we constructed an epigenetic regulatory network based on the gene expression signatures,which revealed 8 distinct modules and identified 10 master epigenetic regulators in breast cancer.Conclusions:Our work deciphered the extensive regulation among hundreds of epigenetic regulators.The identification of 10 master epigenetic regulators offers promising therapeutic targets for breast cancer treatment.

Unraveling the efficacy network: A network meta-analysis of adjuvant external beam radiation therapy methods after hepatectomy

BACKGROUND Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis.Postoperative adjuvant external radiation therapy(RT)has been shown to effectively prevent recurrence after liver cancer resection.However,there are multiple RT techniques available,and the differ-ential effects of these techniques in preventing postoperative liver cancer re-currence require further investigation.AIM To assess the advantages and disadvantages of various adjuvant external RT methods after liver resection based on overall survival(OS)and disease-free survival(DFS)and to determine the optimal strategy.METHODS This study involved network meta-analyses and followed the PRISMA guidelines.The data of qualified studies published before July 10,2023,were collected from PubMed,Embase,the Web of Science,and the Cochrane Library.We included relevant studies on postoperative external beam RT after liver resection that had OS and DFS as the primary endpoints.The magnitudes of the effects were determined using risk ratios with 95%confidential intervals.The results were analyzed using R software and STATA software.RESULTS A total of 12 studies,including 1265 patients with hepatocellular carcinoma(HCC)after liver resection,were included in this study.There was no significant heterogeneity in the direct paired comparisons,and there were no significant differences in the inclusion or exclusion criteria,intervention measures,or outcome indicators,meeting the assumptions of heterogeneity and transitivity.OS analysis revealed that patients who underwent stereotactic body radiotherapy(SBRT)after resection had longer OS than those who underwent intensity modulated radiotherapy(IMRT)or 3-dimensional conformal RT(3D-CRT).DFS analysis revealed that patients who underwent 3D-CRT after resection had the longest DFS.Patients who underwent IMRT after resection had longer OS than those who underwent 3D-CRT and longer DFS than those who underwent SBRT.CONCLUSION HCC patients who undergo liver cancer resection must consider distinct advantages and disadvantages when choosing between SBRT and 3D-CRT.IMRT,a RT technique that is associated with longer OS than 3D-CRT and longer DFS than SBRT,may be a preferred option.

Prognostic value of neutrophil-to-lymphocyte ratio in end-stage liver disease:A meta-analysis

BACKGROUND The neutrophil-to-lymphocyte ratio(NLR)is commonly utilized as a prognostic indicator in end-stage liver disease(ESLD),encompassing conditions like liver failure and decompensated cirrhosis.Nevertheless,some studies have contested the prognostic value of NLR in ESLD.AIM To investigate the ability of NLR to predict ESLD.METHODS Databases,such as Embase,PubMed,Web of Science,Cochrane Library,China National Knowledge Infrastructure,Weipu,and Wanfang,were comprehensively searched to identify studies published before October 2022 assessing the prognostic ability of NLR to predict mortality in patients with ESLD.Effect sizes were calculated using comprehensive meta-analysis software and SATAT 15.1.RESULTS A total of thirty studies involving patients with end-stage liver disease(ESLD)were included in the evaluation.Among the pooled results of eight studies,it was observed that the Neutrophil-to-Lymphocyte Ratio(NLR)was significantly higher in non-survivors compared to survivors(random-effects model:standardized mean difference=1.02,95%confidence interval=0.67-1.37).Additionally,twenty-seven studies examined the associations between NLR and mortality in ESLD patients,reporting either hazard ratios(HR)or odds ratios(OR).The combined findings indicated a link between NLR and ESLD mortality(randomeffects model;univariate HR=1.07,95%CI=1.05-1.09;multivariate HR=1.07,95%CI=1.07-1.09;univariate OR=1.29,95%CI=1.18-1.39;multivariate OR=1.29,95%CI=1.09-1.49).Furthermore,subgroup and meta-regression analyses revealed regional variations in the impact of NLR on ESLD mortality,with Asian studies demonstrating a more pronounced effect.CONCLUSION Increased NLR in patients with ESLD is associated with a higher risk of mortality,particularly in Asian patients.NLR is a useful prognostic biomarker in patients with ESLD.

sTREM-1 as promising prognostic biomarker for acute-on-chronic liver failure and mortality in patients with acute decompensation of cirrhosis

BACKGROUND Acute decompensation(AD)of cirrhosis is associated with high short-term mortality,mainly due to the development of acute-on-chronic liver failure(ACLF).Thus,there is a need for biomarkers for early and accurate identification of AD patients with high risk of development of ACLF and mortality.Soluble triggering receptor expressed on myeloid cells-1(sTREM-1)is released from activated innate immune cells and correlated with various inflammatory processes.AIM To explore the prognostic value of sTREM-1 in patients with AD of cirrhosis.METHODS A multicenter prospective cohort of 442 patients with cirrhosis hospitalized for AD was divided into a study cohort(n=309)and validation cohort(n=133).Demographic and clinical data were collected,and serum sTREM-1 was measured at admission.All enrolled patients were followed-up for at least 1 year.RESULTS In patients with AD and cirrhosis,serum sTREM-1 was an independent prognosis predictor for 1-year survival and correlated with liver,coagulation,cerebral and kidney failure.A new prognostic model of AD(P-AD)incorporating sTREM-1,blood urea nitrogen(BUN),total bilirubin(TBil),international normalized ratio(INR)and hepatic encephalopathy grades was established and performed better than the model for end-stage liver disease(MELD),MELD-sodium(MELD-Na),chronic liver failure-consortium(CLIF-C)ACLF and CLIF-C AD scores.Additionally,sTREM-1 was increased in ACLF and predicted the development of ACLF during first 28-d follow-up.The ACLF risk score incorporating serum sTREM-1,BUN,INR,TBil and aspartate aminotransferase levels was established and significantly superior to MELD,MELD-Na,CLIF-C ACLF,CLIF-C AD and P-AD in predicting risk of ACLF development.CONCLUSION Serum sTREM-1 is a promising prognostic biomarker for ACLF development and mortality in patients with AD of cirrhosis.

Nursing Care of 10 Patients with Vasovagal Reflex Caused by Artificial Liver Support System Treatment

This study outlines the essential nursing strategies employed in the care of 10 patients experiencing vascular vagal reflex, managed with artificial liver support systems. It highlights a holistic nursing approach tailored to the distinct clinical manifestations of these patients. Key interventions included early detection of psychological issues prior to initiating treatment, the implementation of comprehensive health education, meticulous monitoring of vital signs throughout the therapy, prompt emergency interventions when needed, adherence to prescribed medication protocols, and careful post-treatment observations including venous catheter management. Following rigorous treatment and dedicated nursing care, 7 patients demonstrated significant improvement and were subsequently discharged.

Characterization of acute-on-chronic liver diseases: A multicenter prospective cohort study

BACKGROUND Acute-on-chronic liver disease(AoCLD)accounts for the majority of patients hospitalized in the Department of Hepatology or Infectious Diseases.AIM To explore the characterization of AoCLD to provide theoretical guidance for the accurate diagnosis and prognosis of AoCLD.METHODS Patients with AoCLD from the Chinese Acute-on-Chronic Liver Failure(ACLF)study cohort were included in this study.The clinical characteristics and outcomes,and the 90-d survival rate associated with each clinical type of AoCLD were analyzed,using the Kaplan-Meier method and the log-rank test.RESULTS A total of 3375 patients with AoCLD were enrolled,including 1679(49.7%)patients with liver cirrhosis acute decompensation(LC-AD),850(25.2%)patients with ACLF,577(17.1%)patients with chronic hepatitis acute exacer-bation(CHAE),and 269(8.0%)patients with liver cirrhosis active phase(LC-A).The most common cause of chronic liver disease(CLD)was HBV infection(71.4%).The most common precipitants of AoCLD was bacterial infection(22.8%).The 90-d mortality rates of each clinical subtype of AoCLD were 43.4%(232/535)for type-C ACLF,36.0%(36/100)for type-B ACLF,27.0%(58/215)for type-A ACLF,9.0%(151/1679)for LC-AD,3.0%(8/269)for LC-A,and 1.2%(7/577)for CHAE.CONCLUSION HBV infection is the main cause of CLD,and bacterial infection is the main precipitant of AoCLD.The most common clinical type of AoCLD is LC-AD.Early diagnosis and timely intervention are needed to reduce the mortality of patients with LC-AD or ACLF.