Objective To investigate the effects of konjac glucomannan(KGM)on glycemic indicators and insulin resistance in obese individuals with prediabetes.Methods A total of 102 obese individuals diagnosed with prediabetes at the outpatient department of West China Hospital,Sichuan University,between July 2021 and June 2022 were recruited and randomly assigned to either the experimental group(KGM group)or the control group for a three-month trial.All subjects followed personalized dietary and exercise regimens,with the KGM group additionally consuming 60 g of konjac-based dietary fiber biscuits daily to partially replace carbohydrates.This study aimed to examine the impact of KGM on fasting blood glucose,and to explore changes in 2-hour postprandial glucose,insulin-related indicators,and obesity-related parameters in the two groups of subjects.Results A total of 41 participants in the KGM group completed the trial,with a compliance rate of 77.36%.The control group had 38 completers,with a compliance rate of 77.55%.After three months of dietary and exercise intervention,the effective rate of fasting blood glucose control was 100%in the KGM group,significantly higher than the 82%observed in the control group.The KGM group also had higher effective rates in reducing fasting blood glucose,fasting insulin,insulin resistance,insulin sensitivity,body mass,and waist circumference compared to the control group(P<0.05).However,there were no statistically significant differences between the two groups in body mass index,2-hour postprandial blood glucose,2-hour postprandial insulin,or effective control of pancreatic β-cell activity(P>0.05).During the trial,two participants in the KGM group experienced severe abdominal discomfort,which resolved after discontinuing the biscuits;two cases reported transient diarrhea,and one case reported increased anal flatulence.Conclusion KGM can effectively control fasting blood sugar and promotes weight loss,lowers blood sugar,and enhances insulin sensitivity in obese individuals with prediabetes.

AIM:To build a comprehensive nursing risk model for older adults inpatients with multiple chronic conditions to identify nursing risks. METHOD:This study was conducted in Sichuan Province, China from March 2020 to June 2022. We used Python to build logistic regression, decision tree and random forest models. RESULTS:The study included 4458 patients, 2529 were male (56.7 %) and had an average age of 74.31±6.79 years. The mean number of chronic diseases in elderly hospitalized patients was 2.81±0.96. Hypertension (67.0%), diabetes (43.4%), and coronary heart disease (31.4%) are the three diseases with the highest prevalence. There were 552 (12.4%) patients who had nursing risk event. The random forest model has the best comprehensive prediction ability. It has the highest accuracy(0.917), precision(0.667), recall(0.706), Macro-F1(0.933), and AUC values [0.933(95 % CI:0.924-0.943) ] in training set. CONCLUSION:The random forest(AUC=0.933) superior compared to logistic regression and decision tree, suggesting strong potential for clinical implementation.

Background: The possibility of creating an arteriovenous fistula (AVF) depends on the existence of an arterial-venous network that is in good condition, defined by the size and elasticity of the blood vessels. The knowledge, attitudes, and practices (KAP) toward vascular protection play a crucial role in preserving the vascular network for patients with end-stage renal disease (ESRD), it is observed that there is a significant lack of tools to measure these variables. Thus, the aim of this study is to develop and validate a scale to assess KAP regarding vascular protection anticipatory to the creation of an arteriovenous fistula (the KAP-VPAC-AVF Scale).Methods: Initial item development was guided by a literature review and clinical experience, after which the items were improved and perfected through the Delphi process. The content of the scale was judged by an expert panel for content validity. In a convenience sample of 551 patients with ESRD, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to examine the instrument's factor structure.Results: The KAP-VPAC-AVF Scale encompasses 11 items distributed over three factors: knowledge, attitude, and practice, demonstrated excellent internal consistency (Cronbach's alpha = 0.917) and construct validity, as confirmed by CFA with satisfactory fit indices (chi 2/df = 2.394, RMSEA = 0.075, RMR = 0.049, CFI = 0.969, GFI = 0.936, AGFI = 0.892, TLI = 0.957, IFI = 0.970).Conclusion: The KAP-VPAC-AVF Scale is a scientific and effective assessment tool that can evaluate the KAP of ESRD patients regarding measures to preserve the vascular network.

AIMS AND OBJECTIVES This study investigated the relationship between frailty and diabetes complicated with comorbidities. BACKGROUND Frailty is a common geriatric syndrome, and older adults with diabetes are prone to frailty. Patients with diabetes and comorbidities might be at increased risk of developing frailty. DESIGN A multicenter cross-sectional study. METHODS A cross-sectional study was conducted to identify older patients with diabetes and comorbidities in the internal medicine departments of five tertiary general hospitals in Sichuan Province, China, from March 2020 to June 2021. We used the FRAIL scale to identify frailty, and multinomial logistic regression was used to compare sociodemographic characteristics and comorbidities of frail or pre-frail participants with robust participants. The STROBE checklist was used for this cross-sectional study. RESULTS A total of 1652 patients (883 males, 53.5%) were included, and the prevalence of frailty was 26.5%. Multinomial logistic regression analysis revealed that compared with robust patients, diabetic patients with hypertension, coronary heart disease, chronic cardiac failure, COPD, cerebrovascular diseases, osteoarticular diseases, chronic renal diseases, chronic gastrointestinal diseases and cancer were more likely to be frail. In addition, patients who engaged in less exercise, presented more comorbidities, were older and had lower education levels, were more prone to frailty. CONCLUSION There was a clear correlation between diabetes complicated with comorbidities and the development of frailty. Appropriate personalised care levels for patients with diabetes and comorbidities, and early screening for frailty might reduce the prevalence of frailty in these patients. RELEVANCE TO CLINICAL PRACTICE This study provided information for healthcare providers to identify circumstances that increase the risk of frailty and more effectively support patients with diabetes and comorbidities.

AIMS:This study aimed to investigate the influencing factors of frailty in elderly patients with multimorbidity and to develop a predictive risk model for frailty in elderly patients with multimorbidity. METHODS:In total, 3836 elderly patients with multimorbidity who were admitted to the medical wards of five grade A tertiary hospitals in Sichuan Province from March 2020 to June 2021 were selected. Based on the general data of patients with multimorbidity, the independent risk factors for frailty were obtained using logistic analysis, and a risk prediction model of frailty was developed. RESULTS:Independent risk factors for frailty in patients with multimorbidity were age, types of medication, and comorbidity with chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) and chronic cerebrovascular disease (CCVD); and the protective factors for frailty were body mass index (BMI), exercise and education level. The expression of the model was Z = -2.054 + 0.016 × age - 0.029 × BMI - 0.153 × education level-1.059 × exercise + 0.203 × types of medication + 0.788 × comorbidity with CHF + 0.950 × comorbidity with COPD + 0.363 × comorbidity with CCVD. CONCLUSION:Age, BMI, education level, exercise, types of medication, and comorbidity with CHF, COPD and CCVD can affect frailty risk in elderly patients with multimorbidity, which may be helpful to predict the frailty risk of elderly patients with multimorbidity. Geriatr Gerontol Int 2022; 22: 471-476.

Background As patients age, the frailty of those with multimorbidity increases, often resulting in adverse health outcomes. The current study investigated the frailty status and the factors which influence it in elderly patients with multimorbidity in Chinese hospitals. The relationship between the frailty of patients with multimorbidity and adverse outcomes was explored. Methods The current prospective cohort study investigated inpatients in the internal medicine department of 5 tertiary hospitals in Sichuan Province, China. A total of 3836 elderly patients with multimorbidity were enrolled. Frailty was assessed using the FRAIL scale and adverse outcome events occurring during hospitalization were tracked. Descriptive statistics and logistic regressions were used for data analysis. Results The prevalence of frailty was 27.2% and of pre-frailty, 58.9%. Logistic regression analysis showed that increasing age, low BMI, low education level, lack of exercise, multiple types of medications and multiple numbers of chronic diseases were the main risk factors for frailty in elderly patients with multimorbidity (OR values: 1.020, 1.469, 2.350, 2.836, 1.156 and 1.308, respectively). The incidence of adverse outcomes was 13.9% among the cohort with the most common being deep vein thrombosis (42.4%), followed by pressure injury (38.8%). Regression analysis showed a significant correlation of frailty with adverse outcome (OR: 1.496; p < 0.01). Conclusions The prevalence of frailty and pre-frailty in hospitalized elderly patients with multimorbidity was high. Increasing age, low BMI, low education level, lack of exercise, multiple types of medications and multiple numbers of chronic diseases were factors which influenced frailty and frailty was an important factor in the occurrence of adverse outcomes. The most common adverse outcome of elderly multimorbidity patients during hospitalization was deep vein thrombosis.

OBJECTIVE: To explore the long-term postoperative health-related quality of life (HRQoL) of liver transplant recipients in Southwest China. Survivors' physical rehabilitation and psychological changes at 3 stages were used to investigate parameters of their life and assess long-term outcomes of liver transplant among the subjects, especially those living more than 10 years postoperatively. STUDY DESIGN: Data were collected using Medical Outcomes Study Short Form 36 (MOS SF-36) for self-reported HRQoL variables at 3 stages over 8 years. Changes in all dimensions of HRQoL were analyzed every 4 years. Disease-related information of the subjects was obtained from the Transplantation Center database. RESULTS: Compared with a reference general population, the liver transplant recipients showed significantly worse HRQoL scores for all SF-36 domains (p <0.05). However, scores improved postoperatively in subsequent years. Patients living for more than 10 years postoperatively showed significant improvements in health status. Despite aging and reductions in somatic function and physical activity, the long-term survivors showed their mental health scores improved, indicating improved psychological conditions in patients. CONCLUSION: Liver transplant recipients demonstrated gradual HRQoL development. Patients living for more than 10 years postoperatively showed high mental health scores, suggesting improvement in their psychological condition.

OBJECTIVE:To investigate the value of joint score of platelet to lymphocyte ratio (PLR) and prognostic nutritional index (PNI) to predict postoperative recurrence and mortality of patients with hepatocellular carcinoma (HCC) after liver resection.METHODS:Clinical data of HCC patients within Milan criteria who underwent liver resection at our center were retrospectively reviewed (n=269). The preoperative PLR and PNI of all patients were measured, and. the score of PLR+PNI was calculated. The patients with high PLR (≥150) and low PNI <45) were allocated a score of 2; while the patients had one or neither of these elevations were allocated a score of 1 or 0, respectively. Postoperative survival was estimated by Kaplan-Meier method with log-rank test. Multivariate analysis used Cox regression model.RESULTS:Multivariate analysis showed microvascular invasion, high alpha-fetoprotein (AFP) level, multiple tumors and PLR+PNI score were associated with postoperative recurrence. Microvascular invasion, transfusion and PLR+PNI score were independent risks factors for overall survival. The 5-year recurrence-free survival rates for the patient with PLR+PNI score of 0, 1, 2 were 43.4%, 27.8%, and 19.9% respectively (P<0.001). The 5-year overall survival rates were 84.1%, 72.3%, and 17.7% respectively (P<0.001).CONCLUSION:High PLR+PNI score seems related to high incidence of postoperative recurrence and low long-term survival in the patients with HCC after liver resection.

目的 探讨肝切除术围术期避免实施胃肠减压对于患者安全性和可行性的影响.方法 按照纳入排除标准对2016年6月至2017年10月入住四川大学华西医院肝脏外科拟行肝切除术的患者进行临床随机对照试验,对照组常规进行围术期胃肠减压;试验组不进行围术期胃肠减压.收集研究对象的基本资料如性别、年龄、视觉模拟评分量表(VAS)评分、抽烟史、胃管使用史、Child-Pugh评分等,主要终点指标为术后肺部感染发生率,次要重点指标为舒适度评分、不良反应、手术时间、Clavien-Dindo分级、肛门排气时间、排便时间、经口进食时间、住院时间等.结果 研究最终纳入195例研究对象,其中对照组101例,试验组94例,两组患者基线资料比较差异无统计学意义(P>0.05).安置胃肠减压患者VAS评分(5.04±1.32)分,咽喉疼痛是最常见的不良反应,发生率为32.30％,18.50％ 出现恶心呕吐.两组患者手术时间、肛门排气时间、经口进食时间及Clavien-Dindo并发症Ⅰ级的差异具有统计学意义(P<0.05);术后肺部感染发生率、Clavien-Dindo并发症Ⅱ ～Ⅴ级、肛门排便时间及住院时间差异无统计学意义(P>0.05).结论 肝切除术围术期避免使用胃肠减压对于患者来讲是安全的,对于临床工作来讲是可行的.