Objective:To explore the diagnostic value of ultrasound for retained products of conceptions com-plicated with uterine arteriovenous fistula(UAVF)after early pregnancy miscarriage and the predictive value for massive bleeding by constructing a risk model for bleeding.Methods:A total of 90 patients who were diagnosed by ultrasound in West China Second Hospital of Sichuan University as having retained products of conceptions complicated with UAVF after early pregnancy miscarriage from July 2013 to September 2021 were selected,among which 37 cases underwent digital subtraction angiography(DSA).Clinical and ultrasound data were collected and statistical analysis was conducted on the ultrasound parameters of whether DSA examination was accompanied by UAVF and whether there was major bleeding(spontaneous and intraoperative).We performed multivariate Lo-gistic regression analysis on parameters with statistical differences,plotted receiver operating characteristic(ROC)curve for predicting major bleeding(spontaneous and intraoperative),and calculated the area under the curve(AUC).Results:① After DSA examination,14 out of 37 patients(37.8%)were diagnosed with UAVF based on ultrasound diagnosis of pregnancy residue combined with UAVF.Univariate and multivariate Logistic an-alyses showed that the expanding inner diameter of blood vessels was an independent risk factor for residual pregnancy products combined with UAVF after early pregnancy miscarriage(OR 37.099,P=0.027).ROC curve analysis revealed that dilated vessel diameter had an AUC of 0.78,sensitivity of 64%,specificity of 91%,and an optimal cut-off value of 0.85 cm for the diagnosis of UAVF.②Out of 90 patients,44(48.9%)experienced sponta-neous massive bleeding.Univariate and multivariate Logistic analyses showed that the presence of vascular pools or dilated vessels was an independent risk factor for spontaneous massive bleeding(OR 5.163,P=0.004).③A-mong70 patients undergoing surgical treatment,7 experienced intraoperative bleeding(11.7%).Univariate and multivariate Logistic analyses showed that the enlargement of the maximum diameter of the lesion was an inde-pendent risk factor for intraoperative massive bleeding(OR 7.278,P=0.007).ROC curve analysis revealed that the AUC of the maximum diameter of the lesion for predicting the risk of intraoperative bleeding was 0.92,with a sensitivity of 100%,specificity of 82%,and an optimal threshold of 3.95 cm.Conclusions:Dilated vessel diameter in ultrasound examination parameters has high diagnostic value for residual pregnancy products combined with UAVF after early pregnancy miscarriage.Patients with vascular pools or dilated vessels and large lesions have a higher risk of spontaneous and intraoperative bleeding,and clinical prediction models can be used to assess risk of bleeding.

Objective:To evaluate the effects of a reduced-positioning restrictions nursing program on postoperative recovery, sleep quality, self-care ability, and hip joint function in patients undergoing total hip arthroplasty (THA), providing a reference for postoperative positioning management.Methods:A randomized controlled trial was conducted, and 140 THA patients admitted to Zhejiang Provincial People′s Hospital from January 2022 to June 2023 were selected using convenience sampling. They were divided into a control group (70 cases) and an observation group (70 cases) using a random number table. The control group received conventional rehabilitation care, while the observation group received a reduced-positioning restrictions nursing program in addition to the conventional care. The incidence of dislocation at 3 months postoperatively, the activities of daily living, the hip joint function recovery at 1 month and 3 months postoperatively, the sleep quality at 1 month postoperatively were compared between the two groups.Results:Finally 63 cases in the control group and 64 cases in the observation group completed the study. The control group included 25 males and 38 females, with an average age of (65.44 ± 10.97) years, while the observation group included 28 males and 36 females, with an average age of (65.13 ± 12.18) years. At 3 months postoperatively, there was no significant difference in the dislocation rate between the control group and the observation group ( P>0.05). At 1 month and 3 months postoperatively, the scores of activities of daily living in the observation group were (77.89 ± 6.71) and (93.52 ± 6.59) points respectively, which were higher than those in the control group [(69.68 ± 5.53) and (87.38 ± 7.72) points], the differences were statistically significant ( t=5.38, 6.96, both P<0.05), the time, interaction and inter-group effects were all statistically significant ( F=33.93, 10.81, 876.91, all P<0.05). At 1 month postoperatively, the excellent and good rate of hip joint function score grade in the observation group was 73.44% (47/64), which was higher than 41.27% (26/63) in the control group, the difference was statistically significant ( Z=-3.67, P<0.05), there was no statistically significant difference between the two groups at 3 months postoperatively ( P>0.05). At 1 month after the operation, the excellent and good rate of sleep quality score grades in the observation group was 81.25% (52/64), which was higher than 57.14% (36/63) in the control group, and the difference was statistically significant ( Z=-3.00, P<0.05). Conclusions:Incorporating a reduced-positioning restrictions nursing program into the perioperative management of THA does not increase the risk of prosthesis dislocation. This approach enhances patient comfort, improves sleep quality, increases self-care ability, and supports the recovery of hip joint function.

Objective:To explore the diagnostic value of ultrasound for retained products of conceptions com-plicated with uterine arteriovenous fistula(UAVF)after early pregnancy miscarriage and the predictive value for massive bleeding by constructing a risk model for bleeding.Methods:A total of 90 patients who were diagnosed by ultrasound in West China Second Hospital of Sichuan University as having retained products of conceptions complicated with UAVF after early pregnancy miscarriage from July 2013 to September 2021 were selected,among which 37 cases underwent digital subtraction angiography(DSA).Clinical and ultrasound data were collected and statistical analysis was conducted on the ultrasound parameters of whether DSA examination was accompanied by UAVF and whether there was major bleeding(spontaneous and intraoperative).We performed multivariate Lo-gistic regression analysis on parameters with statistical differences,plotted receiver operating characteristic(ROC)curve for predicting major bleeding(spontaneous and intraoperative),and calculated the area under the curve(AUC).Results:① After DSA examination,14 out of 37 patients(37.8%)were diagnosed with UAVF based on ultrasound diagnosis of pregnancy residue combined with UAVF.Univariate and multivariate Logistic an-alyses showed that the expanding inner diameter of blood vessels was an independent risk factor for residual pregnancy products combined with UAVF after early pregnancy miscarriage(OR 37.099,P=0.027).ROC curve analysis revealed that dilated vessel diameter had an AUC of 0.78,sensitivity of 64%,specificity of 91%,and an optimal cut-off value of 0.85 cm for the diagnosis of UAVF.②Out of 90 patients,44(48.9%)experienced sponta-neous massive bleeding.Univariate and multivariate Logistic analyses showed that the presence of vascular pools or dilated vessels was an independent risk factor for spontaneous massive bleeding(OR 5.163,P=0.004).③A-mong70 patients undergoing surgical treatment,7 experienced intraoperative bleeding(11.7%).Univariate and multivariate Logistic analyses showed that the enlargement of the maximum diameter of the lesion was an inde-pendent risk factor for intraoperative massive bleeding(OR 7.278,P=0.007).ROC curve analysis revealed that the AUC of the maximum diameter of the lesion for predicting the risk of intraoperative bleeding was 0.92,with a sensitivity of 100%,specificity of 82%,and an optimal threshold of 3.95 cm.Conclusions:Dilated vessel diameter in ultrasound examination parameters has high diagnostic value for residual pregnancy products combined with UAVF after early pregnancy miscarriage.Patients with vascular pools or dilated vessels and large lesions have a higher risk of spontaneous and intraoperative bleeding,and clinical prediction models can be used to assess risk of bleeding.

Objective:To systematically evaluate the incidence and risk factors of acute kidney injury (AKI) induced by vancomycin in pediatric patients.Methods:Databases of PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wanfang, VIP, Chinese Biomedical Database (CBM) were searched and articles about the risk factors of AKI induced by vancomycin in pediatric patients from inception to June 2024 were collected. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS) for the included studies. Meta-analysis of the data for relevant exposure factors extracted from the included literature was conducted using Rev Man 5.4. The strength of association between the exposure factors and AKI was expressed using the odds ratio ( OR) and its 95% confidence interval ( CI). Results:A total of 13 studies were entered, involving 11 073 patients. Of them, 1 388 patients were in AKI group and 9 685 patients in non-AKI group. The incidence of AKI was 12.53%, ranging from 4.62% to 27.07%. The quality evaluation results showed that the 13 documents were all of high-quality (NOS score ≥7 points). Meta-analysis showed that admission to intensive care unit (ICU) ( OR=2.39, 95% CI: 1.59-3.59, P<0.001), vancomycin using time ≥7 d ( OR=2.19, 95% CI: 1.44-3.34 P=0.003), vancomycin steady-state trough concentration ≥15 mg/L ( OR=2.98, 95% CI: 2.22-4.01, P<0.001), combined with nephrotoxic drugs ≥2 kinds ( OR=2.92, 95% CI=1.84-4.64, P<0.001), combined with piperacillin sodium and tazobactam sodium ( OR=2.71, 95% CI: 1.72- 4.27, P<0.001), combined with carbapenem ( OR=2.36, 95% CI: 1.36-4.10, P=0.002), combined with aminoglycosides ( OR=1.78, 95% CI: 1.35-2.35, P<0.001), combined with loop diuretics ( OR=3.16, 95% CI: 2.36- 4.23, P<0.001), combined with amphotericin B ( OR=2.26, 95% CI: 1.35-3.79, P=0.002), combined with contrast medium ( OR=2.34, 95% CI: 1.04-5.25, P=0.040), and combined with aciclovir ( OR=1.74, 95% CI: 1.04-2.84, P=0.030) were all risk factors of AKI induced by vancomycin in pediatric patients. Conclusions:The incidence of vancomycin-related AKI in pediatric patients was 12.53%. Admission to ICU, vancomycin trough concentration ≥15 mg/L, medication time ≥7 d, and concomitant use of ≥2 nephrotoxic drugs and etc.were risk factors of vancomycin-related AKI.

Objective:To evaluate the safety and efficacy of digital technology-assisted debridement and bone and soft tissue reconstruction in the treatment of chronic osteomyelitis of the tibia.Methods:This retrospective study analyzed clinical data from 38 patients (26 males, 12 females; mean age 45.61±18.36 years, range 16-83 years) with chronic post-traumatic osteomyelitis complicated by soft tissue defects in the tibia, treated at the Department of Orthopaedics, Fourth Medical Center of PLA General Hospital between June 2021 and June 2023. There were 18 cases of traffic accidents, 6 cases of high-altitude falls, 6 cases of heavy objects and 6 cases of low-energy falls. Lesion sites: 12 cases in the upper segment of the tibia, 12 cases in the middle segment, and 14 cases in the lower segment. According to the Cierny-Mader classification, there were 24 cases of type III and 14 cases of type IV. Before the operation, the "3D point cloud technology" was used to plan the debridement range of bone and soft tissue. During the operation, the optical navigation system was used to monitor the debridement range in real time. The flap was designed by combining "Reading Tablet Treasure" with CT angiography, and the amount of bone graft was predicted by AI algorithm. The surgical method adopted is the Masquelet technique, namely thorough debridement, bone cement occupation and soft tissue repair in the first stage, and bone reconstruction in the second stage. Comparing the calculated bone defect amount and soft tissue defect area before the operation with the actual measured values after debridement. The cure rate of infection was evaluated by using the McKee bone infection treatment criteria after the operation. The visual analogue scale (VAS) for pain, lower extremity functional scale (LEFS), and self-rating anxiety scale (SAS) were used to evaluate the improvement of the quality of life of postoperative patients.Results:38 patients were followed up with a mean follow-up of 13.53±2.37 months. 37 patients' infections were effectively controlled, and 1 patient had a recurrence of infection, with an effectiveness rate of 97% for the treatment of McKee's infections. The preoperative calculated bone defect amount and soft tissue defect area were 51.05±26.31 cm 3 and 68.42±43.45 cm 2 respectively, and the actual measured values after debridement during the operation were 51.66±26.35 cm 3 and 68.82±43.76 cm 2 respectively. There was no statistically significant difference before and after the operation ( P>0.05). The interval between the first and second stage surgeries was 10.36±1.61 weeks, and all flaps survived after the first stage surgery. Two months after the operation, one case had recurrent osteomyelitis. After palliative treatment, sinus tracts were formed at the infection site. At the 12-month regular dressing change follow-up, there were still purulent secretions in the sinus tracts. There was no recurrence of infection after primary debridement in 37 cases, and the bone grafts healed. The bone healing time was 3.58±0.97 months. The postoperative VAS, LEFS, and SAS scores were 1.00±0.91, 66.68±7.91, and 34.30±4.29, respectively, which were significantly improved compared with the preoperative scores of 7.54±1.52, 21.22±4.29, and 52.70±6.74, respectively, and the difference was statistically significant ( P<0.05). Conclusions:The application of digital technology to precisely design the debridement range of bone and soft tissue, and the real-time holographic visualization monitoring of the debridement range during the operation can achieve precise debridement of bone and soft tissue and personalized and precise repair of soft tissue defects. It is a safe and effective technique for the treatment of chronic osteomyelitis of the tibia.

Objective:To describe epidemiological characteristics and their influencing factors of diabetes and pre-diabetes among adult residents in Hainan Province and provide a theoretical basis to develop epidemic prevention and control strategies for diabetes.Methods:This study used a two-stage unequal proportion cluster sampling method, and 32 857 subjects (≥18 years old) were collected from 24 cities/counties/districts in Hainan Province. All the subjects were investigated with questionnaires, physical examination, and laboratory tests from January to June 2023. The χ2 and Mantel-Haenszel trend χ2 tests were used to analyze the data. Multivariate logistic regression was used to analyze the factors influencing diabetes and pre-diabetes. SPSS 23.0 software was used to analyze the data. Results:The crude prevalence of diabetes and pre-diabetes in adult residents of Hainan Province were 18.1% and 22.8%, while the weighted rates were 13.7% and 20.7%, respectively. The results of multivariate logistic regression analysis showed that: aging (30-39 years old: OR=2.65, 95% CI: 2.06-3.41; 40-49 years old: OR=5.64, 95% CI: 4.40-7.24; 50- 59 years old: OR=9.88, 95% CI: 7.71-12.67; 60-69 years old: OR=18.34, 95% CI: 14.28-23.55; 70-79 years old: OR=21.30, 95% CI: 16.41-27.65; 80 years old and above: OR=24.13, 95% CI: 17.94-32.46), nationality (Li minority group: OR=1.50, 95% CI: 1.38-1.63; other ethnic groups: OR=1.53, 95% CI: 1.20-1.94), urban ( OR=1.12, 95% CI: 1.04-1.21), central obesity ( OR=2.14, 95% CI: 2.01-2.29), higher frequency of alcohol consumption (5-7 day/week: OR=1.24, 95% CI: 1.11-1.38), physical inactivity ( OR=1.09, 95% CI: 1.02-1.17) were risk factors for diabetes, while aging (30-39 years old: OR=1.53, 95% CI: 1.31-1.79; 40-49 years old: OR=2.36, 95% CI: 2.01-2.76; 50-59 years old: OR=3.03, 95% CI: 2.58-3.55; 60-69 years old: OR=4.22, 95% CI: 3.58-4.97; 70-79 years old: OR=5.05, 95% CI: 4.23-6.04; 80 years old and above: OR=6.08, 95% CI: 4.86-7.61), nationality: (Li minority group: OR=1.18, 95% CI: 1.10-1.28; other ethnic groups: OR=1.40, 95% CI: 1.14-1.71), urban ( OR=1.12, 95% CI: 1.04-1.19), central obesity ( OR=1.72, 95% CI: 1.62-1.83), higher frequency of alcohol consumption (1-4 day/week: OR=1.12, 95% CI: 1.01-1.23; 5-7 day/week: OR=1.35, 95% CI: 1.22-1.49) were risk factors for pre-diabetes. Conclusions:The epidemic situation of diabetes and pre-diabetes among adult residents in Hainan Province was not optimistic. In order to control the development of abnormal blood glucose, measures and targeted health education should be carried out to strengthen the screening, treatment, and management of people with abnormal blood glucose among different populations.

Objective:To establish a quantitative analysis of multi-components by single marker(QAMS)for the determination of 6 alkaloid components,which is benzoylmesaconine,benzoyl-hypaconine,benzoylaconine,mesaconitine,hypaconitine,and aconitine in Zhachong Shisanwei Pills,and prove the scientificity and feasibility of the method in the quality analysis.Methods:The chromatographic separation was performed on an Agilent Eclipse Plus C18(250 mm×4.6 mm,5 μm)with gradient elution using 0.1 mol·L-1 ammonium acetate(0.5 mL of gla-cial acetic acid per 1 000 mL)(A)-acetonitrile:tetrahydrofuran(25∶15)(B),as the mobile phase(0-50 min,18%B-28%B),the detection wavelength was switched from 235 nm,the column temperature was kept at 40℃and the flow rate was 1.0 mL·min-1.The relative correction factors(fs/i)were established with the other 5 compo-nents to be measured using benzoylaconine as the internal reference,which were used to calculate the mass fraction of each component.At the same time,the mass fractions of the 6 effective constituents in Zhachong Shisanwei Pills were calculated by the external standard method(ESM).By comparing the content results of ESMand QAMS,the accura-cy of QAMS method were evaluated.Results:The relative correction factors(fs/i)of benzoylmesaconine,benzoylhyp-aconine,mesaconitine,hypaconitine,and aconitine in Mongolian medicine Zhachong Shisanwei Pills were reproduci-ble with good reproducibility,which were 0.680 4,0.450 6,0.850 8,0.676 1 and 0.757 0,the result obtained by QAMS approximated those obtained by external standard method(ESM).Conclusion:The method is simple,stable and reproducible,and can be used for the quality control of 6 alkaloid components in Zhachong Shisanwei Pills.

Objective:To establish a quantitative analysis of multi-components by single marker(QAMS)for the determination of 6 alkaloid components,which is benzoylmesaconine,benzoyl-hypaconine,benzoylaconine,mesaconitine,hypaconitine,and aconitine in Zhachong Shisanwei Pills,and prove the scientificity and feasibility of the method in the quality analysis.Methods:The chromatographic separation was performed on an Agilent Eclipse Plus C18(250 mm×4.6 mm,5 μm)with gradient elution using 0.1 mol·L-1 ammonium acetate(0.5 mL of gla-cial acetic acid per 1 000 mL)(A)-acetonitrile:tetrahydrofuran(25∶15)(B),as the mobile phase(0-50 min,18%B-28%B),the detection wavelength was switched from 235 nm,the column temperature was kept at 40℃and the flow rate was 1.0 mL·min-1.The relative correction factors(fs/i)were established with the other 5 compo-nents to be measured using benzoylaconine as the internal reference,which were used to calculate the mass fraction of each component.At the same time,the mass fractions of the 6 effective constituents in Zhachong Shisanwei Pills were calculated by the external standard method(ESM).By comparing the content results of ESMand QAMS,the accura-cy of QAMS method were evaluated.Results:The relative correction factors(fs/i)of benzoylmesaconine,benzoylhyp-aconine,mesaconitine,hypaconitine,and aconitine in Mongolian medicine Zhachong Shisanwei Pills were reproduci-ble with good reproducibility,which were 0.680 4,0.450 6,0.850 8,0.676 1 and 0.757 0,the result obtained by QAMS approximated those obtained by external standard method(ESM).Conclusion:The method is simple,stable and reproducible,and can be used for the quality control of 6 alkaloid components in Zhachong Shisanwei Pills.

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 investigate the dietary iodine intake levels of residents and the dietary iodine contribution rates in Hainan Province.Methods:Using cluster random sampling method, common foods sold in 21 counties (cities, districts) markets in Hainan Province in 2023 were collected to determine iodine content. Each county (city, district) was divided into five sampling areas by east, west, south, north, and center, with one township (street) selected from each area, and 20 permanent residents over 18 years old (non same household, half male and half female) and 20 pregnant women were selected from each township (street). The "Iodine-Specific Food Frequency Questionnaire (I-FFQ)" was used to investigate the daily dietary intake of adults and pregnant woman. The average daily salt intake of the survey subjects was measured by the 3-day weighing method, and the dietary iodine intake and the dietary iodine contribution rates were calculated.Results:A total of 632 food samples were collected, and the iodine content of seaweed was relatively high (4 424.76 μg/100 g); the iodine content of seasoning was relatively low (2.41 μg/100 g). A total of 4 227 individuals in Hainan Province were surveyed for dietary iodine intake. The median dietary iodine intake level of residents was 211.6 μg/d, with the medians dietary iodine intake level of adults and pregnant women being 204.5 and 218.4 μg/d ( n = 2 120, 2 107), respectively. There was a statistically significant differences between different populations ( Z = - 8.64, P < 0.001). The medians dietary iodine intake level in the western coastal areas, central mountainous regions, and eastern coastal areas were 210.0, 207.3 and 211.6 μg/d ( n = 1 205, 1 203, 1 819), respectively, with statistically significant differences between different regions ( H = 15.33, P < 0.001). The contribution rate of dietary iodine from iodized salt was the most (59.4%), followed by kelp (8.1%). Conclusions:Under the condition of consuming iodized salt, the dietary iodine intake of adults in Hainan Province meets the recommended dietary iodine intake ( > 120 μg/d), but the dietary iodine intake of pregnant women is insufficient ( < 230 μg/d). Iodized salt is the main source of dietary iodine for residents in Hainan Province.