Objective To explore the effects of esophageal vocalization training based on health empowerment model on self-efficiency,self-management ability and vocal function in patients with laryngeal cancer after total laryngectomy.Methods A total of 86 patients with laryngeal cancer who underwent total laryngectomy in The Second Affiliated Hospital of Naval Medical University from January 2023 to June 2024 were selected as the research subjects.The patients returned to the hospital to receive esophageal vocalization training 2 months after surgery.According to the random number table method,patients were assigned to control group(43 cases,receiving routine care)or observation group(43 cases,receiving routine care and nursing based on health empowerment).The training continued for 3 months.The general self efficacy scale(GSES)score,exercise of self-care agency scale(ESCA),voice handicap index(VHI)score,and training compliance were compared between the two groups before and after nursing care.Results After 3 months of vocal training,the GSES and ESCA scores of both groups increased,while VHI score decreased.The observation group had higher GSES and ESCA scores and lower VHI score than the control group(P<0.05).The overall compliance rate of the observation group was higher than that of the control group(P<0.05).Conclusion The esophageal vocalization training based on health empowerment can improve self-efficacy,self-management ability,training compliance,and vocal function in patients with laryngeal cancer after total laryngectomy.

Objective To analyze the short-term clinical outcomes of emergency conversion to surgery during transcatheter aortic valve replacement (TAVR). Methods Clinical data of patients who underwent emergency surgical conversion from TAVR in the Department of Cardiovascular Surgery, the Second Hospital of Hebei Medical University, from 2018 to 2023 were collected. Postoperative follow-up results at 1 month were recorded. Results A total of 253 patients underwent TAVR, of whom 11 (4.3%) required emergency conversion to surgery. Among these 11 patients, 7 were male and 4 were female, with a mean age of (69.55±5.01) years. The primary cause for emergency surgical conversion was valve stent displacement (63.6%), followed by left ventricular perforation/rupture (18.2%) and significant perivalvular regurgitation persisting after a second valve implantation (18.2%). One (9.1%) patient died intraoperatively. Among the 10 surviving patients, postoperative complications included pulmonary infection in 8 patients, severe pneumonia in 7, pleural effusion in 3, liver dysfunction in 8, renal dysfunction in 3, upper gastrointestinal bleeding in 5, cerebrovascular complications in 1, atrial fibrillation in 1, ventricular premature contractions in 1, atrioventricular block in 1, and complete left bundle branch block in 3. At 1-month postoperative follow-up, one additional patient died, yielding a 30-day mortality rate of 18.2% after TAVR emergency surgical conversion. The quality of life improved significantly compared to preoperative status in 9 (81.8%) patients, and no patients were readmitted for cardiovascular diseases. Conclusion The incidence of emergency conversion to surgery during TAVR is low, but the rates of surgical complications and 30-day postoperative mortality are high. Nevertheless, when severe complications occur during TAVR, emergency conversion to surgery can still yield satisfactory short-term clinical outcomes for a majority of these patients.

Background There is currently limited research on the antibiotic resistance of Legionella pneumophila in China. Establishing analytical methods for antibiotic resistance phenotypes and resistance genes of Legionella pneumophila in artificial water environment is of great significance. Objective To investigate the antibiotic resistance characteristics of Legionella pneumophila isolated from artificial water environment in Zhongshan, and to provide a scientific basis for the prevention and control of Legionella infection. Methods A total of 295 strains of Legionella pneumophila isolated from central air conditioning systems and hot water systems in Zhongshan from 2012 to 2024 were collected. The minimum inhibitory concentrations (MIC) of antimicrobial agents against the strains were determined using the E-test method. Whole genome sequencing combined with bioinformatics techniques was used to analyze the antibiotic resistance genes of 16 strains of Legionella pneumophila. The phylogenetic evolutionary relationships between these strains and clonal strains from different sources worldwide were analyzed based on whole genome single nucleotide polymorphisms (wgSNPs). Results The antimicrobial susceptibility testing results showed that the highest resistance rate of Legionella pneumophila was to erythromycin (ERY) (56.9%), followed by azithromycin (AZM) (27.1%) and levofloxacin (LEV) (12.2%). The antibiotic resistance rates to rifampicin (RIF) and cefotaxime (CTX) were low, and the strains were fully susceptible to clarithromycin (CLA), ciprofloxacin (CIP), and doxycycline (DOX). Compared to the isolates from the hot water systems, those from the central air conditioning systems exhibited higher resistance rates to ERY (70.9% vs. 28.1%) and AZM (34.2% vs. 12.5%), and the differences were statistically significant (χ²=48.226, P<0.001; χ²=15.388, P<0.001). The MIC values of Lp1 isolates for four antibiotics (AZM, CLA, DOX, and CTX) were significantly higher than those of Lp2-14 isolates (Z=−3.490, P <0.001; Z=−3.035, P <0.05; Z=−2.662, P<0.05; Z=−2.973, P <0.05). The MIC values of Lp2−14 isolates for RIF were significantly higher than those of Lp1 isolates (Z=−3.190, P<0.05). The strains isolated from 2019–2024 exhibited higher MIC values for both CLA and DOX than those isolated from 2012–2018 (Z=−4.847, P <0.001; Z=−6.057, P <0.001). Whole genome sequencing analysis showed that the 16 strains of Legionella pneumophila carried antibiotic resistance genes for aminoglycosides, macrolides, cephalosporins, and penicillins. The phylogenetic analysis showed that Legionella pneumophila in this region exhibited high genetic diversity and was consistent with the epidemic trends of strains from other regions worldwide. Conclusion The isolates of Legionella pneumophila in this study are highly susceptible to most antimicrobial agents. However, the antibiotic resistance should not be ignored, and continuous monitoring of antibiotic resistance is necessary.

Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective:To construct decision indicator system for the allocation of life-support equipment on the basis of hospital-based health technology assessment(HB-HTA)theory,and explore its application value in the management for life-support equipment.Methods:The decision indicators of the allocation of life-support equipment were formulated from four dimensions that included equipment safety,effectiveness,suitability and economy on the basis of HB-HTA theory,so as to assess and manage the decision for allocation of equipment.A total of 149 using life-support equipment in clinical work in West China Hospital of Sichuan University from January 2022 to December 2023 were selected,and expert review mode was adopted to conduct decision for allocation of 138 equipment received management for allocation from January to December 2022,and the decision indicator system for the allocation of life-support equipment on the basis of HB-HTA theory was adopted to conduct decision management for the allocation of 143 equipment(included 132 equipment received expert review mode for management of allocation)that received management for allocation from January to December 2023.The predictive assessment value for target,the achievement ratio of HB-HTA performance,the result of examination of management level of 46 personnel from clinical department,15 personnel from department of equipment,and 11 personnel from other department in items of allocation of equipment were compared between two kinds of management modes for allocation.Results:The predictive assessment values for target of the allocation items of heart-support equipment,respiratory-support equipment,anesthesia-support equipment and other support equipment which adopted HB-HTA management mode for allocation were respectively 0.65±0.22,0.68±0.16,0.70±0.15 and 0.58±0.20,which were higher all than those of management mode of expert review for allocation,and the differences were statistically significant(t=3.362,3.585,f4.152,3.247,P<0.05).The achievement ratio of average performance of safety,effectiveness,suitability and economy of allocation items of HB-HTA management mode were respectively(97.29±1.65)%,(96.19±2.08)%,(95.82±2.29)%and(94.92±2.29)%,all of which were higher than those of expert review management mode for allocation,and the differences were statistically significant(t=2.297,2.377,2.753,2.951,P<0.05).The results of the personnel who worked in clinical department,equipment department and other department were respectively(93.24±3.12)scores,(95.35±3.22)scores and(95.78±1.82)scores in adopting HB-HTA management mode for allocation to conduct examination for the management level about allocation items of life-support equipment with allocation decision,all of which were higher than those of expert review management mode for allocation,and the differences of them were statistically significant(t=3.220,2.435,2.404,P<0.05).Conclusion:The application of HB-HTA theory in indicator system of allocation decision of life-support equipment can comprehensively analyze the safety,effectiveness,suitability and economy of equipment allocation,and enhance the scientific nature of declaring project for allocation of life-support equipment,and improve the achievement degree of the target of implementing the project of the allocation of life-support equipment,and raise the business level of the management team for the project of allocation of life-support equipment.

Objective:To analyze the design and application of a three-tier architecture medical consumables management information system based on IoT technology.Methods:Utilizing IoT technologies including network communication,radio frequency identification(RFID),and intelligent processing,a three-tier architecture system comprising perception,application,and interaction layers was designed to achieve comprehensive management of medical consumables throughout their lifecycle.A total of 520 clinical medical consumables in use at West China Hospital of Sichuan University from January 2022 to January 2023 were selected.Using a random number table,they were divided into an observation group and a control group,each containing 260 items.The control group employed conventional management practices,while the observation group utilized the IoT-based three-tier architecture medical consumables management information system.The study compared the quality of medical consumables management,time spent on consumables verification,inventory backlog,test results in different scenarios,and the time required to manage medical consumables per single treatment session between the two management models.Results:The observation group scored(95.69±10.66)points for the timeliness of medical consumables delivery,(94.14±11.33)points for management standardization,and(94.36±11.54)points for the timeliness of consumables recovery.was(94.36±11.54).All scores were significantly higher than those in the control group,with statistically significant differences(t=11.067,9.048,9.492,P<0.05).The observation group exhibited shorter monthly and quarterly physical inventory reconciliation times,as well as lower monthly and quarterly inventory backlogs compared to the control group,with all differences statistically significant(t=19.303,21.303,13.114,28.734,P<0.05).The observation group demonstrated significantly shorter average response times and average processing times for daily replenishment of medical supplies compared to the control group,while exhibiting significantly higher average inventory accuracy rates.All differences were statistically significant(t=11.614,22.122,12.103,P<0.05).During high-demand periods,the observation group exhibited significantly shorter average response times and average processing times compared to the control group,while inventory accuracy was significantly higher.All differences were statistically significant(t=8.358,11.051,22.157,P<0.05).The observation group also demonstrated shorter preparation times for medical supplies,response times for ad hoc requests,and return times to inventory compared to the control group,with statistically significant differences(t=15.881,19.334,17.102,P<0.05).Conclusion:Implementing a three-tier architecture medical consumables management information system based on IoT technology significantly enhances the quality of medical consumables management.It reduces consumables verification time and inventory backlog,enables rapid response and processing during routine replenishment and high-demand periods,and markedly decreases the time required for managing medical consumables per patient visit.

Objective: To compare the clinical efficacy of visual dilated sheath combined with needle nephroscope percutaneous nephrolithotomy (PCNL) with traditional PCNL for renal calculi，so as to enhance the intraoperative safety and puncture accuracy. Methods: A retrospective analysis was conducted on 100 patients with renal calculi treated on hospital during Sep.2022 to Sep.2023.Based on the surgical approaches，patients were divided into the needle nephroscope group (PCNL with visual dilator sheath and needle nephroscope，n=52) and traditional group (traditional PCNL，n=48).Clinical characteristics，surgical parameters，and outcomes were compared between the two groups. Results: There were no significant differences between the two groups in baseline data，total operation time and hospital stay (P>0.05).The needle nephroscope group had a longer channel establishment time compared to the traditional group [20.0(17.0-22.0) min vs.16.0 (15.0-21.0) min，P=0.002]，but significantly shorter puncture time [2.0 (1.0-2.6) min vs. 2.8(2.0-3.5) min，P<0.001]，and fewer adjustments of the puncture needle (9.6% vs. 64.6%，P<0.001).The channel was successfully established on the first attempt in all patients in the needle nephroscope group，while only 41 of patients in the traditional group achieved success on the first attempt，6 cases needed 2 attempts，and 1 case needed 3 attempts.Postoperative complications were absent in the needle nephroscope group，whereas postoperative bleeding requiring interventional treatment occurred in 1 case in the traditional group.There was no significant difference in the first-stage stone-clearance rate between the two groups (88.4%vs. 85.4%，P=0.872). Conclusion: PCNL using a visual dilator sheath combined with a needle nephroscope achieves a comparable first-stage stone-clearance rate to traditional PCNL.However，it offers significant advantages in terms of shorter puncture time，fewer adjustments of the puncture needle，and lower postoperative complication rate.These findings suggest superior safety and precision，making it a valuable technique for clinical application.

BACKGROUND: Angiotensin receptor neprilysin inhibitors (ARNIs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers (BBs), and mineralocorticoid receptor antagonists (MRAs) are the cornerstones in treating heart failure with reduced ejection fraction (HFrEF). Sodium-glucose cotransporter 2 inhibitors (SGLT-2is) are included in HFrEF treatment guidelines. However, the effect of SGLT-2i and the five drugs on HFrEF have not yet been systematically evaluated. METHODS: PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) from inception dates to September 23, 2022. Additional trials from previous relevant reviews and references were also included. The primary outcomes were changes in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter/dimension (LVEDD), left ventricular end-systolic diameter/dimension (LVESD), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV), left ventricular end-systolic volume index (LVESVI), and left ventricular end-diastolic volume index (LVEDVI). Secondary outcomes were New York Heart Association (NYHA) class, 6-min walking distance (6MWD), B-type natriuretic peptide (BNP) level, and N-terminal pro-BNP (NT-proBNP) level. The effect sizes were presented as the mean difference (MD) with 95% confidence interval (CI). RESULTS: We included 68 RCTs involving 16,425 patients. Compared with placebo, ARNI + BB + MRA + SGLT-2i was the most effective combination to improve LVEF (15.63%, 95% CI: 9.91% to 21.68%). ARNI + BB + MRA + SGLT-2i (5.83%, 95% CI: 0.53% to 11.14%) and ARNI + BB + MRA (3.83%, 95% CI: 0.72% to 6.90%) were superior to the traditional golden triangle ACEI + BB + MRA in improving LVEF. ACEI + BB + MRA + SGLT-2i was better than ACEI + BB + MRA (-8.05 mL/m 2 , 95% CI: -14.88 to -1.23 mL/m 2 ) and ACEI + BB + SGLT-2i (-18.94 mL/m 2 , 95% CI: -36.97 to -0.61 mL/m 2 ) in improving LVEDVI. ACEI + BB + MRA + SGLT-2i (-3254.21 pg/mL, 95% CI: -6242.19 to -560.47 pg/mL) was superior to ARB + BB + MRA in reducing NT-proBNP. CONCLUSIONS: Adding SGLT-2i to ARNI/ACEI + BB + MRA is beneficial for reversing cardiac remodeling. The new quadruple drug "ARNI + BB + MRA + SGLT-2i" is superior to the golden triangle "ACEI + BB + MRA" in improving LVEF. REGISTRATION PROSPERO; No. CRD42022354792.
Humans ; Heart Failure/physiopathology* ; Stroke Volume/physiology* ; Angiotensin Receptor Antagonists/therapeutic use* ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use* ; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use* ; Randomized Controlled Trials as Topic ; Mineralocorticoid Receptor Antagonists/therapeutic use* ; Adrenergic beta-Antagonists/therapeutic use*

Objective:To design a set of new type of surgery instrument for pectus excavatum(PE),so as to improve safety and effectiveness of minimally invasive operation in surgery for PE.Methods:The design of the new type of surgical instrument for PE adopted multifunctional orthopedic board that combined both penetrating and supporting functions.The T type handle,special sealing screw for single hole,setscrew and stator,which were convenient for operation,were equipped for the orthopedic board.The new type of surgical instrument was applied in clinical PE surgery since November,2010,and a total of 1398 PE surgeries were conducted in the 10 years,which included 1078 surgeries with single hole,and 320 surgeries with multi holes.The success rate of PE surgery with single hole mode was assessed.Results:In 1398 PE surgeries,the number of PE patients,whose ages were less or equal to 12 years old,and who all adopted single hole mode,was 887 cases,and the success rate of surgery with single hole was 100%.In addition,the number of PE patients,whose age was larger than 12 years old,was 511 cases,and the surgery with single hole was successfully applied in 191 cases of them,and the success rate of surgery with single hole was 37.4%.Conclusion:The the new type of surgical instrument for PE by surgery with single hole and multi holes has mature technique,and it is safety and effectiveness,which has higher clinical application value.

Objective:To construct decision indicator system for the allocation of life-support equipment on the basis of hospital-based health technology assessment(HB-HTA)theory,and explore its application value in the management for life-support equipment.Methods:The decision indicators of the allocation of life-support equipment were formulated from four dimensions that included equipment safety,effectiveness,suitability and economy on the basis of HB-HTA theory,so as to assess and manage the decision for allocation of equipment.A total of 149 using life-support equipment in clinical work in West China Hospital of Sichuan University from January 2022 to December 2023 were selected,and expert review mode was adopted to conduct decision for allocation of 138 equipment received management for allocation from January to December 2022,and the decision indicator system for the allocation of life-support equipment on the basis of HB-HTA theory was adopted to conduct decision management for the allocation of 143 equipment(included 132 equipment received expert review mode for management of allocation)that received management for allocation from January to December 2023.The predictive assessment value for target,the achievement ratio of HB-HTA performance,the result of examination of management level of 46 personnel from clinical department,15 personnel from department of equipment,and 11 personnel from other department in items of allocation of equipment were compared between two kinds of management modes for allocation.Results:The predictive assessment values for target of the allocation items of heart-support equipment,respiratory-support equipment,anesthesia-support equipment and other support equipment which adopted HB-HTA management mode for allocation were respectively 0.65±0.22,0.68±0.16,0.70±0.15 and 0.58±0.20,which were higher all than those of management mode of expert review for allocation,and the differences were statistically significant(t=3.362,3.585,f4.152,3.247,P<0.05).The achievement ratio of average performance of safety,effectiveness,suitability and economy of allocation items of HB-HTA management mode were respectively(97.29±1.65)%,(96.19±2.08)%,(95.82±2.29)%and(94.92±2.29)%,all of which were higher than those of expert review management mode for allocation,and the differences were statistically significant(t=2.297,2.377,2.753,2.951,P<0.05).The results of the personnel who worked in clinical department,equipment department and other department were respectively(93.24±3.12)scores,(95.35±3.22)scores and(95.78±1.82)scores in adopting HB-HTA management mode for allocation to conduct examination for the management level about allocation items of life-support equipment with allocation decision,all of which were higher than those of expert review management mode for allocation,and the differences of them were statistically significant(t=3.220,2.435,2.404,P<0.05).Conclusion:The application of HB-HTA theory in indicator system of allocation decision of life-support equipment can comprehensively analyze the safety,effectiveness,suitability and economy of equipment allocation,and enhance the scientific nature of declaring project for allocation of life-support equipment,and improve the achievement degree of the target of implementing the project of the allocation of life-support equipment,and raise the business level of the management team for the project of allocation of life-support equipment.