BACKGROUND: While emotional distress, encompassing anxiety and depression, has been associated with negative clinical outcomes, its impact across various clinical departments and general hospitals has been less explored. Previous studies with limited sample sizes have examined the effectiveness of specific treatments (e.g., antidepressants) rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients. To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals, this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay (LOS) and rate of long LOS (LLOS, i.e., LOS >30 days) in a large sample of non-psychiatric inpatients. METHODS: This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital. They were divided, according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index (HEI) for brief screening with grading psychological services (BS-GPS), into BS-GPS ( n = 178,883) and non-BS-GPS ( n = 308,988) cohorts. The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression (CSAD, i.e., HEI score ≥11 on admission to the hospital) in the BS-GPS cohort were compared using univariable analyses, multilevel analyses, and/or propensity score-matched analyses, respectively. RESULTS: The detection rate of CSAD in the BS-GPS cohort varied from 2.64% (95% confidence interval [CI]: 2.49%-2.81%) to 20.50% (95% CI: 19.43%-21.62%) across the 20 departments, with a average rate of 5.36%. Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD (12.7 days, 535/9590) and without CSAD (9.5 days, 3800/169,293) and between the BS-GPS (9.6 days, 4335/178,883) and non-BS-GPS (10.8 days, 11,483/308,988) cohorts. These differences remained significant after controlling for confounders using propensity score-matched comparisons. A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge. CONCLUSION Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals. These impacts were moderated by the implementation of BS-GPS. Thus, BS-GPS has the potential as an effective, resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
Humans ; Retrospective Studies ; Male ; Length of Stay/statistics & numerical data* ; Female ; Middle Aged ; Adult ; Psychological Distress ; Inpatients/psychology* ; Aged ; Anxiety/diagnosis* ; Depression/diagnosis*

Acceleration of tooth movement during orthodontic treatment is challenging,with osteoclast-mediated bone resorption on the compressive side being the rate-limiting step.Recent studies have demonstrated that mechanoreceptors on the surface of monocytes/macrophages,especially adhesion G protein-coupled receptors(aGPCRs),play important roles in force sensing.However,its role in the regulation of osteoclast differentiation remains unclear.Herein,through single-cell analysis,we revealed that CD97,a novel mechanosensitive aGPCR,was expressed in macrophages.Compression upregulated CD97 expression and inhibited osteoclast differentiation;while knockdown of CD97 partially rescued osteoclast differentiation.It suggests that CD97 may be an important mechanosensitive receptor during osteoclast differentiation.RNA sequencing analysis showed that the Rap1a/ERK signalling pathway mediates the effects of CD97 on osteoclast differentiation under compression.Consistently,we clarified that administration of the Rap1a inhibitor GGTI298 increased osteoclast activity,thereby accelerating tooth movement.In conclusion,our results indicate that CD97 suppresses osteoclast differentiation through the Rap1a/ERK signalling pathway under orthodontic compressive force.

BACKGROUND:Irreducible femoral neck fracture was difficult to obtain anatomic reduction.As a new type of internal fixation,the femoral neck system is still blank for the treatment of non-anatomical reduced femoral neck fractures. OBJECTIVE:To explore the biomechanical stability of femoral neck system internal fixation under nonanatomical reduction in the treatment of femoral neck fractures based on finite element analysis. METHODS:CT data of the hip joint of a healthy female adult were obtained.Anatomical reduction of femoral neck fracture models with Pauwels angles of 30°,50°,and 70° were established using Mimics 21.0,Geomagic Wrap 2021,and SolidWorks 2020.The fracture proximal ends of the three anatomical reduction models were shifted upward by 2 mm along the fracture line,and three positive buttress models with different Pauwels angles were obtained.In the same way,three negative buttress models were acquired by shifting downward by 2 mm.SolidWorks 2020 was used to make the femoral neck system internal fixation,and the nine femoral neck fracture models were assembled with the femoral neck system.Then Ansys 19.0 was used for finite element analysis.The displacement distribution and maximum displacement,stress distribution and maximum stress of the femur and femoral neck system were recorded under 2100 N stress. RESULTS AND CONCLUSION:(1)When Pauwels angles were 30°,50°,and 70°,the maximum stresses of the femoral neck system appeared to be concentrated at the junction of the sliding hip screw and anti-rotation screw.The maximum femur stresses appeared to be concentrated in the medial cortex of the femur.The maximum displacement was concentrated at the upper of the femoral head and femoral neck system.(2)When Pauwels angles were 30° and 50°,the maximum displacement and maximum stress of the femoral neck system and femur were:negative buttress>anatomical reduction>positive buttress.(3)When Pauwels angle was 70°,the maximum displacement and maximum stress of the femoral neck system were:negative buttress>anatomical reduction>positive buttress;the maximum displacement and maximum stress of the femur were:negative buttress>positive buttress>anatomical reduction.(4)With the increase of Pauwels angle,the biomechanical advantage of the positive buttress was weakening.However,it was better than a negative buttress.When Pauwels angle was 30°,positive buttress was more stable than anatomical reduction.When Pauwels angle was 50°,the biomechanical difference between positive buttress and anatomical reduction became smaller.When Pauwels angle was 70°,the stability of anatomical reduction was slightly better than positive buttress.(5)If it was difficult to achieve anatomical reduction of femoral neck fracture during operation,but the positive buttress had been displaced within 2 mm,the femoral neck system could be used to offer stable mechanical fixation.It is necessary to avoid negative buttress reduction.

Background::Cardiovascular disease (CVD) has emerged as the leading cause of death from prostate cancer (PCa) in recent decades, bringing a great disease burden worldwide. Men with preexisting CVD have an increased risk for major adverse cardiovascular events when treated with androgen deprivation therapy (ADT). The present study aimed to explore the prevalence and risk evaluation of CVD among people with newly diagnosed PCa in China.Methods::Clinical data of newly diagnosed PCa patients were retrospectively collected from 34 centers in China from 2010 to 2022 through convenience sampling. CVD was defined as myocardial infarction, arrhythmia, heart failure, stroke, ischemic heart disease, and others. CVD risk was estimated by calculating Framingham risk scores (FRS). Patients were accordingly divided into low-, medium-, and high-risk groups. χ2 or Fisher’s exact test was used for comparison of categorical variables. Results::A total of 4253 patients were enrolled in the present study. A total of 27.0% (1147/4253) of patients had comorbid PCa and CVD, and 7.2% (307/4253) had two or more CVDs. The enrolled population was distributed in six regions of China, and approximately 71.0% (3019/4253) of patients lived in urban areas. With imaging and pathological evaluation, most PCa patients were diagnosed at an advanced stage, with 20.5% (871/4253) locally progressing and 20.5% (871/4253) showing metastasis. Most of them initiated prostatectomy (46.6%, 1983/4253) or regimens involving ADT therapy (45.7%, 1944/4253) for prostate cancer. In the present PCa cohort, 43.1% (1832/4253) of patients had hypertension, and half of them had poorly controlled blood pressure. With FRS stratification, as expected, a higher risk of CVD was related to aging and metabolic disturbance. However, we also found that patients with treatment involving ADT presented an originally higher risk of CVD than those without ADT. This was in accordance with clinical practice, i.e., aged patients or patients at advanced oncological stages were inclined to accept systematic integrative therapy instead of surgery. Among patients who underwent medical castration, only 4.0% (45/1118) received gonadotropin releasing hormone antagonists, in stark contrast to the grim situation of CVD prevalence and risk.Conclusions::PCa patients in China are diagnosed at an advanced stage. A heavy CVD burden was present at the initiation of treatment. Patients who accepted ADT-related therapy showed an original higher risk of CVD, but the awareness of cardiovascular protection was far from sufficient.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To summarize the experience in the treatment of giant neurofibromas.Methods:A retrospective analysis was performed on the clinical information of patients with giant neurofibromas who were admitted to the Department of Burn and Plastic Surgery, Yichang Central People’s Hospital from January 2019 to December 2022. Preoperative endovascular embolization was performed by interventional technique. Intraoperatively, the tumor was stripped while hemostasis was performed, and the tumor was completely removed radically. Depending on the type of wound, the wound was closed directly, or with the meshed full-thickness skin taken from the surface of the tumor. The vacuum sealing drainage dressing with a stable suction pressure of -150 - -250 mmHg(1 mmHg=0.133 kPa) was used. Then tumor recurrence, defect repair, and associated complications were observed and followed up.Results:A total of 4 patients were included, 2 males and 2 females, aged 43-56 years with an average age of 49.3 years. Two patients had previous resection surgery at other hospitals. The tumors in the four patients were situated in the left thigh, buttocks, left waist and left leg respectively, with volumes of 20 cm×10 cm×10 cm, 50 cm×20 cm×15 cm, 20 cm×15 cm×10 cm and 15 cm×10 cm×8 cm correspondingly. After resection of the tumor from the left thigh and leg, the wounds were closed directly. The mesh skin graft from the tumor on the buttock and left waist was used for wound after tumor resection. Following the surgery, the patient with a neurofibroma on the buttock was transferred to the intensive care unit due to excessive blood loss. The sinus tract was formed, but healed after several dressing changes. The vacuum sealing dressing and sutures were removed two weeks after the operation for other cases. The wounds healed well and during the six months to three years follow-up, no tumor recurrence, impairment of motor or sensory function was found.Conclusion:Surgical resection and plastic surgery techniques are effective in treating giant neurofibromas. Preoperative tumor embolization and complete removal of the tumor during surgery can significantly reduce the risk of bleeding. The wounds resulted from tumor resection can be directly closed or with meshed from skin grafts on the tumor surface. Vacuum sealing drainage can also promote wound healing.

Objective:To summarize the experience in the treatment of giant neurofibromas.Methods:A retrospective analysis was performed on the clinical information of patients with giant neurofibromas who were admitted to the Department of Burn and Plastic Surgery, Yichang Central People’s Hospital from January 2019 to December 2022. Preoperative endovascular embolization was performed by interventional technique. Intraoperatively, the tumor was stripped while hemostasis was performed, and the tumor was completely removed radically. Depending on the type of wound, the wound was closed directly, or with the meshed full-thickness skin taken from the surface of the tumor. The vacuum sealing drainage dressing with a stable suction pressure of -150 - -250 mmHg(1 mmHg=0.133 kPa) was used. Then tumor recurrence, defect repair, and associated complications were observed and followed up.Results:A total of 4 patients were included, 2 males and 2 females, aged 43-56 years with an average age of 49.3 years. Two patients had previous resection surgery at other hospitals. The tumors in the four patients were situated in the left thigh, buttocks, left waist and left leg respectively, with volumes of 20 cm×10 cm×10 cm, 50 cm×20 cm×15 cm, 20 cm×15 cm×10 cm and 15 cm×10 cm×8 cm correspondingly. After resection of the tumor from the left thigh and leg, the wounds were closed directly. The mesh skin graft from the tumor on the buttock and left waist was used for wound after tumor resection. Following the surgery, the patient with a neurofibroma on the buttock was transferred to the intensive care unit due to excessive blood loss. The sinus tract was formed, but healed after several dressing changes. The vacuum sealing dressing and sutures were removed two weeks after the operation for other cases. The wounds healed well and during the six months to three years follow-up, no tumor recurrence, impairment of motor or sensory function was found.Conclusion:Surgical resection and plastic surgery techniques are effective in treating giant neurofibromas. Preoperative tumor embolization and complete removal of the tumor during surgery can significantly reduce the risk of bleeding. The wounds resulted from tumor resection can be directly closed or with meshed from skin grafts on the tumor surface. Vacuum sealing drainage can also promote wound healing.

Objective:To investigate the effect of the pedicled pericranial flap in the treatment of chronic cerebrospinal fluid leakage.Methods:A retrospective analysis was conducted based on the clinical data of patients with cerebrospinal fluid leakage after craniocerebral surgery who were admitted to the First People’s Hospital of Yichang from April 2016 to October 2020. The necrotic tissues were thoroughly removed. The dural defects were repaired with pedicled pericranial flaps, and soft tissue defects were repaired with local flaps. The incision was covered with negative pressure closed drainage dressing, and negative pressure was maintained at -50 to -80 mmHg (1 mmHg=0.133 kPa). Cerebrospinal fluid leakage, defect repair, and related complications were observed in postoperative follow-up.Results:A total of five patients (three males and two females, aged 49-65 years) were included. All patients had postoperative composite tissue defects with local infection after craniocerebral surgery, lasting two months to 12 years. The size of the postoperative dural defect ranged from 1.5 cm × 2.0 cm to 2.5 cm × 3.0 cm. The size of the scalp soft tissue defect ranged from 2.0 cm × 2.0 cm to 3.0 cm × 6.0 cm. The size of the pericranial flap ranged from 2.0 cm × 3.0 cm to 3.0 cm × 3.5 cm, and the local flap ranged from 8.0 cm × 13.0 cm to 12.0 cm × 16.0 cm. The cerebrospinal fluid leakage was still observed in one patient at 5 d after the surgery and was treated with continuous lumbar pool puncture for cerebrospinal fluid drainage, which healed one week later. One patient suffered from poor healing of the flap incision, which healed after two weeks of outpatient dressing changing. At the postoperative follow-up of 3 to 17 months, none had any further cerebrospinal fluid leakage, and no other complications such as intracranial infection, loss of frontal lines, scalp numbness, and necrosis occurred.Conclusions:Repair of dural defects by pedicled pericranial flaps can treat chronic cerebrospinal fluid leakage with less damage to the donor site and fewer complications.

Objective:To investigate the effect of the pedicled pericranial flap in the treatment of chronic cerebrospinal fluid leakage.Methods:A retrospective analysis was conducted based on the clinical data of patients with cerebrospinal fluid leakage after craniocerebral surgery who were admitted to the First People’s Hospital of Yichang from April 2016 to October 2020. The necrotic tissues were thoroughly removed. The dural defects were repaired with pedicled pericranial flaps, and soft tissue defects were repaired with local flaps. The incision was covered with negative pressure closed drainage dressing, and negative pressure was maintained at -50 to -80 mmHg (1 mmHg=0.133 kPa). Cerebrospinal fluid leakage, defect repair, and related complications were observed in postoperative follow-up.Results:A total of five patients (three males and two females, aged 49-65 years) were included. All patients had postoperative composite tissue defects with local infection after craniocerebral surgery, lasting two months to 12 years. The size of the postoperative dural defect ranged from 1.5 cm × 2.0 cm to 2.5 cm × 3.0 cm. The size of the scalp soft tissue defect ranged from 2.0 cm × 2.0 cm to 3.0 cm × 6.0 cm. The size of the pericranial flap ranged from 2.0 cm × 3.0 cm to 3.0 cm × 3.5 cm, and the local flap ranged from 8.0 cm × 13.0 cm to 12.0 cm × 16.0 cm. The cerebrospinal fluid leakage was still observed in one patient at 5 d after the surgery and was treated with continuous lumbar pool puncture for cerebrospinal fluid drainage, which healed one week later. One patient suffered from poor healing of the flap incision, which healed after two weeks of outpatient dressing changing. At the postoperative follow-up of 3 to 17 months, none had any further cerebrospinal fluid leakage, and no other complications such as intracranial infection, loss of frontal lines, scalp numbness, and necrosis occurred.Conclusions:Repair of dural defects by pedicled pericranial flaps can treat chronic cerebrospinal fluid leakage with less damage to the donor site and fewer complications.

This article reported the diagnosis and treatment process of a patient with diffuse infiltrating venous malformation on right lower extremity, perineum and buttock. This is a 14 years old female patient, presented with painless dark blue mass on right perineum, buttock, thigh and leg, after birth. The right perineum lost its normal appearance and the right lower extremity was thicker than contralateral. Imaging examination suggested venous malformations of perineum, buttock and right lower extremity. Anhydrous ethanol combined with lauromacrogol was used to embolize the venous malformations by several times. The patient was satisfied with the treatment outcome, and there was recurrence within a year.