Peri-implant keratinized mucosa (PIKM) augmentation refers to surgical procedures aimed at increasing the width of PIKM. Consensus reports emphasize the necessity of maintaining a minimum width of PIKM to ensure long-term peri-implant health. Currently, several surgical techniques have been validated for their effectiveness in increasing PIKM. However, the selection and application of PIKM augmentation methods may present challenges for dental practitioners due to heterogeneity in surgical techniques, variations in clinical scenarios, and anatomical differences. Therefore, clear guidelines and considerations for PIKM augmentation are needed. This expert consensus focuses on the commonly employed surgical techniques for PIKM augmentation and the factors influencing their selection at second-stage surgery. It aims to establish a standardized framework for assessing, planning, and executing PIKM augmentation procedures, with the goal of offering evidence-based guidance to enhance the predictability and success of PIKM augmentation.
Humans ; Consensus ; Dental Implants ; Mouth Mucosa/surgery* ; Keratins

OBJECTIVE: To investigate the current status of early pain and agitation management in critically ill patients in Guizhou Province. METHODS: A retrospective study was performed using data collected from a quality control activity conducted between April and June 2021 in non-provincial public hospitals with general intensive care unit (ICU) in Guizhou Province. Hospital-level data included hospital name and grade, ICU staffing, and number of ICU beds. Patient-level data included characteristics of patients treated in the general ICU on the day of the survey (e.g., age, sex, primary diagnosis), as well as pain and agitation assessments and the types of analgesic and sedative medications administered within 24 hours of ICU admission. RESULTS: A total of 947 critically ill ICU patients from 145 hospitals were included, among which 104 were secondary-level hospitals and 41 were tertiary-level hospitals. Within 24 hours of ICU admission, 312 (32.9%) critically ill patients received pain assessments, and 277 (29.3%) received agitation assessments. Among the pain assessment tools, the critical care pain observation tool (CPOT) was used in 44.2% (138/312) of critically ill ICU patients, with a significantly higher usage rate in tertiary hospitals compared to secondary hospitals [52.3% (69/132) vs. 38.3% (69/180), P < 0.05]. The Richmond agitation-sedation scale (RASS) was used in 93.8% (260/277) of critically ill ICU patients for agitation assessment, with no significant difference between hospital levels. Among the 947 critically ill patients, 592 (62.5%) received intravenous analgesics within 24 hours, with remifentanil being the most commonly used [42.9% (254/592)]; 510 (53.9%) received intravenous sedatives, with midazolam being the most frequently used [60.8% (310/510)]. Mechanical ventilation data were available for 932 critically ill patients, of whom 579 (62.1%) received mechanical ventilation and 353 (37.9%) did not. Compared with non-ventilated patients, ventilated patients had significantly higher rates of analgesic and sedative use [analgesics: 77.9% (451/579) vs. 38.8% (137/353); sedatives: 71.8% (416/579) vs. 25.8% (91/353); both P < 0.05]. In terms of analgesic selection, ventilated patients were more likely to receive strong opioids than non-ventilated patients [85.8% (95/137) vs. 69.3% (387/451), P < 0.05]. For sedatives, ventilated patients preferred midazolam [66.6% (277/416)], whereas non-ventilated patients more often received dexmedetomidine [45.1 (41/91)]. Blood pressure within 24 hours of ICU admission were available for 822 critically ill patients, of whom 245 (29.8%) had hypotension and 577 (70.2%) did not. Compared with non-hypotensive patients, hypotensive patients had significantly higher rates of analgesic and sedative use [analgesics: 74.7% (183/245) vs. 59.8% (345/577); sedatives: 65.7% (161/245) vs. 51.3% (296/577); both P < 0.05], but there was no significant difference in the choice of analgesic or sedative agents between the two groups. CONCLUSIONS The proportion of critically ill ICU patients in Guizhou Province who received standardized pain and agitation assessments was relatively low. The most commonly used assessment tools were CPOT and RASS, while remifentanil and midazolam were the most frequently used analgesic and sedative agents, respectively. Secondary-level hospitals had a lower rate of using standardized pain assessment tools compared to tertiary-level hospitals. Mechanical ventilation and hypotension were associated with the use of analgesic and sedative medications.
Humans ; Critical Illness ; Intensive Care Units ; Analgesics/therapeutic use* ; Hypnotics and Sedatives/therapeutic use* ; Retrospective Studies ; China ; Pain Measurement ; Pain Management ; Female ; Male ; Critical Care ; Middle Aged

OBJECTIVE: To explore the timing of weaning extracorporeal membrane oxygenation (ECMO) and analyze the risk factors that affect survival outcomes before weaning. METHODS: A retrospective case-control study was conducted. Patients who received ECMO treatment and were weaned according to physicians' orders at the Second Xiangya Hospital of Central South University from January 2020 to June 2024 were enrolled as the study subjects. The general information, underlying diseases, indications and processes of ECMO, vital signs and arterial blood gas analysis 1 hour before weaning test, and biochemical indicators 24 hours before weaning test were collected through the hospital electronic medical record system. The primary outcome measure was the hospital mortality. The variables with P < 0.1 in univariate analysis and correlation analysis were included into binary Logistic regression analysis to identify risk factors. A nomogram model was constructed to predict the risk of weaning death in patients with ECMO, and receiver operator characteristic curve (ROC curve) and calibration curve were drawn to evaluate the model. Decision curve analysis (DCA) was used to evaluate the clinical net benefit rate of the model. RESULTS: A total of 32 ECMO patients were included, among whom 10 received veno-arterial ECMO (VA-ECMO) and 22 received veno-venous ECMO (VV-ECMO). During the hospitalization period, 23 patients survived, while 9 died. The time from mechanical ventilation to ECMO activation in the death group was significantly longer than that in the survival group, and the time from ECMO cessation to discharge was significantly shorter than that in the survival group. The levels of diastolic blood pressure (DBP) and albumin (Alb) before weaning were significantly lower than those in the survival group, and the level of procalcitonin (PCT) was significantly higher than that in the survival group (all P < 0.05). Spearman correlation analysis showed that DBP, PCT, Alb, and thrombin time (TT) were correlated with the weaning outcomes of ECMO patients (r values were -0.450, 0.373, -0.376, -0.346, all P < 0.1). Binary Logistic regression analysis showed that the final indicators entering the regression equation included DBP [odds ratio (OR) = 0.864, 95% confidence interval (95%CI) was 0.756-0.982], PCT (OR = 1.157, 95%CI was 0.679-1.973), and TT (OR = 0.852, 95%CI was 0.693-1.049), and a nomogram model was constructed to predict the weaning outcomes of ECMO patients. ROC curve analysis showed that the area under the curve (AUC) of the nomogram model for predicting the weaning outcome of ECMO patients was 0.831, with a sensitivity of 77.8% and a specificity of 65.2%. Its predictive value was better than that of single indicators DBP, PCT, and TT (AUC of 0.787, 0.739, and 0.722, respectively). The calibration curve showed that the prediction probability of the model was in good consistency with the actual observed results, the Hosmer-Lemeshow goodness of fit test showed that, χ ² = 8.3521, P = 0.400, indicating that the model fits well. DCA showed that across risk threshold of 0-0.8, the net benefit rate was greater than 0, which was significantly better than that of single indicator. CONCLUSIONS The nomogram model constructed with DBP, PCT, and TT has certain predictive value for the weaning outcomes of ECMO patients and can be used as a screening indicator for ECMO weaning timing.
Humans ; Extracorporeal Membrane Oxygenation ; Retrospective Studies ; Risk Factors ; Case-Control Studies ; Hospital Mortality ; Male ; Female ; Nomograms ; Logistic Models ; ROC Curve ; Middle Aged ; Adult ; Ventilator Weaning ; Time Factors

OBJECTIVE: To identify the risk factors related to the timing of patients receiving extracorporeal membrane oxygenation (ECMO) initiation and construct a risk prediction model for ECMO initiation timing. METHODS: Patients who received ECMO admitted to the Second Xiangya Hospital of Central South University from January 2020 to January 2024 were retrospectively collected. The case data mainly included physiological and biochemical indicators 1 hour before ECMO initiation. According to the outcome of the patients, they were divided into survival group and death group. Univariate and multivariate Logistic regression analysis were used to analyze the predictors of mortality risk in patients with ECMO, and a nomogram prediction model was constructed. The discrimination, calibration accuracy, and goodness of the model were evaluated by the receiver operator characteristic curve (ROC curve), calibration curve, and the Hosmer-Lemeshow test, respectively. Decision curve analysis (DCA) evaluated the clinical net benefit rate of the model. RESULTS: A total of 81 ECMO patients were included, including 59 males and 22 females; age range from 16 to 61 years old, with a median age of 56.0 (39.5, 61.5) years old; 20 patients received veno-arterial (V-A) ECMO, and 61 patients received veno-venous (V-V) ECMO; 23 patients ultimately survived and 58 patients died. Univariate analysis showed that age, blood urea nitrogen, serum creatinine, D-dimer, arterial blood carbon dioxide partial pressure, and prothrombin time of the death group were all higher than those of the survival group, while albumin was slightly lower than that of the survival group. There was a statistically significant difference in the direct cause of ECMO initiation between the two groups. Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.069, 95% confidence interval (95%CI) was 1.015-1.125, P = 0.012], direct cause of ECMO initiation [with heart failure as the reference, return of spontaneous circulation (ROSC) after cardiopulmonary support (OR = 30.672, 95%CI was 1.265-743.638, P = 0.035), novel coronavirus infection (OR = 8.666, 95%CI was 0.818-91.761, P = 0.073), other severe pneumonia (OR = 4.997, 95%CI was 0.558-44.765, P = 0.150)], pre-ECMO serum creatinine (OR = 1.008, 95%CI was 1.000-1.016, P = 0.044), prothrombin time (OR = 1.078, 95%CI was 0.948-1.226, P = 0.252), and D-dimer (OR = 1.135, 95%CI was 1.047-1.231, P = 0.002) were entered into the final regression equation. A nomogram prediction model was developed based on these five factors. The area under the ROC curve (AUC) of the model was 0.889 (95%CI was 0.819-0.959), higher than the AUC of the sequential organ failure assessment (SOFA; AUC = 0.604, 95%CI was 0.467-0.742). The calibration curve showed good consistency between the model predictions and the observed results. The Hosmer-Lemeshow goodness-of-fit test showed that χ ² = 4.668, P = 0.792. DCA analysis showed that when the risk threshold was 0-0.8, the net benefit rate was greater than 0, which was significantly better than that of SOFA score. CONCLUSIONS The risk prediction model for the timing of ECMO initiation, constructed using five factors (age, direct cause of ECMO initiation, thrombin time, serum creatinine, and D-dimer), demonstrated good discrimination and calibration. It can serve as a pre-initiation assessment tool to identify and predict post-initiation mortality risk in ECMO patients.
Humans ; Extracorporeal Membrane Oxygenation ; Middle Aged ; Male ; Female ; Retrospective Studies ; Adult ; Risk Factors ; Adolescent ; Young Adult ; Logistic Models ; Nomograms ; ROC Curve ; Time Factors ; Risk Assessment

Objective:To explore the prevalence, clinical features, genetic characteristics and prognosis of Citrin deficiency in Henan province of China.Methods:A total of 986 565 neonates screened by tandem mass spectrometry at the Third Affiliated Hospital of Zhengzhou University from January 2013 to December 2021 were retrospectively analyzed. Analysis of SLC25A13 gene variants and parental verification were carried out for neonates suspected for Citrin deficiency by next-generation sequencing. The clinical, biochemical and genetic characteristics of Citrin deficiency patients were integrated to guide the diet treatment and follow up the growth and development. Paired- t test was used to compare the amino acid levels in the peripheral blood samples before and after the treatment. Results:Nine cases of Citrin deficiency were diagnosed among the 986 565 neonates. Specific elevation of citrulline was observed in all of the 9 cases. Six variants were detected by genetic sequencing, among which c. 852_855delTATG, c. 615+ 5G>A, c. 550C>T and IVS16ins3kb were known pathogenic variants, whilst c. 1111_1112delAT and c. 837T>A were unreported previously. The detection rate for c. 852_855delTATG was the highest (61.6%, 11/18), followed by IVS16ins3kb (16.7%, 3/18). The clinical symptoms of all patients were relieved after the treatment, and the blood amino acid profile and biochemical parameters were significantly improved by gradually falling within the normal range. By June 2022, all patients had shown a good prognosis.Conclusion:The prevalence of Citrin deficiency among neonates from Henan Province by tandem mass spectrometry is 1/109 618, and the carrier rate for the pathogenic variants of the SLC25A13 gene was 1/166. The c. 852_855delTATG may be a hot spot variant among the patients. Discovery of the novel variants has enriched the mutational spectrum of the SLC25A13 gene. Above results have provided a basis for the early diagnosis, treatment, prognosis and genetic counseling for the affected families.

Objective:To survey the quality of medical care and management for chronic obstructive pulmonary disease (COPD) in Shanghai community health service centers.Methods:A questionnaire survey on the institutional capacity for COPD care was conducted among 248 community health service centers in Shanghai from October to November 2023; the contents of self-designed questionnaire included the equipment, drugs, technical support, information exchange and management of COPD in the institutions. At the same time, a questionnaire survey on the knowledge and skill of COPD care was also conducted among half of all physicians selected by stratified sampling from half of the institutions selected by the random cluster sampling, including the knowledge about early screening, diagnosis, treatment and management of COPD, and related training needs .Results:(1)Survey results showed that the most common equipment for diagnosis and treatment of COPD available in community health centers was pulse oxygen saturation detector (97.6%, 242/248), X-ray radiography (96.8%, 240/248) and nebulizer (96.0%, 238/248), The availability of 6-min walking test system, non-invasive ventilator and rehabilitation training instrument in urban community health service centers was higher than that in rural ones ( P<0.05). The availability rates of common COPD drugs in community health service centers were theophylline (91.5%, 227/248), oral glucocorticoid (85.9%, 213/248), intravenous glucocorticoid (81.0%, 201/248), the availability of oral and intravenous glucocorticoids in urban community health service centers was higher than that in rural ones ( P<0.05). The availability rates of COPD diagnosis and treatment techniques were 95.6% (213/248) for pulmonary function test, 93.5% (232/248) for pulse oxygen saturation test, and 53.2% (132/248) for non-invasive respiratory therapy. The availability rate of pulmonary function test, blood gas analysis, non-invasive ventilation and rehabilitation in urban centers was higher than that in rural centers ( P<0.05). Early screening of COPD was conducted in 85.1% (211/248) of community health service centers, the health record system and referral system were established in 66.5% (165/248) and 62.9% (156/248) of centers, respectively; and the establishment of outpatient and referral channels for respiratory diseases in urban areas was higher than that in rural areas ( P<0.05). (2)A total of 1 873 community doctors, aged(38.9±7.8)years and with (15.5±9.1)years of working experience, participated in the COPD knowledge and skill survey. The survey showed that 79.3% participants (1 485/1 873) knew the concept of COPD, 52.6% (986/1 873) mastered the diagnostic criteria, 41.6% (779/1 873) knew the risk factors and 15.5% (291/1 873) mastered the application of glucocorticoids. More than 79% of the community doctors showed the needs for training of knowledge, skills, rehabilitation of COPD and the performance of pulmonary function tests. Conclusion:Availability of COPD diagnosis and treatment equipment in community health center in Shanghai is different, and the availability of basic diagnosis and treatment equipment and drugs is better. The knowledge, skills and management of COPD need to be improved for community doctors, particularly in clinical application of pulmonary function test and active case finding.

Objective:To explore the factors associated with vascular luminal dilatational remodeling (VLDR) following balloon angioplasty for intracranial atherosclerotic stenosis (ICAS).Methods:A case-control study was conducted to analyze the data of symptomatic severe ICAS patients who received either paclitaxel-coated balloon angioplasty (PCBA) or plain balloon angioplasty (POBA) at our center from January 2019 to January 2022 and completed the six-month follow-up. The patients were divided into VLDR group and non-VLDR group according to whether VLDR occurred on follow-up digital subtraction angiography (DSA). The baseline data, preoperative and postoperative lesion characteristics (DSA), and perioperative related information were collected. The definition of VLDR was a decrease in luminal stenosis rate by more than 10% at the time of follow-up compared to the immediate postoperative period. Multivariate logistic regression was performed to analyze possible factors affecting VLDR such as balloon type, balloon length, and expansion time.Results:A total of 88 patients were included in this study, with 16 in the VLDR group and 72 in the non-VLDR group. The follow-up time for all included patients was 6.00 (5.00, 7.00) months. VLDR occurred in 18.2% (16/88) of cases, with a VLDR incidence of 30.4% (14/46) after PCBA and 4.8% (2/42) after POBA. Univariate logistic regression analysis revealed that treatment balloon type, balloon length, inflated time, immediate postoperative stenosis rate, follow-up time and Mori classification may affect the occurrence of VLDR. Multivariate logistic regression analysis showed that the use of paclitaxel-coated balloon (PCB) ( OR=9.82, 95% CI 1.99-48.49, P=0.005) and postoperative immediate stenosis rate ( OR=1.07, 95% CI 1.00-1.14, P=0.042) were independently associated with VLDR. Conclusion:The occurrence of VLDR following balloon angioplasty in ICAS was associated with the use of PCB and immediate postoperative stenosis rates, which will provide guidance for the clinical application of PCB.

Purpose/Significance To analyze the current situation and problems of the development of digital health in China,and to explore how to promote the innovative development of digital health.Method/Process The current situation and main problems of digital health are studied and analyzed by the method of literature research and network survey,and the paths of the innovative development of digital health are devised based on case analysis.Result/Conclusion Digital technology has become the key to breaking down multiple barriers to digital health development.The paper puts forward the specific path of"sharing and cooperative governance platform-indus-trial security system-intelligent supervision mechanism"and the digital technology-based countermeasures to promote innovative devel-opment of the industry.

Objective:To evaluate the performance of an artificial intelligent (AI)-based automated digital cell morphology analyzer (hereinafter referred as AI morphology analyzer) in detecting peripheral white blood cells (WBCs).Methods:A multi-center study. 1. A total of 3010 venous blood samples were collected from 11 tertiary hospitals nationwide, and 14 types of WBCs were analyzed with the AI morphology analyzers. The pre-classification results were compared with the post-classification results reviewed by senior morphological experts in evaluate the accuracy, sensitivity, specificity, and agreement of the AI morphology analyzers on the WBC pre-classification. 2. 400 blood samples (no less than 50% of the samples with abnormal WBCs after pre-classification and manual review) were selected from 3 010 samples, and the morphologists conducted manual microscopic examinations to differentiate different types of WBCs. The correlation between the post-classification and the manual microscopic examination results was analyzed. 3. Blood samples of patients diagnosed with lymphoma, acute lymphoblastic leukemia, acute myeloid leukemia, myelodysplastic syndrome, or myeloproliferative neoplasms were selected from the 3 010 blood samples. The performance of the AI morphology analyzers in these five hematological malignancies was evaluated by comparing the pre-classification and post-classification results. Cohen′s kappa test was used to analyze the consistency of WBC pre-classification and expert audit results, and Passing-Bablock regression analysis was used for comparison test, and accuracy, sensitivity, specificity, and agreement were calculated according to the formula.Results:1. AI morphology analyzers can pre-classify 14 types of WBCs and nucleated red blood cells. Compared with the post-classification results reviewed by senior morphological experts, the pre-classification accuracy of total WBCs reached 97.97%, of which the pre-classification accuracies of normal WBCs and abnormal WBCs were more than 96% and 87%, respectively. 2. The post-classification results reviewed by senior morphological experts correlated well with the manual differential results for all types of WBCs and nucleated red blood cells (neutrophils, lymphocytes, monocytes, eosinophils, basophils, immature granulocytes, blast cells, nucleated erythrocytes and malignant cells r>0.90 respectively, reactive lymphocytes r=0.85). With reference, the positive smear of abnormal cell types defined by The International Consensus Group for Hematology, the AI morphology analyzer has the similar screening ability for abnormal WBC samples as the manual microscopic examination. 3. For the blood samples with malignant hematologic diseases, the AI morphology analyzers showed accuracies higher than 84% on blast cells pre-classification, and the sensitivities were higher than 94%. In acute myeloid leukemia, the sensitivity of abnormal promyelocytes pre-classification exceeded 95%. Conclusion:The AI morphology analyzer showed high pre-classification accuracies and sensitivities on all types of leukocytes in peripheral blood when comparing with the post-classification results reviewed by experts. The post-classification results also showed a good correlation with the manual differential results. The AI morphology analyzer provides an efficient adjunctive white blood cell detection method for screening malignant hematological diseases.

Objective:To analyze the factors influencing pulmonary infections in elderly neurocritical patients in the intensive care unit (ICU) and to explore the predictive value of risk factors for pulmonary infections.Methods:The clinical data of 713 elderly neurocritical patients [age ≥ 65 years, Glasgow coma score (GCS) ≤ 12 points] admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from 1 January 2016 to 31 December 2019 were retrospectively analyzed. According to whether or not they had HAP, the elderly neurocritical patients were divided into hospital-acquired pneumonia (HAP) group and non-HAP group. The differences in baseline data, medication and treatment, and outcome indicators between the two groups were compared. Logistic regression analysis was used to analyze the factors influencing the occurrence of pulmonary infection.The receiver operator characteristic curve (ROC curve) was plotted for risk factors and a predictive model was constructed to evaluate the predictive value for pulmonary infection.Results:A total of 341 patients were enrolled in the analysis, including 164 non-HAP patients and 177 HAP patients. The incidence of HAP was 51.91%. According to univariate analysis, compared with the non-HAP group, mechanical ventilation time, the length of ICU stay and total hospitalization in the HAP group were significantly longer [mechanical ventilation time (hours): 171.00 (95.00, 273.00) vs. 60.17 (24.50, 120.75), the length of ICU stay (hours): 263.50 (160.00, 409.00) vs. 114.00 (77.05, 187.50), total hospitalization (days): 29.00 (13.50, 39.50) vs. 27.00 (11.00, 29.50), all P < 0.01], the proportion of open airway, diabetes, proton pump inhibitor (PPI), sedative, blood transfusion, glucocorticoids, and GCS ≤ 8 points were significantly increased than those in HAP group [open airway: 95.5% vs. 71.3%, diabetes: 42.9% vs. 21.3%, PPI: 76.3% vs. 63.4%, sedative: 93.8% vs. 78.7%, blood transfusion: 57.1% vs. 29.9%, glucocorticoids: 19.2% vs. 4.3%, GCS ≤ 8 points: 83.6% vs. 57.9%, all P < 0.05], prealbumin (PA) and lymphocyte count (LYM) decreased significantly [PA (g/L): 125.28±47.46 vs. 158.57±54.12, LYM (×10 9/L): 0.79 (0.52, 1.23) vs. 1.05 (0.66, 1.57), both P < 0.01]. Logistic regression analysis showed that open airway, diabetes, blood transfusion, glucocorticoids and GCS ≤ 8 points were independent risk factors for pulmonary infection in elderly neurocritical patients [open airway: odds ratio ( OR) = 6.522, 95% confidence interval (95% CI) was 2.369-17.961; diabetes: OR = 3.917, 95% CI was 2.099-7.309; blood transfusion: OR = 2.730, 95% CI was 1.526-4.883; glucocorticoids: OR = 6.609, 95% CI was 2.273-19.215; GCS ≤ 8 points: OR = 4.191, 95% CI was 2.198-7.991, all P < 0.01], and LYM, PA were the protective factors for pulmonary infection in elderly neurocritical patients (LYM: OR = 0.508, 95% CI was 0.345-0.748; PA: OR = 0.988, 95% CI was 0.982-0.994, both P < 0.01). ROC curve analysis showed that the area under the ROC curve (AUC) for predicting HAP using the above risk factors was 0.812 (95% CI was 0.767-0.857, P < 0.001), with a sensitivity of 72.3% and a specificity of 78.7%. Conclusions:Open airway, diabetes, glucocorticoids, blood transfusion, GCS ≤ 8 points are independent risk factors for pulmonary infection in elderly neurocritical patients. The prediction model constructed by the above mentioned risk factors has certain predictive value for the occurrence of pulmonary infection in elderly neurocritical patients.