Objective To evaluate the effectiveness of implementing precise management for Da Vinci robotic surgical consumables under the Diagnosis Related Group(DRG)payment system.Methods This retrospective case-control study ana-lyzed 200 patients undergoing Da Vinci robotic lung resection surgery in a tertiary hospital:100 cases from May to June 2022 as the control group,and 100 cases from May to June 2023 with implemented precision management as the observation group.The control group did not implement the payment according to DRG,while the observers implemented payment according to DRG and optimized refined management of Da Vinci robotic surgical consumables.Hospitalization duration,intraoperative costs,and utili-zation of high-value consumables were compared between the two groups.Results No statistically significant differences(P＞0.05)were observed between the two groups in terms of gender,age,medical insurance status,operative time,or intraoperative blood loss.The observation group exhibited a significantly shorter hospitalization duration(8.29±4.13 vs.10.47±4.57 days;P＜0.05),and higher surgical costs[(11 366.81±2 504.23)RMB vs.(8 716.07.78±256.34)RMB,P＜0.05]compared with the control group.Conclusion DRG-oriented precision management optimizes resource utilization through shortened hospi-talization time and rationalizes cost allocation,and sustainable consumable consumption patterns,demonstrating effective balance between clinical quality and economic efficiency under healthcare payment reforms.

Objective To evaluate the effectiveness of implementing precise management for Da Vinci robotic surgical consumables under the Diagnosis Related Group(DRG)payment system.Methods This retrospective case-control study ana-lyzed 200 patients undergoing Da Vinci robotic lung resection surgery in a tertiary hospital:100 cases from May to June 2022 as the control group,and 100 cases from May to June 2023 with implemented precision management as the observation group.The control group did not implement the payment according to DRG,while the observers implemented payment according to DRG and optimized refined management of Da Vinci robotic surgical consumables.Hospitalization duration,intraoperative costs,and utili-zation of high-value consumables were compared between the two groups.Results No statistically significant differences(P＞0.05)were observed between the two groups in terms of gender,age,medical insurance status,operative time,or intraoperative blood loss.The observation group exhibited a significantly shorter hospitalization duration(8.29±4.13 vs.10.47±4.57 days;P＜0.05),and higher surgical costs[(11 366.81±2 504.23)RMB vs.(8 716.07.78±256.34)RMB,P＜0.05]compared with the control group.Conclusion DRG-oriented precision management optimizes resource utilization through shortened hospi-talization time and rationalizes cost allocation,and sustainable consumable consumption patterns,demonstrating effective balance between clinical quality and economic efficiency under healthcare payment reforms.

Objective:To provide references for aeromedical support for military flying personnel by investigating the current situation of flight fatigue and analyzing its influencing factors.Methods:Fatigue Scale-14 (FS-14) and Flight Fatigue Influence Factor Scale were used to assess the fatigue index of 147 hospitalized military flying personnel. They were grouped according to the FS-14 score, with a score of 0-3 points as the non-fatigue group and ≥3 points as the fatigue group, and the scores of 10 factors in the Flight Fatigue Influence Factor Scale were compared between 2 groups. Factors affecting flight fatigue were analyzed by using multifactor binary Logistic regression with the presence of fatigue as the dependent variable.Results:The total FS-14 score was 3 (1, 6) points, of which the total brain fatigue score was 2 (1, 3) points, and the total somatic fatigue score was 2 (1, 3) points. The flying personnel were grouped according to fatigue scores, with 54 cases (36.73%) in the non-fatigued group and 93 cases (63.27%) in the fatigue group. There were significant analysis results on age ( t=5.79, P<0.001), marital status ( χ2=7.95, P=0.005), flying hours ( Z=-5.09, P<0.001), flying years ( Z=-6.11, P<0.001), aircraft types ( χ2=74.48, P<0.001), smoking history ( χ2=5.42, P=0.020), sleep disorders ( t=2.46, P=0.015), workload ( t=3.58, P=0.001), interpersonal relationships ( t=2.45, P=0.016) and psychological load ( t=3.14, P=0.002) between 2 groups. Multifactorial Logistic regression analysis showed that smoking history ( OR=2.811, 95% CI: 1.105-7.151), sleep disorders ( OR=1.576, 95% CI: 1.125-2.206), workload ( OR=1.559, 95% CI: 1.108-2.194), interpersonal relationships ( OR=1.620, 95% CI: 1.155-2.270) and psychological load ( OR=1.509, 95% CI: 1.069-2.130) were the influencing factors on flight fatigue. Conclusions:Military flying personnel have different degrees of flight fatigue problems, and smoking history, sleep disorders, workload, interpersonal relationships and psychological load are the influencing factors of flight fatigue. Attaching importance to the sleep quality and psychological health of military flying personnel, paying attention to the mode of interpersonal relationship and the degree of workload, giving appropriate sleep and psychological guidance, advocating moderate physical exercise, and carrying out cultural and sports activities are all measures conducive to alleviating the fatigue under high-intensity work.

Chlorfenapyr,an emerging synthetic pesticide,has been linked to a growing number of poisoning incidents,attributed to heightened human exposure as its application becomes more widespread.However,the toxicokinetics and toxicology of chlorfenapyr remain incompletely understood.Research since the 1990s,including animal experiments,has illuminated the absorption,distribution,excretion,and metabolism of chlorfenapyr.Toxicological investigations have revealed that the primary toxicity of chlorfenapyr is the uncoupling of oxidative phosphorylation.Chlorfenapyr exposure in humans and other animals can lead to various toxic effects,including neurotoxicity,cardiotoxicity,skeletal muscle toxicity,genotoxicity,reproductive and developmental toxicity,renal toxicity,splenic toxicity,and hematotoxicity.This article presents a comprehensive review of the toxicokinetics and toxicology of chlorfenapyr,integrating data from animal experiments,human cell line studies,clinical reports,and human autopsy.Its objective is to raise clinical awareness regarding chlorfenapyr poisoning and offer valuable references for its treatment and management.

Objective To evaluate the feasibility of emergency percutaneous coronary intervention(PCI)with extracorporeal membrane oxygenation(ECMO)support in critically ill patients with acute myocardial infarction(AMI)and cardiogenic shock(CS).Methods Retrospective analysis of clinical data of AMI combined with CS patients admitted to the department of emergency of the Second Hospital of Hebei Medical University from December 2018 to December 2021,including gender,age,body mass index(BMI),past history(smoking,coronary heart disease,arrhythmia,diabetes,hypertension,hyperlipidemia,cerebrovascular disease);acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score,highest vasoactive-inotropic score(VIS)within 24 hours of admission,the worst auxiliary examination values within 24 hours after admission:blood lactic acid(Lac),arterial partial pressure of oxygen(PaO2),cardiac troponin I(cTnI),alanine aminotransferase(ALT),total bilirubin(TBil),creatinine(Cr),serum potassium,left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF)],presence of malignant arrhythmia or cardiac arrest during emergency PCI,completion of PCI,and the 30-day prognosis,etc.Patients were divided into an ECMO group and a non-ECMO group based on whether ECMO was applied,to analyze differences in the above indicators between the two groups.Results There were no statistically significant differences between the ECMO group and the non-ECMO group in terms of gender,age,BMI,past history,APACHEⅡ,VIS and the worst auxiliary examination value within 24 hours after admission.The incidence of malignant arrhythmia or cardiac arrest events and 30-day mortality rate during emergency PCI in the ECMO group were significantly lower than those in the non-ECMO group[the incidence of malignant arrhythmia or cardiac arrest during emergency PCI was 17.9％(7/39)vs.45.0％(9/20),and the 30-day mortality was 46.2％(18/39)vs.75.0％(15/20),both P<0.05].The completion rate of PCI in the ECMO group was significantly higher than that in the non-ECMO group[100.0％(39/39)vs.80.0％(16/20),P<0.05].Conclusions For critically ill patients with AMI combined with CS,ECMO support can reduce the risk of malignant arrhythmia or cardiac arrest during emergency PCI,increase the completion rate of PCI,and reduce the 30-day mortality.With the support of the ECMO team,ECMO support emergency PCI is feasible.

BACKGROUND:Early identification of patients requiring ventilator support will be beneficial for the outcomes of botulism.The present study aimed to establish a new scoring system to predict mechanical ventilation(MV)for botulism patients. METHODS:A single-center retrospective study was conducted to identify risk factors associated with MV in botulism patients from 2007 to 2022.Univariate analysis and multivariate logistic regression analysis were used to screen out risk factors for constructing a prognostic scoring system.The area under the receiver operating characteristic(ROC)curve was calculated. RESULTS:A total of 153 patients with botulism(66 males and 87 females,with an average age of 43 years)were included.Of these,49 patients(32.0%)required MV,including 21(13.7%)with invasive ventilation and 28(18.3%)with non-invasive ventilation.Multivariate analysis revealed that botulinum toxin type,pneumonia,incubation period,degree of hypoxia,and severity of muscle involvement were independent risk factors for MV.These risk factors were incorporated into a multivariate logistic regression analysis to establish a prognostic scoring system.Each risk factor was scored by allocating a weight based on its regression coefficient and rounded to whole numbers for practical utilization([botulinum toxin type A:1],[pneumonia:2],[incubation period≤1 day:2],[hypoxia<90%:2],[severity of muscle involvement:grade II,3;grade III,7;grade IV,11]).The scoring system achieved an area under the ROC curve of 0.82(95%CI 0.75-0.89,P<0.001).At the optimal threshold of 9,the scoring system achieved a sensitivity of 83.7%and a specificity of 70.2%. CONCLUSION:Our study identified botulinum toxin type,pneumonia,incubation period,degree of hypoxia,and severity of muscle involvement as independent risk factors for MV in botulism patients.A score≥9 in our scoring system is associated with a higher likelihood of requiring MV in botulism patients.This scoring system needs to be validated externally before it can be applied in clinical settings.

Objective:To provide references for aeromedical support for military flying personnel by investigating the current situation of flight fatigue and analyzing its influencing factors.Methods:Fatigue Scale-14 (FS-14) and Flight Fatigue Influence Factor Scale were used to assess the fatigue index of 147 hospitalized military flying personnel. They were grouped according to the FS-14 score, with a score of 0-3 points as the non-fatigue group and ≥3 points as the fatigue group, and the scores of 10 factors in the Flight Fatigue Influence Factor Scale were compared between 2 groups. Factors affecting flight fatigue were analyzed by using multifactor binary Logistic regression with the presence of fatigue as the dependent variable.Results:The total FS-14 score was 3 (1, 6) points, of which the total brain fatigue score was 2 (1, 3) points, and the total somatic fatigue score was 2 (1, 3) points. The flying personnel were grouped according to fatigue scores, with 54 cases (36.73%) in the non-fatigued group and 93 cases (63.27%) in the fatigue group. There were significant analysis results on age ( t=5.79, P<0.001), marital status ( χ2=7.95, P=0.005), flying hours ( Z=-5.09, P<0.001), flying years ( Z=-6.11, P<0.001), aircraft types ( χ2=74.48, P<0.001), smoking history ( χ2=5.42, P=0.020), sleep disorders ( t=2.46, P=0.015), workload ( t=3.58, P=0.001), interpersonal relationships ( t=2.45, P=0.016) and psychological load ( t=3.14, P=0.002) between 2 groups. Multifactorial Logistic regression analysis showed that smoking history ( OR=2.811, 95% CI: 1.105-7.151), sleep disorders ( OR=1.576, 95% CI: 1.125-2.206), workload ( OR=1.559, 95% CI: 1.108-2.194), interpersonal relationships ( OR=1.620, 95% CI: 1.155-2.270) and psychological load ( OR=1.509, 95% CI: 1.069-2.130) were the influencing factors on flight fatigue. Conclusions:Military flying personnel have different degrees of flight fatigue problems, and smoking history, sleep disorders, workload, interpersonal relationships and psychological load are the influencing factors of flight fatigue. Attaching importance to the sleep quality and psychological health of military flying personnel, paying attention to the mode of interpersonal relationship and the degree of workload, giving appropriate sleep and psychological guidance, advocating moderate physical exercise, and carrying out cultural and sports activities are all measures conducive to alleviating the fatigue under high-intensity work.

Objective To analyze the prognosis and influencing factors of patients with acute myocardial infarction(AMI)complicated with cardiogenic shock(CS)under extracorporeal membrane oxygenation(ECMO)support.Methods Retrospective analysis of the clinical data of ECMO supported coronary angiography and percutaneous coronary intervention(PCI)treatment for AMI complicated with CS patients who visited the department of emergency medicine of the Second Hospital of Hebei Medical University from December 2018 to December 2021,including gender,age,body mass index(BMI),past history(smoking history,coronary heart disease,diabetes,hypertension,hyperlipidemia,cerebrovascular disease),acute physiological and chronic health evaluationⅡ(APACHEⅡ),vasoactive-inotropic score(VIS),the worst auxiliary examination indicators within 24 hours before ECMO[arterial lactate acid,white blood cell count(WBC),cardiac troponin I(cTnI),alanine transferase(ALT),total bilirubin(TBil),creatinine(Cr),serum potassium(K+),left ventricular ejection fraction(LVEF)],time from onset to PCI,coronary angiography results(involved anterior descending branch,circumflex branch,right coronary artery,three-vessel lesions,left main artery lesions),whether to use intra aortic-balloon counterpulsation(IABP)and continuous renal replacement therapy(CRRT).Patients were divided into survival and death groups based on the prognosis after 30 days of onset.Univariate analysis was used to compare the differences in the above indicators between the two groups with different prognoses,Logistic regression analysis was used to analyze the independent risk factors affecting the prognosis of AMI patients with CS under ECMO support coronary angiography and PCI treatment,and the receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of risk factors on patient prognosis.Results Out of 39 patients,21 cases(53.8%)survived and 18 cases(46.2%)died.Compared with the survival group,the VIS score,lactate acid,time from onset to PCI,involvement of the circumflex artery,three-vessel disease,and left main artery lesions significantly increased in the death group(all P＜0.05).Logistic regression analysis showed that lactate acid and three-vessel lesions were independent risk factors affecting the 30-day prognosis of AMI patients with CS[odds ratio(OR)and 95%confidence interval(95%CI)were 1.845(1.018-3.342)and 107.171(1.307-8 785.901),all P＜0.05].ROC curve analysis showed that lactate acid and three-vessel lesions has predictive value for the prognosis of AMI combined with CS patients undergoing ECMO supported coronary angiography and PCI treatment,the area under the ROC curve(AUC)were 0.756 and 0.752,95%CI were 0.601-0.911 and 0.588-0.916,P value were 0.007 and 0.008.When the cut-off value of lactic acid was 5 mmol/L,the sensitivity and specificity of predicting the prognosis of AMI combined with CS patients undergoing coronary angiography and PCI treatment were 94.1%and 57.1%,respectively.Conclusions The indications for using ECMO in critically ill patients with AMI combined with CS need to be further refined.VIS score,lactate acid,time from onset to PCI,three-vessel lesions,and left main artery lesions are risk factors for patient death.When using ECMO support for high lactate,high VIS score,and three-vessel lesions,caution should be exercised.Early ECMO support can improve the prognosis of appropriate patients by reducing lactate,reducing the use of vasoactive drugs,and shortening the time from onset to PCI.

Objective:To investigate the current situation of emergency medical service (EMS) system and its effect on treatment of the acute stage and short- and long-term prognosis in patients with acute myocardial infarction in Hebei province.Methods:Totally 2 961 patients with acute myocardial infarction who were admitted to major tertiary and some representative secondary hospitals in Hebei province from January 2016 to December 2016 were collected. According to the pattern of arriving hospital, all the patients were divided into the EMS group and self-transport group. The general conditions, time from onset to treatment, treatment methods, in-hospital mortality rate and 3-year mortality rate were compared between the two groups.Results:Of the included 2 961 patients, 33.13% of them were transported through EMS and 66.87% of them by private transport. Patients with a history of hypertension and ST-segment elevation myocardial infarction were more likely to choose EMS, and the difference was statistically significant ( P<0.05). Moreover, patients in the EMS group were more likely to go to tertiary hospitals for treatment (88.58% vs 85.76%, P=0.033). The time from onset to treatment of the EMS group was significantly shorter than that of the self-transport group (160 min vs 185 min, P<0.01), and the proportion of patients in the EMS group from onset-to-door time in <3 h and 3-6 h was higher than that of the self-transport group (55.76% vs 49.14%, 21.41% vs 19.09%, P<0.01). Compared with the self-transport group, the EMS group has a higher rate of reperfusion therapy (67.48% vs 61.67%, P=0.002). Patients in the EMS group had a higher in-hospital mortality rate in the acute stage (7.03% vs 4.44%, P=0.003), but its 3-year mortality rate was lower than that of the self-transport group (17.31% vs 20.77%, P<0.05). Conclusions:EMS can shorten symptom-onset-to-arrival time, increase the rate of reperfusion therapy and improve long-term prognosis of patients with acute myocardial infarction.