ObjectiveTo determine the influence of buspirone on sexual function and plasma prolactin in rehabilitative female major depressive patients.MethodsThe female major depressive patients,who had a total HAMD-17 less than 7,were living with a sexual partner and receiving SSRI antidepressant monotherapy for at least six months were recruited.Sexual dysfunction (SD) was assessed using the Arizona Sexual Experience Scale (ASEX).The patients with SD were treated with buspirone 15 ～ 30 mg by 4 weeks.Sexua function and blood samples were compared among the control,non-SD patients,and the SD patients before or after treating with buspirone.The clinical risk factor of SD was also investigated with correlation analysis.ResultsThe general incidence of SD in rehabilitative female major depressive patients was 33.3％.The improvement rate of SD was 60％ after the treatment of buspirone.The ASEX score and it 5 items were significantly decreased in the depressive patients after the treatment of buspirone (P ＜ 0.01 ).Prolactin in subjects treated with buspirone ( ( 20.38 ± 11.91 )ng/ml) was significantly higher than control ( ( 14.2 ± 12.15 ) ng/ml),but not higher than the period prior to treatment with buspirone ( ( 18.15 ±9.84) ng/ml).The ASEX score was significantly correlated the dose of fluoxetine( r=0.504,P=0.002) and paroxetine ( r=0.377,P=0.013).There was no significantly correlation between ASEX score and prolactin in the control,non-SD patients,and the patients before or after treating with buspirone.ConclusionBuspirone can release sexual dysfunction induced by SSRI antideptressant in the depressive patients.

Objective To investigate CT findings of polymyositis(PM) in musculus and the applied value of CT.Methods 20 cases of PM confirmed by pathology and undergone CT scan,including waist,back,gluteus thighs and calfs.Above of these gluteus,thighs and calfs were observed groupingly.The observed contents included :muscle density;muscle volume;changes of delecting myofascitis lesions;clear degree of musculature and thickness of subcutaneous fattiness.Results CT findings included amyotrophy in 15 groups;muscle density lower and muscle fat in 53 groups;thickened fascia in 18 groups;subcutaneous fat thickened in 23 groups and musculus indistinet in 3 groups.Conclusion CT can help display the degree and distribution of lesions,and the accurate localization for biopsies in myofascitis.

Objective To investigate the analgesic effect of ultrasound-guided vertical spinal block (ESPB) in elderly patients after thoracoscopic surgery.Methods 40 elderly patients,aged 60-75 years,were selected for selective thoracoscopic surgery.Patients were randomly divided into two groups,ESPB group (E group) and paravertebral block (PVB) group (P group).In the E group,0.33％ ropivacaine 30 ml was injected between the T5 vertebral body transverse and the erector spines before surgery,and 0.33％ ropivacaine 30 ml was injected into the thoracic paravertebral space of T5-T6 in the P group.Patients in both groups were treated with sufentanil for postoperative patient controlled analgesia (PCA).The dosage of remifentanil intraoperative and sufentanil postoperative,remedial cases recorded in post anesthesia care unit (PACU),numeric rating scale (NRS) score at postoperative 1 h,6 h,12 h and 24 h were recorded,and intraoperative hypotension,postoperative nausea and vomiting cases,and operation time were documented.Results There was no significant difference in remifentanil dosage between the two groups (P ＞ 0.05).The total consumption of sufentanil in group E 24 hours after operation was higher than that in group P (P ＜ 0.05).The operation time of ultrasound-guided nerve block in group E was shorter than that in group P (P ＜ 0.05).The number of PACU remedial cases in group E was higher than that in group P (P ＞ 0.05).The NRS score recorded at postoperative 1 h,6 h,12 h and 24 h show no difference.There was no significant difference in the incidence of nausea and vomiting and intraoperative hypotension in the two groups.Conclusions Ultrasound-guided single ESPB block provides postoperative analgesia,which is similar but weaker compared with PVB and easy to operate.

ObjectiveTo investigate the incidence and risk factors for endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events in patients with primary sclerosing cholangitis (PSC). MethodsThis study included 72 patients who were diagnosed with PSC by magnetic resonance cholangiopancreatography and underwent ERCP in the Third Hospital of Xingtai City from December 2009 to December 2013. The incidence of postoperative adverse events within 30 d after ERCP was monitored and recorded. Univariate and multivariate logistic regression analyses were used to analyze the risk factors for ERCP-related adverse events in PSC patients. ResultsThe success rate of ERCP was 94.4% (68/72). Among all adverse events, the incidence of pancreatitis and biliary tract infection were highest (6.94% and 4.17%), while the incidence of perforation was lowest (1.38%). Univariate logistic regression analysis showed that the risk of adverse events was significantly higher in patients who underwent cholangiopancreatography and sphincterotomy than in those not undergoing these procedures (OR=13.642, P=0.017; OR=7.381, P=0.000); guide wire insertion and cholangiopancreatography also increased the incidence of adverse reactions (OR=8.042, P=0.000; OR=2.651, P=0.032). Multivariate logistic regression analysis showed that guide wire insertion (OR = 4.547, 95%CI: 1.076-12.543) and biliary sphincterotomy (OR=5.023, 95%CI: 2.643-18.321) are associated with the incidence of ERCP-related adverse events. ConclusionSphincterotomy and guide wire insertion can increase the risk of adverse events in PSC patients after ERCP.

Objective:To explore the mechanism of turnover intention of junior nurses after adverse events from three aspects: work pressure, leadership style and personal characteristics.Methods:This study was a cross-sectional survey, using the convenience sampling method, 289 nurses from Shanxi Bethune Hospital from December 2020 to March 2022 were selected as the research subjects, and the general data questionnaire, the Separation Tendency Scale, the Nurses′ Work Stressor Scale, the Service-oriented Leadership Style Scale, and the Prospective Personality Scale were used to survey them.Results:Structural equation model showed that nurses′ job stressor level positively predicted turnover intention, with a path coefficient of 0.74, P<0.01, while service-oriented leadership style and forward-looking personality negatively predicted turnover intention, with path coefficients of -0.60 and -0.37, respectively, both P<0.01. Hierarchical regression analysis showed that both service-oriented leadership style and forward-looking personality negatively moderated the promotion of job stressors on turnover intention, and the moderating effect regression coefficients were -0.146, -0.215, both P<0.01. Conclusions:Hospitals should improve the prospective personality traits of junior nurses and cultivate the service-oriented leadership style of nursing managers after adverse events, so as to reduce the turnover tendency of junior nurses as the second victim, promote the improvement of nursing quality, and stabilize nursing team development.

Objective: To analyze the clinical features of perianal condyloma acuminatum in HIV infected men who have sex with men (MSM) and assess the effects of combined treatment of microwave and photodynamic therapy. Methods: Clinical and laboratory data of 260 male patients with perianal condyloma acuminatum were collected and microwave combined with photodynamic therapy was applied on them. Results: The majority of the patients with perianal condyloma acuminatum were young people (243/260). Warts were mainly located in the anus or from the outside to inside of the anus (245/260). Among them, the proportion of warts position of extraanal in HIV-infected group (8/220) was lower than that of non-HIV-infected group (7/40). HPV types 11 (70/118), 6 (44/118) and 16 (40/118) were the most common types of HPV infection. People with HIV infection were more likely to develop high-risk, mixed types HPV infection and multiple HPV infection than those without HIV infection. More than half of the patients (146/260) needed only 1-3 sessions of photodynamic treatments. There was no significant difference in the times of photodynamic treatments and the numbers of photosensitizers required between the HIV-infected and non-HIV-infected groups. The recurrence rate of HIV-infected group (13.6%, 30/220) was also similar to that of non-HIV-infected group (15.0%, 6/40), but far lower than those who underwent microwave therapy alone (45%, 18/40). Conclusions The combination therapy significantly reduced the recurrence rate of perianal condyloma acuminatum in HIV infected MSM.

Objective:To explore the distribution of different subsets of monocyte in peripheral blood of patients with thyroid-associated ophthalmopathy (TAO).Methods:A cross-sectional study was performed.Fifty-nine TAO patients and 30 healthy subjects were recruited continuously in Zhongshan Ophthalmic Center from January 2017 to December 2019.Clinical data of subjects were recorded, and the severity and activity of TAO were graded based on the criteria of NOSPECS and CAS.TAO patients were grouped according to clinical activity of TAO, and the patients were treated by triamcinolone acetonide (TA) injection or methylprednisolone pulse therapy (MPT) accordingly.Peripheral blood of the subjects was collected and monocytes were isolated.The proportion of different monocyte subsets was assayed by a flow cytometry.The differences in distribution of monocyte subsets between TAO group and normal control group, stable TAO group and active TAO group, TA injected group and MPT treated group were compared and analyzed.The study protocol was approved by the Ethics Committee of Zhongshan Ophthalmic Center, Sun Yat-Sen University (No.2014MEKY005), and the written informed consent was obtained from each subject before any medical intervention.Results:The proportion of classical monocyte (CMo) subset in TAO group was (81.77%±5.53)%, which was significantly lower than (84.35±5.83)% in the normal control group ( P=0.034); the proportion of intermediate monocyte (IMo) subset in the TAO group was (10.17±4.19)%, which was significantly higher than (7.69±4.09)% in the normal control group ( P=0.006); no significant difference was found in the proportion of non-classical monocyte (NMo) subset between the two groups ( P=0.892). The proportion of CMo subset in the active TAO group was (77.29±5.80)%, which was significantly lower than (82.64±5.03)% in the stable TAO group ( P<0.01), and the proportion of IMo subset in the active TAO group was (13.79±4.82)%, which was significantly higher than (9.20±3.56)% in the stable TAO group ( P<0.01); no significant change was found in the proportion of NMo subset between the two groups ( P=0.283). There was no difference in the proportion of different TAO subsets before and after TA injection ( P>0.05). In MPT treated group, the proportion of CMo subset in TAO patients was significantly increased and the proportion of IMo subset was significantly decreased (both at P<0.05); there was no significant difference in proportion of NMo subset before and after MPT treatment ( P=0.187). Conclusions:IMo subset is enriched in patients with TAO, and the IMo subset content varies over the disease activity.MPT may inhibit the shift of CMo subset towards IMo subset.

Objective To investigate the distribution and drug resistance characteristics of pathogens in donors and recipients undergoing simultaneous pancreas-kidney transplantation (SPK). Methods Clinical data of 231 pairs of donors and recipients undergoing SPK were analyzed retrospectively. The pathogens of samples from donors and recipients were identified by VITEK-2 analyzer, and drug sensitivity test was performed by K-B method. The source distribution and composition ratio of pathogens in donor and recipient samples, distribution characteristics of multi-drug resistant organism, infection of recipients and drug resistance characteristics of pathogens were analyzed. Results A total of 395 strains of pathogens were cultured from 1 294 donor samples, and the detection rate was 30.53%. Gram-negative bacteria mainly consisted of klebsiella pneumoniae, Gram-positive bacteria mainly comprised staphylococcus aureus, and fungi primarily included candida albicans, respectively. In total, 2 690 strains of pathogens were cultured from 10 507 recipient samples, and the detection rate was 25.60%. Gram-negative bacteria mainly consisted of pseudomonas maltophilia, Gram-positive bacteria primarily comprised enterococcus faecalis, and fungi mainly included candida albicans, respectively. Among 395 pathogens of donors, 15 strains of methicillin-resistant staphylococcus aureus (MRSA), 16 strains of extended-spectrum β-lactamase (ESBL) positive drug-resistant bacteria, 8 strains of carbapenem-resistant pseudomonas aeruginosa (CR-PA), 21 strains of carbapenem-resistant acinetobacter baumannii (CR-AB), 2 strains of carbapenem-resistant enterobacteriaceae (CRE) and 1 strain of multiple-drug/pan-drug resistant pseudomonas aeruginosa (MDR/PDR-PA) were identified. Among 2 690 strains of recipient pathogens, 73 strains of ESBL positive drug-resistant bacteria, 44 strains of CR-PA, 31 strains of CR-AB and 3 strains of MDR/PDR-PA were detected. One recipient developed donor-derived infection, 69 cases of pneumonia, 52 cases of urinary tract infection, 35 cases of abdominal infection and 2 cases of hematogenous infection were reported within postoperative 1 year. Gram-negative bacteria were resistant to certain antibiotics. Gram-positive bacteria were sensitive to vancomycin. Fungi were sensitive to amphotericin B. Conclusions Gram-negative bacteria are the main pathogens of SPK recipients, which are resistant to certain antibiotics. Empirical use of antibiotics can be delivered before culture results are obtained. Subsequently, sensitive antibiotics should be chosen according to the culture results to improve the survival rate of SPK recipients.

Objective:To explore the association between levels of thyroid-stimulating hormone (TSH) on admission and prognosis of patients admitted to intensive care unit (ICU).Methods:The data were collected from patients who were admitted to the ICU of the Beth Israel Deaconess Medical Center in the United States from 2001 to 2012 with available TSH test records within 24 hours after the ICU admission via the Medical Information Mart for Intensive Care-Ⅲv1.4 (MIMIC-Ⅲv1.4). Information including gender, age, ethnicity, type of admission, mechanical ventilation (MV) or renal replacement therapy (RRT) received on admission, comorbidities, and TSH test records within 24 hours after the ICU admission were collected. The sequential organ failure assessment (SOFA) score, simplified acute physiology score Ⅱ (SAPS Ⅱ) and the comorbidities index Elixhauser (SID30) score were calculated according to the parameters. The primary outcome was hospital mortality. Differences in baseline characteristics and prognosis were examined between patients with normal TSH levels and abnormal TSH levels which was determined according to a dichotomous variable provided by the data. Multivariable Logistic regression was used to analyze the association between TSH levels and prognosis after adjusting for confounding factors. A sensitivity analysis was conducted which categorized the study population as three groups (i.e., decreased, normal, and elevated TSH levels) using the range of 0.30-3.00 mU/L as the normal range of TSH.Results:A total of 3 425 ICU patients were enrolled in the study, of which 2 692 (78.60%) were with normal TSH and 733 (21.40%) were with abnormal TSH. There was no statistically significant difference in gender, age, ethnicity, type of admission and the ratio of MV between the normal TSH and abnormal TSH groups. Compared with normal TSH group, the patients in abnormal TSH had a higher SOFA, SAPS Ⅱ and SID30 scores as well as the ratio of RRT [SOFA score: 4 (2, 7) vs. 4 (2, 6), SAPS Ⅱ score: 38.02±13.76 vs. 36.53±13.75, SID30 score: 11 (4, 22) vs. 11 (0, 20), RRT ratio: 5.32% (39/733) vs. 3.49% (94/2 692), all P < 0.05]. The hospital mortality of patients in normal TSH was significantly higher than that of those in abnormal TSH [9.82% (72/733) vs. 5.94% (160/2 692), P < 0.01]. After adjusting for confounding factors, abnormal TSH was significantly associated with hospital mortality [odds ratio ( OR) = 1.71, 95% confidence interval (95% CI) was 1.24-2.35, P = 0.001]. In the sensitivity analysis in which the range of 0.30-3.00 mU/L was used as the normal range of TSH, compared with normal TSH, decreased TSH ( OR = 2.36, 95% CI was 1.40-3.97, P = 0.001) and elevated TSH ( OR = 1.44, 95% CI was 1.05-1.98, P = 0.023) were both significantly associated with increased hospital mortality. Conclusion:An abnormal level of TSH within 24 hours after admitted to ICU is an independent risk factor for hospital mortality among ICU patients.

One case of COVID-19 infection secondary to pulmonary mucormycosis in a recipient of simultaneous pancreas-kidney transplantation was described. Early identification of the pathogen was achieved by metagenomic next-generation sequencing. On the basis of disease status and liver function changes, targeted treatments included intravenous amphotericin B liposome, amphotericin B nebulization& gargling and subsequently a maintenance therapy of oral posaconazole. This regimen resulted in the absorption of lung infection, stabilization of transplanted pancreas function and reduced levels of creatinine and urea as compared to pre-infection period. The therapeutic efficacy was decent.