PURPOSE: To analyze risk factors for severe trauma and establish a nomogram for early risk prediction, to improve the early identification of severe trauma. METHODS: This study was conducted on the patients treated in 81 trauma treatment institutions in Gansu province from 2020 to 2022. Patients were grouped by year, with 5364 patients from 2020 to 2021 as the training set and 1094 newly admitted patients in 2020 as the external validation set. Based on the injury severity score (ISS), patients in the training set were classified into 2 subgroups of the severe trauma group (n = 478, ISS scores ≥25) and the non-severe trauma group (n = 4886, ISS scores <25). Univariate and binary logistic regression analyses were employed to identify independent risk factors for severe trauma. Subsequently, a predictive model was developed using the R software environment. Furthermore, the model was subjected to internal and external validation via the Hosmer-Lemeshow test and receiver operating characteristic curve analysis. RESULTS: In total, 6458 trauma patients were included in this study. Initially, this study identified several independent risk factors for severe trauma, including multiple traumatic injuries (polytrauma), external hemorrhage, elevated shock index, elevated respiratory rate, decreased peripheral oxygen saturation, and decreased Glasgow coma scale score (all p < 0.05). For internal validation, the area under the receiver operating characteristic curve was 0.914, with the sensitivity and specificity of 88.4% and 87.6%, respectively; while for external validation, the area under the receiver operating characteristic curve was 0.936, with the sensitivity and specificity of 84.6% and 93.7%, respectively. In addition, a good model fitting was observed through the Hosmer-Lemeshow test and calibration curve analysis (p > 0.05). CONCLUSION This study establishes a nomogram for early risk prediction of severe trauma, which is suitable for primary healthcare institutions in underdeveloped western China. It facilitates early triage and quantitative assessment of trauma severity by clinicians prior to clinical interventions.
Humans ; Nomograms ; Male ; Female ; Wounds and Injuries/diagnosis* ; Risk Factors ; Middle Aged ; Adult ; Injury Severity Score ; Risk Assessment ; ROC Curve ; Aged ; Logistic Models ; China ; Glasgow Coma Scale

Objective:To analyze the value of minute ventilation to carbon dioxide production slope (VE/VCO 2 slope) combined with peak systolic blood pressure (SBP) in predicting prognosis for patients with chronic heart failure (CHF). Methods:A total of 170 patients with CHF who visited the Cardiac Rehabilitation Center of Tongji Hospital Affiliated to Tongji University and completed cardiopulmonary exercise test from March 2007 to December 2018 were enrolled in the study. The clinical data, cardiopulmonary exercise testing results and follow-up information of patients were collected to explore the predictors of all-cause mortality in patients with CHF.Results:The median follow-up time was 647 (182-1 764) days. All-cause death occurred in 34 patients. Compared with surviving patients, the proportion of diabetes and angiotensin-converting enzyme inhibitor/angiotensin Ⅱ receptor blocker (ACEI/ARB) use in fatal patients was significantly higher ( P<0.01). The VE/VCO 2 slope and peak SBP*VE/VCO 2 in the fatal patients were significantly higher, and the peak oxygen consumption (peak VO 2) was lower than those in the surviving patients ( P<0.01). The areas under the receiver operating characteristic curve (AUC) of VE/VCO 2 slope and peak SBP*VE/VCO 2 in predicting all-cause mortality in patients with CHF were 0.648 ( P=0.008) and 0.681 ( P=0.001), respectively; the optimal thresholds were >40.95 ( P=0.008) and > 5 423.50 mmHg (1 mmHg=0.133 kPa, P=0.006), the sensitivity was 0.559 and 0.588, and the specificity was 0.728 and 0.735, respectively. Multivariate Cox regression analysis showed that after adjusting for age, gender, diabetes and ACEI/ARB use, VE/VCO 2 slope ( HR=2.12, P=0.036) and peak SBP*VE/VCO 2 ( HR=2.42, P=0.016) were independent risk factors for all-cause mortality in patients with CHF. Conclusion:Compared to the traditional index VE/VCO 2 slope, a novel index peak SBP* VE/VCO 2 provides a relatively better predictive value for all-cause death of CHF patients.

Objective To compare the clinical efficacy and safety of carbon dioxide (CO2) versus high-frequency electroacupuncture based on the assistance of drilling and blunt dissection in the treatment of steatocystoma multiplex.Methods A randomized,self-controlled study was performed in 15 patients.The median line of the body served as the dividing line,and the lesions on the two sides of the median line of the body were randomly divided into 2 groups to be treated with CO2 laser or high-frequency electroacupuncture,which left micropathways into the cyst cavity.After the above treatment,contents in the cysts were squeezed out or drawn out with a mosquito clamp,and the cysts were bluntly dissected.The decrustation time,erythema subsiding time,adverse reactions and recurrence were compared among lesions at different sites or with different sizes.Results For the lesions at the same sites or with similar sizes after treatment,the decrustation time and erythema subsiding time were both significantly shorter in the CO2 laser group than in the high-frequency electroacupuncture group (both P ＜ 0.05).There were significant differences in the decrustation time and erythema subsiding time among lesions at different sites or with different sizes (all P ＜ 0.05).Mild pain occurred in the 2 groups,and no hematoma or secondary infection occurred.There were significant differences in the incidence of scar formation or pigmentation between the 2 groups (both P ＜ 0.05).During the follow-up of 6-18 months,relapse occurred in 1 patient in each group.Conclusion Compared with the high-frequency electroacupuncture,CO2 laser assisted by drilling and blunt dissection shows better efficacy in the treatment of steatocystoma multiplex,and it can remove lesions at various sites at one time.

Objective To research the running status of dual-referral in a township of Dongguan city.Methods Hospitals and community health service centers in C town were selected as the research sites.The dual-referral system implementation situatidn in local area was understood by the questionnaire survey on the patients and medical personnel.Results About 44.4％ of patients understood the dual-referral system in local region.However,82.1％ of patients had no the dual-referral experience.The majority of doctors had the experience of upward referral patients and downward referral patients,but their number only accounted for below 10.0 ％ of diagnosis and treatment patients.When the proportion of community reimbursement increased by 20.0％,for the question of whether or not to go to the community first,57.6 ％ of patients expressed willingness,32.7 ％ of patients expressed unwillingness,and 9.7 ％ of patients expressed no influence on own willingness.Conclusion The understand degree of the patients in C township on dual-referral is in the low side.The links of upward transfer and downward transfer of dual referral are insufficient smooth.

Objective To investigate the clinical application value of the real-time shear wave elastography (SWE)technology in the curative evaluation on Hashimoto′s thyroiditis(HT)patients treated with prednisone. Methods Applying SWE technology to determine the Young′s modulus value of thyroid tissue of 45 HT cases with subclinical hypothyroidism before and one month after treatment. Results 1 month after prednisone treat-ment,the Young′s modulus value and serum thyroid stimulating hormone(TSH),thyroid-peroxidase antibody (TPOAb)and thyroglobulin antibody(TGAb)were observed significantly changed before and one month after treatment(P < 0.05,respectively). The various modulus value was found reduced with different degrees,but the serum TSH was shown back to normal after the treatment with prednisone. Conclusions By quantitative determi-nation of Young′s modulus value,the hardness of organization information was obtained objectively,which could provide more meaningful reference basis to evaluate the treatment of prednisone for HT.

Objective: To compare the efifcacy and safety of sirolimus-eluting stent (SES) and everolimus-eluting stent (EES) for treating the patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Methods: A total of 400 NSTE-ACS patients treated in Jining Medical College Hospital from 2013-09 to 2014-09 were studied. According to different stents, the patients were divided into 2 groups: SES group,n=220 and EES group,n=180. A prospective follow-up study was conducted for 1.5 years to compare the incidence rate of major adverse cardiovascular events (MACE). The patients were further stratiifed by GRACE scores as Low risk group (score<109), Medium risk group (score 109-140) and High risk group (score>140). MACE free survival was studied by Kaplan-Meier curve and analyzed by Long-rank test, predictive value of GRACE for 1.5 year MACE incidence rate was examined. Results: There were 355/400 (89%) patients completed (16.7 ± 5.7) months of follow-up study including 205 in SES group and 150 in EES group. MACE occurrence rates were similar between SES group and EES group (16.10% vs 18.0%), P>0.05. By GRACE score stratiifcation, MACE rates in High risk SES group were higher than High risk EES group (48.00%vs 16.00%),P<0.05; while they were similar between Medium risk groups (14.49% vs 28.00%) and Low risk groups (9.11% vs 12.86%), allP>0.05. ROC curve indicated that the predictive value of GRACE score for 1.5 year MACE incidence was for AUC=0.762, 95% CI (1.026-1.050),P<0.001. Conclusion: Implanting of EES would be more beneifcial for NSTE-ACS patients with high GRACE risk; GRACE score has the better predictive value for their long-term prognosis.

Objective To dynamically observe and evaluate the position and movement of anterior pelvic floor organs in vaginal delivery and selective caesarean section primipara with translabial two-dimensional 2D ultrasound and discuss the short-term effect of delivery mode on the anterior compartment of pelvic floor Methods Translabial 2D ultrasound was performed on selective caesarean section and vaginal delivery primipara in 6-8 weeks The position of bladder the existence of bladder neck funneling were observed and the mobility of bladder neck and the urethral rotation angle were measured during maximum Valsalva maneuver Results The mobility of bladder neck was larger in vaginal delivery group than selective caesarean section group during maximum Valsalva maneuver The rates of bladder neck funneling cystocele and stress urinary incontinence were higher in vaginal delivery group Conclusions Translabial 2D ultrasound could dynamically observe and evaluate the position and movement of anterior pelvic floor organ which could be used to assess the effect of delivery mode on anterior compartment of pelvic floor The short-term effect of vaginal delivery on anterior compartment of pelvic floor is greater than that of selective cesarean delivery.

Objective To analyze the willingness and influencing factors for usage of pre-exposure prophylaxis(PrEP) among male students who have sex with men (MSM) in universities of Guangxi. Meth-ods 295 MSM students in universities were recruited by Snow-balling methods. Questionnaires were self-administered to collect social demographic information,AIDS related risky sexual behaviors and willingness for usage of PrEP. Logistic regression was employed for univariate and multivariate analysis. Results Of the 295 MSM,58(19.7%)had ever heard PrEP,265(89.8%) said that they would like to use PrEP. Multivari-ate logistic regression analysis showed that those who had found partners through friends ( OR=11.419,95%CI:1.363~95.641), those who would advise his friend to use PrEP ( OR=87.946,95%CI:13.660-566. 222),those who concerned the convenience to gain the medicine ( OR=119.652,95%CI:3.765-3802.184) and those who said that they could take medicine every day ( OR=88.245,95%CI:10.237-760.696) were more likely to accept PrEP. The subjects whose partners would be angry if they stick to use condoms( OR=0.106,95%CI:0.019-0.606),and those who suspected the effectiveness of drugs( OR=0.010,95%CI:0. 001-0.112) were less likely to accept PrEP. Conclusion The acceptability of PrEP is high in university students'MSM. The safety of drugs and the convenience to gain the medicine are the main influencing factors for usage of PrEP.Using of PrEP should be strengthened to the MSM.

Objective To investigate the pelvic floor in cystocele patients using translabial ultrasound,and discuss the ultrasound appearance.Methods Translabial 2D ultrasound was performed on 136 patients who were diagnosed or suspected as anterior vaginal wall prolapse or cystocele using pelvic organ prolapse quantitation system,the position of bladder,the retrovesical angle and urethral rotation were measured during maximum Valsalva maneuver.Cystocele subtypes were diagnosed according to the ultrasound findings.Results Translabial 2D ultrasound diagnosed 88 cases cystocele based on the position of bladder,retrovesical angle and urethral rotation,including ten cases cystocele type Ⅰ,32 cases type Ⅱ and the remaining 46 classified as type Ⅲ.Conclusions Translabial 2D ultrasound successfully acquired the ultrasonic characteristics of cystocele subtypes,which could provide imaging evidence for clinic diagnosis of this disease.

Objective: To clarify the predictive value for long-term prognosis of GRACE score and SYNTAX score in patients with non-ST elevation acute coronary syndrome (NSTE-ACS).
Methods: A total of 784 NSTE-ACS patients treated in our hospital from 2009-01 to 2014-01 were retrospectively studied. According to the treatment, the patients were divided into 3 groups: Medication group,n=410, Stent group,n=325 and CABG group,n=49. Based on 2 scoring systems, the patients were divided into another 3 groups: Low risk group, Medium risk group and High-risk group. The relationship between GRACE score and SYNTAX score was studied by Pearson correlation analysis, survival analysis was conducted by Kaplan-Meier method, univariate and multivariate analysis were performed by Cox proportional hazard model, and the area under curve (AUC) of ROC analysis was used to compare two methods.
Results: All 784 patients completed the follow-up study at the median of 47.7 months. Pearson correlation analysis showed that there was a weak positive correlation between GRACE score and SYNTAX score (r=0.40,P<0.01). Survival analysis presented that by GRACE score system, the MACE occurrence rates in Low risk group, Medium risk group and High-risk group were elevated accordingly as 13.81%, 23.64% and 36.55% respectively. And by SYNTAX system, MACE occurrence rates in Medium risk group and High-risk group were 39.29% and 37.93%, which were both higher than that in Low risk group (23.99%), while the scores between Medium and High risk groups were similar,P>0.05. Cox proportional hazard model and ROC analysis indicated that GRACE and SYNTAX scores had the important predictive value for lone term prognosis of NSTE-ACS. ROC analysis of GRACE score, SYNTAX score, the combination of GRACE and SYNTAX scores showed that 3 of them all had good predictive value for MACE occurrence, three of 95% CI had signiifcant overlapping without statistic differences.
Conclusion: GRACE score and SYNTAX score are related, both of them have important while similar predictive value for long term prognosis in NSTE-ACS patients, the combination of 2 scores cannot increase the predictive value. GRACE score is appropriate for the risk stratiifcation in NSTE-ACS patients.