Evaluación de los factores determinantes del recuento de plaquetas en pacientes con cirrosis

Thrombocytopenia is considered one of the hallmarks of patients with cirrhosis. Several mechanisms have been implicated in the pathophysiology of thrombocytopenia in cirrhosis. Hypersplenism caused by splenomegay, classically regarded as an indirect marker of portal hypertension has been considered the main factor implicated [200]. Nevertheless, portal hypertension is best estimated by the hepatic venous pressure gradient (HVPG) [32, 189], although contradictory results have been reported regarding the association between HVPG and platelet count [195-197]. The identification of thrombopoietin (TPO), a growth factor that enhances the maturation of megakaryocytes and the release of platelets from the bone marrow, has shed new light on the physiolgy of platelets [217]. In normal conditions in adults, TPO is mainly produced in the liver [93, 96] and the circulating leves of platelets are controlled by a negative feedback mechanism [99], so there is an inverse relationship between the amount of circulating platelets, and the amount of TPO that can reach the bone marrow to stimulate thrombopoiesis. In liver cirrhosis perhaps a decreased syntehesis of TPO could be implicated in the development of thrombocytopenia. Controversial findings regarding the role of each mechanism in thrombocytopenia of liver cirrhosis have been reported [142, 146, 160-161, 184] and no study has simultaneously evaluated the influence of the different mechanisms including portal hypertension and TPO production nor whether their influence could change in different stages of the disease..

Table_1_Combining stereotactic body radiotherapy with immunotherapy in stage IV non-small cell lung cancer.docx

Immunotherapy has revolutionized the treatment of metastatic non-small cell lung cancer (NSCLC). Oligometastasis has been associated with better prognosis than widespread metastatic disease and may be curable by stereotactic body radiotherapy (SBRT). SBRT can stimulate immunogenic anti-tumor activity, which can be further augmented when combined with immunotherapy, such as immune checkpoint inhibitors (ICIs). Thus, its combination with immunotherapy was recognized as a promising treatment option, especially in the metastatic setting. However, the most optimal approach to combine SBRT with immunotherapy remains controversial with early clinical evidence emerging. Here, we review the current clinical evidence supporting the combination of SBRT with immunotherapy in the treatment of metastatic NSCLC. Also, we discuss the current controversies and areas for further exploration associated with this treatment strategy.</p

Table_2_The nomogram to predict the occurrence of sepsis-associated encephalopathy in elderly patients in the intensive care units: A retrospective cohort study.DOCX

BackgroundSepsis-associated encephalopathy (SAE) is a critical and common problem in elderly patients with sepsis, which is still short of efficient predictive tools. Therefore, this study aims to screen the risk factors and establish a useful predictive nomogram for SAE in elderly patients with sepsis in the intensive care unit (ICU).Patients and methodsElderly patients (age ≥ 65 years) with sepsis were selected from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Data from demographics and laboratory examinations were collected on the first day of admission to the ICU. SAE was defined by two criteria in the presence of sepsis: ① a Glasgow Coma Scale (GCS) score of ResultsA total of 22,361 patients were selected, of which 2,809 patients (12.7%) died in the hospital and 8,290 patients (37.1%) had SAE. In-hospital mortality in the SAE group was higher than that in the non-SAE group (18.8 vs. 8.9%, p +, Sequential Organ Failure Assessment (SOFA) score, heart rate, and body temperature were constructed. The area under the curve (AUC) of the nomogram was 80.2% in the training set and 80.9% in the validation set. Calibration curve analysis showed a good predictive capacity of the nomogram.ConclusionSAE is an independent risk of in-hospital mortality in elderly patients in the intensive care unit. The nomogram has an excellent predictive capability of SAE and helps in clinical practice.</p

Table_3_The nomogram to predict the occurrence of sepsis-associated encephalopathy in elderly patients in the intensive care units: A retrospective cohort study.DOCX

BackgroundSepsis-associated encephalopathy (SAE) is a critical and common problem in elderly patients with sepsis, which is still short of efficient predictive tools. Therefore, this study aims to screen the risk factors and establish a useful predictive nomogram for SAE in elderly patients with sepsis in the intensive care unit (ICU).Patients and methodsElderly patients (age ≥ 65 years) with sepsis were selected from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Data from demographics and laboratory examinations were collected on the first day of admission to the ICU. SAE was defined by two criteria in the presence of sepsis: ① a Glasgow Coma Scale (GCS) score of ResultsA total of 22,361 patients were selected, of which 2,809 patients (12.7%) died in the hospital and 8,290 patients (37.1%) had SAE. In-hospital mortality in the SAE group was higher than that in the non-SAE group (18.8 vs. 8.9%, p +, Sequential Organ Failure Assessment (SOFA) score, heart rate, and body temperature were constructed. The area under the curve (AUC) of the nomogram was 80.2% in the training set and 80.9% in the validation set. Calibration curve analysis showed a good predictive capacity of the nomogram.ConclusionSAE is an independent risk of in-hospital mortality in elderly patients in the intensive care unit. The nomogram has an excellent predictive capability of SAE and helps in clinical practice.</p

Table_4_The nomogram to predict the occurrence of sepsis-associated encephalopathy in elderly patients in the intensive care units: A retrospective cohort study.DOCX

BackgroundSepsis-associated encephalopathy (SAE) is a critical and common problem in elderly patients with sepsis, which is still short of efficient predictive tools. Therefore, this study aims to screen the risk factors and establish a useful predictive nomogram for SAE in elderly patients with sepsis in the intensive care unit (ICU).Patients and methodsElderly patients (age ≥ 65 years) with sepsis were selected from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Data from demographics and laboratory examinations were collected on the first day of admission to the ICU. SAE was defined by two criteria in the presence of sepsis: ① a Glasgow Coma Scale (GCS) score of ResultsA total of 22,361 patients were selected, of which 2,809 patients (12.7%) died in the hospital and 8,290 patients (37.1%) had SAE. In-hospital mortality in the SAE group was higher than that in the non-SAE group (18.8 vs. 8.9%, p +, Sequential Organ Failure Assessment (SOFA) score, heart rate, and body temperature were constructed. The area under the curve (AUC) of the nomogram was 80.2% in the training set and 80.9% in the validation set. Calibration curve analysis showed a good predictive capacity of the nomogram.ConclusionSAE is an independent risk of in-hospital mortality in elderly patients in the intensive care unit. The nomogram has an excellent predictive capability of SAE and helps in clinical practice.</p

Table_1_The nomogram to predict the occurrence of sepsis-associated encephalopathy in elderly patients in the intensive care units: A retrospective cohort study.docx

BackgroundSepsis-associated encephalopathy (SAE) is a critical and common problem in elderly patients with sepsis, which is still short of efficient predictive tools. Therefore, this study aims to screen the risk factors and establish a useful predictive nomogram for SAE in elderly patients with sepsis in the intensive care unit (ICU).Patients and methodsElderly patients (age ≥ 65 years) with sepsis were selected from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Data from demographics and laboratory examinations were collected on the first day of admission to the ICU. SAE was defined by two criteria in the presence of sepsis: ① a Glasgow Coma Scale (GCS) score of ResultsA total of 22,361 patients were selected, of which 2,809 patients (12.7%) died in the hospital and 8,290 patients (37.1%) had SAE. In-hospital mortality in the SAE group was higher than that in the non-SAE group (18.8 vs. 8.9%, p +, Sequential Organ Failure Assessment (SOFA) score, heart rate, and body temperature were constructed. The area under the curve (AUC) of the nomogram was 80.2% in the training set and 80.9% in the validation set. Calibration curve analysis showed a good predictive capacity of the nomogram.ConclusionSAE is an independent risk of in-hospital mortality in elderly patients in the intensive care unit. The nomogram has an excellent predictive capability of SAE and helps in clinical practice.</p

Change in pulmonary diffusion capacity after 24-week interventions.

Diffusion capacity of the lungs for carbon monoxide (DLCO) was significantly improved (P < 0.001) in Group A and Group B. There was no DLCO change in Group C. Black dots denote the individual data and the dashed gray lines indicate the group mean.</p

Table_1_Patient's care bundle benefits to prevent stroke associated pneumonia: A meta-analysis with trial sequential analysis.DOCX

BackgroundPatient's care bundle has been found to have a beneficial effect on refractory diseases, but the preventive effect of this strategy on stroke-associated pneumonia (SAP) remains unclear. The purpose of this meta-analysis was to determine the role of the patient's care bundle in the prevention of SAP.MethodsA systematic search was conducted in five electronic databases to identify randomized controlled trials (RCTs) published before January 31, 2022. The incidence of SAP and aspiration and the length of hospital stay were assessed. Random pair-wise meta-analysis was conducted using Review Manager 5.4, and trial sequential analysis (TSA) was also performed.ResultsTwenty eligible RCTs involving 1916 patients were included for data analysis. Pooled results suggested that patient's care bundle was associated with significantly lower incidence of SAP (risk ratio [RR], 0.37; 95% CI, 0.29–0.46; p 2 = 0%) and aspiration (RR, 0.23; 95% CI, 0.15–0.35; p 2 = 0%). Meanwhile, patient's care bundle also significantly shortened the length of hospital stay for general patients (mean difference [MD], −3.10; 95% CI, −3.83 to −2.37; p 2 = 16%) and the length of intensive care unit (ICU) stay for patients with severe stoke (MD, −4.85; 95% CI, −5.86−3.84; p 2 = 0%). Results of TSA confirmed that none of the findings could be significantly reversed by future studies.ConclusionsThe patient's care bundle effectively prevents the occurrence of SAP and aspiration and shortens the hospital stay of stroke patients. However, it is necessary to design more high-quality studies to further validate our findings and investigate their applicability in other geographical regions.</p

Table_1_Latent profile analysis and influence factors study of presenteeism among ICU nurses in China.xlsx

BackgroundPresenteeism is a significant global public health problem, and nurses are a high-prevalence group of presenteeism, affecting not only nurses’ physical and mental health, work efficiency, and quality of work but even poses a serious threat to patient safety.ObjectiveThe categorization of presenteeism among ICU nurses is unclear. Our research aims to explore the subtypes of presenteeism among ICU nurses based on latent profile analysis, analyze the influencing factors of different subtypes, and provide a reference basis for developing targeted interventions to reduce the presenteeism rate.MethodsFrom January to February 2023, 509 ICU nurses in Sichuan Province, China, were selected as respondents and surveyed using the general information questionnaire, the presenteeism scale, and the perceived social support scale. Potential categories of presenteeism among ICU nurses were explored using potential profile analysis, and factors influencing the potential types of presenteeism among ICU nurses were investigated using the chi-square test and multivariate logistic regression analysis.ResultsThe best model was suggested to consist of three profiles: low presenteeism-normal coping group (18.3%), moderate presenteeism group (47.9%), and high presenteeism-work limitation group (33.8%). Multiple logistic regression results showed that secondary hospitals (OR = 0.116, p = 0.015), good physical health (OR = 0.084, p = 0.023), general physical health (OR = 0.016, p = 0.037), ICU human resource allocation = 1:2.5 to 3 (OR = 0.315, p = 0.007), and higher social support scores (OR = 0.975, p = 0.047) were more likely to be grouped into low presenteeism-normal coping group; married with no children (OR = 24.554, p = 0.005) were more likely to be grouped into moderate presenteeism group; and having experienced workplace violence in the past year (OR = 1.182, p = 0.049) were more likely to be grouped into high presenteeism-work limitation group.ConclusionThere is group heterogeneity in the presenteeism of ICU nurses, and nursing managers should develop targeted interventions to reduce the presenteeism rate of ICU nurses according to the characteristics and influencing factors of each type of presenteeism of ICU nurses.</p

Basic physical and physiological characteristics.

This study evaluated the effect of 24-week Taichi training and Taichi plus resistance band training on pulmonary diffusion capacity and glycemic control in patients with Type 2 diabetes mellitus (T2DM). Forty-eight patients with T2DM were randomly divided into three groups: Group A—Taichi training: practiced Taichi 60 min/day, 6 days/week for 24 weeks; Group B—Taichi plus resistance band training: practiced 60-min Taichi 4 days/week plus 60-min resistance band training 2 days/week for 24 weeks; and Group C–controls: maintaining their daily lifestyles. Stepwise multiple regression analysis was applied to predict diffusion capacity of the lungs for carbon monoxide (DLCO) by fasting blood glucose, insulin, glycosylated hemoglobin (HbA1c), tumour necrosis factor alpha (TNF-α), von Willebrand Factor (vWF), interleukin-6 (IL-6), intercellular adhesion molecule 1 (ICAM-1), endothelial nitric oxide synthase (eNOS), nitric oxide (NO), endothelin-1 (ET-1), vascular endothelial growth factor, and prostaglandin I-2. Taichi with or without resistance band training significantly improved DLCO, increased insulin sensitivity, eNOS and NO, and reduced fasting blood glucose, insulin, HbA1c, TNF-α, vWF, IL-6, ICAM-1, and ET-1. There was no change in any of these variables in the control group. DLCO was significantly predicted (R2 = 0.82) by insulin sensitivity (standard-β = 0.415, P</div