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*

ObjectiveTo investigate the application value of liver/spleen CT value （CT_L/S）， controlled attenuation parameter （CAP）， and magnetic resonance imaging-proton density fat fraction （MRI-PDFF） in chronic hepatitis B （CHB） patients with hepatic steatosis. MethodsA retrospective analysis was performed for the clinical data of 213 CHB patients who underwent liver CT， CAP， and MRI-PDFF examinations in Affiliated Hospital of Yan’an University from October 2018 to December 2022. According to MRI-PDFF， the 213 patients were divided into CHB group with 111 patients （MRI-PDFF<5%） and CHB+hepatic steatosis group with 102 patients （MRI-PDFF≥5%）， among whom there were 69 patients with mild hepatic steatosis and 33 patients with moderate to severe hepatic steatosis. The independent-samples t test was used for comparison of normally distributed continuous data between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The Bland-Altman plot was used to evaluate the consistency in MRI-PDFF measurement between two physicians. The Spearman’s correlation coefficient was used to analyze the correlation between CT_L/S and MRI-PDFF and between CAP and MRI-PDFF. The receiver operating characteristic （ROC） curve was plotted and the area under the ROC curve （AUC） was calculated to investigate the value of CT_L/S and CAP in the diagnosis of different degrees of hepatic steatosis， and the DeLong test was used to compare the AUCs of the two radiological examinations. ResultsMRI-PDFF had relatively high repeatability and stability in CHB patients. There is a significant negative correlation between CT_L/S and MRI-PDFF （r=-0.800， P<0.001） and a significant positive correlation between CAP and MRI-PDFF （r=0.692， P<0.001）. Both CT_L/S and CAP had a relatively high accuracy in the diagnosis of hepatic steatosis in CHB patients， with an AUC of 0.951 and 0.902， respectively， and CT_L/S had a better accuracy than CAP （P<0.05）. In the diagnosis of mild and moderate-to-severe hepatic steatosis， CT_L/S had an AUC of 0.921 and 0.895， respectively， and CAP had an AUC of 0.859 and 0.825， respectively， suggesting that CT_L/S had a slightly higher diagnostic efficiency than CAP. ConclusionMRI-PDFF has high repeatability and stability in CHB patients， and CT_L/S and CAP have a high diagnostic value for different degrees of hepatic steatosis in CHB patients.

Glioma is the most common primary central nervous system tumor,mainly derived from glial cells,with strong invasiveness,easy recurrence,and poor prognosis.Glioblastoma is a high-grade glioma with the highest degree of malignancy.The clinical treatment method is mainly surgical resection,supplemented by compre-hensive treatment such as radiotherapy,chemotherapy,and electric field therapy,but the treatment effect is not satisfactory.In recent years,with the rapid development of the field of tumor immunotherapy,CD73 is a novel immune checkpoint related to adenosine metabolism,which can promote tumor progression by inhibiting anti-tumor immune responses and promoting angiogenesis.This article systematically reviews the mechanism of action of CD73 and discusses its biological role and application in glioma,aiming to provide potential treatment options for glioma patients.

Objective To investigate the value of computer-assisted quantification of pulmonary embolism volume(PEV)in identifying mild-to-high-risk acute pulmonary embolism(APE).Methods We retrospectively enrolled 143 patients with suspected APE confirmed by computed tomography pulmonary angiography(CTPA)at Yan'an University Affiliated Hospital from January 2017 to December 2020.According to the 2018 Chinese Guidelines for Diagnosis,Treatment and Prevention of Pulmonary Thromboembolism,all the patients were divided into low-risk group(n=88)and mild-to-high-risk group(n=55).We collected the patients'basic demographic data,clinical manifestations,and serum levels of N-terminal-B type natriuretic peptide precursor(NT-proBNP)and D-dimer.Based on CTPA images,the degree of pulmonary thromboembolism was artificially evaluated to obtain the pulmonary artery occlusion index(PAOI).The thrombus was segmented using the pulmonary embolism detection tool based on digital lung,and PEV was calculated.We compared the differences in clinical and laboratory indicators and PAOI and PEV between the two risk groups.We analyzed the value of PAOI and PEV in identifying mild-to-high-risk APE using receiver operating characteristic(ROC)curves,and used Logistic regression analysis to identify independent risk factors in predicting mild-to-high-risk APE.Different models were established.Results Compared with the low-risk group,APE patients in the mild-to-high-risk group were older(P＜0.05),had lower diastolic blood pressure(P＜0.05),higher levels of D-dimer and NT-proBNP(P＜0.05),lower levels of platelet count,arterial oxygen partial pressure and arterial carbon dioxide partial pressure(P＜0.05),and higher levels of PAOI and PEV(P＜0.001).ROC curve analysis showed that the area under the curve for PEV in identifying mild-to-high-risk APE was 0.809(95％CI:0.734-0.884),while that for PAOI was 0.753(95％CI:0.667-0.839).Logistic regression analysis showed that PEV and NT-proBNP were independent risk factors for mild-to-high-risk APE(P＜0.05).Conclusion PEV and NT-proBNP are independent risk factors for mild-to-high-risk APE.

Objective:To explore the effective indicators that can predict the poor prognosis of neonates with congenital heart disease after surgery.Methods:178 cases of neonatal congenital heart disease were retrospectively analyzed. According to the outcome, they were divided into normal prognosis group (132 cases) and poor prognosis group (46 cases).Results:15 (8.4%) patients died in hospital. There were statistical differences between the two groups in terms of whether PGE and vasoactive drugs were needed before surgery, preoperative respiratory support mode, blood lactate level from anesthesia induction to 24 h after surgery, VIS and VVR scores, whether delayed sternal closure or peritoneal dialysis were needed ( P<0.05). Logistic regression analysis showed that elevated lactate levels and VVR scores on 24 h after surgery were independent risk factors for death or other poor postoperative prognosis in neonates ( P<0.05). Conclusion:The levels of lactate and VVR scores in 24 h after operation are sensitive indicators for monitoring the severity of the condition, guiding treatment and judging prognosis of neonatal congenital heart disease surgery.

Objective To investigate the influence of different cell structures on the static and dynamic mechanical performance of porous titanium alloy scaffolds,and to provide a theoretical mechanical basis for the application of scaffolds in the repair of mandibular bone defects.Methods Porous titanium alloy scaffolds with diamond,cubic,and cross-sectional cubic cell structures were manufactured using three-dimensional printing technology.Uniaxial compression tests and ratcheting fatigue with compression load tests were conducted to analyze the static and dynamic mechanical performances of scaffolds with different cell structures.Results The elastic moduli of the diamond cell,cross-sectional cubic cell,and cubic cell scaffolds were 1.17,0.566,and 0.322 GPa,respectively,and the yield strengths were 71.8,65.1,and 31.8 MPa,respectively.After reaching the stable stage,the ratcheting strains of the cross-sectional cubic,diamond,and cubic cell scaffolds were 3.3%,4.0%,and 4.5%,respectively.The ratcheting strain increased with increasing average stress,stress amplitude,and peak holding time,and decreased with increasing loading rate.Conclusions The evaluation results of the static mechanical performance showed that the diamond cell scaffold was the best,followed by the cross-sectional cubic cell scaffold and the cubic cell scaffold.The evaluation results of the dynamic mechanical performance showed that the cross-sectional cubic cell scaffold performed the best,followed by the diamond cell scaffold,whereas the cubic cell scaffold performed the worst.The fatigue performance of the scaffold is affected by the loading conditions.These results provide new insights for scaffold construction for the repair of mandibular bone defects and provide an experimental basis for further clinical applications of this scaffold technology.

An efficient vacuum suction system is a necessary prerequisite for the smooth operation of the oral diagnosis and treatment.During the use of the dental units,there is often a situation of vacuum suction weakness,resulting in the inability to discharge the mixture of blood,saliva,dental tissue and other mixtures in time,which affects the doctor's treatment field and increases the risk of aspiration pneumonia and cross-infection in patients.The working principle,pipeline system,filters and other aspects of the vacuum suction system that may affect the suction efficiency was analyzed.The causes and solutions of vacuum suction weakness were discussed,and operation suggestions were proposed to ensure the safe and effective use of equipment and ensure the safety of diagnosis and treatment.

Objective:To compare the medium and long-term efficacy between the deltoid split approach and the conventional deltopectoral approach in locking plate fixation for proximal humerus fractures.Methods:A retrospective study was performed in the 65 patients with proximal humerus fracture who had been operatively treated at Department of Orthopedics, The Third People's Hospital of Nantong from January 2018 to December 2020. They were 20 males and 45 females with an age of (64.6±9.2) years. Of them, 34 were assigned to fixation with proximal humerus internal locking system (PHILOS) through the deltoid split approach (minimally invasive group), and 31 to PHILOS fixation through the deltopectoral approach (conventional group). The 2 groups were compared in terms of general data, operation time, intraoperative blood loss, hospital stay, fracture union time, intraoperative fluoroscopy, postoperative 2-year imaging scores, and Constant-Murley shoulder score at the last follow-up.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). In the minimally invasive group and the conventional group, respectively, the intraoperative blood loss was (97.9±16.6) mL and (155.8±27.4) mL, and the frequency of intraoperative fluoroscopy (12.0±1.8) times and (6.7±1.8) times, both showing a statistically significant difference ( P<0.05). There was no significant difference in operation time, hospital stay, or fracture union time ( P>0.05). All patients were followed up for (43.9±5.5) months. There was no statistically significant difference between the 2 groups in postoperative 2-year imaging scores ( P>0.05). Compared with the conventional group, patients in the minimally invasive group had significantly lower Constant-Murley strength scores and significantly lower Constant-Murley scores for the Neer four-part fractures ( P<0.05). Postoperatively, one case of screw protrusion and one case of complete ischemic necrosis occurred in both groups while one case of partial ischemic necrosis was observed in the minimally invasive group and 3 cases of partial ischemic necrosis were observed in the conventional group. Conclusions:In locking plate fixation for proximal humerus fractures, compared with the deltopectoral approach, the deltoid split approach shows advantages of less soft tissue damage, less intraoperative bleeding, and less destruction of the blood supply to the humeral head. However, the deltopectoral approach may be more appropriate for the Neer four-part fractures.

Objective Developing a new type of full-face respiratory protective mask for nuclear facility sites to enhance the sound transmission function and improve the facial adaptability. Methods Combined with feedback from on-site practical needs, this study utilized finite element simulation and ergonomic design methods to investigate the voice transmission units of full-face masks and the facial features of workers at key nuclear facilities. Based on the research results, a new full-face respiratory protection mask structure was designed. Results The optimized structure of passive thin film voice transmission unit significantly enhanced voice transmission efficiency, reducing average voice transmission loss by approximately 70% compared to the control group using thin plate units of equivalent thickness. The existing facial feature test panels insufficiently cover and unevenly classify the facial features of workers at key nuclear facilities. In this study, a specialized test panel based on measurement data achieved a total coverage of 98.5% with high distribution uniformity within each class, providing effective guidance for redesigning full-face mask structural parameters. In comparison to foreign products currently utilized in nuclear facilities, the newly designed full-face mask structure exhibited excellent tightness and structural safety and reliability, and can be cleaned, decontaminated, and reused. Conclusion The results of this study provide significant guidance for improving and optimizing full-face respiratory protection mask used at nuclear facilities, as well as promoting domestic production of high-quality full-face respiratory protection masks.

Objective To investigate the effects of remimazolam and propofol on postoperative nausea and vomiting(PONV)in patients undergoing painless prostate biopsy,so as to optimize the anesthesia protocols.Methods A retrospective analysis was conducted on the clinical data of 1217 patients who underwent painless prostate biopsy in our hospital during Jan.2023 and Jun.2024.Among them,1093 patients met the inclusion criteria and were divided into two groups:the remimazolam group(n=294)and the propofol group(n=799).After 1∶1 propensity score matching,with 267 patients in either group,a comparison was conducted regarding the incidence of PONV and anesthesia recovery time.Results Before propensity score matching,the remimazolam group had older age[66(53,83)years vs.63(49,78)years],higher body mass index(BMI)[25.30(21.83,29.23)vs.24.46(20.79,28.91)],larger intraoperative use of sufentanil[9(8,10)μg vs.7(6,9)μg],higher intraoperative use rate of ondansetron(55.4％vs.47.6％),and longer surgical duration[16(14,20)min vs.15(13,17)min],with statistically significant differences(P＜0.05).There were no statistically significant differences in the aforementioned factors between the two groups after propensity score matching(P＞0.05).Before propensity score matching,the incidence of PONV was higher in the remimazolam group than in the propofol group(17.7％vs.11.5％,P=0.007),while after propensity score matching,the incidence of PONV did not differ significantly between the two groups(12.7％vs.17.2％,P=0.146).Before and after propensity score matching,the anesthesia recovery time was significantly shorter in the remimazolam group than in the propofol group[3(2,4)min vs.7(4,10)min,P＜0.001].Conclusion Compared with propofol,remimazolam does not increase the incidence of PONV in patients undergoing painless prostate biopsy but can shorten anesthesia recovery time.