OBJECTIVE: To explore the implementation effect of hour-1 bundle for sepsis patients based on crisis resource management (CRM) system. METHODS: A historical control study was conducted. The hour-1 bundle for sepsis based on CRM was used to train 24 nurses in the emergency department from October 2022 to March 2023. Clinical data of sepsis patients admitted to the emergency department of the First People's Hospital of Zunyi from April 2022 to September 2023 were collected. The patients were divided into three groups based on different stages of CRM system construction: control group (before construction, from April to September in 2022), improvement group (during construction, from October 2022 to March 2023) and observation group (after construction, from April to September in 2023). The baseline data, implementation rate of hour-1 bundle [including blood culture, antibiotic usage, blood lactic acid (Lac) detection, fluid resuscitation, hypertensors usage], identification and diagnosis time, and prognosis parameters [including correction rate of hypoxemia, intensive care unit (ICU) occupancy rate, and 28-day survival rate]. Sepsis cognition survey and non-technical skill (NTS) evaluation of nurses in emergency department were conducted before and after training. RESULTS: Finally 43 cases were enrolled in the control group, improvement group and observation group, respectively. There was no statistically significant difference in baseline data including the gender, age, primary site, heart rate, systolic blood pressure, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, mechanical ventilation ratio among the three groups with comparability. With the gradual improvement of the CRM system, the implementation rate of 1-hour bundle was gradually increased, and the implementation rate in the control group, improvement group and observation group were 65.12% (28/43), 74.42% (32/43) and 88.37% (38/43), respectively, with statistically significant difference (P < 0.05). It was mainly reflected in the completion rate of blood culture, antibiotic usage rate, Lac detection rate and hypertensors usage rate within 1 hour, which were significantly higher in the observation group than those in the control group [completion rate of blood culture: 90.70% (39/43) vs. 62.79% (27/43), antibiotic usage rate: 88.37% (38/43) vs. 60.47% (26/43), Lac detection rate: 93.02% (40/43) vs. 72.09% (31/43), hypertensors usage rate: 88.37% (38/43) vs. 60.47% (26/43), all P < 0.05]. The fluid resuscitation rates within 1 hour in the three groups were all over 90%, with no statistically significant difference among the three groups. The recognition and diagnosis time in the observation group was significantly shorter than that in the control group and the improvement group (hours: 0.41±0.15 vs. 0.61±0.21, 0.51±0.18, both P < 0.05), the correction rate of hypoxemia and 28-day survival rate were significantly higher than those in the control group [correction rate of hypoxemia: 95.35% (41/43) vs. 74.42% (32/43), 28-day survival rate: 83.72% (36/43) vs. 60.47% (26/43), both P < 0.05], and ICU occupancy rate was significantly lower than that in the control group [72.09% (31/43) vs. 93.02% (40/43), P < 0.05]. After training in the CRM system, the score of the sepsis awareness survey questionnaire for emergency department nurses was significantly increased as compared with before training (60.42±5.29 vs. 44.17±9.21, P < 0.01), and NTS also showed significant improvement. CONCLUSION CRM plays a significant role in promoting the implementation of sepsis hour-1 bundle, which can improve the implementation rate of hour-1 bundle and NTS of medical staff, effectively improve patients' hypoxemia, reduce patients' ICU occupancy rate and 28-day risk of death.
Humans ; Sepsis/therapy* ; Emergency Service, Hospital ; Patient Care Bundles ; Intensive Care Units ; Female ; Male ; Middle Aged

With the widespread adoption of lung cancer screening, an increasing number of patients are being diagnosed with early-stage lung adenocarcinoma. For stage ⅠA lung adenocarcinoma, sublobar resection is the primary treatment approach. However, in patients with concomitant spread through air space (STAS), numerous studies advocate for lobectomy as the mainstay of treatment. Due to the limitations in preoperative prediction and intraoperative frozen section evaluation for assessing STAS, current research is largely restricted to using clinical and imaging features to predict STAS occurrence, with results that are inconsistent and unsatisfactory. Furthermore, most studies focus on individual clinical or imaging characteristics, and there is a lack of large-sample investigations. The rise of artificial intelligence in recent years has provided new insights into solving this problem, and existing studies have shown that artificial intelligence demonstrates better performance in STAS prediction compared to conventional methods. This article reviews the value of artificial intelligence in predicting STAS.

Objective To investigate the changing trends in etiology and treatment of male urethral stricture in recent 10 years.Methods A total of 940 male patients with urethral stricture admitted to the Department of Urology of Beijing Jishuitan Hospital during Jan.2013 and Dec.2022 were continually collected.The clinical data were divided into two groups according to the time of admission,namely the group from 2013 to 2017 and the group from 2018 to 2022,for a comparative analysis of the previous and subsequent 5 years.The etiology,location,length and the type of treatment of urethral stricture were retrospectively analyzed.Results The causes of the 940 cases of male urethral stricture were trauma in 447(47.55％),iatrogenic injury in 220(23.40％),idiopathic causes in 128(13.62％),lichen sclerosus(LS)in 78(8.30％),infection in 46(4.89％),and other causes in 21(2.23％).The treatment methods were urethroplasty in 691(73.51％),direct vision internal urethrotomy(DVIU)in 122(12.98％),urethral dilatation in 86(9.15％),and suprapubic cystostomy in 41(4.36％).Compared with the previous 5 years,in the past 5 years,the proportion of urethral stricture caused by trauma decreased significantly(60.34％vs.41.71％,P＜0.001),while the proportion of iatrogenic injury increased significantly(17.63％vs.26.05％,P=0.005).In the past 5 years,the proportion of urethroplasty increased from 68.81％to 75.66％(P=0.027),while the proportion of DVIU decreased from 19.66％to 9.92％(P＜0.001).Inthe past 5 years,the proportion of membranous urethral stenosis decreased significantly(26.98％vs.50.85％,x2=51.06,P＜0.001),the proportion of penile urethral stricture(21.40％vs.7.80％,=26.37,P＜0.001)and meatal stenosis(9.30％vs.4.75％,x2=5.80,P＜0.001)increased significantly.Conclusion In the past decade,trauma was the main cause of male urethral strictures,but its proportion showed a decreasing trend.Iatrogenic injury led to a gradual increase in urethral strictures,which was the second leading cause of male urethral stricture.The application of urethroplasty increased significantly,making it the main treatment method for male urethral stricture.

Pyran- and furanocoumarins are key representatives of tetrahydropyrans and tetrahydrofurans, respectively, exhibiting diverse physiological and medical bioactivities. However, the biosynthetic mechanisms for their core structures remain poorly understood. Here we combined multiomics analyses of biosynthetic enzymes in Peucedanum praeruptorum and in vitro functional verification and identified two types of key enzymes critical for pyran and furan ring biosynthesis in plants. These included three distinct P. praeruptorum prenyltransferases (PpPT1-3) responsible for the prenylation of the simple coumarin skeleton 7 into linear or angular precursors, and two novel CYP450 cyclases (PpDC and PpOC) crucial for the cyclization of the linear/angular precursors into either tetrahydropyran or tetrahydrofuran scaffolds. Biochemical analyses of cyclases indicated that acid/base-assisted epoxide ring opening contributed to the enzyme-catalyzed tetrahydropyran and tetrahydrofuran ring refactoring. The possible acid/base-assisted catalytic mechanisms of the identified cyclases were theoretically investigated and assessed using site-specific mutagenesis. We identified two possible acidic amino acids Glu303 in PpDC and Asp301 in PpOC as vital in the catalytic process. This study provides new enzymatic tools in the epoxide formation/epoxide-opening mediated cascade reaction and exemplifies how plants become chemically diverse in terms of enzyme function and catalytic process.

Objective:To analyze the differences in information needs of doctors, middle managers, and hospital leaders in tertiary public hospitals in the process of new technology access.Methods:From January to October 2018, 1 200 doctors and hospital administrators from 30 tertiary public hospitals in 8 provinces were selected. The importance scores of different positions for decision-making information demand of new technology introduction were collected through questionnaire survey, and the scores were analyzed by SPSS 25.0 software. Descriptive statistical analysis was performed.Results:1 032 valid questionnaires were obtained. Hospital-level leaders, middle-level managers, and doctors scored higher on the clinical application, safety, and effectiveness of technology at home and abroad(more than 4 points, maximum 5 points). Hospital-level leaders and middle-level managers had higher scores on effectiveness, evidence quality, possibility of being covered by medical insurance, ethics and relevant indicators of strategic level, while doctors had higher scores on health economics and organizational indicators.Conclusions:There are some differences in the information demand for new technology access among different positions in tertiary public hospitals. Understanding the decision-making needs of different positions is conducive to promoting the actual implementation of hospital-based health technology assessment standards in China′s public hospitals.

Gallstone is one of the most common diseases in hepatobiliary, cholesterol gallstone is the most common type of gallstone. One of the important causes of gallstone formation is the precipitation of cholesterol crystals caused by cholesterin supersaturation. Scavenger receptor type BI (SR-BI) is a kind of multifunctional membrane receptor protein, which can mediate the selective uptake of cholesterol in liver and then affect the content of cholesterol in bile. Its role in the formation of gallstone has been initially revealed. In this paper, the relationship between the occurrence of cholesterol gallstones and scavenger receptor type B type I was summarized in order to provide new ideas for the further study of the pathogenesis of gallstone.

Objective: To identify the key pathogenic genes of leptin regulating gallbladder contraction and secretion in mice and to reveal the potential molecular mechanism by comprehensive bioinformatics. Methods: The expression profile of GSE3293 was downloaded from Gene Expression Omnibus (GEO) database. The data contained 8 samples, including 4 leptin-treated gallbladder samples and 4 saline-treated gallbladder samples. The most valuable 250 differentially expressed genes (DEGs) were obtained by grouping analysis of GEO online GEO 2 R-TOP 250 software or tools, and further analyzed by bioinformatics. The GO function and KEGG pathway enrichment of DEGs were analyzed by DAVID online software. The protein-protein interaction (PPI) network of DEGs was constructed from STRING database. Results: A total of 250 differentially expressed genes were identified from the GSE3293 dataset, of which 197 genes were up-regulated and 53 genes were down-regulated. GO analysis showed that the biological functions of DEGs were mainly concentrated on MHC class II protein complexes, plasma membrane, extracellular exosome. KEGG pathway analysis showed that these DEGs were mainly involved in tuberculosis, leishmaniasis, cell adhesion molecules, bacteriophages, infection and other signaling pathways. PPI network showed that these DEGs coded proteins interacted strongly, and the first five pairs of DEGs with the strongest correlation were screened out. Conclusions The molecular mechanism of cholelithiasis is predicted from gene level by bioinformatics analysis of function enrichment and PPI of DEGs in mouse gallbladder. However, the function of DEGs still needs a lot of clinical and molecular biological experiments to confirm.

Objective To investigate the clinical effect of individual prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap for reconstruction of mandibular defects.Methods From Aug.2010 to Dec.2014,12 cases with mandibular tumor received preoperative maxillofacial CT scans and 3-dimensional reconstruction.Based on the CT results,mirror imaging technology was used to simulate the reconstruction of the defect at affected side.The individual reconstructive titanium plate was prefabricated on the model.The iliac bone-muscular flap was designed according to the defect shape and size,combined with reconstructive plate.All patients underwent CT scan and oral curved surface tomography postoperatively.The maxillofacial function and appearance were also evaluated.Results According to the CT scan and curved surface tomography,the 12 iliac bone-muscular flaps survived completely with good bone union and good condyle position.Both the functional and cosmetic results were satisfactory.There was no complication on the donor sites.Conclusions Individual prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap provides an precise method for reconstruction of mandibular defects.The cosmetic and functional results could be expected.

Objective To investigate the clinical effect of individual prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap for reconstruction of mandibular defects.Methods From Aug.2010 to Dec.2014,12 cases with mandibular tumor received preoperative maxillofacial CT scans and 3-dimensional reconstruction.Based on the CT results,mirror imaging technology was used to simulate the reconstruction of the defect at affected side.The individual reconstructive titanium plate was prefabricated on the model.The iliac bone-muscular flap was designed according to the defect shape and size,combined with reconstructive plate.All patients underwent CT scan and oral curved surface tomography postoperatively.The maxillofacial function and appearance were also evaluated.Results According to the CT scan and curved surface tomography,the 12 iliac bone-muscular flaps survived completely with good bone union and good condyle position.Both the functional and cosmetic results were satisfactory.There was no complication on the donor sites.Conclusions Individual prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap provides an precise method for reconstruction of mandibular defects.The cosmetic and functional results could be expected.

Objective To investigate the effects of total nutrient admixture (TNA) on the recovery of patients with gastric cancer after radical gastrectomy.Methods The clinical data of 50 patients with gastric cancer who were admitted to the Affiliated Hospital of Luzhou Medical College between March 2013 and March 2014 were retrospectively analyzed.Among 50 patients receiving radical gastrectomy,26 patients receiving TNA were allocated to the experimental group and 24 patients receiving conventional fluid infusion were allocated to the control group.Patients in the experimental group received the nutritional support therapy using TNA at preoperative day 5 and at postoperative days 1-5,and patients in the control group received the postoperative intravenous rehydration including water,glucose,electrolyte,vitamins and micro elements.The nutritional indexes [albumin (Alb),prealbumin,transferrin and hemoglobin (Hb)],time to anal exsufflation,incidence of complications (wound infection,anastomotic leakage,blooding and intestinal obstruction) and duration of hospital stay were observed before nutritional support therapy and at postoperative day 8.The count data were analyzed using the chi-square test.The chi-square value of correction for continuity was used when 1 ≤ minimum theoretical frequency ≤ 5.The measurement data with normal distribution were presented as (x) ±s and analyzed using the t test or repeated measures ANOVA.The ordinal data were analyzed by the analysis of variance.Results The Alb,prealbumin,transferrin and Hb in the experimental group were (38.6 ± 2.0) g/L,(281 ± 33) mg/L,(2.5 ± 0.9) g/L and (111 ± 20) g/L before nutritional support therapy and (38.2 ± 1.9) g/L,(277 ± 16) mg/L,(2.3 ± 1.1) g/L and (112 ± 37) g/L at postoperative day 8,respectivley.The Alb,prealbumin,transferrin and Hb in the control group were (38.3 ±2.4) g/L,(287 ± 34) mg/L,(2.4 ± 1.1) g/L and (107 ± 21) g/L before nutritional support therapy and (30.3 ±2.3) g/L,(190 ± 41) mg/L,(1.6 ± 0.3) g/L and (93 ± 22) g/L at postoperative day 8,respectivley.There were significant differences in the nutritional indexes at postoperative day 8 between the 2 groups (F =174.042,95.637,9.529,4.919,P ＜ 0.05).The time to anal exsufflation in the experimental group were (52 ± 11) hours,which was significantly different from (70 ± 12) hours in the control group (t =-5.176,P ＜ 0.05).The incidence of complications was 15.4％ (4/26) in the experimental group,which was significantly different from 58.3％ (14/24) in the control group (x2=6.460,P ＜0.05).Patients with complications in the 2 groups were cured by anti-infective or symptomatic treatment.The duration of hospital stay was (9 ± 3) days in the experimental group and (12 ± 4) days in the control group,with a significant difference between the 2 groups (t =-2.912,P ＜ 0.05).Conclusion TNA can improve the nutritional status of patients after radical gastrectomy in a short time.It could help patients to get through the perioperative period smoothly,and enhance the postoperative recovery.