Objective: Severe or critical patients with coronavirus disease 2019 (COVID-19) are at increased risk for developing acute kidney injury (AKI). However, the rate of AKI in patients of different severities and independent predictive factors associated with AKI are not well understood. Patients and Methods: We enrolled 107 severely or critically ill elderly patients with COVID-19 who were admitted to the intensive care unit (ICU) in Wuhan, China. AKI was defined according to the 2012 KDIGO criteria. We explored the association between AKI and in-hospital mortality using logistic regression. A predictive nomogram was formulated to predict the AKI development of patients with COVID-19 based on multivariate logistic regression. Results: A total of 107 elderly patients were enrolled during the study period. The mean age was 70 (64– 78) years, and 69 (64.5%) were men. For the 107 patients, the degree of severity of COVID-19 was categorized as 37 patients with the severe type (34.6%) and 70 patients with the critical type (65.4%). Overall, 48 of the 107 patients (44.9%) developed AKI during their hospitalization, while AKI occurred in 7 (18.9%) out of the 37 severe patients and 41 (44.9%) out of the 70 critical patients. Of the AKI patients, 35.4% (17/48) required continuous renal replacement therapy, including 14.3% of AKI patients in severe cases and 39.0% of AKI patients in critical cases. Kaplan–Meier analysis demonstrated that patients with AKI had a significantly higher risk for in-hospital mortality than severely and critically ill patients without AKI. Multivariate logistic regression analysis showed that AKI (OR = 33.74; 95% CI = 3.34– 341.29; P = 0.003), septic shock (OR = 15.58; 95% CI = 2.08– 116.78; P = 0.008), invasive mechanical ventilation (OR = 18.44; 95% CI = 2.35– 144.69; P = 0.006), and oxygenation index (OR = 0.99; 95% CI = 0.98– 1.000; P = 0.014) were independent risk factors for in-hospital mortality. A nomogram was established based on the multivariate analysis results. The C-index for the developed AKI model was 0.935 (95% CI, 0.892– 0.978); when 10-fold cross validation was used to validate the model, the corrected C-index was 0.825. Conclusion: AKI is common among COVID-19 patients admitted to the ICU and is recognized as a marker of disease severity. The proposed nomogram accurately predicted AKI development in ICU patients with COVID-19 based on individual characteristics. Therefore, the strategy for kidney protection against severe or critical pneumonia is appropriate.

Combined use of heparin and aspirin is frequently prescribed for treatment of recurrent miscarriage (RM) in patients with antiphospholipid syndrome (APS), or in those without apparent cause of RM other than thrombophilia; however, this strategy is largely based on expert opinion and has not been well studied. The option for the use of different antithrombotic therapies to improve live birth remains unclear. In this network meta-analysis, we incorporated direct and indirect evidence to evaluate effects of different antithrombotic treatments on prevention of pregnancy losses.We searched PubMed and Embase for randomized clinical trials comparing effects of at least 2 antithrombotic treatments on live birth in RM patients published from 1965 through the early of May 2015. Potential risk bias of eligible trials was evaluated according to the Cochrane Collaboration guidelines. Bayesian network meta-analysis was used to estimate relative effects on live birth.A total of 19 trials involving 2391 RM patients with or without thrombophilia and 543 with APS were included. No beneficial effect of antithrombotic treatment was observed either in RM patients with or without thrombophilia or in patients with APS; however, for patients with or without thrombophilia, low molecular weight heparin therapy had the greatest probability (61.48%) of being the best option in terms of live birth; for patients with APS, unfractionated heparin plus aspirin was the superior treatment for RM with the highest possibility (75.15%) of being top 2 places for reducing pregnancy losses. Aspirin was inferior in both groups.Our results do not support the use of combined low molecular weight heparin and aspirin for RM treatment, and suggested aspirin may have negative effects for lowering the risk of pregnancy loss.

Dual anti-human epidermal growth factor receptor 2 (HER2) therapies have been shown to improve outcomes of HER2-positive breast cancer patients. We undertook a systematic review to compare treatment outcomes for patients who received single or combined anti-HER2 therapies. We identified randomized control trials that compared dual anti-HER2 therapy and anti-HER2 monotherapy in patients with HER2-positive breast cancer. Outcomes included pathologic complete response (pCR), overall survival (OS), progression-free survival (PFS), and adverse events. Included in the analysis were seven trials that recruited 2,609 patients. In the neoadjuvant setting, the pooled pCR rate in the dual anti-HER2 therapy and monotherapy groups in combination with chemotherapy was 54.8% and 36%, respectively. This difference was statistically significant (relative risk, 1.56; 95% confidence interval (CI), 1.23–1.97; p < 0.001). In the metastatic setting, dual anti-HER2 therapy demonstrated significant benefits in both PFS (hazard ratio (HR), 0.71; 95% CI, 0.62–0.81; p < 0.001) and OS (HR, 0.68; 95% CI, 0.57–0.82; p < 0.001). Subgroup analyses indicated that the addition of chemotherapy to dual anti-HER2 therapy could greatly improve pCR in the neoadjuvant settings. However, in the metastatic setting, similar PFS and OS were found in patients receiving dual anti-HER2 therapy with or without chemotherapy. Dual anti-HER2 therapy was associated with more frequent adverse events than monotherapy, but no statistical differences were observed in cardiac toxicity. This systematic review provides a summary of all the data currently available, and confirms the benefits and risks of dual anti-HER2 therapy for HER2-positive breast cancer.

Background: The coronary artery bypass grafting (CABG) is one of the high-risk litigated medical specialties. Further elucidating the causes behind these malpractice claims can help physicians avoid patient injury. This study analyzed CABG litigations occurred in different level hospitals to outline the basic characteristics, as well as present a analysis on the medical malpractice that result in lawsuits. Methods: This study utilized the “China Judgments Online” database to compile litigations from 2012 to 2021 across China. 109 cases related to the CABG were included in the study, and were analyzed for demographic, patient outcomes and verdict characteristics in different levels of hospitals. Results: The median age of plaintiff patient was 62 years, the median length of stay was 25 days, and the median responsibility ratio of the litigation cases was 30%. The average proportion of responsibility of national, provincial and municipal hospitals were 29.6%, 28.4% and 39.5% respectively, and the median days after surgery to death of that were 15, 9 and 5 separately. The top 5 postoperative complications in dispute cases were: low cardiac output syndrome, postoperative hemorrhage, non-surgical site infections, surgical site infections and arrhythmia. Conclusions: The diagnosis and treatment capabilities of coronary artery bypass grafting in different levels of hospitals in China were inconsistent, and the treatment capabilities in prefecture-level hospitals were lower than that in national hospitals. The procedural error, failure to properly monitor the patient and diagnostic errors were common in CABG litigations. Postoperative complications related to surgical injuries and insufficient basic postoperative management lead to a higher responsibility proportion.

Background: Older adults with ischemic stroke (IS) are prone to develop comorbidities, thus worsening clinical outcome and intensifying cost burden. Limited studies have revealed evidence linking types of combined diseases with economic burden in IS patients. In this study, prevalent combined diseases and clusters of comorbidity among IS patients aged≥ 60 years were identified. Meanwhile, we explored the combined diseases significantly correlated with incremental hospital costs, aiming to promote the individualized and comprehensive management of IS patients. Methods: The study was a multicenter, cross-sectional study based on clinical data of IS patients (aged ≥60 years) obtained from three tertiary centers of PLA General Hospital between 2018 and 2023. Patients were stratified into three age groups: 60–69 years, 70–79 years, and ≥80 years. Descriptive analyses were performed to show patient number, the composition of combined diseases, and medical costs. Apriori association rules mapped the clusters of comorbidity. Spearman correlation analysis combined with age-stratified quantile regression identified cost-intensive health conditions. Results: Apriori correlation analysis revealed a dominant cardio-metabolic-cluster and the intermediary role of diabetes. Hypoproteinemia aggregated with pulmonary infection and anemia, forming a clinically significant malnutrition-infection-anemia triad. The healthcare costs were highest in advanced older adult group despite an overall expenditure declining from 2018 to 2023. Spearman correlation and quantile regression analyses showed correlation between incremental costs and malnutrition-infection-anemia triad, especially at higher cost quantiles. Pulmonary infection was associated with relatively higher cost burdens in patients aged ≥80 years, with significant estimated increases of about ¥5,953, ¥8,538, ¥13,810, and ¥18,945 at the 10th, 25th, 50th, and 75th percentiles. Hypoproteinemia tended to correspond to the significant rise in costs at the 50th percentile for patients aged 60–69 years ( β = ¥20,957) and for those aged ≥80 years ( β = ¥12,962). Conclusion: This study identified three prevalent comorbidity clusters in the study population: cardio-metabolic, diabetes-mediated multi-organ injury, and malnutrition-infection-anemia clusters. From the perspective of healthcare cost, pulmonary infection, hypoproteinemia, and anemia might represent the principal cost-intensive clusters of comorbidity, especially in those aged ≥80 years. The persistent cost-age gradient necessitates risk-stratified resource allocation. Implementation of geriatric-specific comorbidity control protocols, particularly targeting the identified clusters with high costs, may optimize both clinical outcomes and healthcare economics in aging populations.