Hospitals In China Research Articles

Effect of Parecoxib and transversus abdominis plane block on postoperative anxiety and cognition: A randomized controlled-trial

Objective: To investigate the impact of parecoxib and transversus abdominis plane block on postoperative anxiety and early cognitive function in patients undergoing laparoscopic intestinal surgery. Method: The multicentre, randomised controlled trial was conducted at three tertiary hospitals in China from September 1, 2020, to September 30, 2022, and comprised individuals aged 60-85 years scheduled for elective laparoscopic intestinal surgery They were randomised into 4 groups. Patients in group C received normal saline. Patients in group P were given parecoxib 40mg intravenously 30 minutes before the start of surgery and 10 minutes after the end of surgery. In group T, a bilateral transversus abdominis plane block was performed 30 minutes before the start of surgery. Patients in group PT received a combination of interventions used in groups P and T. Serum samples of all the patients were obtained one day before surgery, 30 minutes after surgery and 24 hours after surgery. Anxiety levels were assessed one day before surgery, 24 hours after surgery, and 7 days after surgery. Data was analysed using SPSS 25. Results: Of the 205 patients, 115(56%) were males and 90(44%) were females. There were 51(24.9%) patients in group C with mean age 67.61±5.46 years, 51(24.9%) in group P with mean age 66.53±4.30 years, 52(25.3%) in group T with mean age 67.23±5.36 years and 51(24.9%) in group PT with mean age 66.49±4.62 years. Compared to group C, anxiety scores in groups P and PT were significantly lower at 24 hours post-surgery (p<0.05). Compared to group C, the concentration of tumour necrosis factor-alpha in the serum samples of groups P and group PT was significantly lower at 30 minutes after surgery (p< 0.05). Conclusion: A single transversus abdominis plane block did not have a significant effect on postoperative anxiety and cognition, while parecoxib could alleviate postoperative anxiety in elderly patients undergoing laparoscopic intestinal surgery. RCT Reg No: ChiCTR1900024953. Key Words: Anti-inflammatory agents, Non-steroidal, Anxiety, Cognition.

Efficacy and safety of calcium polystyrene sulphonate and sodium zirconium cyclosilicate as potassium binders for chronic hyperkalemia in hemodialysis patients: A prospective study.

Sodium zirconium cyclosilicate (SZC) and calcium polystyrene sulfonate (CPS) are indicated for treating hyperkalemia in chronic renal disease. Individuals undergoing maintenance hemodialysis (HD) are at significantly increased risk of developing hyperkalemia, clinically defined as serum potassium concentrations of >5.0mmol/L. The objective of this study was the evaluation and comparison of the efficacy and safety of two potassium binders (SZC and CPS) in HD patients with hyperkalemia. This research utilized a prospective non-randomized controlled clinical trial design. Patients with chronic hyperkalemia were enrolled at a tertiary care hospital in China from September 2021 to May 2022. HD patients received SZC (5g) or CPS (5g) once daily, later adjusted to 10g. Serum potassium levels were quantified at a specified timepoint at 0, 2, 4, 8, and 12 weeks. The mean serum K+ levels for SZC- and CPS-treated participants were 5.93±0.46 and 5.88±0.54 mmol/L, respectively, at baseline (p=0.683) and 4.94±0.44 vs. 5.12±0.49 mmol/L respectively after 12 weeks (p=0.017). A serum potassium concentration of less than 5.3 mmol/L was achieved in 81% of treated patients who received SZC treatment over 12 weeks, compared to 65% of those treated with CPS. Additionally, SZC also achieved a higher percentage of patients exhibiting serum potassium levels below 6.0 mmol/L at the 2-week timepoint (28/28 vs. 27/31, p=0.015). The mean daily doses were 6.8g for SZC and 7.42 g for CPS, with no serious adverse events attributable to the study drug. SZC demonstrated superior effectiveness in reducing potassium levels and controlling severe hyperkalemia in patients undergoing maintenance HD. It also facilitated more rapid control of serum potassium levels offering an improved long-term management strategy for chronic hyperkalemia.

A randomized, open-label, multicenter, blank-controlled, phase IV clinical trial of Biyan Qingdu Granula in attenuating acute nose and oral damage in patients undergoing radiotherapy for nasopharyngeal carcinoma.

6014 Background: This randomized, open-label, multicenter, blank-controlled, phase IV trial aimed to evaluate the efficacy and safety of Biyan Qingdu Granula (BQG) in attenuating acute radiation-induced nasal and oral injuries in nasopharyngeal carcinoma(NPC) patients receiving radiotherapy, and to explore the potential advantages and application values of BQG through comparison with conventional treatments. Methods: This trial was conducted at 30 hospitals in China between July 21st, 2022 and May 21st, 2024.This trial was registered with the Chinese Clinical Trial Registry, ChiCTR2200060900. A total of 1000 NPC patients with first-time radiotherapy or chemoradiotherapy for NPC were randomly assigned (1:3) to receive routine cure (the control group, n=250) or that with additional BQG (the treatment group, n=750). All patients received basic oral hygiene guidance, gargled the oral cavity with normal saline and flushed the nasal cavity with normal saline. The treatment group patients were instructed to take BQG twice daily from the initiation to the end of radiotherapy for 6 weeks. The primary end points were the incidence of nasopharyngeal secretion and the incidence of Oral Mucositis (OM). The second end points were the grade of nasal mucosal congestion, the Visual Analog Scale (VAS) score for sore throat pharyngeal pain, the grade of symptom in dry and burning throat, the incidence of nasal comorbidities, and the incidence of adverse events (AEs). Results: 731 patients in the treatment group and 250 patients in the control group completed the trial, baseline patient characteristics were similar. After six weeks, the incidence of severe nasopharyngeal secretion (grade middle or higher)in the treatment group was significantly lower as compared with the control group(12.4% vs 20.0%, P=0.0033). The incidence of severe OM (World Health Organization grade 3 or higher) was significantly lower in the treatment group than in the control group (12.3% vs 22.4%, P=0.0001). The intergroup rate difference and 95% CI of the incidence of OM between the two groups was -10.1% (-15.8%, -4.4%). The upper limit of the 95% CI was greater than -10%, so it could not be concluded that the experimental group was superior to the control group. However, compared with the control group, the treatment group showed a certain trend in reducing oral mucositis. The BQG group also remarkably reduced the incidence of severe VAS score for sore throat pharyngeal pain and the grade of symptom with dry and burning throat compared to the control group. The incidence of AEs were similar between the groups. Conclusions: BQG significantly attenuated the incidence of nasal secretions in NPC patients undergoing radiotherapy, improved pharyngeal pain and the symptoms with dryness and burning, with a good safety profile. Clinical trial information: ChiCTR2200060900 .

External validation of the 2017 EULAR/ACR classification criteria for idiopathic inflammatory myopathies in anti-MDA5 antibody-positive interstitial lung disease patients: A multicenter retrospective cohort study in China.

External validation of the 2017 EULAR/ACR classification criteria for idiopathic inflammatory myopathies in anti-MDA5 antibody-positive interstitial lung disease patients: A multicenter retrospective cohort study in China.

Effectiveness and safety of anti-CD20 monoclonal antibodies versus csDMARDs in anti-Jo-1 antisynthetase syndrome: A retrospective cohort study.

Effectiveness and safety of anti-CD20 monoclonal antibodies versus csDMARDs in anti-Jo-1 antisynthetase syndrome: A retrospective cohort study.

Neoadjuvant chemoimmunotherapy with afatinib for locally advanced head and neck squamous cell carcinoma (neoCHANCE-2): An open-label, single-arm, phase 2 study.

6069 Background: Neoadjuvant chemoimmunotherapy has been an emerging hotspot for the treatment of locally advanced head and neck squamous cell carcinoma (LA-HNSCC), but the treatment response still requires improvement. Given the potential synergistic antitumor effects of dual inhibition of the PD-1/L1 and EGFR pathways, we proposed a novel neoadjuvant treatment regimen combining chemoimmunotherapy with EGFR-TKI, followed by adjuvant immunotherapy treatment, and evaluated the efficacy and safety of this approach. Methods: This open-label, single-arm, phase 2 trial was done at a tertiary hospital in China. Patients were eligible if they were aged at least 18 years old; had pathologically confirmed HNSCC with locally advanced disease according to the AJCC 8th Edition; had an ECOG performance status of 0−1; had at least one measurable target lesion according to RECIST 1.1 criteria; and had sufficient organ function. Patients with LA-HNSCC received two cycles of tislelizumab (200mg) and TP (nab-paclitaxel and cisplatin) chemotherapy, administrated on day one of each three-week cycle, along with afatinib (30mg) during the intermittent period between chemoimmunotherapy cycles, followed by 15 cycles of adjuvant tislelizumab treatment. The primary endpoint was the complete pathologic response (pCR) rate, defined as the percentage of patients with no detectable RVT cells in the resected primary tumor. Results: A total of 40 patients were enrolled and received neoadjuvant treatment, 32 of whom proceeded to surgical resection and achieved a pCR rate of 40.6% (95% CI: 23.7−59.4%). The overall response rate (ORR) was 82.5% (95% CI: 67.2−92.7%). The median follow-up time was 14.4 months (range: 2.4−27.6 months) . The estimated 1-year overall survival (OS) was 96.7% (95%CI: 90.5%−100%). No deaths occurred among patients who achieved pCR/MPR. The most common treatment-related adverse events (TRAEs) of any grade were alopecia (100%), followed by nausea (62.5%), lymphopenia (57.5%), diarrhea (55%), and rash (55%). The most common TRAE of grade 3−4 was lymphopenia (5/40, 12.5%). No treatment-related surgical delays were observed. Neoadjuvant treatment induced a significant increase in the proportion of peripheral CD8+ T cells, along with a reduction in B cells. TP53 wild-type patients were more likely to achieve a more favorable pathologic response compared to those with a TP53 mutation. A significant difference in oral microbial composition was found between patients with different pathologic responses. Conclusions: This study firstly reported the promising efficacy and acceptable safety profile of neoadjuvant chemoimmunotherapy combined with apatinib in the treatment of patients with LA-HNSCC. Further evaluation in large-scale clinical trials with longer follow-up periods is needed. Clinical trial information: NCT05516589 .

Postoperative Movement-evoked Pain Trajectories in Abdominal Surgery Patients: A Retrospective Study.

Postoperative Movement-evoked Pain Trajectories in Abdominal Surgery Patients: A Retrospective Study.

ST11 Carbapenem-Resistant Klebsiella pneumoniae Clone Harboring Capsular Type KL25 became the primarily prevalent capsular serotypes in a Tertiary Teaching Hospital in China.

ST11 Carbapenem-Resistant Klebsiella pneumoniae Clone Harboring Capsular Type KL25 became the primarily prevalent capsular serotypes in a Tertiary Teaching Hospital in China.

Should radiotherapy be considered for the initial treatment of ovarian cancer brain metastases? Findings from a 12-year multicenter retrospective study.

e17541 Background: Ovarian cancer brain metastases (OCBM) are rare and have poor prognosis, with limited clinical guidelines. This study aims to identify prognostic factors and optimal treatment strategies for OCBM patients. Methods: We conducted a multicenter retrospective analysis of OCBM patients from 12 hospitals in China, spanning from May.1 2010 to May.31 2022. The primary endpoints were overall survival (OS) and brain metastasis-specific survival (BMSS). Kaplan-Meier and Cox regression analyses were used to assess treatment outcomes and identify risk prognostic factors. Results: A total of 129 OCBM patients were included. The median interval from ovarian cancer diagnosis to brain metastasis (BM) was 25.7 months (range: 0-102.9). Intracranial hypertension was the most common primary symptom reported in 64 (49.6%) patients, followed by paralysis in 23 (17.8%) patients. The cerebellum and brainstem were the most frequent sites of BM (36 patients, 27.9%), followed by the frontal lobe (27 patients, 20.9%). For BMSS-specific analysis, multiple BM lesions (HR 2.060, 95% CI: 1.308-3.244, p=0.002), intracranial hypertension (HR 1.765, 95% CI: 1.049-2.968, p=0.032), and relapse lines before BM diagnosis (HR 2.060, 95% CI: 1.308-3.244, p=0.002) as independent factors associated with poorer BMSS. Subgroup Kaplan-Meier analysis showed that patients with a single BM lesion had significantly better outcomes with stereotactic radiosurgery (SRS) compared to those with multiple lesions. Conclusions: This study identifies key prognostic factors for advanced OCBM patients, particularly intracranial hypertension, and the number of relapse-lines prior to BM diagnosis. Furthermore, it provides evidence that patients with a single BM lesion may benefit from SRS, whereas those with multiple lesions require more tailored treatment strategies. Univariate analysis of treatments for brain metastases. BM treatment OS BMSS Hazard ratio 95% CI P value Hazard ratio 95% CI P value Chemotherapy or support care Ref. Ref. WBRT ± Chemotherapy 0.78 0.412-1.477 0.446 0.652 0.334-1.274 0.652 Craniotomy ± Radiation/Chemotherapy 0.377 0.179-0.792 0.010 0.407 0.191-0.867 0.020 SRS ± Chemotherapy 0.270 0095-0.762 0.013 0.274 0.095-0.787 0.016 Abbreviations: BM: Brain metastasis; OS: Overall survival; BMSS: Brain metastases-specific survival; WBRT: Whole-brain radiotherapy; SRS: Stereotactic radiosurgery.

Efficacy of regorafenib following first-line immune checkpoint inhibitor failure in patients with advanced hepatocellular carcinoma: A multicenter retrospective study.

e16166 Background: Hepatocellular carcinoma (HCC) remains a significant global health challenge While immune checkpoint inhibitors (ICIs) have become standard first-line treatments, identifying effective second-line therapies remains an unmet need. This study evaluates the efficacy and safety of regorafenib as a second-line option in advanced HCC patients post-progression on ICI-based regimens. Methods: This retrospective study included advanced HCC patients from eight hospitals in China who received regorafenib after progression on first-line ICI therapies, alone or combined with ICIs. Propensity score matching (PSM) was used to ensure comparability between treatment groups. The primary endpoint was overall survival (OS), secondary endpoints included progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events (TRAEs). Results: A total of 149 patients were included: 113 in the combination therapy group (Rego-ICI group) and 36 in the regorafenib monotherapy group (Rego group). After PSM, there were 67 patients in the Rego-ICI group and 31 in the Rego group. The median age was 59.00 years. Most patients had HBV-related infection (83.9%), ECOG PS 1 (76.3%), and Child-Pugh class A (73.2%). In the first-line treatment, only 10.7% of patients received ICI combined with bevacizumab, the rest were combined with MKIs. After PSM, there were 67 patients in the Rego-ICI group and 31 in the Rego group. The Rego-ICI group showed significantly improved median PFS (4.0 vs. 3.0 months, HR : 0.62 [95% CI: 0.389-0.986]) and OS (19.0 vs. 11.0 months, HR = 0.475 [95% CI: 0.272-0.832]) compared to the Rego group. Differences in ORR and DCR were not statistically significant (ORR 19.4% vs. 9.7%, P = 0.226; DCR 64.2% vs. 48.4%, P = 0.139), but the Rego-ICI group showed better disease control. Multivariate Cox analysis identified regorafenib plus ICI treatment as a protective factor for both PFS and OS. Subgroup analysis showed OS improvement with Rego-ICI in older patients ( > 60 years), ECOG 1/2, BCLC C stage, AFP < 400 ng/mL, and those with vascular invasion and/or extrahepatic metastasis. PFS improvement with Rego-ICI was observed in subgroups with ECOG 1/2, ALBI 2/3, NLR < 3.64, and PLR ≥ 136.9. In the Rego-ICI group, patients with NLR < 3.64 had significantly longer OS than those with NLR ≥ 3.64 (20.0 months vs. 16.8 months, P = 0.036). Conclusions: Adding ICIs to regorafenib therapy significantly improves OS in advanced HCC patients post-progression on first-line ICI treatments, highlighting the potential of regorafenib plus ICIs as an effective second-line option. These findings provide a strong foundation for further prospective clinical research. Clinical trial information: ChiCTR2400091318 .

Optimized design of hospital open space based on outdoor thermal comfort: The case of Shaanxi People’s Hospital in China

Optimized design of hospital open space based on outdoor thermal comfort: The case of Shaanxi People’s Hospital in China

Node-sparing modified short-course radiotherapy combined with CAPOX and tislelizumab versus conventional short-course preoperative chemoradiotherapy for proficient mismatch repair or microsatellite stable locally advanced rectal cancer (mRCAT-III): A multicenter, randomized, open-label, phase 3 trial.

TPS3641 Background: Total neoadjuvant chemoradiotherapy is the standard of care for locally advanced rectal cancer (LARC) to control local recurrence and achieve organ preservation. However, for proficient mismatch repair (pMMR) or microsatellite stable (MSS) LARC, which accounts for nearly 90% of rectal cancers, conventional chemoradiotherapy has limited efficacy and is associated with significant side effects. Recent studies have shown that combining radiotherapy with immunochemotherapy can improve pathological complete response (pCR) rates, but the inclusion of tumor-draining lymph nodes (TDLNs) in the conventional irradiation field may impair T-cell immunity and reduce response to immunotherapy. Our previous phase II trial demonstrated that node-sparing modified short-course radiotherapy combined with chemotherapy and PD-1 blockade could achieve a high pCR rate of 78.8% in pMMR LARC 1 . Building on these findings, we initiated this phase III trial to compare this novel treatment regime with conventional short-course chemoradiotherapy in improving pCR rates. Methods: This is a phase III, open-label, multicenter, randomized trial conducted across 17 hospitals in China. A total of 170 eligible MSS/pMMR middle or low rectal cancer patients (cT3-4N0/+M0) will be recruited and randomly assigned (5:5:1) to three groups: control group (conventional short-course chemoradiotherapy), experimental group (node-sparing modified short-course chemoradiotherapy plus PD-1 blockade), and exploratory group (conventional short-course chemoradiotherapy plus PD-1 blockade). The innovative node-sparing modified short-course radiotherapy targets only the primary tumor bed, excluding TDLNs. Following randomization, patients will receive short-course radiotherapy (conventional or node-sparing) followed by four cycles of CAPOX ± tislelizumab: tislelizumab 200 mg IV on day 1, oxaliplatin 130 mg/m² IV on day 1, and capecitabine 1000 mg/m² orally on days 1-14, and Total mesorectal excision (TME) will be performed at weeks 14-15. The primary endpoint is pCR rate, while secondary endpoints include organ preservation rate, disease-free survival, overall survival, adverse effects, and quality of life. As of January 2025, 46 of the planned 170 patients have been enrolled. The Data Monitoring Committee (DMC) reviewed the trial in December 2024 and recommended continuing as planned. Reference: Annals of Oncology (2024) 24 (suppl_1): 1-20. 10.1016/iotech/iotech100744. Clinical trial information: NCT06507371 .

Efficacy of Chinese medicine compound Fufang E’jiao Syrupfor symptom burden of cancer-related fatigue in patients with advanced cancer: A randomized clinical trial.

12070 Background: Cancer-related fatigue ( CRF) is often accompanied by a high symptom burden, significantly impacting the quality of life in patients with advanced cancer. Traditional Chinese medicine compound Fufang E’jiao Syrup (FFEJS) has shown promising potential in alleviating fatigue and reducing the overall burden of cancer-related symptoms. This study aims to investigate the efficacy and safety of FFEJS in reducing symptom burden in patients with advanced cancer. Methods: This multicenter, double-blinded, placebo-controlled trial was conducted across 29 hospitals in China and included 611 patients with advanced non-small cell lung cancer, colorectal cancer, or gastric cancer experiencing moderate-to-severe fatigue (Visual Analogue Fatigue Scale score ≥ 4). Participants were randomized to receive FFEJS (20 mL, 3 times daily) or placebo for six weeks. The primary outcome was the change in symptom burden, assessed via the Edmonton Symptom Assessment Scale (ESAS; score range 0-110, higher scores indicate greater burden). Secondary outcomes included changes in 11 individual symptoms (e.g., tiredness, depression, pain) and the incidence of adverse events. Linear mixed models were used for statistical analysis. Results: Among 611 patients randomized (303 received FFEJS and 308 received placebo; 210 [34.4%] had non-small cell lung cancer, 201 [32.9%] had colorectal cancer, and 200 [32.7%] had gastric cancer; mean [SD] age 62.8 [9.3] years; 413 [68.6%] male; mean [SD] baseline mean total symptom burden 38.96 [15.68] points, 503 (82.3%) completed the primary end point analysis. At week 6, FFEJS demonstrated a significantly greater reduction in total symptom burden compared to placebo (6.67 vs 3.16; adjusted mean difference: 3.51[95% CI 1.21–5.8]; P = .004). Patients in the FFEJS arm showed significant improvements in tiredness (1.68 vs 0.79; adjusted mean difference, 0.89 [95% CI, 0.62-1.18]; P < .001), drowsiness (1.13 vs 0.50; adjusted mean difference, 0.63 [95% CI, 0.32-0.95]; P < .001), pain (0.34 vs 0.01; adjusted mean difference, 0.33 [95% CI, 0.08-0.62]; P = .049), depression (0.41 vs -0.15; adjusted mean difference, 0.56 [95% CI, 0.28-0.86]; P = .003) compared with the placebo arm. Subgroup analysis revealed greater symptom reduction in geriatric patients (≥ 60 years; P < .001) and in non-small cell lung ( P = .044) and colorectal cancer ( P = .047), compared to gastric cancer ( P = .123). Conclusions: FFEJS significantly reduced total symptom burden and improved fatigue-related symptoms in patients with advanced cancer. Subgroup analysis highlighted enhanced efficacy in geriatric populations and certain cancer types. These results highlight the potential of FFEJS as a valuable integrative therapy for improving symptom management and quality of life in advanced cancer care. Clinical trial information: NCT04147312 .

Influencing factors of the implementation of mechanical restraint in open psychiatric ward: a retrospective study (2016–2021)

BackgroundMechanical restraint, a widely utilized yet contentious restrictive intervention in psychiatric practice, adversely affects both physical and psychological well-being of patients. Understanding the determinants associated with its implementation is crucial for reducing its clinical application. Current studies have primarily evaluated factors influencing mechanical restraint use and related organizational adaptations, but these investigations are limited to short-term observations. Furthermore, research examining correlates in patients subjected to recurrent mechanical restraint episodes in open psychiatric wards remains scarce, with biological contributing factors particularly lacking empirical evidence.ObjectiveThis study aimed to analyze differences between inpatients experiencing single versus multiple restraint episodes in the open psychiatric ward setting and identify factors associated with multiple restraint occurrences.MethodsThis study is a retrospective analysis of electronic health record data from patients who underwent mechanical restraint in the open psychiatric ward of a Class III Grade A general hospital in China between 2016 and 2021. The data encompassed sociodemographic information, clinical characteristics, and biological indicators.ResultsThe study included a total of 449 patients who underwent mechanical restraint during hospitalization. Of these, 63.5% experienced a single episode of restraint, while 36.5% experienced multiple episodes. Furthermore, compared to patients with a single episode of mechanical restraint, those with multiple episodes exhibited a significantly earlier timing of the first restraint (p = 0.011), a prolonged hospital stay (p = 0.044), and relatively higher creatine kinase levels (p = 0.008). Multivariate analysis identified the timing of restraint (OR: 0.947, p = 0.005) and the duration of hospitalization (OR: 1.034, p = 0.003) as significant predictors of multiple restraint episodes.ConclusionAmong psychiatric inpatients in open wards, those subjected to multiple restraints exhibited earlier occurrence of the first restraint after admission, prolonged hospital stays, and relatively higher serum creatine kinase levels at admission. These findings suggest that in clinical practice, repeated restraint may potentially prolong hospitalization duration. Monitoring serum creatine kinase levels at admission may aid in identifying patients at risk for repeated restraints. Furthermore, early risk identification and the implementation of alternative interventions are critical to reducing the necessity for restraint interventions.

Diverse modes of ceftazidime/avibactam resistance acquisition in carbapenem-resistant Klebsiella pneumoniae and Pseudomonas aeruginosa from a Chinese intensive care unit

ObjectivesTo investigate the mechanisms of ceftazidime/avibactam (CZA) resistance and the nosocomial dissemination of carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-resistant Klebsiella pneumoniae (CRKP) in an intensive care unit (ICU) in China.MethodsClinical CRPA and CRKP isolates were obtained from an ICU of a tertiary hospital in China from August 2020 to February 2021. Antimicrobial susceptibility was determined according to CLSI. WGS, cloning experiments and kinetic parameters were conducted to reveal resistance mechanisms, molecular characteristics and dissemination of CRPA and CRKP.ResultsWe isolated 32 CZA-resistant strains, including 12 CRPA and 20 CRKP strains from an ICU between August 2020 and February 2021. CZA resistance was associated with the presence of NDM and efflux pumps in CRKP strains, whereas blaAFM-2, blaKPC-87, and blaPER-1 contributed to CZA resistance in CRPA strains. Compared to KPC-2, KPC-87 exhibited a 1.5-fold elevation in kcat/Km for ceftazidime, a 7.5-fold increase in Ki for avibactam, and a loss of carbapenem hydrolysis. blaKPC-87 was located in the NTEKPC-IIa like element based on the Tn3. Insertion of 656 bp ΔblaTEM-1 upstream of blaKPC-87 introduced an additional promoter that increased KPC-87 expression. Cluster 2 and 3 of CRKP represented two different clones of ST11 transmitted between patients. KPC-87-producing ST270 CRPA strains exhibited a small-scale dissemination and cross-regional transfer with the referral of a patient. The evolutionary pathways of AFM-2-producing ST275 CRPA strains were more complex to elucidate the transmission events.ConclusionsIn CRKP and CRPA, diverse resistance mechanisms contributed to CZA resistance. These CZA-resistant strains were transmitted among patients in the ICU and even across regions to the other healthcare unit when the patient was transferred.

Correlation between vascular access satisfaction and demoralization syndrome in elderly patients with maintenance hemodialysis: a multi-center study

ObjectiveThis multi-center study aimed to investigate the correlation between vascular access satisfaction (VAS) and demoralization syndrome (DS) in elderly patients undergoing maintenance hemodialysis (MHD). Secondary objectives included identifying predictors of VAS and comparing DS severity between patients with high and low VAS scores.MethodsA retrospective analysis was conducted from April 2024 to October 2024, involving 350 elderly MHD patients from three tertiary hospitals in China. Participants were stratified into two groups based on VAS scores: the VA dissatisfaction group (n = 220) and the VA satisfaction group (n = 130). Data collection utilized the Short Form Vascular Access Questionnaire (VAQ) and the Chinese Version of the Demoralization Syndrome Scale. Binary logistic regression and independent t-tests were employed to analyze predictors of VAS and DS scores.ResultsSignificant differences in VAS scores were observed between the dissatisfaction and satisfaction groups (p < 0.001). Multivariate analysis identified living alone (OR = 2.1, 95% CI 1.4–3.2), prolonged dialysis duration (OR = 1.8, 95% CI 1.2–2.7), and elevated parathyroid hormone (PTH) levels (OR = 1.5, 95% CI 1.1–2.0) as independent risk factors for VAS, while higher hemoglobin levels (OR = 0.6, 95% CI 0.4–0.9) served as a protective factor. Notably, the dissatisfaction group exhibited markedly higher DS scores (73.6 ± 8.7 vs. 51.2 ± 6.9, p < 0.01), indicating a strong association between VAS and psychological distress.ConclusionThis study underscores a robust correlation between VAS and DS in elderly MHD patients. Interventions targeting social support optimization, anemia management, and mineral metabolism regulation may improve vascular access outcomes and mitigate demoralization, thereby enhancing quality of life.Clinical trial numberNot applicable.

Effect of Nucleos(t)ide Analogues Withdrawal on Survival Outcomes in Patients With Hepatitis B Virus‐Related Acute‐on‐Chronic Liver Failure

ABSTRACTBackground/AimsNucleos(t)ide analogues (NA) withdrawal is an important cause of hepatitis B virus (HBV) infection relapse or flare, potentially triggering HBV‐related acute‐on‐chronic liver failure (HBV‐ACLF). Although both NA withdrawal and spontaneous severe acute exacerbation (SAE) of chronic hepatitis B are recognised HBV‐ACLF triggers, comparative evidence regarding their distinct clinical trajectories remains absent. This multicenter retrospective cohort study sought to determine whether NA withdrawal independently predicts adverse outcomes in HBV‐related ACLF compared to SAE‐induced cases.MethodsWe retrospectively enrolled consecutive patients with HBV‐ACLF admitted to four tertiary hospitals in China. The relationship between NA withdrawal and all‐cause mortality in HBV‐ACLF patients was evaluated using multivariate Cox regression analysis. Additionally, sensitivity analyses including propensity score matching (PSM) and inverse probability treatment weighting (IPTW) were performed.ResultsAmong the 313 HBV‐ACLF patients, 66 patients (21.1%) experienced NA withdrawal. HBV‐ACLF patients in the NA‐withdrawal group exhibited lower liver enzyme levels and higher infection rates at diagnosis compared with those in the NA‐naïve group. Multivariate Cox regression models indicated that, after adjusting for demographic and clinical confounders, NA withdrawal was significantly associated with 90‐day mortality (hazard ratio [HR], 1.610; 95% confidence interval [CI], 1.095–2.365; p = 0.015) and 180‐day mortality (HR, 1.549; 95% CI, 1.057–2.271; p = 0.025). Notably, the association remained consistent following PSM and IPTW.ConclusionsNA withdrawal is an independent risk factor for death in patients with HBV‐ACLF, underlining the importance of adherence to NA therapy in patients with chronic hepatitis B.

Risk of Metachronous Advanced Neoplasia After Colonoscopy in Patients With Different Index Findings.

Patients undergoing colonoscopy are at risk of developing metachronous advanced neoplasia (AN). This study explores risk factors of metachronous AN and refines risk stratification based on different index findings. This retrospective cohort study included patients undergoing multiple colonoscopies performed by experienced endoscopists at a major tertiary hospital in China in 2012-2023. Cox regression, adjusted for covariates, estimated the risk of metachronous AN. Cumulative hazard was determined using Kaplan-Meier estimation. Multiple sensitivity analyses validated the impact of risk factors. A total of 3638 patients was included. In the index nonadvanced adenoma (NAA) group, covariate-adjusted Cox regression showed proximal adenomas (hazard ratio [HR], 2.99; 95% confidence interval [CI], 1.20-7.44), adenomas ≥ 6 mm (HR, 3.29; 95% CI, 1.49-7.26), and ≥ 3 adenomas (stratified by time horizons: HR, 4.05; 95% CI, 1.25-13.10) were associated with increased risk of metachronous AN. In the group with non-significant findings at index colonoscopy, age ≥ 50 years (HR, 2.19; 95% CI: 1.36-3.51), family history of colorectal cancer (HR: 5.55; 95% CI: 2.96-10.44), and male sex (HR: 2.45; 95% CI: 1.61-3.73) were associated with increased risk of metachronous AN. Survival analysis revealed that patients with these risk factors reached reference risk for developing metachronous AN much earlier. Based on a Chinese population, we identified independent risk factors for metachronous AN across different baseline diagnostic subgroups, facilitating personalized risk stratification for high-risk patients. Risk profiles should be considered when defining the optimal surveillance interval for colonoscopy.

Understanding the role of resourcefulness in family functioning: mediating effects of family coping and social support in caregivers of young and middle-aged lymphoma patients

BackgroundFamilies of young and middle-aged lymphoma patients face significant burdens affecting their overall functioning and well-being. Caregivers play a critical role in managing these challenges, yet the factors that enhance their ability to support their families effectively, such as caregiver resourcefulness, remain inadequately understood.AimsThis study aimed to explore the relationships between caregiver resourcefulness and family functioning, focusing on the mediating roles of family coping and perceived social support.MethodsThis cross-sectional study was conducted in the oncology units of two tertiary hospitals in China from May to November 2022. Data were collected on caregiver resourcefulness, family coping, perceived social support, and family functioning, and were analyzed using parallel mediation techniques.ResultsThe study included 211 caregivers. Those with higher levels of resourcefulness demonstrated better family functioning. Mediation analysis revealed that family coping and perceived social support partially mediated these relationships (β = − 0.132, 95% CI [−0.208, − 0.063]; β = − 0.123, 95% CI [−0.200, − 0.054], respectively). Both factors jointly mediated the relationships between resourcefulness and the communication and general functioning dimensions. However, neither significantly mediated the relationship between resourcefulness and behavioral control.ConclusionsFamily coping and perceived social support act as partial parallel mediators in the relationship between caregiver resourcefulness and family functioning. Caregivers who exhibit higher resourcefulness, stronger family coping, and greater perceived social support experience enhanced family functioning, particularly in communication and general functioning domains. These findings highlight the importance of contextual factors, indicating that interventions designed to boost caregiver resourcefulness while promoting effective family coping and support systems are essential for improving outcomes for families navigating the challenges of lymphoma.Clinical trial numberNot applicable.

Effects of psychological and physiological factors in perioperative thirst discomfort trajectories in endonasal transsphenoidal surgery: a prospective cohort study.

Endonasal transsphenoidal surgery (ETSS) is a minimally invasive treatment for pituitary adenomas. Perioperative thirst discomfort is common and may signal complications like diabetes insipidus and the syndrome of inappropriate antidiuretic hormone secretion. Understanding the psychological and physiological factors influencing thirst is crucial for improving patient care. This prospective cohort study enrolled 224 ETSS patients from July 2024 to December 2024 at a tertiary hospital in China. We measured thirst discomfort, the salivary pH, and serum thyroid thyroid-stimulating hormone (TSH) levels at multiple perioperative time points and collected data on demographics, anxiety, and depression. Latent growth mixture modeling identified thirst trajectories, principal component analysis determined key TSH and pH patterns, logistic regression assessed influencing factors, and structural equation modeling explored pathways among psychological and physiological variables. Four distinct thirst discomfort trajectories were identified: low-level rapid relief, high-level unresolved, low-level slow relief, and low-level continuous deterioration. Principal component analysis revealed a stable decreasing trend in TSH, while salivary pH followed three trends, including stable decrease, postoperative recovery, and early fluctuations. Protective factors for the high-level unresolved group included stable decreasing TSH trends and higher anxiety, while diabetes and depression were risk factors. For the low-level slow relief group, stable decreasing TSH trends and higher anxiety were protective. The low-level continuous deterioration group was influenced by a decreasing pH trend as a risk factor, with stable decreasing TSH trends providing protection. Path analysis indicated that stable decreasing TSH trends were negatively correlated with anxiety and influenced pH stability, impacting thirst discomfort. Perioperative thirst discomfort in ETSS patients exhibits significant heterogeneity influenced by both psychological and physiological parameters (TSH levels and salivary pH). Identifying these factors can inform targeted perioperative management strategies, potentially mitigating thirst-related discomfort and improving overall patient outcomes.