Objective: To investigate the distribution patterns and risk factors for multidrug-resistant bacterial pulmonary infections in patients with oral squamous cell carcinoma (OSCC) undergoing flap reconstruction surgery, and to provide evidence for infection prevention and treatment in this population. Methods: This study was approved by the institutional medical ethics committee. We retrospectively analyzed sputum culture results, antimicrobial susceptibility testing data, and clinical records of 109 OSCC patients undergoing flap reconstruction. Chi-square tests were employed to identify pathogens and risk factors for multidrug-resistant bacteria (MDR) in postoperative pulmonary infections. Multivariate logistic regression analysis was conducted to determine MDR risk factors and establish a nomogram prediction model. The model’s discriminatory power, accuracy, and clinical utility were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results: Among the 109 patients, 52 had negative sputum cultures and 57 tested positive, of whom 14 developed multidrug-resistant (MDR) pulmonary infections. Chi-square analysis revealed that blood transfusion, pre-existing pulmonary diseases, operation time ≥ 490 min, intraoperative blood loss ≥ 400 mL, and abnormal BMI were significant risk factors for postoperative MDR infections (P < 0.05). Multivariate logistic regression identified pre-existing pulmonary diseases, intraoperative blood loss ≥ 400 mL, abnormal BMI, and operative duration ≥ 490 min as independent risk factors for MDR infections (P < 0.05). The nomogram prediction model for MDR infections demonstrated an area under the ROC curve (AUC) of 0.874 (95% CI: 0.775-0.973). The calibration plot showed good agreement between predicted and observed outcomes. DCA indicated a net clinical benefit when the threshold probability for high-risk MDR infections ranged from 0.000 to 0.810. Common MDR pathogens included MDR Pseudomonas aeruginosa, MDR Klebsiella pneumoniae, carbapenem-resistant Acinetobacter baumannii (CRAB), and methicillin-resistant Staphylococcus aureus (MRSA). Conclusion Among OSCC patients undergoing flap reconstruction, MDR pulmonary infections were predominantly caused by gram-negative bacteria (including CRAB, MDR Pseudomonas aeruginosa, and MDR Klebsiella pneumoniae along with the gram-positive pathogen MRSA. Pre-existing pulmonary comorbidities, prolonged surgery duration (≥ 490 min), significant intraoperative blood loss (≥ 400 mL), and abnormal BMI were confirmed as independent risk factors for these MDR infections. The nomogram predictive model incorporating these four variables demonstrated clinically reliable accuracy in risk stratification for postoperative MDR pulmonary infections in this patient population.

BACKGROUND: Postoperative pulmonary complications (PPCs) are major adverse events in neurosurgical patients. This study aimed to develop and validate machine learning models predicting PPCs after neurosurgery. METHODS: PPCs were defined according to the European Perioperative Clinical Outcome standards as occurring within 7 postoperative days. Data of cases meeting inclusion/exclusion criteria were extracted from the anesthesia information management system to create three datasets: The development (data of Huashan Hospital, Fudan University from 2018 to 2020), temporal validation (data of Huashan Hospital, Fudan University in 2021) and external validation (data of other three hospitals in 2023) datasets. Machine learning models of six algorithms were trained using either 35 retrievable and plausible features or the 11 features selected by Lasso regression. Temporal validation was conducted for all models and the 11-feature models were also externally validated. Independent risk factors were identified and feature importance in top models was analyzed. RESULTS: PPCs occurred in 712 of 7533 (9.5%), 258 of 2824 (9.1%), and 207 of 2300 (9.0%) patients in the development, temporal validation and external validation datasets, respectively. During cross-validation training, all models except Bayes demonstrated good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.840. In temporal validation of full-feature models, deep neural network (DNN) performed the best with an AUC of 0.835 (95% confidence interval [CI]: 0.805-0.858) and a Brier score of 0.069, followed by Logistic regression (LR), random forest and XGBoost. The 11-feature models performed comparable to full-feature models with very close but statistically significantly lower AUCs, with the top models of DNN and LR in temporal and external validations. An 11-feature nomogram was drawn based on the LR algorithm and it outperformed the minimally modified Assess respiratory RIsk in Surgical patients in CATalonia (ARISCAT) and Laparoscopic Surgery Video Educational Guidelines (LAS VEGAS) scores with a higher AUC (LR: 0.824, ARISCAT: 0.672, LAS: 0.663). Independent risk factors based on multivariate LR mostly overlapped with Lasso-selected features, but lacked consistency with the important features using the Shapley additive explanation (SHAP) method of the LR model. CONCLUSIONS: The developed models, especially the DNN model and the nomogram, had good discrimination and calibration, and could be used for predicting PPCs in neurosurgical patients. The establishment of machine learning models and the ascertainment of risk factors might assist clinical decision support for improving surgical outcomes. TRIAL REGISTRATION ChiCTR 2100047474; https://www.chictr.org.cn/showproj.html?proj=128279 .
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Algorithms ; Lung Diseases/etiology* ; Machine Learning ; Neurosurgical Procedures/adverse effects* ; Postoperative Complications/diagnosis* ; Risk Factors ; ROC Curve

The paper discusses the scientific connotation of"heart and brain co-dominating the mind",including the connotation of"heart and brain co-dominating the mind"in traditional Chinese medicine and the physiological and pathological relationship be-tween heart and brain in modern medicine.Based on the understanding of"heart and brain co-dominating the mind",this paper be-lieves that"restlessness of mind"is the core pathogenesis of insomnia,and regulating mind is the key to the acupuncture and moxibus-tion treatment of insomnia.The autonomic nervous system(ANS)is a bridge connecting the heart and brain,and is closely related to the central anatomy,neurotransmitters and physiological rhythms of sleep.The imbalance of ANS is highly consistent with the patho-genesis of"heart and brain restlessness"in traditional Chinese medicine.The Governor Vessel runs through the brain and the heart,and the"Governor Vessel regulating spirit acupuncture"can communicate the heart and brain,regulate ANS function,and thus im-prove sleep quality.

Objective:To explore the implementation method of the "daily-monthly-quarterly" quality control model based on total quality management (TQM) theory in nursing quality management, and evaluate its application effectiveness.Methods:A quasi-experimental research method was used. The quarterly quality control model employed at Shanxi Medical University Second Hospital from 2018 to 2019 was set as the control group, and the"day-month-quarter" quality control model based on TQM implemented from 2020 to 2022 was set as the observation group. The nurse practice environment assessment scores from 2018 to 2022 were analyzed; the nursing quality-sensitive indicators between the two groups were compared, including the incidence rate of overall adverse event, falls among hospitalized patients, pressure ulcers of stage 2 and above, unplanned extubations, and catheter-related infections (central venous catheter-related bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections).Results:The nurse practice environment assessment scores from 2018 to 2022 were (69.11 ± 19.66), (75.20 ± 18.70), (77.60 ± 17.65), (82.45 ± 16.44), and (88.00 ± 15.06). The differences compared to the previous year were statistically significant ( t=3.63-9.24, all P<0.05).After the intervention, the incidence rates of overall adverse events, falls among hospitalized patients, unplanned extubation, central venous catheter-related bloodstream infections, and ventilator-associated pneumonia in the control group were 0.385% (499/129 678), 0.072% (94/129 678), 0.051% (66/129 678), 0.037% (23/62 390), and 0.746% (43/5 761). Compared to 0.258% (551/213 851), 0.048% (103/213 851), 0.033% (71/213 851), 0.019% (19/98 642), and 0.444% (88/19 826) in the observation group. The differences were statistically significant ( χ2values were 3.89-42.83, all P<0.05). There were no statistically significant differences in the incidence rates of pressure ulcers of stage 2 and above and catheter-associated urinary tract infections (both P>0.05). Conclusions:The "daily-monthly-quarterly" quality control model based on TQM is beneficial in improving nursing quality and ensuring patient safety.

The paper discusses the scientific connotation of"heart and brain co-dominating the mind",including the connotation of"heart and brain co-dominating the mind"in traditional Chinese medicine and the physiological and pathological relationship be-tween heart and brain in modern medicine.Based on the understanding of"heart and brain co-dominating the mind",this paper be-lieves that"restlessness of mind"is the core pathogenesis of insomnia,and regulating mind is the key to the acupuncture and moxibus-tion treatment of insomnia.The autonomic nervous system(ANS)is a bridge connecting the heart and brain,and is closely related to the central anatomy,neurotransmitters and physiological rhythms of sleep.The imbalance of ANS is highly consistent with the patho-genesis of"heart and brain restlessness"in traditional Chinese medicine.The Governor Vessel runs through the brain and the heart,and the"Governor Vessel regulating spirit acupuncture"can communicate the heart and brain,regulate ANS function,and thus im-prove sleep quality.

Objective:To explore the implementation method of the "daily-monthly-quarterly" quality control model based on total quality management (TQM) theory in nursing quality management, and evaluate its application effectiveness.Methods:A quasi-experimental research method was used. The quarterly quality control model employed at Shanxi Medical University Second Hospital from 2018 to 2019 was set as the control group, and the"day-month-quarter" quality control model based on TQM implemented from 2020 to 2022 was set as the observation group. The nurse practice environment assessment scores from 2018 to 2022 were analyzed; the nursing quality-sensitive indicators between the two groups were compared, including the incidence rate of overall adverse event, falls among hospitalized patients, pressure ulcers of stage 2 and above, unplanned extubations, and catheter-related infections (central venous catheter-related bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections).Results:The nurse practice environment assessment scores from 2018 to 2022 were (69.11 ± 19.66), (75.20 ± 18.70), (77.60 ± 17.65), (82.45 ± 16.44), and (88.00 ± 15.06). The differences compared to the previous year were statistically significant ( t=3.63-9.24, all P<0.05).After the intervention, the incidence rates of overall adverse events, falls among hospitalized patients, unplanned extubation, central venous catheter-related bloodstream infections, and ventilator-associated pneumonia in the control group were 0.385% (499/129 678), 0.072% (94/129 678), 0.051% (66/129 678), 0.037% (23/62 390), and 0.746% (43/5 761). Compared to 0.258% (551/213 851), 0.048% (103/213 851), 0.033% (71/213 851), 0.019% (19/98 642), and 0.444% (88/19 826) in the observation group. The differences were statistically significant ( χ2values were 3.89-42.83, all P<0.05). There were no statistically significant differences in the incidence rates of pressure ulcers of stage 2 and above and catheter-associated urinary tract infections (both P>0.05). Conclusions:The "daily-monthly-quarterly" quality control model based on TQM is beneficial in improving nursing quality and ensuring patient safety.

Objective:To observe the hemodynamic changes in the retina and choroid after scleral buckling surgery in eyes with rhegmatogenous retinal detachment (RRD).Methods:A prospective clinical observational study. A total of 25 eyes of 25 patients with RRD who underwent scleral buckling surgery in Tianjin Eye Hospital from February to April 2024 were included in the study. Among them, 10 were male and 15 were female. Age was 17-68 years old. All cases were monocular. The surgical eye and the contralateral healthy eye were divided into the affected eye group and the contralateral healthy eye group respectively. Best corrected visual acuity (BCVA), scanning source optical coherence tomography angiography (SS-OCTA), and axial length (AL) measurements were performed 3 months after surgery. SS-OCTA examination of macular area was performed by VG200 of Visual Microimaging (Henan) Technology Co., LTD. Scanning range 21 mm×26 mm. According to the partitioning method of the early treatment group of glycosuria retinopathy, the retina within 21 mm of the macular fovea was divided into concentric circles with the macular fovea as the center and diameters of 1-3, 3-6, 6-12, 12-21 mm, respectively. The built-in software of the device was used to record the central area (12 mm×12 mm in the fovea of the macula) and the peripheral area (12-21 mm range) retinal superficial capillary plexus (SCP), deep capillary plexus (DCP), radial peripapillary capillaries (RPC) blood density and choroidal vascular index (CVI), choroidal vascular volume (CVV), and 1-3, 3-6, 6-12, 12-21 mm above concentric circles (S), nasal side (N), temporal side (T), and lower side (I) SCP, DCP, and RPC blood flow density. Quantitative data between the two groups were compared by independent sample t test or Wilcoxon signed rank test. The correlation between retinal and choroid blood flow parameters and postoperative BCVA was analyzed by Spearman correlation analysis. Results:Compared with the opposite healthy eye group, SCP blood density in the central area ( Z=-4.372), DCP blood density in the central area ( Z=-2.829), and CVI in the peripheral area ( Z=-2.138) were decreased in the affected eye group, and the differences were statistically significant ( P<0.05). SCP: in the affected eye group, the blood flow density in T 3-6 mm, T 6-12 mm, N 6-12 mm and T 12-21 mm regions decreased, while the blood flow density in I 6-12 mm regions increased, with statistical significance ( P<0.05). DCP: blood flow density in S 6-12 mm, I 6-12 mm, S 12-21 mm and I 12-21 mm regions decreased significantly, and the differences were statistically significant ( P<0.05). RPC: blood flow density decreased significantly in T 6-12 mm and I 12-21 mm, and the differences were statistically significant ( P<0.05). CVI: T 6-12 mm, S 12-21 mm, T 12-21 mm, I 12-21 mm significantly decreased, and T 1-3 mm, S 12-21 mm significantly increased, the differences were statistically significant ( P<0.05). Correlation analysis showed that AL growth was positively correlated with CVV in central region ( r=0.408, P=0.040). The number of pad pressure was negatively correlated with the blood density of central DCP ( r=-0.422, P=0.030). Conclusions:After scleral buckling operation, the blood flow density and choroidal blood flow parameters in RRD affected eyes are lower than those in contralateral healthy eyes in some areas. The increase of AL is positively correlated with CVV in the central region, and the wider the range of pad pressure, the worse the recovery of DCP blood density.

Objective:To observe the hemodynamic changes in the retina and choroid after scleral buckling surgery in eyes with rhegmatogenous retinal detachment (RRD).Methods:A prospective clinical observational study. A total of 25 eyes of 25 patients with RRD who underwent scleral buckling surgery in Tianjin Eye Hospital from February to April 2024 were included in the study. Among them, 10 were male and 15 were female. Age was 17-68 years old. All cases were monocular. The surgical eye and the contralateral healthy eye were divided into the affected eye group and the contralateral healthy eye group respectively. Best corrected visual acuity (BCVA), scanning source optical coherence tomography angiography (SS-OCTA), and axial length (AL) measurements were performed 3 months after surgery. SS-OCTA examination of macular area was performed by VG200 of Visual Microimaging (Henan) Technology Co., LTD. Scanning range 21 mm×26 mm. According to the partitioning method of the early treatment group of glycosuria retinopathy, the retina within 21 mm of the macular fovea was divided into concentric circles with the macular fovea as the center and diameters of 1-3, 3-6, 6-12, 12-21 mm, respectively. The built-in software of the device was used to record the central area (12 mm×12 mm in the fovea of the macula) and the peripheral area (12-21 mm range) retinal superficial capillary plexus (SCP), deep capillary plexus (DCP), radial peripapillary capillaries (RPC) blood density and choroidal vascular index (CVI), choroidal vascular volume (CVV), and 1-3, 3-6, 6-12, 12-21 mm above concentric circles (S), nasal side (N), temporal side (T), and lower side (I) SCP, DCP, and RPC blood flow density. Quantitative data between the two groups were compared by independent sample t test or Wilcoxon signed rank test. The correlation between retinal and choroid blood flow parameters and postoperative BCVA was analyzed by Spearman correlation analysis. Results:Compared with the opposite healthy eye group, SCP blood density in the central area ( Z=-4.372), DCP blood density in the central area ( Z=-2.829), and CVI in the peripheral area ( Z=-2.138) were decreased in the affected eye group, and the differences were statistically significant ( P<0.05). SCP: in the affected eye group, the blood flow density in T 3-6 mm, T 6-12 mm, N 6-12 mm and T 12-21 mm regions decreased, while the blood flow density in I 6-12 mm regions increased, with statistical significance ( P<0.05). DCP: blood flow density in S 6-12 mm, I 6-12 mm, S 12-21 mm and I 12-21 mm regions decreased significantly, and the differences were statistically significant ( P<0.05). RPC: blood flow density decreased significantly in T 6-12 mm and I 12-21 mm, and the differences were statistically significant ( P<0.05). CVI: T 6-12 mm, S 12-21 mm, T 12-21 mm, I 12-21 mm significantly decreased, and T 1-3 mm, S 12-21 mm significantly increased, the differences were statistically significant ( P<0.05). Correlation analysis showed that AL growth was positively correlated with CVV in central region ( r=0.408, P=0.040). The number of pad pressure was negatively correlated with the blood density of central DCP ( r=-0.422, P=0.030). Conclusions:After scleral buckling operation, the blood flow density and choroidal blood flow parameters in RRD affected eyes are lower than those in contralateral healthy eyes in some areas. The increase of AL is positively correlated with CVV in the central region, and the wider the range of pad pressure, the worse the recovery of DCP blood density.

Objective To assess the reliability and validity of the Chinese version of the Beck Depression Inventory,Second Edition(BDI-Ⅱ-C)among Yi middle school students in Liangshan Prefecture.Methods A stratified cluster sampling method was used to select 466 Yi middle and high school students in Liangshan Prefecture to respond to the BDI-Ⅱ-C.The general demographic characteristics of the samples were described,and independent sample t-test,chi-square test,and reliability analysis were conducted to analyze the data.The sample was randomly divided into 2 halves for exploratory factor analysis and confirmatory factor analysis.Results The Cronbach's alpha coefficient for BDI-Ⅱ-C was 0.925 for the sample of Yi middle school students in Liangshan Prefecture.The correlation coefficients between individual items ranged from 0.192 to 0.612,and those between individual items and total scores ranged from 0.492 to 0.761.Exploratory factor analysis found that the scale could be divided into three dimensions,including emotional symptoms,somatic symptoms,and negative symptoms.Confirmatory factor analysis results revealed that the various indicators of the three-factor model were x2/df=1.604,comparative fit index(CFI)=0.940,Tucker-Lewis index(TLI)=0.932,incremental fit index(IFI)=0.941,and root mean square error of approximation(RMSEA)=0.051.Conclusion BDI-Ⅱ-C exhibits good reliability and validity among Yi middle school students in Liangshan Prefecture,but the convergent validity of the structural validity is poor.

Objective With the goal of improving the patient experience of intravitreal injection,the diagnosis and treatment process is optimized and the waiting time is shortened.Methods In the medical records of patients who underwent intravitreal injection,the medical records of patients in the same period before and after the optimization of the process were extracted by systematic sampling method as the observation group(n=336)and the control group(n=150).The data of medical quality,medical efficiency and waiting time of patients were compared between the two groups.Results After the optimization a of the process,the appointment time of intravitreal injection surgery decreased from(67.77±29.95)h to(10.66±5.69)h,the time in hospital on the operation day decreased from(4.52±0.94)h to(2.55±0.67)h,the preoperative examination time decreased from(14.34±6.49)h to(5.19±1.60)h,and the number of surgeries per doctor half day owerage increased from(37.88±10.94)to(47.50±4.77),the difference was statistically significant(P＜0.01).There was no significant difference in the incidence of secondary glaucoma and endophthalmitis between the two groups(P＞0.05).Conclusion The process optimization of the intravitreal injection center around the patient experience has significantly reduced the waiting time and improved the patient experience.