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Clinical Focus    2024, 39 (9): 842-846.   DOI: 10.3969/j.issn.1004-583X.2024.09.015 Abstract （249）   HTML （11）    PDF（pc） （905KB）（165）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Risk prediction model for readmission of chronic obstructive pulmonary disease: A systematic review Zhu Jieyun, Gao Min, Huang Chunli, Pan Dongzan, Wang Qiaoyan, Lu Zhao Clinical Focus    2024, 39 (9): 773-779.   DOI: 10.3969/j.issn.1004-583X.2024.09.001 Abstract （227）   HTML （10）    PDF（pc） （597KB）（130）       Knowledge map    Save Objective To systematically evaluate the risk for readmission in patients with chronic obstructive pulmonary disease (COPD) and provide references for the construction and optimization of prediction model.Methods The literatures on the risk prediction model for COPD readmission were independently screened in China National Knowledge Infrastructure (CNKI), VIP, WanFang Data, Cochrane Library, PubMed, Embase databases from database inception to November 22, 2023 by two researchers. After extracting data, the bias risk and applicability of the models were evaluated using the PROBAST tool. Results Twelve cohort studies representing 21 models were finally included. Eleven studies reported the area under a receiver operator characteristic (ROC) curve (AUC) and one study for the C-index. The AUC ranged from 0.603 to 0.917, with AUC>0.7 for 16 models. Six studies conducted model calibration and eight studies for internal or external validation. The overall applicability of the 12 studies was good, but with a high risk of bias, mainly in the analysis domain. The included studies had significant differences in the predictive factors, with the most common predictive factors of lung function indicators, Charlson comorbidity index, times of hospitalization due to a history of acute exacerbation during the previous year, eosinophil levels, and inhaled drug therapy. Conclusion The performance of the included models varied greatly, with good applicability but high risk of bias. Due to the incomplete screening method, and there were significant differences in predictive factors of the included studies. Future prediction models should focus on lung function, Charlson comorbidity index, times of hospitalization due to a history of acute exacerbation during the previous year, eosinophil levels, and inhaled drug therapy. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Longitudinal cohort study of oral health status and cognitive function in the elderly: A meta-analysis Wang Lin, Wang Ting, Pu Xiaolan, Ju Mei Clinical Focus    2024, 39 (8): 677-683.   DOI: 10.3969/j.issn.1004-583X.2024.08.001 Abstract （221）   HTML （7）    PDF（pc） （1364KB）（145）       Knowledge map    Save Objective To explore the correlation between oral health status and the risk of cognitive dysfunction by meta-analysis. Methods Cohort studies on the correlation between oral health status and cognitive function from inception to August 2023 were searched in PubMed, Web of Science, EMBASE, Scopus, Chinese National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Wanfang, VIP and Duxiu databases. Two reviewers independently screened literatures, extracted data and evaluated the quality of included studies. Meta-analysis was performed using RevMan 5.3 and Stata 17.0 software. Results A total of 34 cohorts were included. The results of meta-analysis showed that the risk of cognitive impairment in the elderly with poor oral health status was significantly higher than that in the elderly with good oral health status (RR=1.31, 95%CI 1.18-1.46, P<0.01). The results of subgroup analysis showed that there were significant differences in periodontitis disease, posterior occlusal support, dentition status, and tooth loss (P<0.05), but there was no significant difference in the oral frailty (RR=1.32, 95%CI 0.96-1.81, P=0.09). There was no significant difference in the risk of oral health status and cognitive impairment in the subgroup with a follow-up time>10 years (RR=1.01, 95%CI 0.83-1.23, P=0.90), but a significant difference was detected in the subgroup with a follow-up time ≤10 years (RR=1.48, 95%CI 1.32-1.67, P<0.001). There was no significant difference in the risk of oral health status and cognitive impairment in the moderate quality subgroup (RR=1.05, 95%CI 0.91-1.20, P=0.51), but a significant difference was detected in the high quality subgroup (RR=1.35, 95%CI 1.21-1.51, P<0.01). Conclusion Oral health status is associated with the risk of cognitive dysfunction. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (8): 752-757.   DOI: 10.3969/j.issn.1004-583X.2024.08.012 Abstract （214）   HTML （4）    PDF（pc） （879KB）（32）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Association of TyG index and its derivatives with the risk of diabetic kidney disease in patients with type 2 diabetes mellitus Li Jiawen, Liu Yanlan, Li Yaoshuang, Qiu Huina, Li Fang, Wu Fan, Lin Chenying, Lin Jingna Clinical Focus    2024, 39 (10): 901-908.   DOI: 10.3969/j.issn.1004-583X.2024.10.006 Abstract （201）   HTML （3）    PDF（pc） （1253KB）（85）       Knowledge map    Save Objective To study the correlation of triglyceride-glucose (TyG) and its derivative index with the risk of diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM), and to explore its clinical application value. Methods This was a cross-sectional study including 895 T2DM patients hospitalized in the Endocrinology Department of Tianjin People's Hospital from 2018 to 2022. Patients were divided into DKD group (n=326) and non-DKD group (n=569) according to whether they had DKD or not. The clinical data of the two groups were compared. The correlation of TyG, triglyceride glucose-waist circumference (TyG-WC), triglyceride glucose-body mass index (TyG-BMI), and homeostatic model assessment for insulin resistance (HOMA-IR) with DKD was identified. The interaction of TyG and its derivatives with stratification factors was explored. Results There were significant differences in TyG, TyG-WC, TyG-BMI and HOMA-IR between the two groups (P<0.05). TyG and TyG-WC were independent influencing factors of the risk of DKD before and after adjusting for influencing factors (P<0.05). The prevalence of DKD in T2DM patients increased gradually with the increased TyG, TyG-WC and HOMA-IR (trend test P<0.05). In the T3 subgroup of TyG and TyG-WC, the prevalence of DKD was significantly higher than that of T1 subgroup (P<0.05). At varied levels of TyG, it was an independent risk factor for the risk of DKD before and after adjusting for the influencing factors (P<0.05). Conclusion As an independent risk factor for the risk of DKD, continuous and categorical variables of TyG and its derivatives as well as HOMA-IR stably predict DKD in T2DM patients. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (9): 855-860.   DOI: 10.3969/j.issn.1004-583X.2024.09.018 Abstract （200）   HTML （5）    PDF（pc） （952KB）（71）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (9): 861-864.   DOI: 10.3969/j.issn.1004-583X.2024.09.019 Abstract （196）   HTML （9）    PDF（pc） （897KB）（113）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (9): 847-850.   DOI: 10.3969/j.issn.1004-583X.2024.09.016 Abstract （196）   HTML （7）    PDF（pc） （885KB）（76）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (8): 763-768.   DOI: 10.3969/j.issn.1004-583X.2024.08.014 Abstract （185）   HTML （6）    PDF（pc） （999KB）（39）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Bioinformatic analysis of differentially expressed genes of primary Sjögren's syndrome Wang Yun, Wang Dandan Clinical Focus    2024, 39 (9): 792-797.   DOI: 10.3969/j.issn.1004-583X.2024.09.004 Abstract （181）   HTML （3）    PDF（pc） （1352KB）（19）       Knowledge map    Save Objective To screen for differentially expressed genes (DEGs) associated with primary Sjögren's syndrome(pSS) by bioinformatics and to explore its underlying pathogenesis. Methods Gene expression profiles were downloaded from the GEO database, and DEGs were obtained by integrating the datasets. Furthermore, we explored DEGs’ potential function by GO and KEGG enrichment analysis. Finally, we screened the hub genes of pSS by PPI network analysis. Results A total of 29 DEGs(27 up-regulated and 2 down-regulated) were identified, and the GO enrichment results showed that these genes are involved in lymphocyte and monocyte differentiation and proliferation, T cell activation, positive regulation of cell-cell adhesion, and chemokine-related molecular functions. KEGG analysis mainly involves chemokine signaling pathways, hematopoietic cell regulatory signaling pathways, B cell receptor signaling, viral protein-cytokine and receptor interaction pathways. Five hub genes, including MX1, SELL, IFIT1, IFI44L and SAMD9L were screened from the PPI network.Conclusion The MX1, SELL, IFIT1, IFI44L, and SAMD9L genes were identified and may be involved in pSS pathogenesis. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Vitamin D deficiency and orthostatic hypotension in the elderly: A systematic review and meta-analysis Zhao Jiahua, Ma Qinghua, Yu Jianghua Clinical Focus    2024, 39 (10): 869-876.   DOI: 10.3969/j.issn.1004-583X.2024.10.001 Abstract （177）   HTML （6）    PDF（pc） （1279KB）（95）       Knowledge map    Save Objective To study the relationship between vitamin D deficiency, defined as 25-hydroxyvitamin D3 (25 (OH) D3) deficiency and the risk of orthostatic hypotension (OH) in the elderly population. Methods From the establishment of the database to June 2023, a systematic literature search was conducted on Pubmed, Embase, Web of Science, Scopus, and Cochrane databases. Two researchers independently screened the included literatures, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was performed using Stata software (version 17.0) and RevMan5.4 software. Results A meta-analysis was conducted using the random-effect model involving 9,155 participants from 9 cross-sectional studies. Serum 25-hydroxyvitamin D levels were measured by radioimmunoassay (RIA) and liquid chromatography mass spectrometry (LC-MS). The overall analysis results showed that vitamin D deficiency was directly correlated with OH in the elderly population. Compared with individuals with normal vitamin D levels, low serum vitamin D levels significantly increased the risk of OH in the elderly (OR=1.22, 95%CI=1.12-1.33,P<0.05). Conclusion There is a clear correlation between vitamin D deficiency and the risk of OH in the elderly. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (10): 945-952.   DOI: 10.3969/j.issn.1004-583X.2024.10.014 Abstract （172）   HTML （8）    PDF（pc） （870KB）（40）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Efficacy and safety of laparoscopic Heller myotomy versus peroral endoscopic myotomy on esophageal achalasia: A meta-analysis Ye Zhibo, Li Keyong, Que Changhao, Wang Yaping, Gou Yunjiu Clinical Focus    2024, 39 (8): 684-692.   DOI: 10.3969/j.issn.1004-583X.2024.08.002 Abstract （169）   HTML （6）    PDF（pc） （2200KB）（19）       Knowledge map    Save Objective To systematically evaluate the efficacy and safety of laparoscopic Heller myotomy (LHM) versus peroral endoscopic myotomy (POEM) on esophageal achalasia. Methods Relevant articles reporting the efficacy and safety of LHM versus POEM on esophageal achalasia published up to November 2023 were searched in the PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang database, VIP and China Knowledge Network database (CNKI). Meta-analysis was performed using RevMan 5.0 software. Results A total of 15 articles were included, including 1 randomized controlled trial, 8 retrospective cohort studies, and 6 prospective non-randomized controlled trials. A total of 1, 439 patients were included, with 696 patients in the LHM group and 743 in the POEM group. Meta-analysis showed that POEM resulted in a significantly lower recurrent rate of postoperative dysphagia (OR=2.01, 95%CI 1.17, 3.44, P=0.01), shorter operative time (MD=22.66, 95%CI 5.57, 39.75, P=0.009), shorter length of stay (MD=0.55, 95%CI 0.38, 0.71, P<0.01), fewer days to return to normal life after surgery (MD=4.49, 95%CI 4.00, 4.97, P<0.01) than those in the LHM group, LHM resulted in a significantly lower incidences of gastroesophageal reflux disease (OR=0.64, 95%CI 0.45, 0.90, P=0.009) and postoperative subcutaneous emphysema (OR=0.33, 95%CI 0.11, 0.99, P=0.05) than those in the POEM group. The incidence of total postoperative complications, postoperative proton pump inhibitors utilization, and postoperative Eckardt score at 6 months were comparable between groups (P>0.05). Conclusion Compared with LHM, POEM has more advantages in lowering the recurrence of postoperative dysphagia, operative time, length of stay, and duration to return to normal life after surgery. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (10): 953-968.   DOI: 10.3969/j.issn.1004-583X.2024.10.015 Abstract （164）   HTML （6）    PDF（pc） （1073KB）（19）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Current situation and influencing factors for the demand for “Internet+Nursing Service” among the elderly in Yuhua District, Shijiazhuang City, China Sun Kejuan, Zhao Yuting, Zhang Xinjie, Ke Guiyin, Zhang Wenjie, Wu Suning Clinical Focus    2024, 39 (8): 734-740.   DOI: 10.3969/j.issn.1004-583X.2024.08.009 Abstract （160）   HTML （3）    PDF（pc） （888KB）（21）       Knowledge map    Save Objective In response to the pilot work of “Internet + Nursing service” released by Health Commission of Shijiazhuang, approaches are carried out to more benefit the elderly population in Yuhua District. Methods Through literature review, a questionnaire was designed to survey the elderly in Yuhua District, Shijiazhuang City for the demand for “Internet + Nursing service”. Data were processed by SPSS 27.0. The current situation and influencing factors for the demand for “Internet+Nursing Service” among the elderly in Yuhua District, Shijiazhuang City were analyzed. Results Area, whether to understand the “nurse on-site service”, education level, monthly medical expenses and living conditions were the independent influencing factors for the demand for “Internet+Nursing service” among the elderly in Yuhua District (P<0.05). Age had no effect on it (P>0.05). Conclusion The proportion of elderly people in Yuhua District who know about “Internet+Nursing Service” is low, but there is a high and diverse demand. It is recommended to establish a market-oriented publicity and promotion plan, and carry out a comprehensive and strict “Internet+” qualification and competence assessment for at-home nurses. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Summaries from best evidence in brief for management of hyperglycemia after enteral nutrition in patients with severe stroke Shi Shasha, Ren Haotian, Song Lifei, Li Jiani, Zhou Yan, Zhang Yan Clinical Focus    2024, 39 (11): 1000-1006.   DOI: 10.3969/j.issn.1004-583X.2024.11.007 Abstract （160）   HTML （0）    PDF（pc） （479KB）（14）       Knowledge map    Save Objective To search, evaluate and summarize the relevant evidence at home and abroad on the management of hyperglycemia after enteral nutrition (EN) in patients with severe stroke, so as to provide a reference basis for clinical nursing practice. Methods According to the “6S” classification model of evidence-based search resources, literatures related to the management of hyperglycemia after EN in patients with severe stroke were searched in domestic and foreign databases, guideline websites and professional association websites, including guidelines, expert consensus, systematic reviews, evidence summaries and randomized controlled trials. The search time limit was from the establishment of the database to December 12, 2023. Two researchers who have undergone systematic training in evidence-based methodology were independently responsible for literature quality evaluation, data extraction, summary and analysis. Results A total of 15 articles were included, involving 1 randomized controlled trial, 2 systematic reviews, 1 evidence summary, 6 guidelines, and 5 expert consensuses. The overall quality of the literatures was relatively high. From 5 aspects of assessment and screening, blood glucose monitoring and control targets, EN implementation plan, hyperglycemia management, and hypoglycemia management, 28 pieces of evidence were summarized.Conclusion This study summarized the best evidence for the management and prevention of hyperglycemia after EN in patients with severe stroke, which can provide an evidence-based basis for the management of blood glucose related to clinical EN and the standard of nursing quality. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Evidence summary of the application of the diary method in adult ICU patients Wang Yu, Peng Lili, Shi Yao, Du Yunhong, Duan Yuliang, Wang Li Clinical Focus    2024, 39 (9): 780-786.   DOI: 10.3969/j.issn.1004-583X.2024.09.002 Abstract （159）   HTML （4）    PDF（pc） （1158KB）（101）       Knowledge map    Save Objective To systematically screen, evaluate, summarize and extract the optimal evidence for the application of the diary method in adult patients in the intensive care unit (ICU), so as to provide evidence-based basis for the implementation of the diary method in ICU. Methods All the evidence on the application of the diary to adult ICU patients were searched in relevant professional websites and databases at home and abroad, including the guidelines, evidence summary, expert consensus, systematic reviews, clinical decisions, etc. The retrieval time was from the establishment of the database to January 25, 2024. Two researchers independently conducted literature screening, quality evaluation, data extraction, classification and evidence summary according to the topic. Results A total of 13 articles were included, with 1 expert consensus, 2 guidelines and 10 systematic reviews. The optimal evidence for the application of diary method in ICU adult patients was formed, including 8 dimensions (application cognition, application effect, target population, writers, diary content, writing notes, application guidance and diary management) and 32 pieces of evidence. Conclusion Medical staff should carefully select appropriate evidence according to the corresponding clinical situation, and a multidisciplinary team cooperation should be carried out to yield the optimal individualized evidence practice of the diary method in ICU. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical value of different ultrasound methods in assessing the left anterior descending artery stenosis Li Xing, Feng Huaping, Lan Shengfeng, Li Zhiyong Clinical Focus    2024, 39 (8): 693-699.   DOI: 10.3969/j.issn.1004-583X.2024.08.003 Abstract （159）   HTML （4）    PDF（pc） （3373KB）（20）       Knowledge map    Save Objective To explore the clinical value of different ultrasound methods in assessing the left anterior descending artery (LAD) stenosis. Methods A retrospective analysis was conducted on the ultrasound data of 240 patients diagnosed as the LAD stenosis by coronary angiography (CAG) in our hospital from April 2023 to April 2024, who underwent three different ultrasound evaluation methods, including ventricular wall motion analysis, velocity vector imaging (VVI), and coronary artery flow imaging (CFI). According to the degree of LAD stenosis, patients were divided into the experimental group (stenosis≥50%, n=120) and control group (stenosis<50%, n=120). The wall motion analysis, VVI, and CFI ultrasound characteristics of patients in the two groups were summarized, and the diagnostic efficacy of three different ultrasound methods was analyzed using CAG as the gold standard. Results Wall motion analysis showed that the proportion of regional wall motion abnormalities in the experimental group was significantly higher than that of the control group (P<0.05). VVI showed that the longitudinal peak strain of the anterior interval and anterior wall contraction period in the experimental group was significantly lower than that of the control group (P<0.05). CFI showed that the diastolic peak velocity of LAD in the experimental group was significantly faster than that of the control group (P<0.05). Using the CAG results as the gold standard, the sensitivity of wall motion analysis for diagnosing LAD stenosis≥50% was 0.467, with the specificity of 0.717, accuracy of 0.591, positive predictive value (PPV) of 0.622, and negative predictive value (NPV) of 0.573. VVI in diagnosing LAD stenosis≥50% had a sensitivity of 0.800, specificity of 0.817, accuracy of 0.808, PPV of 0.813, and NPV of 0.803. CFI in diagnosing LAD stenosis≥50% had a sensitivity of 0.850, specificity of 0.783, accuracy of 0.817, PPV of 0.796, and NPV of 0.839. The consistency test results showed that the consistency between wall motion analysis and CAG was average, with a Kappa value of 0.183. VVI, CFI, and CAG showed a high consistency, with Kappa values of 0.617 and 0.633, respectively. The receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of wall motion analysis, VVI, and CFI in diagnosing LAD stenosis was 0.592, 0.808, and 0.817, respectively. Conclusion Abnormal anterior septal and anterior wall motion, decreased anterior septal and anterior wall longitudinal peak strain, and diastolic peak velocity acceleration of LAD are all diagnostic criteria of wall motion analysis, VVI, and CFI for LAD stenosis. However, the diagnostic efficacy of the former one is significantly lower than the latter two. VVI and CFI have a high diagnostic efficacy in diagnosing LAD stenosis and good consistency with CAG, which is worthy of clinical application and promotion. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Efficacy of empagliflozin combined with liraglutide on obese and overweight T2DM patients and its impact on inflammatory factors: A prospective, randomized, open-label, parallel-controlled clinical study Wang Jing, Li Caige, Wang Ting, Liu Zibo, Gai Bin, Jin Yangyu, Zhang Lihui Clinical Focus    2024, 39 (10): 909-914.   DOI: 10.3969/j.issn.1004-583X.2024.10.007 Abstract （157）   HTML （2）    PDF（pc） （419KB）（59）       Knowledge map    Save Objective To investigate the clinical efficacy of empagliflozin combined with liraglutide on obese/overweight patients with type 2 diabetes mellitus (T2DM) and its effects on inflammatory factors and islet function. Methods A total of 58 obese/overweight T2DM patients hospitalized and treated at the Second Hospital of Hebei Medical University from June 2021 to September 2023 were selected as the study subjects. They were randomly assigned into the experimental group (Lira+Empa group) and the control group (Lira group), with 29 cases in each group. Patients in the experimental group received a combination therapy of empagliflozin and liraglutide, while those in the control group received liraglutide monotherapy. Pre- and post-treatment glycometabolic indicators, lipid metabolic indicators, inflammatory factors, islet function indicators, and adverse events were compared between groups. Results After treatment, the levels of fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2 hPPG), glycated albumin (GA), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), body mass index (BMI), interleukin-6 (IL-6), and interleukin-10 (IL-10) in both groups were significantly lower than those before treatment. The levels of FPG, 2 hPPG, GA, BMI, IL-6, and IL-10 in the Lira+Empa group were all significantly lower than those of the Lira group (P<0.05). After treatment, the levels of C-peptide (C-P), fasting insulin (FINS), and homeostasis model assessment of β-cell function (HOMA-β) in both groups were significantly higher than those before treatment, and HOMA-β was significantly higher in the Lira+Empa group than the Lira group (P<0.05). There was no significant difference in the incidence of adverse events between the two groups. Conclusion Compared with liraglutide monotherapy, the combination therapy of empagliflozin and liraglutide can further improve the blood glucose-lowering effect, lower blood sugar levels, promote islet function of patients, reduce body weight, and reduce inflammatory factors in obese/overweight T2DM patients, with a good safety. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Effect of a multidisciplinary intervention on the quality of life in maintenance hemodialysis patients Guo Xiaocui, Yu Xiaojuan, Shen Xia, Ye Shuiying, Zhou Dongchi, Lai Bihong Clinical Focus    2024, 39 (9): 803-807.   DOI: 10.3969/j.issn.1004-583X.2024.09.006 Abstract （156）   HTML （2）    PDF（pc） （902KB）（14）       Knowledge map    Save Objective To investigate the effect of a multidisciplinary intervention on the quality of life in patients with maintenance hemodialysis (MHD). Methods A total of 100 MHD patients admitted to the Department of Hemodialysis, Shanghai Pudong Hospital from January 2020 to December 2022 were included. They were randomly assigned 1∶1 into the intervention group (n=50) and control group (n=50). A multidisciplinary team which comprised nephrologists, nutritionists, and nurses was responsible for managing MHD patients the intervention group, while those in the control group received a standard daily care from the nursing team. After 12 months of intervention, 1 case in each group withdrew, and finally, 49 eligible cases were included in each group. The self-management ability, quality of life, and nutritional status were compared between two groups. Results There were no significant differences in general information, quality of life, self-management ability, and nutritional status between the two groups before intervention (P>0.05). After intervention, the self-management score and quality of life score of the intervention group were significantly higher than those of the control group (P<0.05). Body mass index, serum albumin, serum ferritin, and total cholesterol were significantly better than those in the control group (P<0.05). Conclusion A multidisciplinary intervention effectively improves the nutritional status, self-management ability and quality of life of MHD patients. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (8): 758-762.   DOI: 10.3969/j.issn.1004-583X.2024.08.013 Abstract （153）   HTML （4）    PDF（pc） （870KB）（33）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Cortical “ribbon sign” on DWI in adults: A case report and literature review Zhang Yingqiu, Zhang Jin, Ge Shihao, Chen Junmin Clinical Focus    2024, 39 (9): 821-824.   DOI: 10.3969/j.issn.1004-583X.2024.09.010 Abstract （152）   HTML （3）    PDF（pc） （1059KB）（114）       Knowledge map    Save Objective To investigate the clinical characteristics of cortical “ribbon sign” on diffusion-weighted imaging (DWI). Methods The clinical data, relevant examination data, and imaging data of a case of cortical “ribbon sign” were analyzed, and relevant literatures were reviewed. Results The patient was admitted to the hospital due to involuntary grasping of objects with a walking instability for 10 days, and aggravated for 2 days. Brain imaging examination showed cortical “ribbon sign”, manifesting as a high signal intensity along the cerebral sulcus on T1-weighted imaging, DWI and fluid-attenuated inversion recovery sequence. The increase in signal intensity was pronounced on DWI sequence, reflecting the cytotoxic edema of the cerebral cortex. Symptomatic treatment was performed. The patient's symptoms gradually worsened and died about half a year later. Conclusion Cortical ribbon sign is a typical imaging change of laminar necrosis of the cerebral cortex, usually observed in vascular, infectious, metabolic, and toxic nerve system diseases. A deep mining of the pathogenesis and causes of cortical ribbon sign favors the clinical diagnosis and differentiation diagnosis. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Gastric adenocarcinoma of fundic gland type: A case report and literature review Liu Jing, Liu Lianpei, Zhang Mengmeng, Chai Linlin, Li Rong, Zhu Liying Clinical Focus    2024, 39 (10): 929-934.   DOI: 10.3969/j.issn.1004-583X.2024.10.011 Abstract （151）   HTML （7）    PDF（pc） （2150KB）（18）       Knowledge map    Save Objective To investigate the clinical characteristics, diagnosis and differential diagnosis of gastric adenocarcinoma of fundic gland type (GA-FG).Methods The diagnosis and treatment of a GA-FG patient were retrospectively analyzed, and the related literatures were reviewed. Results A 54-year-old woman had fading lesions of submucosal tumors (SMT) found in the upper part of the gastric body during gastroscopy. The mucosal surface of the lesion was smooth, and dilated dendritic vascular changes could be seen. Magnification endoscopy (ME) plus narrow-band imaging (NBI) showed typical honeycomb changes in the surrounding mucosa of the brown lesion, fused surface microglandular ducts, varied opening of the glandular ducts, irregular white area and surface microvessels. Ultrasonic gastroscopy showed that the mucosal lesions of the gastric body were visible, with moderate to low echo, originated from the mucosal layer; unclear boundary in the muscular layer of the mucosa; the submucosa was intact, with a size of about 0.8 cm×0.5 cm. Pathology after endoscopic resection showed: fundic adenocarcinoma with 0.3 cm×0.3 cm under the microscopy, infiltrated into the submucosa (diffuse depth of about 220 μm); negative vascular and nerve invasion; no cancer was found in the horizontal and vertical margins. Chronic inflammation of the surrounding mucosa. Immunohistochemistry: positive MUC6; negative mUC5AC; negative p53 nonsense mutation; positive desmin (incomplete mucosal muscle); positive Syn in individual cells; positive CgA in individual cells; positive CD31 and D2-40 (no tumor thrombus in the vessel) ; 10% positivity for Ki-67. Conclusion GA-FG is a new histological type of gastric cancer with unique clinical endoscopic and pathological features. The prognosis of GA-FG is good, but a long-term follow-up is needed. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (9): 837-841.   DOI: 10.3969/j.issn.1004-583X.2024.09.014 Abstract （149）   HTML （5）    PDF（pc） （1682KB）（20）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (11): 1047-1051.   DOI: 10.3969/j.issn.1004-583X.2024.11.014 Abstract （147）   HTML （3）    PDF（pc） （820KB）（20）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (9): 851-854.   DOI: 10.3969/j.issn.1004-583X.2024.09.017 Abstract （146）   HTML （7）    PDF（pc） （899KB）（18）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Comparative study on the clinical efficacy of different antiviral drugs in the treatment of COVID-19 Wu Wanfeng, Wang Yunyun, Yang Daokun Clinical Focus    2025, 40 (2): 147-152.   DOI: 10.3969/j.issn.1004-583X.2025.02.009 Abstract （146）   HTML （1）    PDF（pc） （860KB）（116）       Knowledge map    Save Objective To explore the clinical efficacy of different antiviral drugs in the treatment of Coronavirus Disease 2019 (COVID-19). Methods A total of 456 COVID-19 patients admitted to Jincheng People's Hospital from February 2023 to June 2023 were selected for the study. According to the random number method, they were randomly divided into group A (treated with azvudine, n=152), group B (treated with nirmatrelvir/ritonavir, n=152) and group C (treated with simnotrelvir/ritonavir, n=152). The clinical efficacy, symptom and sign recovery time, mortality, lung imaging, complete blood count (white blood cell count [WBC], absolute neutrophil count [ANC], and lymphocyte count [LYC]), CT values (mRNA levels) of the ORF1ab and N genes, and adverse events were observed. Results There were no significant differences in the clinical efficacy, symptom and sign recovery time, CT values of the ORF1ab and N genes, mortality, time required for lung imaging improvement, and negative conversion time of nucleic acid testing among groups A, B and C (P>0.05). After treatment, WBC and ANC significantly decreased, and LYC significantly increased in all the three groups, although intergroup comparisons did not show significant differences (P>0.05). The total incidence of adverse events was 15.12%(23/152) in group A, 16.44%(25/152) in group B, and 13.80% (21/152) in group C. There was no significant difference in the total incidence of adverse events among groups A, B and C (P>0.05). Conclusion Azvudine, nirmatrelvir/ritonavir, and simnotrelvir/ritonavir have significant antiviral effects against COVID-19, although leading to some adverse events and medication restrictions. Therefore, when using the above drugs in clinical practice, the specific conditions and medication risks of patients should be fully considered, and a strict compliance and medication guidance are essential, aiming to ensure patient's safety and efficacy. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Effect of prolonged early empirical antibiotic exposures on hospitalization outcomes of premature infants Xu Yuanyuan, Yu Jianmei, Zhang Xiuli, Li Liangliang, Yin Xiangyun, Li Xianghong Clinical Focus    2024, 39 (8): 728-733.   DOI: 10.3969/j.issn.1004-583X.2024.08.008 Abstract （144）   HTML （2）    PDF（pc） （907KB）（27）       Knowledge map    Save Objective To explore the effect of prolonged early empirical antibiotic exposures on the hospitalization outcome of preterm infants by retrospectively analyzing the clinical data of preterm infants born with gestational age <32 weeks or birth weight < 1500 g, and to further guide the rational application of antibiotics in preterm infants. Methods Clinical data of preterm infants born with gestational age <32 weeks or birth weight <1500 g in the Affiliated Hospital of Qingdao University from January 1, 2018 to December 31, 2020 were collected. They were divided into short-term exposure group (≤5 days) and long-term exposure group (>5 days) according to the duration of empirical antibiotic application in the early postnatal period. The complications during hospitalization between the two groups were analyzed and compared. Results A total of 291 cases were retrospectively included, involving 166 males and 125 females. The median duration of antibiotic use in the short-term and long-term exposure groups was 3 days and 9 days, respectively. Compared with those of the short-term exposure group, cases in the long-term exposure group presented significantly higher incidence of feeding intolerance (FI), and longer duration of half-intestinal feeding, full intestinal feeding and the length of stay (P<0.05). The incidence of bronchopulmonary dysplasia (BPD) and late-onset sepsis (LOS) was significantly higher in the long-term exposure group than that of the short-term exposure group (P<0.05). Univariate Logistic regression analysis showed that prolonged antibiotic exposure was associated with increased incidences of FI, BPD, LOS, and composite outcomes during hospitalization. Multivariate Logistic regression analysis showed that prolonged exposure of empirical antibiotics was an independent risk factor for FI and BPD. Multiple linear regression analysis showed that the duration of antibiotic use was positively correlated with the length of stay and the length of whole intestinal feeding. Conclusion Prolonged early empirical antibiotic exposures can increase the risk of BPD in preterm infants, affect intestinal feeding, and lead to a longer length of stay. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical application of multispectral irradiation combined with conventional therapy on acute exacerbation of chronic obstructive pulmonary disease Zhou Zhiming, Ru Yi, Li Ping, Ping Fen Clinical Focus    2025, 40 (1): 27-32.   DOI: 10.3969/j.issn.1004-583X.2025.01.004 Abstract （142）   HTML （5）    PDF（pc） （883KB）（20）       Knowledge map    Save Objective To investigate the efficacy of multispectral irradiation combined with conventional therapy on the acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 86 patients with AECOPD who were treated in Hebei General Hospital from January 2022 to November 2023 were selected and divided into observation group (n=42) and control group (n=44) according to a random number table. Patients in the control group were treated with conventional therapy, and those in the observation group were treated with multispectral irradiation plus conventional therapy. The clinical data within 24 hours before and after treatment were compared between the two groups. Results There were significant differences in the modified medical research council score, alkaline phosphatase, serum amyloid A, white blood cell, absolute neutrophil count, 6-meter walking test, vitamin D, Ca2+, and oxygenation index between groups after treatment (P<0.05), while there were no significant differences in the Global Initiative for Chronic Obstructive Lung Disease grading, C-reactive protein, forced expiratory volume in one second/forced vital capacity, forced expiratory volume in 1 second percentage of predicted, P5+, and eosinophil(P>0.05). Conclusion The application of multispectral irradiation combined with conventional therapy on AECOPD patients can better increase their oxygen content, subjective perception of breathing difficulties, vitamin D levels, exercise endurance, and inflammatory response. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Spinal dural arteriovenous fistula: A case report and literature review San Dan, Zhen Jin Clinical Focus    2024, 39 (9): 825-827.   DOI: 10.3969/j.issn.1004-583X.2024.09.011 Abstract （141）   HTML （2）    PDF（pc） （1025KB）（10）       Knowledge map    Save Objective To study the clinical manifestations, pathogenesis and imaging pattern of spinal dural arteriovenous fistula (SDAVF). Methods The diagnosis and treatment of a SDAVF patient was analyzed retrospectively, and the related literature was reviewed. Results The 61-year-old male patient presented mobility limitation as initial symptom, followed by urination and defecation dysfunction, with strip long T2 signal in magnetic resonance imaging and spinal arteriovenous fistula at L1 segment in spinal angiography. Conclusion Although SDAVF is very rare and clinically atypical, spinal angiography is the gold standard for confirmed diagnosis, and surgery should be performed as soon as possible after diagnosis. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Analysis of influencing factors of sleep quality and metabolically associated fatty liver disease in the physical examination population Gou Caixia, Zhang Jie, Baoyixiamu·Ababaikeli , Wang Yiming, Yao Lei, Zheng Rongjiong, Pan Jinliang, Lu Xiaobo Clinical Focus    2025, 40 (1): 33-38.   DOI: 10.3969/j.issn.1004-583X.2025.01.005 Abstract （141）   HTML （1）    PDF（pc） （447KB）（8）       Knowledge map    Save Objective To study the association between sleep quality and metabolically associated fatty liver disease (MAFLD) in the physical examination population, and to explore the influencing factors of MAFLD. Methods From March 2024 to April 2024, 142 people who received the assessment of the Pittsburgh Sleep Quality Index (PSQI) and physical examination in the physical examination center of a tertiary hospital in Urumqi, Xinjiang were selected. According to the exclusion criteria, 2 cases that did not meet the requirements were excluded, and a total of 140 cases were finally selected. According to whether they had MAFLD, they were divided into MAFLD group (n=60) and non-MAFLD group (n=80). Clinical data between the two groups were compared to explore the influencing factors of MAFLD. Results Compared with the non-MAFLD group, patients in the MAFLD group had a significantly higher male proportion, hemoglobin, total bilirubin (T-BIL), urine albumin, total cholesterol, triglyceride, alanine aminotransferase and aspartate aminotransferase, and lower high density lipoprotein cholesterol (HDL-C)(P<0.05). There were significant differences in daytime nap time, total PSQI, the score of sleep quality factor, the score of sleep disorder factor and the score of hypnotic drug factor between the two groups (P<0.05). Further multivariate logistic regression analysis showed that T-BIL, HDL-C, daytime nap time, sleep quality score and sleep disorder score were the influencing factors of MAFLD (P<0.05). Pearson correlation analysis and scatter plots showed that PSQI score was not correlated with T-BIL, HDL-C and daytime nap time (P>0.05), but significantly correlated with sleep quality factor score and sleep disorder factor score in MAFLD patients (P<0.05). Conclusion In the physical examination population, higher T-BIL, lower HDL-C, longer daytime nap time, worse sleep quality, and more serious the sleep disorder indicate a higher risk of MAFLD. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Association of urinary transferrin with new-onset cardiovascular disease in type 2 diabetes mellitus Ma Jiannan, Tao Jie, Sang Dasen, Wu Shouling, Zhang Qi Clinical Focus    2024, 39 (8): 700-705.   DOI: 10.3969/j.issn.1004-583X.2024.08.004 Abstract （140）   HTML （8）    PDF（pc） （1135KB）（116）       Knowledge map    Save Objective To explore the correlation between urinary transferrin to urinary creatinine ratio (uTRF/Cr) and new onset cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). Methods A total of 8 163 T2DM patients who participated in the 6th health examination in Kailuan and underwent urinary transferrin and urinary creatinine detection were recruited. Subjects were divided into the first group (n=2 721), the second group (n=2 721), and the third group (n=2 721) based on baseline uTRF/Cr. The effects of uTRF/Cr on the risk of CVD were analyzed by multivariate Cox regression model. Results The baseline age of the study population was (60.46±9.96) years, with 78.30% of males, and 0.24(0.16-0.47) mg/mmol of baseline uTRF/Cr. The median follow-up time was 3.85(3.43-4.22) years, with 411(6.79%) of CVD events occurred. The cumulative incidence of total CVD events in the first, second and third groups was 3.81%, 4.65%, and 7.29%, respectively. After adjusting for relevant influencing factors, the risk of total CVD events in the second and third groups of uTRF/Cr was 1.12(95%CI 0.86-1.46) times and 1.52(95%CI 1.18-1.97) times that in the first group, respectively. Conclusion Increased uTRF/Cr is an independent risk factor for CVD in T2DM populations, and the risk of CVD increases with increased uTRF/Cr, even before the onset of macroalbuminuria. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Congenital drug-resistant tuberculosis combined with bronchial granuloma: A case report and literature review Mu Shiyin, Zou Yingxue, Guo Yongsheng, Zhai Jia, Huang Bing Clinical Focus    2024, 39 (8): 747-751.   DOI: 10.3969/j.issn.1004-583X.2024.08.011 Abstract （140）   HTML （7）    PDF（pc） （1369KB）（22）       Knowledge map    Save Objective To report the diagnosis and treatment of a case of congenital drug-resistant tuberculosis combined with bronchial granuloma, thus summarizing the clinical experience and providing references for clinical management. Methods Clinical data of a child with congenital drug-resistant tuberculosis combined with bronchial granuloma admitted to our department on April 22, 2022 were analyzed, including the clinical characteristics, diagnosis and treatment. Results The child was prematurely, vaginally delivered at 34 weeks and 4 days of gestation, in an in vitro fertilization. At 40 days of age, the child developed symptoms of cough, wheezing, and fever, and repeatedly hospitalized for pneumonia. The mother of the child underwent in vitro artificial insemination due to tubal obstruction, and presented a history of obsolete pulmonary tuberculosis. Physical examination on admission showed rapid breathing, positivity for the Hoover's sign, slightly low respiratory sounds in the right lung, and wheezing sounds in both lungs. Lung CT showed multiple inflammatory consolidations and multiple nodules in both lungs, and extensive granulation tissue proliferation in bilateral bronchi on fiberoptic bronchoscopy. The tissue polymerase chain reaction for tuberculosis (TB-PCR) test showed positive Mycobacterium tuberculosis in the alveolar lavage fluid, and second-generation sequencing consistently showed Mycobacterium tuberculosis. The child was treated by oral rifampicin, isoniazid, and linezolid for antituberculosis therapy. One month after discharge, a follow-up lung CT and fiberoptic bronchoscopy showed disease progression. The rifampicin fluorescence quantitative nucleic acid amplification detection(X-pert MTB/RIF) assay indicated rifampicin resistance, and the child was then treated with a quadruple anti-tuberculosis therapy of levofloxacin, linezolid, pyrazinamide, and isoniazid. Fiberoptic bronchoscopy procedures, including granuloma electrocoagulation and resection, cryotherapy, and foreign body forceps extraction were performed for multiple times to relieve airway obstruction. The child had regular follow-up visits and underwent interventional therapy under fiberoptic bronchoscopy for nearly 7 months. At present, the child had a stable breathing, well-ventilated in both lungs, and no adverse drug reactions. The follow-up is ongoing. Conclusion Symptoms of congenital tuberculosis are atypical, and prone to a missed diagnosis. It is necessary to strengthen the application of fiberoptic bronchoscopy in the diagnosis and treatment of tuberculosis. Tubal blockage leading to infertility in women undergoing in vitro fertilization and embryo transfer may be the main cause of congenital tuberculosis. In addition, sputum Mycobacterium tuberculosis and drug resistance gene testing can guide clinical medication in patients with drug-resistant tuberculosis. However, there is currently limited guidance and treatment plans for drug-resistant tuberculosis in infants and young children, and the further research is needed. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Risk prediction models for weaning failure from mechanical ventilation: A systematic review Hu Feifei, Wang Fang, Wang Yongni, Huang Shini, Ming Yao Clinical Focus    2025, 40 (2): 107-116.   DOI: 10.3969/j.issn.1004-583X.2025.02.002 Abstract （140）   HTML （2）    PDF（pc） （1306KB）（80）       Knowledge map    Save Objective To systematically evaluate the risk prediction models for mechanical ventilation weaning failure. Methods Computerised searches of PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, Wanfang and VIP databases were conducted to collect risk prediction models for weaning failure from mechanical ventilation from the establishment of the database to February 2025. The risk of bias and applicability of risk prediction models were evaluated using the prediction model risk of bias assessment tool (PROBAST) after the literatures were independently screened and data extracted by two researchers. Results Twenty-one literatures representing 44 risk prediction models for weaning failure from mechanical ventilation were included. The number of predictors ranged from 3-21, with the most common predictors being the duration of mechanical ventilation, age, and the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ). The area under the receiver operating characteristic curve (AUC) of the included models ranged 0.689-0.926. The models had a good overall predictive performance, but the overall risk of bias was high. Conclusion Currently, the risk prediction models for weaning failure from mechanical ventilation has well overall predictive performance, but the clinical applicability of the model requires further validation because most studies have not been externally validated and there are variations in the definitions of outcome metrics. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Incidence and risk factors of postoperative multidrug-resistant bacterial infections in liver transplant patients: A meta-analysis He Tian, Han Linqiu, Shi Zuxin, Shen Mingyan Clinical Focus    2024, 39 (11): 965-973.   DOI: 10.3969/j.issn.1004-583X.2024.11.001 Abstract （139）   HTML （4）    PDF（pc） （1400KB）（22）       Knowledge map    Save Objective To identify the incidence and risk factors of postoperative multidrug-resistant bacterial infections in liver transplant patients.Methods A systematic search of the literatures was conducted in the Cochrane Library, CINAHL, Embase, Web of science, Pubmed, SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Data, and CQVIP up to July 2023. Stata16.0 and RevMan5.4 software were used to perform meta-analysis.Results A total of 13 articles representing 5,877 patients were included, and 40 risk factors were extracted. The results of the meta-analysis showed that the combined incidence of postoperative multidrug-resistant bacterial infections in liver transplant patients was 18%, with an incidence ranging from 3% to 48%. The main risk factors included pre-transplant ICU admission (OR=3.71, 95%CI: 2.52-5.46), colonization rate of carbapenem-resistant Acinetobacter baumannii (CRAB) before liver transplant (OR=10.73, 95%CI: 3.79-30.37), the model for End-Stage Liver Disease (MELD) score (OR=5.85, 95%CI: 0.68-11.2), length of post-transplant ICU stay (OR=4.34,95%CI: 2.84-5.84), post-transplant dialysis (OR=2.61, 95%CI: 1.60-4.25), reoperation (OR=4.22, 95%CI: 2.07-8.63), prolonged prothrombin time (OR=1.01, 95%CI: 0.30-1.54), and biliary complications (OR=3.52, 95%CI: 1.98-6.23).Conclusion The incidence of postoperative multidrug-resistant bacterial infections in liver transplantation patients is high. There are many risk factors to be concerned to reduce the incidence of postoperative multidrug-resistant bacterial infections in liver transplantation patients, thus improving the survival. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Blood potassium fluctuations before and after dialysis in maintenance hemodialysis patients Yang Haiyan, Chen Ling, Dai Bo, Liu Xia, Sun Shangping Clinical Focus    2024, 39 (9): 798-802.   DOI: 10.3969/j.issn.1004-583X.2024.09.005 Abstract （136）   HTML （3）    PDF（pc） （919KB）（14）       Knowledge map    Save Objective To observe the fluctuations of serum potassium in maintenance hemodialysis (MHD) patients before and after hemodialysis.Methods A total of 42 MHD patients admitted in the Nephrology and Rheumatology Department of Zunyi Hospital of Traditional Chinese Medicine from February 2021 to February 2023 were selected. According to the median grouping method, patients were divided into Δserum potassium (difference of serum potassium before and after dialysis) ≥1.44 mmol/L group (n=21) and Δserum potassium <1.44 mmol/L group (n=21). Clinical data between the two groups were compared. Results There were no significant differences in the age, gender, urea reduction ratio (URR), single-pool urea Kt/V (sp Kt/V) and hemodialysis (HD) mode between the two groups (P>0.05). Compared with the Δserum potassium <1.44 mmol/L group, the proportion of non-diabetic nephropathy (P =0.019) and serum potassium before dialysis were significantly higher in the Δserum potassium ≥1.44 mmol/L group (P <0.001). Partial correlation analysis showed that after adjusting for age, Δserum potassium was positively correlated with serum potassium before and after dialysis, and the positive correlation between Δserum potassium and serum potassium before dialysis was more significant (P <0.05).Conclusion Non-diabetic nephropathy as the comorbidity and the high-level serum potassium before MHD is related to the large fluctuation of serum potassium before and after MHD, which should be paid attention to in clinical practice. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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The potential of geriatric nutritional risk index in predicting the short-term outcome of intravenous thrombolysis in elderly individuals with acute cerebral infarction Liu Jinhua, Wang Chunmei, Wang Ying, Chen Kai Clinical Focus    2025, 40 (1): 21-28.   DOI: 10.3969/j.issn.1004-583X.2025.01.003 Abstract （135）   HTML （3）    PDF（pc） （934KB）（19）       Knowledge map    Save Objective To evaluate the value of Geriatric Nutritional Risk Index (GNRI) in predicting the short-term outcome of elderly patients with acute ischemic stroke (AIS) after intravenous thrombolysis with alteplase. Methods A retrospective study was performed in 773 elderly AIS patients treated with alteplase intravenous thrombolytic therapy from July 2021 to January 2024 at Beichen Hospital in Tianjin, China. GNRI was calculated based on clinical data, and the nutritional status was assessed. Patients were evaluated with a modified Rankin score (mRS), and 575 patients were included in the poor outcome group (mRS score>2) and 198 in the good outcome group (mRS score≤2). They were further classified into the low GNRI (GNRI<92.107, n=388) and high GNRI (GNRI≥92.107, n=385) groups based on the optimal cut-off. The correlation of GNRI with short-term outcome of AIS after alteplase intravenous thrombolytic therapy was analyzed by logistic regression. Results Significantly lower GNRI was detected in the poor outcome group than the good outcome group (90.106[84.622-98.141] vs 90.722[82.239-100.055], P<0.01). Multivariate logistic regression revealed that age, the National Institutes of Health Stroke Scale (NIHSS) score on admission, the Trial Org 10172 in Acute Stroke Treatment (TOAST) classification system of cardioembolism, outcome of bleeding, body mass index (BMI), and low GNRI were independent risk factors for the short-term poor outcome of AIS after alteplase intravenous thrombolytic therapy (P<0.01). The receiver operating characteristic (ROC) curve showed that an area under the curve (AUC) of GNRI predicting the prognosis of intravenous thrombolysis in elderly AIS patients is 0.876(95%CI: 0.845-0.907). Conclusion GNRI, as an independent risk factor for malnutrition and inadequate regression after intravenous thrombolysis in elderly AIS patients, is a promising indicator for assessing immune and nutritional status in this population. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical characteristics of children with Mycoplasma pneumoniae infection complicated with asthmatic bronchopneumonia Yang Xiaolin, Yang Yan Clinical Focus    2024, 39 (9): 808-811.   DOI: 10.3969/j.issn.1004-583X.2024.09.007 Abstract （134）   HTML （2）    PDF（pc） （904KB）（15）       Knowledge map    Save Objective To investigate the clinical characteristics of children with Mycoplasma pneumoniae (MP) infection complicated with asthmatic bronchopneumonia. Methods Fifty children with MP infection and asthmatic bronchopneumonia admitted to Children's Hospital Affiliated to Zhengzhou University from September 2021 to February 2023 were selected as the observation group, and 50 children with MP infection but not asthmatic bronchopneumonia during the same period were selected as the control group. The levels of T cell lymphocyte subsets (CD3+, CD4+, CD8+), immunoglobulins (IgG, IgM and IgE), and lung function (vital capacity [VC], forced expiratory volume in the first second [FEV1], forced vital capacity [FVC], peak expiratory flow [PEF], maximum mid-expiratory flow [MMEF]), serum inflammatory factors (transforming growth factor-beta1 [TGF-β1], tumor necrosis factor alpha [TNF-α]), and complement C3 levels were compared. Results The levels of CD3+, CD4+, CD8+ in the observation group were significantly higher than those of control group (p<0.05). IgG, IgM, and IgE levels in the observation group were significantly higher than the control group (P<0.05). The levels of VC, FEV1, FVC, PEF and MMEF in the observation group were significantly lower than those of control group (P<0.05). The levels of TNF-α and complement C3 in the observation group were significantly higher than those of control group (P<0.05). There was no significant difference in TGF-β1 level between the two groups (P>0.05). Conclusion Children with MP infection and asthmatic bronchopneumonia have a significant immune response, reduced pulmonary function, and increased levels of TNF-α and complement C3. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Application of musculoskeletal ultrasound in ankylosing spondylitis with peripheral osteophytes Xie Jianli, Wang Junxiang, Chen Haiying Clinical Focus    2024, 39 (9): 787-791.   DOI: 10.3969/j.issn.1004-583X.2024.09.003 Abstract （134）   HTML （2）    PDF（pc） （1119KB）（20）       Knowledge map    Save Objective To investigate the application of musculoskeletal ultrasound in ankylosing spondylitis (AS) patients with peripheral osteophytes. Methods Peripheral joint ultrasound examination was performed in 80 patients with AS. According to the detection of osteophytes, the patients were divided into the observation group (42 cases with osteophytes) and the control group (38 cases without osteophytes). The clinical characteristics, laboratory indexes, dual-energy bone mineral density (BMD) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score were compared. The t-test and Sperman's rank correlation were used for statistical analyses. Results The highest incidence of osteophytes of finger joints (33.3%) was detected in the observation group. The C-reactive protein (CRP), BASDAI score and course of disease in the observation group were significantly higher than those of the control group, and the BMD was significantly lower (P<0.05). In the observation group, the erythrocyte sedimentation rate (ESR), CRP and course of disease in the smoking subgroup were significantly higher than those of the non-smoking subgroup (P<0.05). CRP was positively correlated with ESR, BASDAI score and smoking index. Conclusion Inflammatory response in patients with AS is related to osteophyte formation. Musculoskeletal ultrasound is used to detect osteophytes, which is helpful to disease assessment. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Protection and use of medical and health information with the construction of smart hospitals Zhou Di, Wang Mao, Wang Jingwei Clinical Focus    2024, 39 (9): 833-836.   DOI: 10.3969/j.issn.1004-583X.2024.09.013 Abstract （133）   HTML （6）    PDF（pc） （873KB）（13）       Knowledge map    Save With the construction of smart hospitals, the conflict between health data sharing and protection is increasingly obvious. Medical and health information has properties of privacy, sensitivity, and commonweal. In the present article, we recommended to establish and improve the classification and hierarchical protection system of medical and health data based on the dual-attribute characteristics. Through an optimal application of the informed consent of special notification plus individual agreement, and the exemption principle of informed consent via legitimate purpose+necessity+safety guarantee, the value of data sharing and the protection of patients' rights and interests can be balanced, and the medical and health information can be rationally utilized. Reference | Related Articles | Metrics | Comments（0）