Objective To investigate the level of benefit finding and positive psychological capital of stroke patients and their spouses,and to analyse the dyadic interaction between benefit finding and positive psychological capital of patients and their spouses.Methods From March to August 2023,235 stroke patients and their spouses were conveniently selected from the neurology wards of 3 tertiary hospitals in Henan Province,and were surveyed using a general information questionnaire,the positive psychological capital questionnaire,revised version of benefit finding scale,and caregiver benefit finding scale.Results The positive psychological capital scores of stroke patients and their spouses were(4.29±0.75)and(4.56±0.71);benefit finding scores of the dyads were(2.85±0.69)and(3.64±0.68).The results of actor-partner interdependence model showed that positive psychological capital of stroke patients and their spouses positively predicted their benefit finding;positive psychological capital of patients positively predicted benefit finding of spouses,and positive psychological capital of spouses positively predicted benefit finding of patients(all P＜0.05).In particular,spousal self-efficacy and resilience positively predicted their benefit finding;their optimism positively predicted the patient's benefit finding;their hopefulness negatively predicted the patient's benefit finding(all P＜0.05).Conclusion There was a dyadic interaction between benefit finding and positive psychological capital for stroke patients and their spouses.The role of spouses on patients'positive psychological capital should not be overlooked,and nurses should develop positive psychological capital intervention strategies centered on couples of stroke patients to enhance positive couple experiences.

OBJECTIVES: The conventional Fr26 resectoscope is difficult to use in patients with benign prostatic hyperplasia (BPH) complicated by urethral stricture. This study aims to evaluate the safety and efficacy of transurethral plasmakinetic resection of the prostate (PKRP) using a small-caliber (Fr18.5) plasmakinetic resectoscope combined with urethral dilation in patients with BPH and mild urethral stricture. METHODS: A retrospective analysis was conducted on 37 patients with BPH and mild urethral stricture treated at the Department of Urology, Hunan Provincial People's Hospital from January 2023 to December 2023. All patients underwent PKRP with a small-caliber plasmakinetic resectoscope, followed by routine placement of a Fr20 three-way Foley catheter for continuous bladder irrigation. International Prostate Symptom Score (IPSS), maximum urinary flow rate (Q_max), post-voiding residual urine volume (PVR), and Quality of Life (QOL) scores were compared before and after surgery. Perioperative indicators (intraoperative bleeding, operative time, postoperative catheterization time, and postoperative hospital stay) and complications were recorded. RESULTS: The median age was 69 years, and the median duration of voiding difficulty was 36 months. Median total prostate specific antigen (T-PSA) was 2.095 ng/mL, free prostate specific antigen (F-PSA) 0.561 ng/mL, and F/T ratio 0.3. Median prostate diameter was 48 mm and volume 41 mL. All 37 surgeries were completed successfully: 11 had external meatal stricture, 19 had mild anterior urethral stricture, and 7 had mild posterior urethral stricture (1 patient with a 1 cm pseudo-blind tract near the membranous urethral). Operative time was (2.4±0.7) hours, blood loss was (40±29) mL, median catheterization duration was 7 days, and median hospital stay was 7 days. No cases of postoperative urinary incontinence, recurrent hematuria, or sepsis occurred, and patients were satisfied with the surgical outcome. At 3 to 6 months follow-up, IPSS, Q_max, PVR, and QOL scores significantly improved compared to preoperative levels (all P<0.01), with no cases of urethral stricture progression or new-onset stricture. CONCLUSIONS PKRP using a small-caliber plasmakinetic resectoscope is safe and effective for treating BPH with mild urethral stricture. It offers advantages such as minimal trauma, rapid postoperative recovery, and a lower risk recovery, and a lower risk of aggravating urethral injury.
Humans ; Male ; Prostatic Hyperplasia/complications* ; Urethral Stricture/complications* ; Retrospective Studies ; Aged ; Transurethral Resection of Prostate/instrumentation* ; Middle Aged ; Treatment Outcome ; Quality of Life ; Aged, 80 and over

ObjectiveTo investigate the current situation of rehabilitation therapists' work, and analyze the factors related to their career development and transformation. MethodsFrom September, 2022 to January, 2023, 153 rehabilitation therapists in Weifang were investigated with a cross-sectional questionnaire, using general questionnaire, Job Satisfaction Scale for Grassroots Health Technicians, Social Responsibility Scale, Job Role and Identity Inventory, and Employee Turnover Scale. ResultsThe majority of rehabilitation therapists interviewed were male (52.28%), under 35 years old (88.24%), with a bachelor's degree (77.78%), income less than 5 000 yuan a month (46.40%), and less than five years of service (48.36%). The work time was (7.78±0.84) hours a day, (5.39±0.51) days a week. The favorable rate of the physical environment of work was 67.32%, and the favorable rate of the interpersonal relationship environment of work was 80.39%. The score of professional identity was (3.61±0.84), the score of job satisfaction was (3.62±0.97), the score of social responsibility was (3.53±0.79), and the score of turnover was (2.39±1.10). Education level, job satisfaction, and social responsibility were the main factors related to the employee turnover (P < 0.05). ConclusionThe overall educational level of rehabilitation therapists is relatively low, and the human resource structure needs to be optimized. There is a significant difference between academic education and continuing education, and career development needs to be improved. The main factors related to career development and transformation are education level, job satisfaction, and social responsibility.

Background::Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation associated with poor outcomes. This study aimed to analyze the efficacy and safety of low-dose aspirin for preventing TRAS.Methods::After kidney transplantation, patients were enrolled from January 2018 to December 2020 in Henan Provincial People’s Hospital. A total of 351 enrolled recipients were randomized to an aspirin group with low-dose intake of aspirin in addition to standard treatment ( n = 178), or a control group with only standard treatment ( n = 173). The patients was initially diagnosed as TRAS (id-TRAS) by Doppler ultrasound, and confirmed cases were diagnosed by DSA (c-TRAS). Results::In the aspirin and control groups, 15.7% (28/178) and 22.0% (38/173) of the recipients developed id-TRAS, respectively, with no statistical difference. However, for c-TRAS, the difference of incidence and cumulative incidence was statistically significant. The incidence of c-TRAS was lower in the aspirin group compared with the control group (2.8% [5/178] vs. 11.6% [20/173], P = 0.001). Kaplan–Meier estimates and Cox regression model identified the cumulative incidence and hazard ratio (HR) of TRAS over time in two groups, showing that recipients treated with aspirin had a significantly lower risk of c-TRAS than those who were not treated (log-rank P = 0.001, HR = 0.23, 95% confidence interval [CI]: 0.09–0.62). The levels of platelet aggregation rate ( P < 0.001), cholesterol ( P = 0.028), and low-density lipoprotein cholesterol ( P = 0.003) in the aspirin group were decreased compared with the control group in the third-month post-transplantation. For the incidence of adverse events, there was no statistical difference. Conclusion::Clinical application of low-dose aspirin after renal transplant could prevent the development of TRAS with no significant increase in adverse effects.Trial Registration::Clinicaltrials.gov, NCT04260828.

Nucleoside analogues and nucleotide analogues can not only achieve long-term viral suppression in the treatment of most CHB patients but also have a positive impact on other CHB therapeutic goals and an improved prognosis. A certain difference can be observed in the impact of nucleotide analogues such as TDF and TAF and nucleoside analogues such as ETV on the clinical outcomes of CHB. Studies on the mechanism of action indicate that apart from inhibiting the direct antiviral effects of HBV reverse transcriptase, these two categories of drugs exhibit distinct impacts on immune-related signaling pathways, gene expression, genome stability, and other non-antiviral mechanisms. This article reviews the evidence on the potential non-antiviral mechanism of action of nucleoside analogues and nucleotide analogues and proposes a preliminary explanation for the observation trend of nucleotide analogues having a comparative advantage in clinical outcomes in CHB patients based on the latest research advancement.

OBJECTIVE To analyze the risk factors of substandard drug blood concentration of meropenem in patients with hospital acquired pneumonia （HAP）. METHODS Totally 130 HAP patients who were admitted to the intensive care unit of Suzhou Hospital Affiliated to Nanjing Medical University from January 2020 to June 2021 and received steady -state blood concentration test of meropenem were selected as the study subjects . The patient ’s age ，sex，body mass and other medical history were recorded . The steady-state blood trough concentration of meropenem was determined and its target was determined . Univariate and multivariate Logistic regression analysis were used to screen the risk factors for the substandard steady -state blood trough concentration of meropenem. The receiver operating characteristic （ROC）curve was drawn to screen the warning value of the risk factors and evaluate the predictive value of the risk factors . RESULTS The steady -state blood trough concentrations of 85 cases were ≥2 mg/L， and those of 45 cases were ＜2 mg/L. Multivariate Logistic regression analysis showed that age ，negative balance and brain injury were independent risk factors for the substandard steady-state blood trough concentration of meropenem （P＜ 0.05）.ROC curve showed that when the patient was 58 years old，the area under the ROC curve was the largest （0.744）， the sensitivity was 0.882，the specificity was 0.556，and the Youden index was 0.438；when the negative balance was 520.5 mL/24 h，the area under the ROC curve reached the maximum （0.827），the sensitivity was 0.722，the specificity was 0.905，and th e Youden index was 0.628. The creatinine clearance rate in the brain injury group was significantly higher than that in the non -brain injury group ，and the steady -state blood trough concentration of meropenem in the brain injury group was significantly lower than that in the non -brain injury group （P＜0.001）. CONCLUSIONS When the HAP patient ’s age is less than 58 years old ，the brain injury and the negative balance is more than 520.5 mL/24 h，the risk of substandard steady -state blood trough concentration of meropenem will increase .

Objective:To explore the effect of the wearing time of cervical collar on the rehabilitation of patients with anterior cervical discectomy and fusion (ACDF) .Methods:The data of 97 patients with cervical spondylosis who were admitted to the Neurosurgery Spine Group of Xuanwu Hospital of Capital Medical University and underwent 1-2 segment ACDF from January 2016 to December 2017 were retrospectively analyzed. According to the wearing time of cervical collar after operation, the patients were divided into 1-4 weeks group (39 cases) , 5-8 weeks group (22 cases) , and 9-12 weeks group (36 cases) .The scores of the Japanese Orthopaedic Association Score (JOA) , Axial Symptom Score (AS) , and Neck Disability Index (NDI) were compared among the three groups before operation and 3 months after operation.Results:The postoperative JOA scores of the three groups were improved compared with those before the operation, and the differences were statistically significant ( P<0.05) ; however, there was no significant difference among the three groups before operation and 3 months after operation ( P> 0.05) . Compared with preoperative, the postoperative AS scores in 1-4 weeks group and 5-8 weeks group has no significant difference ( P> 0.05) , but the AS score of the 9-12 weeks group decreased compared with that before operation, and the difference was statistically significant ( P< 0.05) . After operation, the difference of AS scores among three groups was statistically significant ( P< 0.05) . The postoperative NDI scores of the three groups were improved compared with those before operation, and the differences were statistically significant ( P<0.05) . The improved effect of NDI in the 5-8 weeks group was better than that in the 1-4 weeks group, and the difference was statistically significant ( P<0.05) . Conclusions:The incidence of axial symptoms in patients with 1-2 segment ACDF increases with the wearing time of cervical collar. The cervical collar wearing time for 5 to 8 weeks has the best effect, the patients have the lowest disability index, and did not significantly increase the patients ' axial symptoms.

Because of the widespread development and application of rapid response system (RRS) in medical institutions in developed countries, such as Europe, America and Australia, the clinical adverse events (cardiac arrest, accidental death, etc.) in hospital patients have been reduced and improved. Meanwhile, the hospitalization rate and mortality rate of intensive care unit in hospital patients have been reduced, thus shortening the hospitalization time and reducing the medical expenses. Nevertheless, RRS is still in the exploration stage in our country. Therefore, the article reviews the RRS model and application development.

Objective:To compare the leaf open time (LOT) parameters and γ passing rates between the 4.0.4 and 4.2.3 helix Tomotherapy planning systems and evaluate the improvement.Methods:Retrospective comparison of the treatment plans of 345 cases selected by 4.0.4 and 4.2.3 versions was performed. The Machine Specific Sinogram of each plan was extracted from the archived plan file to calculate the LOT. The evaluated LOT parameters included the projection time, the maximum LOT, the mean non-zeros time, the time difference between the projection time and the maximum LOT, the relative count of leaves with LOT greater than maximum LOT minus 5 ms, the relative count of leaves with LOT lower than 100 ms and the beam on time. The γ passing rate (criteria: 3 mm/3%, 10% threshold and global error) and the LOT parameters between two version systems were evaluated with the independent t-test. The relationship between the LOT parameters and γ passing rate was analyzed by the multiple linear regression method. Results:The γ passing rate of the Ver 4.0.4 system was 97.86%, significantly lower than 98.6% of the Ver 4.2.3 system ( P<0.001). The time gap between the projection time and the maximum LOT of the Ver 4.2.3 system was significantly less than that of the Ver 4.0.4 system (1 ms vs. 11 ms, P<0.001). For the Ver 4.0.4 system, the multiple linear regression method showed that the maximum LOT ratio and the beam on time were negatively correlated with the γ passing rate (both P<0.001). However, for the Ver 4.2.3 system, only the beam on time showed a negative correlation with the γ passing rate ( P<0.001). Conclusion:The γ passing rate of the Ver 4.2.3 system is significantly higher than that of the Ver 4.0.4 system. The decrease of γ passing rate caused by the leaves near the maximum LOT is properly resolved in the new version system.

Objective:To evaluate the sensitivity of the ArcCheck dosimetry system in detecting the leaf open time errors during the center and off-center helical tomotheray delivery quality assurance (DQA).Methods:Nine nasopharyngeal carcinoma (NPC) patients were selected in this study. Two DQA plans were created for each patient: the" center" plan was created by moving the image of the ArcCheck phantom to place the high dose region on the phantom center and the " off-center" plan was created by offsetting the phantom and putting several diodes through a higher does region. Leaf open time errors of 2, 4, 6, 8 and 10 ms were introduced to the Sinogram which was modified using Matlab. Each intentional error plan and original (no error) plan for each patient were measured using both " center" and " off-center" DQA methods, the γ analysis was performed to evaluate the DQA results. The different dose and distance error criteria of 3%/3 mm, 3%/2 mm and 2%/2 mm were selected, and different thresholds of 5%, 10% and 15% were selected for γ analysis. The gradient and the minimum detectable error approach were taken to quantitatively analyze the sensitivity. The correlation between different dose distance error criteria and different thresholds was also evaluated by Pearson correlation analysis. Results:The absolute value of γ gradient of the " center" DQA plans were larger than those of the " off-center" plans in all different γ criteria (all P<0.05). The stricter the γ criteria were adopted, the more sensitive DQA results of leaf open time error were obtained. The minimum detectable error was 2 ms in all different γ criteria for the " center" DQA plan. The minimum error detectability of the " off-center" DQA plan was weaker than that of the " center" DQA plan. The γ passing rates of three different dose distance error criteria were significantly strongly correlated for the " center" DQA plan ( R2>0.9). For the " off-center " DQA plan, only the 3%/3 mm and 3%/2 mm criteria were significantly strongly correlated ( R2>0.9). Significant strong correlation was observed in the γ passing rate at different thresholds between the " off-center" and " center" DQA plans. Conclusions:The " center" DQA plan method is more sensitive than the " off-center" DQA plan method in all γ criteria, and the γ passing rates in different γ criteria are strongly correlated for the " center" DQA plan. The " center" DQA plan method is recommended.