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To assess the correlation between complete blood count (CBC)-derived inflammatory markers and sepsis-associated delirium (SAD) risk in older intensive care unit (ICU) patients.
Retrospective cohort study.
ICUs at Beth Israel Deaconess Medical Center (2008–2019), using the Medical Information Mart for Intensive Care IV V.3.0 database.
3412 critically ill patients aged ≥65 years with sepsis. Exclusion: repeated ICU admission, death/discharge within 24 hours, missing delirium assessment or pre-sepsis delirium from non-septic aetiologies. SAD was diagnosed by Confusion Assessment Method for the ICU.
Incidence of sepsis-associated delirium.
Among 3412 older sepsis patients, 2092 (61.3%) developed SAD. Significant differences in platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index, systemic inflammation response index, pan-immune-inflammation value and neutrophil-monocyte-to-lymphocyte ratio were observed between SAD and non-SAD groups (all p0.05). Receiver operating characteristic and random forest analyses demonstrated predictive utility; incorporating markers into a baseline model significantly improved discrimination, with MLR providing the largest gain (area under the curve (AUC)=0.716 vs 0.703; AUC=0.013, DeLong test, p
CBC-derived inflammatory markers, particularly MLR, are associated with increased SAD risk in older adults and enhance the performance of a clinical prediction model in this population. Further research is needed to better understand the pathophysiological mechanisms underlying these associations.
Until now, there has still been a lack of sufficient evidence on patient-reported outcomes (PROs) measured by the EuroQol-5 Dimension (EQ-5D) in patients with systemic lupus erythematosus (SLE) in China. This study aims to comprehensively assess EQ-5D outcomes and influencing factors in Chinese patients with SLE.
A multicentre, cross-sectional study based on the Chinese Systemic Lupus Erythematosus Treatment and Research Group registry.
101 hospitals across 27 provinces of China.
1336 patients with SLE.
The information on EQ-5D was collected via an online questionnaire. Medical records were obtained from the Chinese Rheumatology Data Centre (CRDC). Clinical influencing factors related to the reported health problems were identified using multivariate logistic regression. Then, each health state was converted into a health utility score based on the Chinese 2014 tariff. Given the ceiling effects, Tobit regression models were used to analyse the factors influencing health utility scores.
A total of 1336 patients with SLE were included. Of them, 626 patients (46.9%) reported health problems using EQ-5D. The proportions of patients reporting problems in mobility, self-care, usual activities, pain/discomfort and anxiety/depression were 12.80%, 5.24%, 14.90%, 27.47% and 30.46%, respectively. The mean utility score was 0.89 (SD: 0.15), and the mean Visual Analogue Scale (VAS
EQ-5D may be a useful, preference-based PRO measure for SLE and could potentially be integrated into routine clinical monitoring of patients with SLE and applied in economic evaluations in the future.
Individuals in high-altitude areas (HAs) have a relatively high prevalence of hypertension. However, only a few studies have reported the out-of-office blood pressure (BP) at HAs. This study aimed to evaluate the differences in ambulatory BP parameters between untreated hypertensives at high and low altitudes and explore the influencing factors.
This was a cross-sectional, case–control study.
Participants were recruited from 15 hospitals in Tibetan HAs and low altitudes in Sichuan Province, Southwest China.
A total of 755 participants were eligible prior to matching, among whom 209 untreated hypertensive patients in each group were matched using 1:1 propensity score matching, with low altitudes/HAs as grouping variables (55.71±10.79 years, 55.7% male).
The differences in ambulatory BP parameters between untreated hypertensives at high and low altitudes, and the influencing factors.
Compared with patients at low altitudes, multivariate linear regression analysis revealed that the 24-hour and night-time diastolic BP (DBP) of patients at HAs increased by 2.16 mm Hg (95% CI 0.12 to 4.19), p=0.04, and 2.89 mm Hg (95% CI 0.49 to 5.30), p=0.02, respectively; the 24-hour and night-time DBP loads increased by 6.40% (95% CI 2.38% to 10.42%), p=0.002 and 4.14% (95% CI 0.23% to 8.05%), p=0.04, respectively. Mediation effect analysis revealed that 22% (95% CI 5.00% to 81.00%), p=0.01 of the increase in night-time DBP was mediated by night-time pulse rate (PR). However, the mediating effect of haemoglobin was relatively weak (5%, p=0.73).
Compared with patients at low altitudes, with no difference in the risk of 10-year Framingham cardiovascular disease, the night-time DBP of hypertensive patients in HAs was significantly greater, which was mediated through an increased night-time PR. This difference may be related to the increased nocturnal sympathetic excitability in hypertensives at HAs.
ChiCTR2200059719.
To describe self-care behaviours and explore factors associated with self-care behaviours in older adults with multiple chronic conditions (MCCs).
The prevalence of MCCs is increasing in a rising trend. MCCs complicate the self-care behaviours of older adults. There is limited evidence regarding the factors associated with self-care behaviours in older adults with MCCs.
A cross-sectional design was adopted using the convenience sampling method.
Participants were recruited from a community health service centre. Measurements included the Self-Care of Chronic Illness Inventory, a single item for loneliness, the 6-item Lubben Social Network Scale, the 4-item Patient Health Questionnaire, the 15-item Tilburg Frailty Indicator, and a self-developed questionnaire for sociodemographic and disease-related characteristics. Descriptive statistics were used as appropriate. Multiple linear regression and multivariate logistic regression were adopted to examine the influencing factors.
A total of 223 participants were enrolled in this study. Among the 223 participants, 49.3%, 32.7% and 28.7% achieved a cut-off score of ≥ 70 in self-care maintenance, monitoring and management, respectively. The linear regression models indicated that smoking status, frailty and self-care confidence were significantly associated with self-care maintenance; education level, per capita monthly household income and self-care confidence were significantly associated with self-care monitoring; and employment status and self-care confidence were significantly associated with self-care management. In addition, multivariate logistic regression showed that living in cities or towns was significantly associated with higher odds of adequate self-care management.
Three domains of self-care behaviours were influenced by distinct factors, and self-care confidence demonstrated consistent associations with all three domains of self-care behaviours. Self-efficacy-focused interventions may have the potential to promote self-care behaviours in older adults with MCCs.
Healthcare providers need to take into account the pivotal factors influencing self-care behaviours of this cohort to deliver structured and effective education and support. Clinicians should consider adopting confidence-building strategies in routine education for this cohort.
We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
No patient or public contribution.
To explore the complex relationships among non-suicidal self-injury, depression and anxiety symptoms in adolescents, identify key symptoms and provide a theoretical foundation for targeted interventions.
A cross-sectional study.
In total, 1126 adolescents from a tertiary hospital in Shandong Province were assessed using the Adolescent Self-Injury Questionnaire, Patient Health Questionnaire and Generalised Anxiety Disorder Scale. Network analysis was employed to construct symptom networks and identify central and bridging symptoms.
The network analysis revealed that nodes GAD5 (Restlessness), GAD2 (Uncontrollable worry), and GAD4 (Trouble relaxing) exhibited the highest centrality indices, establishing them as core symptoms within the overall symptom network. The highest bridge intensity nodes were GAD1 (Nervousness), GAD5 (Restlessness) and non-suicidal self-injury.
By accurately identifying core and bridging symptoms, a scientific foundation is provided for developing precise and effective symptom management plans.
The study identified the most influential nodes in anxiety and depression among adolescents with non-suicidal self-injury. The findings would help in carrying out personalised and precise interventions to reduce non-suicidal self-injury occurrence and alleviate anxiety and depression symptoms among adolescents.
This study adheres to the STROBE guideline of reporting.
This study did not include patient or public involvement in its design, conduct or reporting.
To study the reliability and validity of adverse childhood experiences (ACE) scores measured using a questionnaire versus abstraction of medical records, and to test whether the scores vary by history of bilateral oophorectomy, or by age and presence of anxiety or depressive symptoms at the time of questionnaire administration.
The study involved a reliability component and a predictive validity component.
A population-based sample in Olmsted County, Minnesota, was derived from the Mayo Clinic Cohort Study of Oophorectomy and Aging-2.
We included 198 women who underwent premenopausal bilateral oophorectomy for a non-malignant indication between 1988 and 2007 and 174 referent women of the same age randomly sampled from the general population (total of 372 women). At a later time (median of 22.7 years later), the women were contacted and invited to self-administer the ACE questionnaire during an inperson visit. Independent of the visit, their medical records were abstracted for ACE by a physician.
Questionnaire and abstraction-based ACE scores.
Agreement between the two ACE scores (reliability; weighted kappa statistics) and comparison of incidence of multimorbidity in women with ACE scores ≥1 vs 0 (predictive validity; survival analyses). Data were analysed in March and April 2024.
The 372 women in the study had a median age of 65 years at the time of ACE questionnaire self-administration (IQR, 62–69). Questionnaire-based ACE scores showed moderate agreement with abstracted ACE scores (weighted kappa 0.44 (95% CI 0.34 to 0.54)). The cut-off score of ACE ≥1 showed an overall fair agreement between the two scores (kappa 0.33 (95% CI 0.24 to 0.43)). A comparison of the cumulative incidence of multimorbidity in women with an ACE score ≥1 versus women with ACE score of 0 yielded a HR of 1.13 (95% CI 1.00 to 1.27) for abstracted ACE and 1.13 (95% CI 1.01 to 1.27) for questionnaire-based ACE. The best predictive validity was for ACE measured by both methods combined (either or) with a HR of 1.29 (95% CI 1.13 to 1.46).
Questionnaire-based ACE scores have moderate agreement with medical records abstracted ACE scores. However, both sets of ACE scores are predictive of the accumulation of multimorbidity at older age and should be considered complementary.
Many systematic reviews (SRs) and meta-analyses (MAs) have reported the potential advantages and risks of ICU diary psychotherapy in patients and relatives, but the results remain uncertain and their quality has not yet been adequately assessed. We summarise existing SRs/MAs and assess their quality and level of evidence.
This overview of SRs was conducted in accordance with the preferred reporting items for overviews of reviews statement.
We conducted a detailed and comprehensive search of eight Chinese and English electronic databases from inception until March 2025. The Assessment of Multiple Systematic Reviews 2 (AMSTAR 2), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020), and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used to assess methodological quality, reporting quality and evidence quality for inclusion in SRs/MAs, respectively.
Fifteen published SRs/MAs met the inclusion criteria and were included in the study. The results of the AMSTAR 2 assessment showed that the methodological quality of the included studies was critically low. In the PRISMA 2020 assessment, the response rate of “Yes” for items 7, 14, 15, 16, 21, 22, 24, 25 and 27 was less than 50%. The GRADE assessment showed that no results were high-quality evidence, 2 results were moderate-quality evidence, 26 results were low-quality evidence and 45 results were very low-quality evidence.
ICU diaries can improve patients' psychological outcomes and quality of life, and whether there are advantages for their relatives needs to be further explored. However, the methodological quality of the studies was low and the risk of migration was high, reducing its reliability. Therefore, these conclusions should be treated with caution. High-quality studies with large sample sizes are needed to provide stronger and more scientific evidence.
Our paper presents an overview of systematic reviews, and therefore, such specific details may not be relevant to our study.
PROSPERO: CRD42023448359
by Kazuo Teramoto, Yuji Ueda, Ryosuke Murai, Kazumasa Ogasawara, Misako Nakayama, Hirohito Ishigaki, Yasushi Itoh
Reducing the number of immunosuppressive cells in blood is a potential strategy for activating anti-tumor immunity, which provides a promising approach to cancer treatment. In this study, we developed an adsorbent designed to selectively target and adsorb lymphocytes expressing latency-associated peptide (LAP), which is abundantly expressed on the surface of CD4+ regulatory T cells (Tregs) and CD14+ monocytes. We investigated whether diethylenetriamine-conjugated polysulfone adsorbent-based direct hemoperfusion (DHP) enhances anti-tumor immunity in a rat cancer model with KDH-V liver cells. Our findings revealed that DHP significantly reduced LAP+ Tregs in both peripheral blood and tumor tissues in treated mice. Consequently, cytotoxic T-lymphocytes increased in tumor-bearing rats. The anti-tumor effect was negated by the addition of cells detached from the absorbent, indicating that these cells play a crucial role in inhibiting the observed therapeutic effect. The results suggest that depleting LAP+ immunosuppressive cells in blood can enhance anti-tumor immunity and improve survival of patients.This study investigates the effects of comprehensive nursing interventions on wound pain in patients undergoing catheter insertion for peritoneal dialysis. Sixty patients who underwent catheter insertion for peritoneal dialysis from January 2021 to January 2023 at our hospital were selected as subjects and randomly divided into an experimental group and a control group using a random number table method. The control group received routine nursing care, while the experimental group was subjected to comprehensive nursing interventions. The study compared the impact of nursing measures on visual analogue scale (VAS), self-rating anxiety scale (SAS), self-rating depression scale (SDS) and nursing satisfaction between the two groups. The analysis revealed that on the third, fifth and seventh days post-intervention, the experimental group's wound VAS scores were significantly lower than those of the control group (p < 0.001). Furthermore, levels of anxiety and depression were markedly lower in the experimental group compared with the control group (p < 0.001). In addition, the nursing satisfaction rate was significantly higher in the experimental group than in the control group (96.67% vs. 73.33%, p = 0.011). This study indicates that the application of comprehensive nursing interventions in patients undergoing catheter insertion for peritoneal dialysis is highly effective. It can alleviate wound pain and negative emotions to a certain extent, while also achieving high patient satisfaction, thus demonstrating significant clinical value.
Following pancreatic resection, there may be a variety of complications, including wound infection, haemorrhage, and abdominal infection. The placement of drainage channels during operation may decrease the chances of postoperative complications. However, what kind of drainage can decrease the rate of postoperative complications is still a matter of debate. The purpose of this research is to evaluate the efficacy of both active and passive drainage for post-operation wound complications. From the beginning of the database until November 2023, EMBASE, the Cochrane Library and the Pubmed database have been searched. The two authors collected 2524 related studies from 3 data bases for importation into Endnote software, and 8 finished trials were screened against the exclusion criteria. Passive drainage can decrease the incidence of superficial wound infection in postoperative patients with pancreas operation (Odds Ratio [OR], 1.30; 95% CI, 1.06–1.60 p = 0.01); No statistically significant difference was found in the incidence of deep infections among the two groups (OR, 1.51; 95% CI, 0.68–3.36 p = 0.31); No statistical significance was found for the rate of haemorrhage after active drainage on the pancreas compared with that of passive drainage (OR, 0.72; 95% CI, 0.29–1.77 p = 0.47); No statistically significant difference was found in the rate of death after operation for patients who had received a pancreas operation in active or passive drainage (OR, 0.90; 95% CI, 0.57–1.42 p = 0.65); On the basis of existing evidence, the use of passive abdominal drainage reduces postoperative surface wound infections in patients. But there were no statistically significant differences in the risk of severe complications, haemorrhage after surgery, or mortality. However, because of the limited sample size of this meta-analysis, it is necessary to have more high-quality research with a large sample size to confirm the findings.
This meta-analysis aims to systematically investigate the clinical efficacy of Chinese herbal compound dressings in treating patients with diabetic foot ulcers (DFUs). A comprehensive computerised search was conducted in databases including PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases, from database inception to November 2023, to identify randomised controlled trials (RCTs) concerning the use of Chinese herbal compound dressings in patients with DFU. Two researchers independently screened the literature, extracted data, and assessed the quality based on inclusion and exclusion criteria. Data analysis was performed using Stata 17.0 software. Overall, 18 RCTs involving 1405 DFU patients were included. The analysis indicated that compared to the control group, the group treated with Chinese herbal compound dressings had significantly shorter ulcer healing time (standardised mean difference [SMD] = −2.49, 95% confidence interval [CI]: −3.53 to −1.46, p < 0.001), reduced ulcer surface area (SMD = −3.38, 95% CI: −4.67 to −2.09, p < 0.001), and higher healing rates (odds ratio [OR] = 2.24, 95% CI: 1.72–2.92, p < 0.001) as well as overall effectiveness rates (OR = 4.56, 95% CI: 3.10–6.71, p < 0.001). This study demonstrates that the external application of Chinese herbal compound dressings in patients with DFU can significantly shorten the ulcer healing time and improve wound healing rates.
There are many debates regarding the risk factors of surgical site infection (SSI) following posterior cervical surgery in previous studies. And, till now there is no such a study to examine cervical laminoplasty surgery. From January 2011 through October 2021, a total of 405 patients who were treated with unilateral open-door laminoplasty surgeries were enrolled in this study. We divided the patients into the SSI group and the non-SSI group and compared their patient-specific and procedure-specific factors. Univariate and multiple logistic regression analysis were performed to determine the risk factors. Of the 405 patients, 20 patients had SSI. The rate of SSI found to be 4.93%. There were significant differences between groups in the thicker subcutaneous fat thickness (FT) (p < 0.001), the higher ratio of subcutaneous FT to muscle thickness (MT) (p < 0.001), the higher preoperative Japanese Orthopaedic Association (JOA) Scores (p < 0.003), the decreased preoperative serum albumin (p < 0.001), the more postoperative drainage (p < 0.05) and the longer time of draining (p < 0.001). Logistic regression analysis of these differences showed that the higher ratio of subcutaneous FT/MT, the higher preoperative JOA scores, the decreased preoperative serum albumin and the longer time of draining were significantly related to SSI (p < 0.05). The higher ratio of subcutaneous FT/MT, the higher preoperative JOA scores, the decreased preoperative serum albumin and the longer time of draining are identified as the independent risk factors of SSI in cervical laminoplasty. Identification of these risk factors could be useful in reducing the SSI incidence and patients counselling.
To summarise research studies on scar laser therapy since the 21st century using bibliometric methods, and to speculate on the possible development in the future. The literature about scar laser therapy in Web of Science database was searched. CiteSpace and VOSviewer were used to analyse main countries, institutions, journals，subject hotspots and trends, etc. A total of 884 papers have been published since the 21st century. These publications were written by 653 authors from 515 institutions in 58 countries. The United States published 287 papers in this field and ranks first. Laser in Surgery and Medicine is the most widely published journal, with Shumaker as the core author. The main keyword clustering includes terms such as combination therapy, wound healing, fractional photothermolysis, experience, scar formation, etc. CiteSpace and VOSviewer were used to sort out and summarise the countries, institutions, authors, journals, research hotspots and frontier topics of related literature about scar laser therapy since the 21st century. The current situation of its application and basic scientific research in clinical treatments were summarised briefly. This provides a new idea for the development and research of scar laser therapy in the future.
FreshRSS 