Aim: To investigate the relationship between the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score and prognosis in patients with acute ischemic stroke (AIS).
Methods: This retrospective, cross-sectional, observational, single-center study enrolled 1128 patients with AIS who presented to the emergency department and were hospitalized between June 2019 and December 2021. The HALP score was calculated as follows: hemoglobin (g/L) × albumin (g/L) × lymphocytes (/L)/platelets (/L). Demographics, clinical characteristics, and HALP scores were compared between survivors and nonsurvivors to identify factors associated with in-hospital mortality.
Results: The HALP scores for nonsurvivors and survivors were 13.9 [7.2-25.9] and 36.4 [22.8-52.8], respectively. Compared to the survivors, the HALP score was significantly lower in nonsurvivor patients.
Conclusions: The HALP score has prognostic value in patients with AIS. Patients with lower HALP scores at admission are at higher risk for prolonged hospital stay, need for intensive care, and mortality, suggesting that a low score may be predictive of poor prognosis in patients with AIS. The cut-off value for predicting mortality was 21.5. Key messages What is already known on this topic: Acute ischemic stroke (AIS) is a leading cause of death and disability worldwide, and accurate early prognostic markers are essential for guiding clinical decisions. Nutritional and inflammatory parameters such as hemoglobin, albumin, lymphocyte, and platelet counts have individually been associated with stroke prognosis. The HALP score-originally validated in cancer and critical illness-has recently emerged as a composite marker reflecting inflammation and nutritional status. However, data on its prognostic value in AIS patients remain limited and inconsistent. What this study adds: This study demonstrates that the HALP score on admission is an independent predictor of in-hospital mortality in AIS patients. A specific cut-off value of 21.5 was identified, below which the risk of death, intensive care unit (ICU) admission, and prolonged hospital stay significantly increased. The HALP score also showed good discriminative ability (Area under the curve (AUC) = 0.781) in predicting adverse outcomes. How this study might affect research, practice or policy: The HALP score, calculated using routine and inexpensive laboratory parameters, may serve as a practical bedside tool for early risk stratification in AIS. Its use could help clinicians identify high-risk patients at triage and prioritize monitoring or interventions. Future prospective studies could support its integration into prognostic models or emergency care pathways for stroke.
Cardiovascular-kidney-metabolic (CKM) syndrome is a multisystemic condition arising from the intricate interactions among cardiovascular disease, chronic kidney disease, and metabolic risk factors, which together impose a high burden of morbidity and mortality. Poor CKM health leads to a clinical syndrome with multiorgan dysfunction, with the most significant consequence being a high risk of cardiovascular events and serious renal outcomes. Based on the growing recognition of CKM syndrome, antidiabetic drugs with cardiorenal benefits are considered as first-line therapeutic strategies for patients with type 2 diabetes mellitus. In this review, we summarize several common antidiabetic agents with cardiorenal benefits, and elaborate on their clinical efficacy in addressing cardiovascular events and kidney outcomes in clinical practice, with the aim of developing a holistic CKM management framework and getting a ward-documentation skills among junior doctors. Individualized treatment and precision medicine treatment is also of great importance for CKM health.
Cancer-related loneliness is a feeling of social disconnection caused by a diagnosis of cancer, and it is associated with individuals' cancer-related social expectations. It is conceptually distinct when compared with loneliness in a general population due to the unique challenges of cancer. Cancer-related loneliness also impacts close persons including caregivers and dependent youth, with both these populations reporting experiences of loneliness. Given that loneliness is related to a range of harmful psychological and physical outcomes, and there is a paucity of interventions to address cancer-related loneliness in patients and close persons, it is vital for healthcare professionals to be aware of loneliness in these populations. This review provides key takeaways for healthcare professionals to best support patients and close persons experiencing cancer-related loneliness and provides recommendations for future research directions.
Objective: Depression is a prevalent psychological disorder involving complex pathogenesis mechanisms. Cathepsins may play a significant role in the pathogenesis of depression, yet the exact impact of cathepsins on the risk of developing depression remains unclear. The objective of this research was to examine the cause-and-effect link between cathepsins and the susceptibility to depression through the application of Mendelian randomization (MR) techniques.
Methods: Univariate MR, bidirectional MR, and multivariable MR were employed to study this causal relationship. Additionally, horizontal pleiotropy, heterogeneity, and sensitivity assessments were performed on the results obtained from MR.
Results: The univariate MR analysis indicated that elevated levels of cathepsin S increase the risk of depression. Conversely, the reverse MR analysis showed no causal relationship between depression, serving as an exposure dataset, and nine types of cathepsins. The multivariable MR analysis, based on nine types of cathepsins, revealed that increased expression levels of cathepsin S and F are associated with an increased risk of depression.
Conclusion: A positive causal relationship has been identified between cathepsin S and cathepsin F and the risk of depression. Consequently, individuals exhibiting elevated levels of cathepsin S and F should be vigilant regarding their mental health to mitigate the potential risk of developing depression in the future. Key message What is already known on this topic Depression is a prevalent psychological disorder involving complex pathogenesis mechanisms. Cathepsins may play a significant role in the pathogenesis of depression, yet the exact impact of cathepsins on the risk of developing depression remains unclear. What this study adds This study presents the inaugural univariate and multivariate Mendelian randomization analysis examining the association between cathepsins and depression, identifying a positive causal relationship between cathepsins S and F and the risk of developing depression. How this study might affect research, practice, or policy Individuals exhibiting elevated levels of cathepsin S and F should prioritize monitoring their mental health to mitigate the potential risk of developing depression in the future.
Purpose: This retrospective study assessed the effectiveness of Mohs micrographic surgery (MMS) combined with adjuvant radiotherapy for the treatment of extramammary Paget's disease (EMPD).
Methods: This retrospective study included 87 patients with pathologically confirmed EMPD and complete follow-up data who were treated at the Radiation Therapy Department of Peking University First Hospital between January 2012 and December 2021. The surgical approach for the primary lesion involved MMS, followed by postoperative radiotherapy with doses ranging from 50 to 60 Gy administered over 25-30 fractions. Lymph node dissection was performed on selected patients exhibiting clinical lymphatic metastasis. The primary endpoint of this study was the disease-specific survival (DSS) rate, while secondary endpoints included local recurrence-free survival (LRFS). Survival rates were calculated using the Kaplan-Meier method and statistically analyzed using the log-rank test.
Results: The study population comprised 78 men and 9 women. The median age was 65 years (range: 44-84). The median follow-up period was 71 months (range: 5-139). The 1-, 3-, 5-, and 10-year DSS rates were 99%, 95%, 92%, and 92%, respectively. The LRFS rates at 1, 3, 5, and 10 years were 100%, 100%, 97%, and 94%, respectively. The LNM rates at 1, 3, 5, and 10 years were 1.1%, 2.3%, 5.7%, and 5.7%, respectively. The DM rates at 1, 3, 5, and 10 years were 1.1%, 5.7%, 8.0%, and 9.2%, respectively.
Conclusion: The combination of MMS and adjuvant radiotherapy offers excellent local control in the treatment of extramammary Paget's disease. Key messages What is already known on this topic: Surgical excision is the established primary treatment for extramammary Paget's Disease (EMPD). However, the role of adjuvant radiotherapy in improving outcomes was not definitively established. What this study adds: This study provides robust evidence that adjuvant radiotherapy combined with surgical excision significantly improves local disease control rates in EMPD compared to surgery alone. How this study might affect practice: These findings strongly support the integration of adjuvant radiotherapy into the standard management paradigm for EMPD, particularly for cases with risk factors for local recurrence.
Background: Inappropriate coagulation testing contributes to inefficiency, cost, and environmental harm. Baseline audits on our acute medical unit (AMU) showed that one-third of coagulation screen requests lacked a clear clinical indication.
Aim: To reduce unnecessary coagulation screens on acute medical services [AMU and Medical Same Day Emergency Care (mSDEC)] by 90% within 12 months, aligned with National Health Service (NHS) Net Zero ambitions and our Trust's Green Plan.
Methods: Using the Model for Improvement, we conducted three Plan-Do-Study-Act cycles. Our analogue and digital interventions included revised triage order sets, condition-specific electronic order sets, and a digital decision prompt requiring clinicians to confirm test indication. Data were collected at baseline (January-February 2024) and re-audited after interventions (December 2024). Outcome measures were the proportion of inappropriate tests, cost savings, staff time, and carbon reduction.
Results: At baseline, 34%-39% of coagulation screens were inappropriate across AMU areas. Postintervention, inappropriate testing reduced to 20% in mSDEC, 10% in AMU 1B, and 15% in AMU 1C. This equates to a projected annual reduction of 44 000 tests, saving £130 000, 367 staff hours, and 3.6 tonnes CO₂e (equivalent to a 9000-mile car journey). Laboratory workload and plastic waste also fell substantially.
Conclusion: Embedding decision prompts within electronic order systems achieved rapid, sustained reductions in unnecessary testing. This scalable, low-cost intervention aligns clinical practice with sustainability goals and offers a model for reducing unwarranted diagnostics across the NHS. In the face of the climate crisis, aligning practice with environmental goals is both a professional responsibility and an opportunity to improve care, efficiency, and outcomes. Key messages What is already known on this topic Inappropriate coagulation testing is common across NHS acute care, with studies showing over one-third of tests lack a clinical indication.Excess diagnostic testing contributes to financial costs, staff workload, plastic waste, and carbon emissions.Previous quality improvement initiatives have focused mainly on education or guideline dissemination, with variable success. What this study adds Embedding a simple digital decision prompt into electronic order sets significantly reduced inappropriate coagulation screens across an Acute Medical Unit.The intervention was low-cost, rapidly implemented, and co-designed with frontline clinicians to improve uptake and sustainability.Projected impact includes avoidance of 44 000 tests annually, saving ~£130 000, 367 staff hours, and 3.6 tonnes CO₂e, supporting NHS Net Zero targets.This scalable model demonstrates how small digital changes can drive large improvements in clinical quality, efficiency, and sustainability.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：