Asymmetric longitudinal links between learning anxiety and engagement in Chinese primary school students: The role of peer relationship.

Cirrhosis is a major global health burden, leading to significant morbidity and mortality, primarily through its complications such as ascites, variceal hemorrhage, and hepatic encephalopathy (HE).[] Spontaneous bacterial peritonitis (SBP), an infection of the ascitic fluid without an evident intra-abdominal source, is one of the most severe complications in patients with advanced cirrhosis, occurring in 10%–30% of hospitalized patients with ascites and carrying an in-hospital mortality rate approaching 30%.[] The pathogenesis of SBP is primarily attributed to bacterial translocation from the gut lumen. Alterations in the gut microbiota, increased intestinal permeability, and impaired systemic and local host defenses create a permissive environment for bacteria, predominantly gram-negative bacilli, to cross the intestinal barrier, enter the mesenteric lymph nodes, and subsequently seed the ascitic fluid.[] The cornerstone of SBP diagnosis is a timely diagnostic paracentesis followed by ascitic fluid analysis. The current standard test is an ascitic fluid polymorphonuclear (PMN) neutrophil count of ≥250 cells/mm.[] While this criterion is well-established, it is not without limitations. The procedure is invasive, carrying risks of bleeding, infection, and bowel perforation. Manual cell counting is subject to significant inter- and intra-observer variability, and automated counters can be inaccurate at low cell counts.[] Furthermore, ascitic fluid culture, which could identify the causative organism and guide therapy, has a low yield, with up to 60% of cases being culture-negative neutrocytic ascites.[] These diagnostic delays and uncertainties can impede the timely initiation of appropriate antibiotic therapy, which is critical for improving patient outcomes.