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Yiqin Xia,1– 3 Hongyu Long,4 Qiang Lai,1– 3 Yiwu Zhou1– 3 1Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 3Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 4Department of Critical Care Medicine, Chengdu First People’s Hospital, Chengdu, Sichuan, People’s Republic of ChinaCorrespondence: Yiwu Zhou, Emergency Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China, Email 456zyw@163.comObjective: Acute pancreatitis (AP) progresses to septic shock can be fatal. Early identification of high-risk patients and timely intervention can prevent and interrupt septic shock. By analyzing the clinical characteristics of AP with sepsis, this study uses machine learning (ML) to build a model for early prediction of septic shock within 28 days of admission, which guided emergency physicians in resource allocation and medical decision-making.Methods: This retrospective cohort study collected data from the emergency departments (EDs) of three tertiary care hospitals in China. The dataset was randomly divided into a training dataset (70%) and a testing dataset (30%). Ten ML classifiers were utilized to analyze characteristics of AP with sepsis in the training dataset upon admission. Results were evaluated through cross-validation analysis. The optimal model was then tested on the testing dataset without any parameter modifications. The ML model was evaluated using the receiver operating characteristic curve (ROC) and compared to scoring systems through the DeLong test.Results: A total of 604 AP patients with sepsis were included in this study. The auto-encoder (AE) model based on mean normalization, Pearson correlation coefficient (PCC), and recursive feature elimination (RFE) selection, achieved the highest Area Under the Curve (AUC) on the validation dataset (AUC 0.900, accuracy 0.868), with the AUC of 0.879 and accuracy of 0.790 on the testing dataset. Compared to the Sequential Organ Failure Assessment (AUC 0.741), quick Sequential Organ Failure Assessment (AUC 0.727), Acute Physiology and Chronic Health Evaluation II (AUC 0.778), and Bedside Index of Severity in Acute Pancreatitis (AUC 0.691), the AE model showed superior performance.Conclusion: The AE model outperforms traditional scoring systems in predicting septic shock in AP patients with sepsis within 28 days of admission. This assists emergency physicians in identifying high-risk patients early and making timely medical decisions.Keywords: machine learning, acute pancreatitis, sepsis, septic shock

Bin Yang,1,* Qingsong Lai,2,* Aiqi Chen,2 Li Ye,1 Xiaohua Wang,1 Yulin Lai,2 Dan Liu,3 Mao-Qiang Man3 1Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou City, Guangdong, 510091, People’s Republic of China; 2Department of Dermatology, Medical Center for Public Health of Puning, Puning City, Guangdong, 515300, People’s Republic of China; 3Department of Product Development, Dermatology Hospital, Southern Medical University, Guangzhou City, Guangdong, 510091, People’s Republic of China*These authors contributed equally to this workCorrespondence: Mao-Qiang Man, Department of Dermatology, Dermatology Hospital, Southern Medical University, 2 Lujing Road, Guangzhou City, 510091, Guangdong, People’s Republic of China, Tel +86 20 8725 7353, Email mqman@hotmail.comBackground/Objective: Epidermal function is altered in a number of cutaneous and extracutaneous disorders. To determine whether epidermal function is also altered in children with obesity, we assessed the correlation between the body mass index (BMI) z score and epidermal function in children.Participants and Methods: Participants were enrolled from outpatient clinic, schools and kindergartens. Epidermal biophysical properties, including transepidermal water loss rate, stratum corneum hydration and skin surface pH, were measured on the flexor forearm and shin. Correlations between epidermal biophysical properties and BMI were analyzed. In addition, the association of epidermal biophysical properties with BMI z score was also determined.Results: Overall, BMI did not differ significantly between boys and girls among the age groups. BMI z scores correlated negatively with stratum corneum hydration levels and positively with skin surface pH in boys, but not in girls. The negative correlation between TEWL and BMI z score was not significant. Moreover, stratum corneum hydration levels were lower in boys with a BMI z score of ≥ 2 than in those with a BMI z score of − 2 to 0.99.Conclusion: Both stratum corneum hydration levels and skin surface pH are significantly correlated with BMI z scores in boys, but not in girls. Whether epidermal function influences BMI or vice versa remains to be determined.Keywords: transepidermal water loss, stratum corneum hydration, skin surface pH, body mass index, BMI z score

Qiang Lai,1– 3 Yiqin Xia,1– 3 Wentao Yang,1– 3 Yiwu Zhou1– 3 1Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 3Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People’s Republic of ChinaCorrespondence: Yiwu Zhou, Emergency Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China, Email 456zyw@163.comObjective: To develop a concise scoring system for efficient and rapid assessment of sepsis prognosis applicable to emergency departments.Methods: This was a single-center retrospective cohort study of patients with sepsis. In this study, a new scoring system (oxygenation index, lactate, and Glasgow coma scale: GOL) was developed through a derivation group, and then the GOL was validated using a validation group. Multivariate logistic regression analysis was performed to investigate the relationship between GOL and 28-day adverse outcomes. The GOL was compared with the previous scoring system using receiver operating characteristic curves (ROC) and decision analysis curves. The endpoints of this study were mortality, mechanical ventilation (MV), and admission to the intensive care unit (AICU).Results: 608 patients were included in the derivation group and 213 patients in the validation group, with 131 and 42 deaths, respectively. In the validation group, lactate (Lac), oxygenation index (PaO2/FiO2), and Glasgow coma scale score (GCS), the three best performers in predicting 28-day mortality from receiver operating characteristic curves, were used to construct the GOL. The higher the GOL score, the higher the incidence of death, MV and AICU within 28 days. Multifactorial logistic regression analysis showed that when the GOL was greater than 1, it was an independent risk factor for 28-day mortality, MV, and AICU. In predicting 28-day mortality, GOL was superior to the quick Sequential Organ Failure Assessment (qSOFA), Mortality in Emergency Department Sepsis Score (MEDS), Systemic Inflammatory Response Syndrome Score (SIRS), and Modified Early Warning Score (MEWS), and was comparable to the Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA).Conclusion: The GOL is a simple, rapid, and accurate method for early identification of patients at increased risk of in-hospital death from sepsis.Keywords: sepsis, GCS, lactic acid, oxygenation index, PaO2/FiO2, prognosis

Qiang Lai,1– 3 Wei Wei,1– 3 Yarong He,1– 3 Tao Cheng,1– 3 Tianyong Han,1– 3 Yu Cao1– 3 1Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 3Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People’s Republic of ChinaCorrespondence: Yu Cao, Emergency Department, West China Hospital of Sichuan University, 37 Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, People’s Republic of China, Email yuyuer@126.comObjective: To establish a rapid and concise prognosis scoring system for pancreatitis in the emergency department based on bedside arterial blood gas analysis (ABG).Methods: A single-center, retrospective cohort study was used to establish the new scoring system, and a validation group was used to verify it. The primary endpoint was 60-day death, and secondary endpoints were 28-day death, admission to the intensive care unit (AICU), requirement for mechanical ventilation (MV) and persistent organ failure (POF). Receiver operating characteristic (ROC) curves was drawn to validate the predictive value of the new scoring system. The performance of the new scoring system was compared with that of conventional predictive scoring.Results: 443 patients were in the derivation group and 217 patients in the validation group, of which 27 and 25 died during follow-up. A total of 443 patients in the derivation group, 27 of whom died during the follow-up period. Multivariate regression analysis showed that mental status, hematocrit (HCT), base excess (BE) and Serum ionic calcium (Ca2+) were independent risk factors for 60-day mortality of pancreatitis, and they were used to create a new scoring system (MHBC). In the derivation and validation, the ability of MHBC (AUC= 0.922, 0.773, respectively) to predict 60-day mortality from pancreatitis was no less than that of APACHE II (AUC= 0.838, 0.748, respectively) and BISAP (AUC= 0.791, 0.750, respectively), while, MHBC is more quickly and concisely than APACHE II and BISAP. Compared with MHBC less than or equal to 2, when MHBC is greater than 2, the 28-day mortality, 60-day mortality and the incidence of AICU, MV and POF increased significantly (P < 0.001).Conclusion: The MHBC can quickly and concisely evaluate the 60-day mortality, 28-day mortality, and the incidence of AICU, MV and POF of patients with acute pancreatitis in the emergency department.Keywords: acute pancreatitis, prognosis, emergency department, arterial blood gas analysis, ABG

Tianyong Han,1,&ast; Tao Cheng,1,&ast; Ye Liao,2 Qiang Lai,1 Shiyuan Tang,1 Bofu Liu,1 Yarong He,1 Chenxi Lei,1 Yuling Cao,3 Yu Cao1 1Emergency Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Medical Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China; 3Operations Management Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yu Cao, Emergency Department, West China Hospital of Sichuan University, 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan, 610041, People’s Republic of China, Tel +86 28-85422288, Email caoyu@wchscu.cnPurpose: The thrombo-inflammatory prognostic score (TIPS) and the bedside index for severity in acute pancreatitis (BISAP) are both scoring systems that enable the rapid prognostic assessment of early-stage acute pancreatitis (AP) patients, but the overall prognostic utility of these individual systems is limited. This study was thus developed to explore whether a combination of TIPS and BISAP scores would offer better insight to facilitate the risk stratification of AP patients.Methods: This single-center retrospective cohort research evaluated AP cases referred to the emergency department from January 1, 2017 to September 30, 2017. The ability of TIPS scores to improve BISAP-based AP patient risk stratification was appraised employing the curves of receiver-operating characteristic (ROC) and decision curve analysis (DCA) approaches. The initial endpoint for this research was 28-day mortality, while secondary endpoints comprised intensive care unit admission (AICU) and mechanical ventilation (MV) over a 28-day follow-up period.Results: Totally, 440 cases enrolled in the current study were divided at a ratio of 1:1 to derivation and validation cohorts. When estimating 28-day mortality, the combination of TIPS and BISAP (T-BISAP) improved the area under the curve (AUC) value in the derivation group from 0.809 to 0.903 (P

Ju Zhu,1 Haoming Shi,1 Haoyu Ran,1 Qiancheng Lai,2 Yue Shao,1 Qingchen Wu1 1Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Cardiothoracic Surgery, Chengdu Fifth People’ Hospital, Chengdu, People’s Republic of ChinaCorrespondence: Qingchen Wu, Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China, Email wuqingchencqmu@126.comBackground: Non-small cell lung cancer (NSCLC) survivors are at an increased risk of developing second primary malignancies, such as small cell lung cancer. This paper sought to establish a prognostic nomogram to assess overall survival (OS) in patients with second primary small cell lung cancer (SPSCLC) after NSCLC.Methods: 420 patients who developed SPSCLC after NSCLC were randomly split into the training and validation groups. A nomogram was established by stepwise regression. Area under the curve (AUC) and calibration plots were applied to assess the prognostic performance of the nomogram. Concordance index (C-index), integrated discrimination improvement (IDI), net reclassification index (NRI) and decision curve analysis (DCA) were performed to compare the nomogram with the American Joint Committee on Cancer (AJCC) 8th staging system. Survival risk classification was constructed based on the nomogram.Results: Five variables were chosen to construct the nomogram. The AUC showed that it had a satisfactory discrimination ability. All calibration plots displayed good concordance between nomogram and observation. The C-index, IDI, NRI and DCA showed the nomogram was superior to the AJCC 8th staging system. The Kaplan-Meier curves suggested huge differences in prognosis among the three risk groups.Conclusion: This study build a nomogram and risk stratification system for predicting probabilities of OS in patients with SPSCLC after NSCLC, which can help clinicians in individualized survival assessment and treatment decisions.Keywords: nomogram, non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), SEER database

Tao Cheng,1,2,&ast; Tian-Yong Han,1,2,&ast; Bo-Fu Liu,1,2 Pan Pan,1,2 Qiang Lai,1,2 Haifang Yu,1,2 Yu Cao1,2 1Emergency Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Laboratory of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yu CaoEmergency Department of West China Hospital and Laboratory of Emergency Medicine of West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, 610041, Sichuan, People’s Republic of China, Tel +86-28-85422288, Email caoyu@wchscu.cnObjective: To develop a new approach based on Balthazar grades of acute pancreatitis (AP) and to assess this modified method as a tool for the early prediction of AP severity in the emergency department (ED).Methods: Data pertaining to AP patients ≥ 18 years old that had undergone computed tomography (CT) scanning within 24 h following ED admission between January 1, 2017 and September 30, 2017 were retrospectively analyzed. Patients were separated into two groups based on the length of time between the onset of their AP symptoms and the completion of CT scanning (Group 1: < 72 h; Group 2: ≥ 72 h). Modified Balthazar grades for these patients were then assessed, with the concordance between these modified grades and the 2012 revised Atlanta classification being assessed using the Kappa (κ) statistic. The modified grade with the largest κ value was evaluated based on performance traits including Harrell’s concordance index (C-index), area under the receiver operating characteristic curve (AUC) analyses, calibration curves, and decision curve analyses (DCA) in comparison with bedside index for severity in AP (BISAP) scores.Results: In total, 372 patients were included in the present analysis. These patients were regraded according to six methods, with the method yielding the largest κ value consisting of regraded Balthazar grades A–C, D, and E, respectively, corresponding to mild, moderate, and severe AP. The κ values for this method were 0.786 (95% CI, 0.706– 0.853) in Group 1 and 0.907 (95% CI, 0.842– 0.955) in Group 2, exhibiting nearly complete agreement with the latest Atlanta classification of AP. AUROC values for these modified Balthazar grades when used to predict SAP were significantly higher than those for BISAP scores in Group 1, Group 2, and the overall cohort (P < 0.05). The DCA curves for Group 1, Group 2, and the overall patient cohort exhibited substantial net benefits when using these modified grades across a range of POFs relative to BISAP scores. The calibration curve for this modified approach to predicting POF in AP patients revealed good agreement in this cohort.Conclusion: Modified Balthazar grades exhibited substantial to near-total agreement with the 2012 revised Atlanta classification of AP patients, and this modified method can thus be used for the early prediction of AP severity in the ED.Keywords: acute pancreatitis, severity, Balthazar grade, revised Atlanta classification

Tianyong Han,1,&ast; Tao Cheng,1,&ast; Ye Liao,2 Yarong He,1 Bofu Liu,1 Qiang Lai,1 Pan Pan,1 Junzhao Liu,1 Chenxi Lei,1 Yu Cao1 1Emergency Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Medical Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yu CaoEmergency Department, West China Hospital of Sichuan University, 37 Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, People’s Republic of China, Tel +86 28-85422288, Email caoyu@wchscu.cnBackground: Acute pancreatitis (AP) is a multifactorial disease that is associated with substantial morbidity and mortality. Thrombosis and inflammation are involved in the development and progression of AP.Aim: To develop and validate a novel and simple scoring system for predicting 28-day adverse outcomes in AP patients based on a thrombotic and an inflammatory biomarker.Methods: A single-center, retrospective cohort study was used to establish the new scoring system (thrombo-inflammatory prognostic score; TIPS), and another study was used to verify it. The study end points were 28-day mortality, requirement for mechanical ventilation (MV), persistent organ failure (POF), and admission to the intensive care unit (AICU). Receiver operating characteristic (ROC) curves was drawn to validate the predictive value of the TIPS. The performance of the TIPS was compared with that of conventional predictive scoring systems. Logistic regression models were used to investigate the relationship between the TIPS and the different end points.Results: Among 440 patients with AP in the derivation group, 27 patients died within the 28-day follow-up period. Prothrombin time (PT) and interleukin-6 (IL-6) were used to calculate the TIPS. The TIPS (AUC=0.843) showed a performance comparable to that of the more established APACHE II (AUC=0.841), SOFA (AUC=0.797), BISAP (AUC=0.762), and Balthazar CT (AUC=0.655) in predicting 28-day mortality in AP. The 28-day mortality and the incidence of MV, POF, and AICU were significantly higher among patients with a higher TIPS (P< 0.001). The results of logistic regression analyses indicated that the TIPS was independently associated with the risks of 28-day mortality, AICU, MV and POF.Conclusion: The TIPS can enable prediction of 28-day adverse clinical outcomes with AP patients in the ED.Keywords: acute pancreatitis, prognosis, clinical outcomes, thrombosis, inflammation

Xiaohua Wang,1,* Qingsong Lai,2,* Baoqing Zheng,1 Li Ye,1 Si Wen,1 Yunling Yan,1 Bin Yang,1 Mao-Qiang Man1 1Dermatology Hospital, Southern Medical University, Guangdong, 510091, People’s Republic of China; 2Center for Chronic Disease Prevention and Control of Puning City, Puning, Guangdong, 515300, People’s Republic of China*These authors contributed equally to this workCorrespondence: Mao-Qiang Man; Bin YangDermatology Hospital, Southern Medical University, 2 Lujing Road, Yuexiu District, Guangzhou, Guangdong, 510091, People’s Republic of ChinaEmail mqman@hotmail.com; yangbin101@hotmail.comBackground: Although the characteristics of pruritus in some skin diseases are documented, characteristics of pruritus related to gender-, age-, and skin disorder have not yet been well defined.Objective: To characterize dermatosis-associated pruritus in Chinese patients.Methods: A cross-sectional study was carried out in a single center. The intensity of pruritus was evaluated using a 0– 10 visual analog scale (VAS). Skin disorders were diagnosed by dermatologists. The prevalence and intensity of pruritus were compared among skin disorders, and between males and females.Results: Valid questionnaires were obtained from 1,246 female and 864 male patients. Patients with acne, eczematous dermatitis, and urticaria accounted for 18%, 17%, and 14%, respectively. Both the prevalence and severity of pruritus varied greatly with skin disorders (p< 0.0001). Patients with either urticaria or eczematous dermatitis displayed a higher prevalence of pruritus (92% and 82%, respectively), while subjects with urticaria exhibited the highest VAS in comparison to those with other skin disorders (p< 0.05 to p< 0.001 vs the others). Moreover, both the prevalence and severity of pruritus were positively associated with age in both males and females (p< 0.0001). Furthermore, 60 out of 77 patients (78%) with topical glucocorticoid-induced dermatitis experienced pruritus, with a VAS of 2.03± 0.21. Finally, a lower VAS was found in subjects with oily skin than those with either dry or normal skin.Conclusion: The prevalence and severity of pruritus vary with skin disorders, skin type, age, and gender in Chinese patients.Keywords: skin disorder, pruritus, prevalence, severity, gender, age

Milad T Jannesari,1 Zhongming Wang,2 Jianzhuang Zheng,1 Wenwu Xie,1 Qin Lai,1 Lu Wu1 1School of Business, Zhejiang University City College, Hangzhou, People’s Republic of China; 2School of Management, Zhejiang University, Hangzhou, People’s Republic of ChinaCorrespondence: Milad T JannesariSchool of Business, Zhejiang University City College, Hangzhou, People’s Republic of ChinaEmail miladjannesari@gmail.comPurpose: This study answer calls for research on host country nationals (HCNs) by examining factors that may influence HCN task performance and contextual performance during work with their self-initiated expatriate (SIE) colleagues.Participants and Methods: Data on personality traits (extraversion, openness), socialization self-efficacy, and frequency of interaction, task, and contextual performance were collected by surveying 373 Chinese HCNs. The first author recruited the HCNs through SIEs working and living in China. SIEs who participated in this project provided the email addresses of HCNs with whom they worked.Results: The frequency of interactions fully mediated the relationship between (a) extraversion with task and contextual performance and (b) openness with task and contextual performance. Only socialization self-efficacy moderated the mediating effects of extraversion on task performance via the frequency of interaction; it also moderated the mediating effects of openness on contextual performance via the frequency of interactions, but not in the hypothesized direction.Conclusion: This study investigated the neglected stakeholder in the expatriation process, namely, HCNs, and what factors may impact HCNs’ performance during work and collaboration with their SIE colleagues.Keywords: host country nationals, expatriates, career, personality, socialization self-efficacy

Qingyun Zhang,1– 3 Qinqiao Lai,1 Shan Wang,4 Qinggui Meng,1 Zengnan Mo2,3,5 1Department of Urology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, People’s Republic of China; 2Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, People’s Republic of China; 3Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, People’s Republic of China; 4Department of Research, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, People’s Republic of China; 5Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, People’s Republic of ChinaCorrespondence: Qinggui MengDepartment of Urology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People’s Republic of ChinaEmail mqg15315@163.comZengnan MoInstitute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region 530021, People’s Republic of ChinaTel/Fax +86-771-5353342Email mozengnan@gxmu.edu.cnPurpose: This study investigated the clinical significance of postoperative neutrophil-to-lymphocyte ratio (NLR) changes in bladder cancer recurrence.Patients and Methods: For evaluating the predictive value of postoperative dynamic change of NLR, a retrospective cohort study was performed to analyze 213 patients with bladder cancer who underwent surgical treatment from January 2013 to December 2019 at the Affiliated Tumor Hospital of Guangxi Medical University. Baseline characteristics and recurrence-free survival (RFS) were statistically compared, and a multivariate analysis was used to identify prognostic factors.Results: Compared with preoperative NLR levels, postoperative decreased NLR in 130 patients and postoperative increased NLR in 83 patients were detected. The 1-, 3- and 5-year RFS rates were 88.0%, 75.4% and 75.4% in the decreased postoperative NLR group, respectively, and 51.2%, 25.8% and 16.1% in the increased postoperative NLR group, respectively (P < 0.05). Kaplan–Meier curves showed that the cumulative DFS rate in the increased group was significantly lower than that in the decreased group (P < 0.05). The preoperative NLR showed significant difference with postoperative NLR in the total cohort, high-grade non-muscle-invasive bladder cancer (HG-NMIBC) and muscle-invasive bladder cancer (MIBC) group, while there was no significant difference between postoperative NLR and NLR of recurrence or last follow-up. Multivariate analysis suggested that postoperative-preoperative NLR was an independent predictor for RFS (HR=6.206, 95% CI: 3.826– 10.067, P < 0.001) in the total cohort, RFS (HR=9.373, 95% CI: 2.724– 32.245, P < 0.001) in the LG-NMIBC group, RFS rates (HR=6.873, 95% CI: 2.486– 18.999, P < 0.001) in the HG-NMIBC group and RFS rates (HR=6.109, 95% CI: 2.847– 13.109, P < 0.001) in the MIBC group.Conclusion: The dynamic change of postoperative NLR is a potential marker for the early detection of bladder cancer recurrence. Patients with increased NLR after surgery tend to have higher risk of recurrence.Keywords: bladder cancer, NLR dynamic change, prognosis, recurrence

Xiaohua Wang,1,* Qingsong Lai,2,* Baoqing Zheng,1 Li Ye,1 Si Wen,1 Yunling Yan,1 Bin Yang,1 Mao-Qiang Man1 1Dermatology Hospital, Southern Medical University, Guangdong 510095, People’s Republic of China; 2Puning City Chronic Disease Prevention and Control Center, Guangdong 515300, People’s Republic of China*These authors contributed equally to this workCorrespondence: Mao-Qiang Man; Bin Yang Email mqman@hotmail.com; yangbin101@hotmail.comBackground/Aim: Although the characteristics of cutaneous sensory symptoms in the general population have been documented, dermatological condition-associated skin pain has not been characterized yet. In the present study, we aimed to characterize dermatological condition-associated skin pain in the Chinese.Subjects and Methods: A questionnaire was given to outpatients to identify self-proclaimed skin pain at our dermatology clinic. The severity of skin pain was assessed using pain scale 0– 10. Prevalence and pain severity were compared between males and females.Results: A total of 2144 patients, including 1254 females and 890 males aged 13– 94 years, were included in this study. The overall prevalence of skin pain was 9.93% in this cohort. The prevalence of skin pain varied greatly with dermatological conditions (p< 0.0001). Moreover, a higher prevalence of skin pain was observed in males than in females (p< 0.05). Among the dermatological conditions reported, higher skin pain scales were found in subjects with either glucocorticoid-induced dermatitis (4.20 ± 0.73) or herpes zoster (4.00 ± 0.29). While the overall pain scales were comparable between males and females (2.38 ± 0.13 versus 2.68 ± 0.13), pain scales in patients with eczematous dermatitis were higher in females than in males (p< 0.05). Furthermore, pain scales correlated positively with age. However, pain scales did not differ between subjects with versus without a family history of cutaneous sensory symptoms. These results demonstrate that the prevalence and severity of dermatological condition-associated skin pain vary with dermatological conditions and gender in the Chinese.Conclusion: Patients with some dermatological conditions may experience skin pain. Although the pain is moderate, it can negatively impact the quality of patients’ lives. Alleviation of skin pain should be considered when treating patients with certain dermatological conditions.Keywords: skin disorders, skin pain, gender, prevalence

Junhao Huang,1 Qinhao Lai,1 Dan Wang,1 Honggang Yin,1 Jingwen Liao,1 Shen Wang,1–3 Fengpeng Xu,1 Xiaohui Hou,2 Min Hu1 1Guangdong Provincial Key Laboratory of Sports and Health Promotion, Scientific Research Center, Guangzhou Sport University, Guangzhou, Guangdong, People’s Republic of China; 2Department of Sports and Health, Guangzhou Sport University, Guangzhou, Guangdong, People’s Republic of China; 3School of Kinesiology, Shanghai University of Sport, Shanghai, People’s Republic of ChinaCorrespondence: Min HuScientific Research Center, Guangzhou Sport University, 1268 Middle Guangzhou Avenue, Guangzhou 510500, People’s Republic of ChinaTel/fax +86-20-38027669Email whoomin@aliyun.comXiaohui HouDepartment of Sports and Health, Guangzhou Sport University, 1268 Middle Guangzhou Avenue, Guangzhou 510500, People’s Republic of ChinaTel +86-20-38025087Fax +86-20-38027669Email lilyhxh@163.comPurpose: This study aimed to assess the effects of exercise with dietary restriction on arterial stiffness, central hemodynamics, and cardiac autonomic function in obese adolescents.Patients and methods: Twenty-one obese adolescents completed a 6-week exercise and dietary program. Body composition and metabolic parameters were measured. Carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV) were used to assess central and systemic arterial stiffness, respectively. Using applanation tonometry, the analyses of central hemodynamic parameters [central blood pressure, heart rate (HR), augmentation index normalized at 75 bpm (AIx75), and subendocardial viability ratio (SEVR)] were performed. To determine cardiac autonomic function, heart rate variability (HRV) was analyzed by standard deviation of normal R–R intervals (SDNN), root mean square of successive R–R interval differences (RMSSD), percentage of successive R–R intervals that differed by >50 ms (pNN50), total power (TP), low-frequency (LF) and high-frequency (HF) power, and LF/HF ratio.Results: Following the intervention, obese adolescents had reductions in body mass index, body fat percentage, brachial systolic and diastolic blood pressure, and HR; and they had shown improvements in lipid profiles. There were reductions in both cfPWV and baPWV following the intervention. Moreover, there were reductions in AIx75, aortic systolic and diastolic blood pressure and an augmentation in SEVR after intervention. The intervention increased cardiac autonomic function (determined by increased SDNN, RMSSD, pNN50, HF, and reduced LF/HF). Furthermore, we observed a correlation between increased cardiac autonomic function (SDNN, RMSSD, pNN50 and HF) and increased central hemodynamics, as measured by SEVR and AIx75.Conclusion: Obese adolescents had increased central hemodynamics and autonomic function with reduced arterial stiffness after exercise and dietary restriction. Moreover, a positive correlation between an enhancement of cardiac autonomic function and an augmentation in central hemodynamics was found after the intervention.Keywords: obesity, adolescents, exercise, cardiac autonomic function, arterial stiffness, diet

Qiao Lai,1 Jiabao Wei,1 Mohammed Mahmoodurrahman,2 Chenxue Zhang,1 Shijian Quan,1 Tongming Li,1 Yang Yu11Department of Formulas of Traditional Chinese Medicine, School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People’s Republic of China; 2College of Medicine, Alfaisal University, Riyadh, Saudi ArabiaAbstract: Cyclosporine A (CsA) is a powerful immunosuppressive drug. However, nephrotoxicity resulting from its long-term usage has hampered its prolonged therapeutic usage. Schisandra chinensis extracts (SCE) have previously been used in traditional Chinese medicine and more recently coadministered with Western medicine for the treatment of CsA-induced side effects in the People’s Republic of China. This study aimed to investigate the possible effects of SCE on the pharmacokinetics of CsA in rats and elucidate the potential mechanisms by which it hinders the development of CsA-induced nephrotoxicity. A liquid chromatography/tandem mass spectrometry method was developed and validated for determining the effect of SCE on the pharmacokinetics of CsA. Male Sprague Dawley rats, which were administered with CsA (25 mg/kg/d) alone or in combination with SCE (54 mg/kg/d and 108 mg/kg/d) for 28 days, were used to evaluate the nephroprotective effects of SCE. Our study showed that SCE increased the mean blood concentration of CsA. Furthermore, we found that the concomitant administration of SCE alongside CsA prevented the disruption of catalase activity and reduction in creatinine, urea, renal malondialdehyde, and glutathione peroxidase levels that would have otherwise occurred in the absence of SCE administration. SCE treatment markedly suppressed the expression of 4-hydroxynonenal, Bcl-2-associated X protein, cleaved caspase 3, and autophagy-related protein LC3 A/B. On the other hand, the expression of heme oxygenase-1, nuclear factor erythroid 2-related factor 2 (Nrf2), and P-glycoprotein was enhanced by the very same addition of SCE. SCE was also able to increase the systemic exposure of CsA in rats. The renoprotective effects of SCE were thought to be mediated by its antiapoptotic and antioxidant abilities, which caused the attenuation of CsA-induced autophagic cell death. All in all, these findings suggest the prospective use of SCE as an effective adjunct in a CsA-based immunosuppressive regimen.Keywords: Schisandra chinensis extracts, cyclosporine A, pharmacokinetics, nephroprotective, oxidative stress, apoptosis, autophagy