Objective To analyze the characteristics and causes of an occupational acute carbon monoxide poisoning incident caused by a nitrogen generator malfunction. Methods The workers and the workshop from an electronic component manufacturing company in Guangzhou City, which had an occupational acute carbon monoxide poisoning incident, were selected as the research subjects using the retrospective investigation method. Relevant data of worksite survey of occupational health, clinical records of poisoning patients, and occupational disease diagnosis data were collected for analysis. Results A total of 15 workers who experienced discomfort in this incident, were from the final inspection workshop using high-purity nitrogen (purity of 99.999%). The short-term exposure concentration of carbon monoxide in the workplace air at three oven operating posts using high-purity nitrogen was 64.1, 581.0, and 142.0 mg/m³, respectively, while the concentration in the workplace air at the oven operating posts using regular nitrogen and the nitrogen-generating room was <0.1 mg/m³. Carboxyhemoglobin saturation levels in the 15 patients ranged from 2.000%-17.300%. Occupational acute mild carbon monoxide poisoning was diagnosed in nine patients, occupational acute carbon monoxide exposure reactions was diagnosed in six patients. This poisoning incident was caused by machine malfunction and improper operation, leading to occupational acute carbon monoxide poisoning. Conclusion Companies using nitrogen production machine should enhance their ability to identify carbon monoxide risks, strengthen training and management of workers, establish emergency response plans for nitrogen production and use, ensure proper maintenance of production equipment, and optimize operational procedures to prevent acute poisoning incidents.

OBJECTIVES: To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application. Methods and. RESULTS: Recommendations were formulated based on literature review and expert group discussion, and consensus was reached following expert consultation. The consensus recommendations are comprehensive, covering the entire treatment procedures from preoperative assessment and preparation, surgical operation process, postoperative management and traditional Chinese medicine treatment to individualized treatment planning. The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain, reduced the use of opioid drugs, and significantly improved the quality of life and enhanced immune function of the patients. Postoperative follow-up suggested good treatment tolerance among the patients without serious complications. CONCLUSIONS The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy. The combined treatment has a high clinical value with a good safety profile for management of cancer pain.
Humans ; Medicine, Chinese Traditional ; Cancer Pain/therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Drug Delivery Systems ; Pain Management/methods* ; China

The rapid development of artificial intelligence (AI), especially generative AI (GenAI), has already brought, and will continue to bring, revolutionary changes to our daily production and life, as well as create new opportunities and challenges for diagnostic and therapeutic practices in the medical field. Haihe Hospital of Tianjin University collaborates with the National Supercomputer Center in Tianjin, Tianjin University, and other institutions to carry out research in areas such as smart healthcare, smart services, and smart management. We have conducted research and development of a full-process disease diagnosis and treatment assistance system based on GenAI in the field of smart healthcare. The development of this project is of great significance. The first goal is to upgrade and transform the hospital's information center, organically integrate it with existing information systems, and provide the necessary computing power storage support for intelligent services within the hospital. We have implemented the localized deployment of three models: Tianhe "Tianyuan", WiNGPT, and DeepSeek. The second is to create a digital avatar of the chief physician/chief physician's voice and image by integrating multimodal intelligent interaction technology. With generative intelligence as the core, this solution provides patients with a visual medical interaction solution. The third is to achieve deep adaptation between generative intelligence and the entire process of patient medical treatment. In this project, we have developed assistant tools such as intelligent inquiry, intelligent diagnosis and recognition, intelligent treatment plan generation, and intelligent assisted medical record generation to improve the safety, quality, and efficiency of the diagnosis and treatment process. This study introduces the content of a full-process disease diagnosis and treatment assistance system, aiming to provide references and insights for the digital transformation of the healthcare industry.
Artificial Intelligence ; Humans ; Delivery of Health Care ; Generative Artificial Intelligence

Objectives:The present study evaluated the impact of ablation pain during pulmonary vein isolation(PVI)on catheter-tissue contact at different regions. Methods:Forty consecutive patients with atrial fibrillation(AF)referred to Central China Fuwai Hospital for catheter radiofrequency ablation from February to May 2023 were enrolled.The pulmonary veins on each side were divided into 8 regions.The catheter-tissue contact force(CF)and the number of ablation contact stability(>50%catheter attach time CF≥10 g)of each ablation lesion were analyzed.Pain scores during the ablation were assessed using the Faces Pain Scale-Revised and the maximum score was taken for each ablation region.Based on the pain scores,in each region,20 cases with higher pain scores were categorized into the pain group and 20 cases with lower pain scores were categorized into the normal group.The CF characteristics of each region and the relationship with ablation induced pain were analyzed. Results:A total of 3 832 lesions were recorded in 40 patients with AF,with a mean CF of(12.2±7.8)g.Among them,the CF in the pain group was significantly lower than that in the normal group([11.1±5.1]g vs.[13.4±4.8]g,P<0.05).The top region of the right pulmonary vein was the region with the largest CF(16.5±5.8)g,and the upper part of the left anterior wall(at the ridge between the left atrial appendage)was the region with the smallest CF(7.5±3.7)g.At the bottom of right pulmonary vein,right lower posterior wall,left pulmonary vein,and left posterior wall,as well as the middle region of left posterior wall,and upper region of left posterior wall,the CF was significantly smaller in the pain group than that in the normal group(all P<0.05).Of the 3 832 lesions,2 193(57.2%)were stable lesions,and the proportion of stable lesions in the pain group was significantly lower than that in the normal group(55.2%vs.59.5%,P<0.05).In the right pulmonary vein bottom,right lower posterior wall,left lower anterior wall,left pulmonary vein bottom,and left lower posterior wall,the proportion of stable lesions was significantly lower in the pain group than in the normal group(all P<0.05).In addition,the ratio of stable lesions in left pulmonary vein regions was lower than in the right(54.2%vs.60.5%,P<0.05).In the upper part of the left anterior wall(at the ridge between the left atrial appendage),only 88(39.3%)of the 224 lesions in 40 patients were stable lesions. Conclusions:Pain during ablation significantly affects the stability of the catheter to tissue.Monitoring real-time CF during PVI may have important implications for improving ablation efficacy,especially in regions with more intense pain.

【Objective】 To explore the feasibility of en-bloc resection of bladder tumors by flexible cystoscope combined with laparoscopic instruments through urethra and to provide reference for the clinical application of this technique. 【Methods】 Self-designed and processed transurethral single-hole PORT and Olympus electronic cystoscope were used as observation mirror; Φ1.8 mm soft grasper, tissue scissors, electric hook, and ultrasonic scalpel were used as instruments; the porcine bladder was used as a model.The PORT was placed through the urethra, and the cystoscope was inserted to observe the inner wall of the bladder and the condition of the mucosa.After the lesion site was identified in the bladder cavity, the soft grasper was inserted to pull the mucosa to be removed, which was then fixed with tension at the target position to maintain a satisfactory feild of view.The surgeon held the cystoscope in the left hand, and operated the laparoscopic instruments into the bladder cavity through the PORT with the right hand.Observing with the cystoscope and lifting and pulling the mucosa with the grasper, the surgeon simulated the cutting and pushing actions to realize the en-bloc resection of the lesioned mucosa. 【Results】 The mucosa at 4 different locations were successfully resected on 2 in vitro porcine bladder models. 【Conclusion】 The in vitro experiments show that the combination of flexible electronic cystoscope and laparoscopic instruments achieves synergistic effects in en-bloc resection of bladder tumor by transurethral single-hole laparoscope without additional iatrogenic bladder injury caused by percutaneous bladder incision.This method is feasible in the treatment of bladder tumors, and has the potential of clinical application after further optimization.

Objective To explore the clinical value of methylation at promoter sites of urine protein kinase Y-linked(PRKY)gene in the early diagnosis of prostate cancer(PCa).Methods Urine samples were collected from 50 suspected PCa patients.After extracting DNA,the methylation levels of the PRKY gene promoter sites cg05163709,cg08045599,and cg05618150 were detected using quantitative methylation-specific PCR(qMSP).Simultaneously,the patients were divided into the benign prostatic hyperplasia(BPH)group and the PCa group.The differences in clinical indicators between the two groups were analyzed,as well as the methylation status of the PRKY gene promoter sites in the urine of the two groups of patients.The receiver operating charac-teristic(ROC)curve of PRKY promoter sites methylation was established,and the area under the curve(AUC)was calculated to analyze the diagnostic value of PRKY promoter sites methylation in PCa,and to perform com-bined diagnosis with clinical indicators.Results The methylation rates of cg05163709 and cg05618150 in urine specimens of PCa patients were significantly higher than those of BPH patients.The AUC for cg05163709 methyla-tion in diagnosing PCa was 0.762,with a sensitivity of 86.70%.It showed better performance in early screening for PCa compared to total prostate specific antigen(tPSA),percentage free prostate specific antigen(f/tPSA)and prostate specific antigen density(PSAD)index.We found that the AUC for cg05618150 methylation in conjunc-tion with PSAD in diagnosing PCa was 0.787,with a sensitivity of 86.70%.The AUC of cg05163709 methylation and PSAD in the joint diagnosis of PCa was 0.855,and the specificity could reach 95.00%.Conclusion The methylation of urine PRKY gene promoter sites cg05163709 and cg05618150 shows high sensitivity and specificity in diagnosing PCa,making them promising biomarkers for early detection of PCa.

To analyze the disease group structure and its trends in key departments of large public hospitals using diagnosis related group (DRG) data, explore the key points of intervention and optimization of disease groups in departments, and further promote the rational allocation of department resources.

Background: Recent studies have reported that costoclavicular blocks (CCBs) can consistently block almost all branches of the brachial plexus while sparing the phrenic nerve and provide effective analgesia after shoulder surgery. We aimed to compare the efficacy of the CCB with that of the interscalene block (ISB) as the sole blocking technique for shoulder surgery. Methods: A total of 212 patients undergoing elective arthroscopic shoulder surgery were randomized to receive an ISB or CCB based on a non-inferiority design. All patients received titration sedation with propofol under monitored anesthesia during surgery. The primary outcomes were the proportion of patients with complete motor blockade of the suprascapular nerve (SSN) and incidence of hemidiaphragmatic paralysis (HDP). The secondary outcomes included block-related variables, complications, and postoperative pain scores. Results: The proportion of patients with complete motor blockade of the SSN at 20 min between the CCB and ISB groups (53% vs. 66%) exceeded the predefined non-inferiority margin of −5%, but was comparable at 30 min (87% vs. 91%). The CCB resulted in a significantly lower incidence of HDP (7.55% vs. 92.45%), Horner’s syndrome (0% vs. 18.87%), and dyspnea (0% vs. 10.38%) than the ISB. None of the patients experienced failed blocks or required conversion to general anesthesia. Pain scores were comparable between the groups. Conclusions Ultrasound-guided CCBs may be comparable to ISBs, with fewer unfavorable complications in patients with impaired lung function undergoing arthroscopic shoulder surgery.

Strengthening quality and safety monitoring is beneficial for standardizing pharmaceutical management, promoting rational clinical medication, and ensuring patient medication safety. In January 2022, a certain hospital took the opportunity of reassessment of grade-A tertiary general hospitals to construct a pharmaceutical quality and safety monitoring system. The hospital took such measures as building a three-layer personnel organizational structure, revising and updating pharmacy related systems and processes, establishing a monitoring mechanism of self inspection-supervision-feedback-rectification-traceability, implementing personnel cross integration supervision, and conducting assessment and evaluation of pharmacy and clinical departments. This monitoring system covered the entire hospital, and promoted continuous improvement of its pharmaceutical service quality. After three months of practice, a total of 320 rectification tasks were implemented, the error rate of drug use decreased from 0.015 ‰ in the fourth quarter of 2021 to 0.012 ‰ in the first quarter of 2022, the number of adverse drug events reported by clinical departments decreased from 67 to 33, and the overall satisfaction rate of medical workers with pharmaceutical services increased from 99.1% to 99.5%. The practice of the pharmaceutical quality and safety monitoring system had achieved certain results, which can provide references for other hospitals to improve the pharmaceutical management level.

Objective:To explore the reliability and validity of the 10-item Connor-Davidson resilience scale (CD-RISC-10) in Chinese community-dwelling adults.Methods:Using multistage stratified sampling, totally 2 051 community-dwelling adults were selected and they were investigated by the 10-item Connor-Davidson resilience scale, the center for epidemiological studies depression scale (CES-D) and 10-item Kessler psychological distress scale (K10). The exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the CD-RISC-10 by SPSS 22.0 and AMOS 22.0.A parallel analysis and Velicer's minimum average partial (MAP) test were also supplemented to confirm the EFA-derived structure of the scale.Results:The Cronbach α coefficient of the CD-RISC-10 was 0.94, and the Spearman-Brown reliability was 0.89.The total correlation of the questions ranged from 0.74 to 0.81 (all P<0.01). The exploratory factor analysis retained its single dimension, which can explain 63.24% of the total variance.Confirmatory factor analysis revealed the single factor model fit data adequately ( χ2/ df=4.596, CFI=0.967, TLI=0.973, RMSEA=0.065). The resilience(27.02±13.50) was negatively correlated with depression(9.75±5.24) and psychological distress (19.23±6.37)( r=-0.32, -0.35, both P<0.01). Conclusion:The CD-RISC-10 scale has acceptable reliability and validity, with using easily and conveniently.Therefore, it is an effective tool for measuring the resilience of the community-dwelling adults.