Serum cholinesterase as a new nutritional indicator for predicting weaning failure in patients.

Aim: The objective of this study is to examine the correlation between patient serum cholinesterase (SCHE) concentration and weaning failure in the context of invasive mechanical ventilation (IMV), as well as to identify predictors of ventilator weaning failure. Additionally, this study investigates the potential relationship between SCHE and nutritional risk for developing more effective weaning strategies. Method: A retrospective observational study was conducted. The sample was collected from 227 patients with IMV over 48 h who underwent SBT before weaning. Relevant experimental samples and data collection were analyzed at the time of patient admission and before the initiation of the SBT. The correlation between SCHE and weaning failure was determined by multifactorial logistic regression and propensity matching scores. Results: Weaning was successful in 127 patients and failed in 100 patients. Depending on the difficulty of weaning, 55 of these patients had difficulty in weaning and 45 had long-term weaning. In the crude cohort, experimental data collected on the day of SBT showed that SCHE concentrations were higher in patients with successful weaning than in those with failed weaning (4,514 u/l vs. 3,190 u/l p < 0.01). The critical value for predicting weaning failure was SCHE 3,228 u/l (p < 0.01). Ventilator weaning failure was predicted by multifactorial logistic regression analysis of SCHE, heart rate, and PaO2 before SBT, with SCHE predicting ventilator weaning failure (AUC 0.714; 95% CI 0.647-0.782) better than heart rate (AUC 0.618; 95% CI 0.545-0.690), PaO2 (AUC 0.59; 95% CI 0.515-0.664). After propensity-matched scores, SCHE remained an independent predictor of weaning failure (p = 0.05). And the SCHE concentration was strongly correlated with the patient's weaning difficulties (p < 0.01). The Nutrition Risk in Critically Ill (NUTRIC) score was also significantly correlated with SCHE according to Spearman's correlation analysis (p < 0.01). Conclusion: Our study revealed that the patients who experienced weaning failure exhibited lower SCHE values compared to those who successfully underwent weaning. Before spontaneous breathing trial (SBT), SCHE, heart rate, and PaO2 were identified as independent predictors of weaning failure. Following propensity score matching (PSM), SCHE and heart rate remained independent predictors. Patients with SCHE levels below 3,228 u/l should undergo careful evaluation before weaning. Our findings suggest that malnutrition may be a contributing factor to weaning failure in patients.

The role of estrogen receptor-beta gene +1730G/A polymorphisms in recurrent pregnancy loss: A protocol for systematic review and meta-analysis.

OBJECTIVE: To identify the role of estrogen receptor-beta (ER-ß) gene +1730G/A (rs4986938) polymorphisms in recurrent pregnancy loss (RPL). METHODS: All relevant case-control studies will be systematically searched in multiple databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Internet (CNKI), Wanfang and Cqvip. Both pooled odds rations (ORs) and 95% confidence intervals (CIs) will be used to assess the association between ER-ß gene +1730G/A polymorphisms and RPL risk. The publication bias will be evaluated using Egger test. RESULTS: ER-ß gene +1730G/A variation may be associated with a higher risk of RPL in Caucasian population. CONCLUSIONS: The findings of this meta-analysis will provide high-quality evidence for the association between ER-ß gene +1730G/A polymorphisms and RPL, facilitating clinical practice and further scientific studies. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/EW9FB.

Paraneoplastic pemphigus associated with small lymphocytic lymphoma: A case report.

INTRODUCTION: Paraneoplastic pemphigus (PNP) is a life-threatening autoimmune blistering disease associated with underlying neoplasms. Currently, this disease is very difficult to treat. PATIENT CONCERNS: We reported a rare case of paraneoplastic pemphigus associated with small lymphocytic lymphoma responsive to desmoglein 3 (Dsg3) and bullous pemphigoid (BP) antigen 180. DIAGNOSES: The initial diagnosis was hypothesized to be Stevens-Johnson syndrome based on the severe mucosal erosion and polymorphous skin lesions. However, the histopathological examination of the skin biopsy and immunology revealed PNP. INTERVENTIONS: Anti-tumor therapy, immunosuppression and anti-infective therapy were administered. OUTCOMES: After a series of treatments, the skin lesions had been alleviated remarkably. Enzyme-linked immunoassays indices for Dsg3 and bullous pemphigoid antigen 180 decreased (Dsg3, 32; bullous pemphigoid antigen 180, 70.44). Unfortunately, 2 months later, the patient suffered respiratory failure due to the lung impairment of small lymphocytic lymphoma and infection. Eventually, the patient chose to be discharged from the hospital and lost the opportunity for follow-up treatment as he could not afford the expensive treatment costs. LESSONS: It is highly susceptible to misdiagnosis due to polymorphous skin lesions. In this case, it was also initially misdiagnosed as Stevens-Johnson syndrome. Therefore, we should pay great attention to differential diagnosis. When refractory stomatitis and mucosal erosions occur, the possibility of PNP should be considered first. At the same time, pathology, immunology and other related tests as well as the examination of primary tumors should be carried out as soon as possible.

[Observation on therapeutic effect of acupoint injection desensitization with autoblood on chronic urticaria].

OBJECTIVE: To compare the effect of acupoint injection desensitization with autoblood and routine combined therapy for treatment of chronic urticaria. METHODS: Two hundred patients with chronic urticaria were randomly divided into an acupoint injection with autoblood (AJA) group and a medicine group, 100 cases in each group. The AJA group was treated by acupoint injection desensitization with autoblood and Dazhui (GV 14), Fengfu (GV 16), Feishu (BL 13), Neiguan (PC 6) and etc. were selected, 3-5 acupoints each time, once every three days, 30 days for a course. The therapeutic effect was assessed after one course. The medicine group was treated with external application of Dexamethasone Acetate cream, twice a day, and oral administration of Setastine Hydrochloride, twice a day, 1 mg each time and the treatment duration was the same as that in the AJA group. RESULTS: The clinical cured rate was 66.0% (66/100) in the AJA group, which was superior to that of 0 (0/100) in the medicine group (P < 0.05). CONCLUSION: The acupoint injection desensitization with autoblood has obvious therapeutic effect on chronic urticaria with no apparent dependence and rebound problem.