Objective:To gain a deeper understanding of the fear of recurrence in patients with atrial fibrillation during the "blanking period" after catheter ablation.Methods:The interview outline was developed based on common-sense model of self-regulated. From July to September 2023, purposive sampling was used to select 15 patients with atrial fibrillation in the "blanking period" after catheter ablation at the Cardiovascular Outpatient of the Affiliated Hospital of Qingdao University as research subjects, and semi-structured interviews were conducted. The targeted content analysis method was used to analyze data.Results:Four themes were extracted, namely triggering factors of fear of recurrence, perception of atrial fibrillation recurrence, negative emotional distress, and insufficient ability to cope with atrial fibrillation recurrence.Conclusions:For patients with atrial fibrillation during the "blanking period" after catheter ablation, medical and nursing staff should closely monitor the patient's cognitive level and psychological state, and carry out targeted health education to meet the patient's needs for postoperative disease management, life adaptation, and other aspects, so as to reduce the fear of recurrence in atrial fibrillation patients during the "blanking period" after surgery.

OBJECTIVE: To investigate the safety of laparoscopic pancreaticoduodenectomy (LPD) in elderly patients and the related risk factors admitted to the intensive care unit (ICU) after LPD. METHODS: The perioperative data of patients who underwent LPD in Tianjin Medical University General Hospital from February 2017 to June 2023 were retrospectively collected, including basic data, preoperative laboratory indicators, intraoperative and postoperative indicators, pathological results (tumor size, lymph node dissection and pathological type), postoperative complications, ICU postoperative management and prognosis. The patients were divided into the elderly group (≥ 65 years) and the non-elderly group (< 65 years) according to age. Perioperative data between two groups were compared. Kaplan-Meier survival curve was drawn to analyze the survival rate of the elderly group and the non-elderly group, and the pancreatic head carcinoma group and other type of tumors group after LPD. Logistic regression was used to analyze the risk factors of ICU stay (length of ICU stay > 1 day) after LPD in elderly patients. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of this risk factor for ICU stay after LPD in elderly patients. RESULTS: A total of 160 patients were enrolled, including 57 cases in the elderly group (17 cases of vascular reconstruction) and 103 cases in the non-elderly group (40 cases of vascular reconstruction). All patients underwent R0 resection and were transferred to the comprehensive ICU for treatment. The follow-up time of patients with malignant tumors was 43 (6, 72) months. The elderly group had significantly longer surgery time, postoperative hospital stay and oral feeding time than the non-elderly group, and the incidence of delayed gastric emptying (DGE) was significantly higher than that in the non-elderly group. There were no significant differences in intraoperative blood transfusion rate, intraoperative blood loss, pathological results, short-term and severe postoperative complications, reoperation rate and 90-day mortality between the two groups. In patients with vascular resection reconstruction, the intraoperative blood loss in the elderly group was significantly higher than that in the non-elderly group, and the operation time and postoperative hospital stay were significantly longer. During ICU, the acute physiology and chronic health evaluation II [APACHE II: 12 (9, 14) vs. 8 (7, 10)], sequential organ failure assessment [SOFA: 6 (4, 8) vs. 3 (2, 5)] within 24 hours after admission to ICU were significantly increased in the elderly group (both P < 0.05), the time of mechanical ventilation [hours: 12 (10, 15) vs. 9 (5, 13)] and the length of ICU stay [days: 2 (1, 2) vs. 1 (1, 1)] were significantly increased in the elderly group (both P < 0.05), and the proportion of multi-disciplinary team (MDT) was also significantly increased in the elderly group (33.3% vs. 17.4%, P < 0.05), there were no significant differences in the levels of hemoglobin (Hb), albumin, and blood lactic acid between the two groups. Logistic regression analysis showed that the APACHE II score was an independent risk factor for ICU stay after LPD in elderly patients (β = 1.737, P = 0.028). ROC curve showed that the prediction performance was the best when the APACHE II score was 13, with the sensitivity of 72.41% and the specificity of 96.43%, and the area under the ROC curve (AUC) of 0.884. The Kaplan-Meier survival curve showed that there were no significant difference in median survival time (months: 24.1 vs. 24.7) and 5-year survival rate (19.01% vs. 19.02%) between the elderly group (52 cases) and the non-elderly group (92 cases) among the 144 patients with malignant tumors (both P > 0.05). The median survival time in the pancreatic head carcinoma group was significantly shorter than that in the other tumors group (63 cases; months: 20.2 vs. 40.1, P < 0.05), 5-year survival rate was significantly lower than that in the other tumors group (21.98% vs. 30.91%, P < 0.05). CONCLUSIONS LPD is a safe and feasible treatment for elderly patients. APACHE II score has a certain predictive value for ICU stay after LPD in elderly patients.
Humans ; Aged ; Middle Aged ; Sepsis/therapy* ; ROC Curve ; Pancreaticoduodenectomy/adverse effects* ; Retrospective Studies ; Blood Loss, Surgical ; Prognosis ; Pancreatic Neoplasms/surgery* ; Postoperative Complications ; Intensive Care Units

Background: Job performance is known as an essential reflection of nursing quality. Colleague solidarity, positive emotion, and turnover intention play effective roles in a clinical working environment, but their impacts on job performance are unclear. Investigating the association between nurses’ colleague solidarity and job performance may be valuable, both directly and through the mediating roles of positive emotion and turnover intention. Methods: In this cross-sectional study, a total of 324 Chinese nurses were recruited by convenience sampling method from July 2016 to January 2017. Descriptive analysis, Spearman’s correlation analysis, and the structural equation model were applied for analysis by SPSS 26.0 and AMOS 24.0. Results: A total of 49.69% of participants were under 30 years old, and 90.12% of participants were female. Colleague solidarity and positive emotion were positively connected with job performance. The results indicated the mediating effects of positive emotion and turnover intention in this relationship, respectively, as well as the chain mediating effect of positive emotion and turnover intention. Conclusions In conclusion, dynamic and multiple supportive strategies are needed for nurse managers to ameliorate nursing job performance by improving colleague solidarity and positive emotion and decreasing turnover intention based on the job demand-resource model.

Patients with cardiovascular diseases have poor medication adherence, which seriously affects the prognosis of their diseases. This article reviewed the prediction model of medication compliance for patients with cardiovascular diseases, analyzed its predictive factors, model efficacy and application, and put forward opinions on the construction of relevant prediction models, which could provide reference for the clinical development of targeted intervention programs.

To investigate the degradation of polycyclic aromatic hydrocarbons (PAHs) and the changes of rhizosphere microorganisms in the rhizosphere soil of Leymus chinensis during the remediation of PAHs contaminated soil by Comamonas testosteroni (C.t)-assisted Leymus chinensis, we evaluated the removal of PAHs in the rhizosphere of Leymus chinensis using gas chromatography-mass spectrometry (GC-MS), analyzed the bacterial community and the diversity in Leymus chinensis rhizosphere soil by high-throughput sequencing technology, characterized the correlation among PAHs degradation and bacterial community components performing redundancy analysis (RDA) and network analysis, and predicted PAHs degradation potential via PICRUSt software in this paper. The degradation of PAHs in the rhizosphere of Leymus chinensis was promoted, the abundance and diversity of bacteria and the correlation among bacteria and PAHs were changed, and the degradation potential of PAHs in Leymus chinensis rhizosphere soil was enhanced in the later stage of phytoremediation (60-120 d) due to the incorporation of C.t. The accelerated degradation of three PAHs (Nap, Phe, BaP) was accompanied by the differ abundance and correlation of Proteobacteria (Sphingomonas, MND1, Nordella), Actinomycetes (Rubrobacter, Gaiella), Acidobacteria (RB41) and Bacteroides (Flavobacterium) affected by C.t. The results provide new insight into the microorganism choices for microbial assisted plant remediation of soil PAHs and the mechanisms of enhanced PAHs degradation via the combination of Comamonas testosteroni engineering bacteria and plants.
Biodegradation, Environmental ; Comamonas testosteroni/genetics* ; Polycyclic Aromatic Hydrocarbons/analysis* ; Rhizosphere ; Soil ; Soil Microbiology ; Soil Pollutants

Objective:To compare and analyze the clinical efficacy of hand-assisted laparoscopic surgery (HALS) and laparoscopic assisted surgery (LAS) in the treatment of advanced gastric cancer.Methods:Articles of the efficacy comparison of HALS and LAS in D2 radical gastrectomy for gastric cancer from 2000 to 2019 published in PubMed, Cochrane library, EM-BASE, China National Knowledge Infrastructure (CNKI), Wanfang, Weipu, Chinese full-text database of Chinese Sci-Tech journals, Chinese biomedical literature database were retrieved, and the literatures were screened according to the pre-established inclusion and exclusion criteria. The quality of the two groups was evaluated, and the short-term indexes and complications for meta-analysis of the two groups were analyzed by using Revman 5.3 software.Results:A total of 1277 patients were included in 10 articles, including 629 in the HALS group and 648 in the LAS group. The results of the meta-analysis showed that compared with the LAS group, the operation time was shorter in the HALS group (WMD=24.02, 95% CI: -40.41--7.62, P=0.004), but the auxiliary incision was slightly longer (WMD=0.27, 95% CI: 0.06-0.47, P=0.01), and there were no statistically significant difference in the remaining number of lymph node dissections (WMD=0.58, 95% CI: -1.22-2.39, P=0.53), intraoperative blood loss (WMD=-7.94, 95% CI: -16.21-0.33, P=0.06), gastrointestinal tract recovery time (WMD=0.00, 95% CI: -0.03- 0.04, P=0.85), total length of hospital stay (WMD=-0.14, 95% CI0: -0.36-0.09, P=0.23) and postoperative complications ( OR=0.89, 95% CI: 0.58-1.37, P=0.61). Conclusions:Compared with the LAS for D2 radical surgery of advanced gastric cancer, HALS has significantly shorter operation time and is easier to perform than LAS, but the incision length is slightly increased. Physicians can choose the appropriate operation method according to the specific conditions of the operation and themselves.

Ear and upper airway are portal organs of human body. Because of their fine and narrow structure, the non-invasive research and the effect of clinical diagnosis and treatment in traditional medicine are always unsatisfactory. With the development of computer technology, numerical simulation has become an effective means of auxiliary research. Numerical simulation can reproduce or evaluate the diagnosis and treatment of ear and upper airway diseases, and it is a powerful means to promote the development of basic medicine and technology of clinical diagnosis and treatment. The application of numerical simulation in relationship between the structure and function of ear and upper airway, the influence of diseases on function, the evaluation of clinical diagnosis and treatment technology， as well as the design of related medical devices were reviewed. The clinical application of numerical research in ear and upper airway was prospected, so as to provide references for the future clinical diagnosis and treatment of ear and upper airway.

Objective: To study the effect on immune indexes in children with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after resection of adenoid and/or tonsil. Methods: A total of 100 children with OSAHS due to adenoid hypertrophy were enrolled in Department of Otorhinolaryngology Head and Neck Surgery, the Second Hospital of Dalian Medical University from December 2016 to December 2018. Some cases were complicated with tonsil hypertrophy or chronic tonsillitis. 6 ml of fasting peripheral venous blood were collected from all subjects at the 1st day before surgery, 4th day, 1 month, 3 months and 6 months after surgery to detect lymphoid subsets percentage (CD3⁺, CD4⁺,CD8⁺, CD4/CD8, CD19, NK) and level of immunoglobulin (IgG, IgA, IgM). Grouping: group A was a total of 51 cases with adenoid hypertrophy after Adenoid plasma ablation; group B was a total of 27 cases with adenoid hypertrophy and chronic tonsillitis after plasma ablation of adenoid and tonsil; and group C was a total of 22 cases hypertrophy of adenoid and tonsil after plasma ablation of adenoid and tonsil.In the baseline data, age, gender and other variables were analyzed by anova and chi-square test, repeated measurement anova was used for intra-group and inter-group comparison of observation indicators at different time points after operation, and independent sample t-test was used for comparison between the two groups at observation points 3 months after operation. Results: (1) In group A, the percentage of CD19 lymphocytes before surgery was higher than that at 4th day after surgery, and the difference was statistically significant (21.85±6.20 vs.19.18±5.91, P<0.05). The other immune indexes were not statistically different before and after surgery (P>0.05). (2) In group B, the percentage of CD19 lymphocytes, CD3⁺T lymphocytes, CD8⁺T lymphocytes and the level of IgG at 4th day after surgery were significantly different between those before surgery (all P<0.05). At the 1st month after surgery, the percentage of CD3⁺T lymphocytes, CD8⁺T lymphocytes, CD19 lymphocytes and the level of IgG were significantly different between those before surgery (all P<0.05). The other immune indexes were not statistically different before and after operation (P>0.05). (3) In group C, the percentage of CD19 lymphocytes and the CD3⁺T lymphocytes at 4th day after surgery were significantly different between those before surgery (all P<0.05).In the 1st month after surgery, the percentage of CD8⁺T lymphocytes and CD19 lymphocytes were significantly different between those before surgery (all P<0.05). The other immune indexes were not statistically different before and after operation (P>0.05). (4) Among three groups, the percentage of CD4⁺T lymphocytes, the levels of IgG and IgA before surgery between group A and Group B were statistically significant (all P<0.05). At 4th day after surgery, the percentage of CD4⁺T lymphocytes in group B and C were lower than those in group A, and the differences were statistically significant (32.22±6.14, 32.36±6.87 vs. 36.36±5.19, all P<0.05); the other immune indexes were not statistically different among each group before and after surgery (P>0.05). Conclusions Resection of adenoid has no significant effect on the immune indexes in children with OSAHS. The children with OSAHS complicated with tonsil problems have immune index disorder before surgery. Surgery has a certain effect on the immune indexes of children with OSAHS in a short period of time, and tends to normal level after one month.

Getting volume change of hippocampus by segmenting on brain MRI is an important step in the diagnose of Alzheimer's disease and other brain disease. Three dimensional segmentation can make use of the correlation of image in gray and spatial position, so it has high accuracy. This paper proposes a novel three-dimensional lattice Boltzmann model combined with the surface evolution of deformable model and taking the prior information as an external force term to constrain the evolution of three dimensional surfaces. In order to solve the problem of high computational cost caused by 3D segmentation, the parallelization of the method is programmed on single GPU platform and dual GPU platform. Comparison experiments were set to test the accuracy of segmentation and computational efficiency between the novel LB method and another method by using 20 real AD patient's MRI from ADNI. In ensuring the accuracy of the segmentation, the time can be reduced to 12.76 s on single GPU platform, and 17.32 s on dual GPU platform, contrasting 132.43 s on CPU platform. It fully validates the characteristics of lattice Boltzmann method which can be highly parallelized.
Algorithms ; Hippocampus ; diagnostic imaging ; Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging

OBJECTIVE To evaluate the effect of intravenous infusion of methylprednisolone on postoperative recovery and complications after coblation tonsillectomy.METHODS Eighty three patients who were scheduled for coblation tonsillectomy from December 2015 to December 2016 were included in this study.Firstly,they were divided into 2 groups,i.e.,the younger group (＜12 years) and the older group (≥12 years old).Secondly,these two groups were further divided into experimental group and control group by the prospective,double-blind and randomized method.The experimental group was treated with methylprednisolone and antibiotics for 3 days.Then,the postoperative reactions such as the pain,activity,pharyngeal edema,body condition,exfoliation time of the tunic albuginea,post-tonsillectomy hemorrhage were observed.RESULTS 1.From the third day to fifth day,using methylprednisolone can alleviate pain (Z=4.42,P=0.00),increase the activity(Z=2.64,P=0.00)and reduce pharyngeal edema(Z=2.84,3.10,all P=0.00) in younger group.2.After operation,in the younger group,the incidence rate of gastrointestinal discomfort in control group was higher than that in experimental group(x2=4.97,P=0.03).In the older group,the incidence rate of gastrointestinal discomfort(x2=5.24,P=0.02) and sleep disturbance(x2=5.03,P=0.03) in control group was higher than those in experimental group.3.In the older group,exfoliation average time of the tunic albuginea in experimental group was longer than that in control group(t=2.16,P=0.04).4.Secondary bleeding rate was not statistically significant in the two groups(x2=1.29,P=0.26).CONCLUSION Intravenous infusion of methylprednisolone after coblation tonsillectomy is beneficial,especially in the relief of pain,gastrointestinal discomfort and pharyngeal edema.