BACKGROUND: While emotional distress, encompassing anxiety and depression, has been associated with negative clinical outcomes, its impact across various clinical departments and general hospitals has been less explored. Previous studies with limited sample sizes have examined the effectiveness of specific treatments (e.g., antidepressants) rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients. To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals, this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay (LOS) and rate of long LOS (LLOS, i.e., LOS >30 days) in a large sample of non-psychiatric inpatients. METHODS: This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital. They were divided, according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index (HEI) for brief screening with grading psychological services (BS-GPS), into BS-GPS ( n = 178,883) and non-BS-GPS ( n = 308,988) cohorts. The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression (CSAD, i.e., HEI score ≥11 on admission to the hospital) in the BS-GPS cohort were compared using univariable analyses, multilevel analyses, and/or propensity score-matched analyses, respectively. RESULTS: The detection rate of CSAD in the BS-GPS cohort varied from 2.64% (95% confidence interval [CI]: 2.49%-2.81%) to 20.50% (95% CI: 19.43%-21.62%) across the 20 departments, with a average rate of 5.36%. Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD (12.7 days, 535/9590) and without CSAD (9.5 days, 3800/169,293) and between the BS-GPS (9.6 days, 4335/178,883) and non-BS-GPS (10.8 days, 11,483/308,988) cohorts. These differences remained significant after controlling for confounders using propensity score-matched comparisons. A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge. CONCLUSION Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals. These impacts were moderated by the implementation of BS-GPS. Thus, BS-GPS has the potential as an effective, resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
Humans ; Retrospective Studies ; Male ; Length of Stay/statistics & numerical data* ; Female ; Middle Aged ; Adult ; Psychological Distress ; Inpatients/psychology* ; Aged ; Anxiety/diagnosis* ; Depression/diagnosis*

Objective:To report the follow-up status of patients participating phase Ⅲ clinical trial (ZGDD3) of Donafenib tosilate (abbreviated as Donafenib) in the treatment of progressive radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC), and to explore its efficacy, safety and prognostic factors.Methods:This study was a randomized controlled trial, and the clinicopathological data and follow-up results of 29 patients (16 males, 13 females, age 40-68 years) who participated in the clinical trial ZGDD3 between August 2018 and March 2021 were analyzed. Patients were divided into Donafenib group and placebo group using the central dynamic randomization method with the ratio of 2∶1. Adverse reactions (AE) during the trial were observed. Independent-sample t test, Mann-Whitney U test and Fisher exact test were used to analyze the differences of baseline characteristics between the two groups. Progression-free survival (PFS) and overall survival (OS) were followed up. Kaplan-Meier method was used to draw the survival curve (log-rank test) and Cox regression analysis was used to analyze the prognostic factors. Results:There were 22 patients in Donafenib group and 7 patients in placebo group. There were no significant differences of baseline characteristics between the two groups ( t values: -0.68, Z values: from -1.47 to -0.56, all P>0.05). The follow-up was 32.07(21.07, 49.85) months. During the trial, drug-related AEs occurred in all patients in Donafenib group, mostly was grade Ⅰ-Ⅱ, no grade Ⅳ or Ⅴ AEs were found. The median PFS was significantly longer in Donafenib group than that in placebo group (13.23 vs 4.03 months; χ2=9.68, P=0.002), and the median OS was 55.00 and 24.30 months respectively ( χ2=2.07, P=0.150). Metastasis to less common sites was the independent risk factor for OS (hazard ratio ( HR)=6.789, 95% CI: 1.272-36.246, P=0.025). Conclusions:Donafenib shows good clinical application in the treatment of RAIR-DTC, demonstrating good safety and efficacy. Metastasis to less common sites is closely related to OS.

Objective:To explore the efficacy and safety of supplementing early rehabilitation with local vibration therapy in the prevention and treatment of ICU-acquired weakness (ICU-AW).Methods:Ninety-six critically ill patients were randomly divided into a control group, a rehabilitation group, and a combination group, each of 32. All received routine treatment and care, but the rehabilitation group and the combination group received earlier rehabilitation and the combination group early rehabilitation + local vibration therapy. Before and after 2 weeks of the treatments, the incidence of ICU-AW was recorded, Acute Physiology and Chronic Health Evaluation II (APACHE-II) scoring was performed and ultrasound was used to detect the rehabilitation effect. The incidence of adverse events was also recorded.Results:The incidence of ICU-AW was significantly lower in the combination group than among the rehabilitation group, while that of the rehabilitation group was significantly lower than among the control group. The APACHE II scores showed the same progression. The thickness, cross-sectional area, muscle echo, and diaphragm thickness and activity of the rectus femoris, rectus abdominis, and biceps brachii muscles in the combination group were, on average, significantly better than among the rehabilitation group, but with the rehabilitation group′s results significantly better than among the control group. The average mechanical ventilation time and ICU stay of patients in the combination group were significantly shorter than the rehabilitation group′s averages, which in turn were significantly shorter than those of the control group. The combination group′s average Barthel Index after the experiment was significantly higher than that of the rehabilitation group, which was in turn significantly higher than the control group′s average. The incidence of adverse events in the combination group was significantly lower than in the rehabilitation group, with that of the latter significantly lower than among the control group.Conclusions:Combining local vibration therapy with early rehabilitation is beneficial for the safe prevention and treatment of ICU-AW.

Objective:To explore the longitudinal relationship between adolescents' future self-continuity and depression, providing insights into their future development.Methods:A total of 419 adolescents from a school in Shandong Province were selected, and two followed-up surveys were conducted at 6-month intervals in April (T1) and October (T2) of 2023 using the future self-continuity questionnaire and Beck depression inventory-Ⅱ. Cross-lagged analysis was performed using Mplus 8.0.Results:The scores of future self-continuity were 36.01±8.69 at baseline (T1) and 35.89±9.92 after six months (T2), while the scores of depression were 2.00(0, 14.00) and 1.00(0, 9.00), respectively. There was a negative correlation between future self-continuity and depression at both time points (T1: r=-0.195, T2: r=-0.239, both P<0.01). Adolescents' future self-continuity could predict depression six months later ( β=-0.098, P<0.01), and depression also could predict the level of future self-continuity six months later ( β=-0.114, P<0.01). Conclusion:There is an interactively influence effect between adolescents' future self-continuity and depression.While enhancing adolescents' future self-continuity level to alleviate depression, attention should also be paid attention to the impact of depression on their future self-continuity, which can help adolescents overcome the interference of depressive emotions and grow into a better future self.

Objective To compare the effects of remimazolam and propofol on postoperative nausea and vomiting(PONV)after pancreatic extracorporeal shock wave lithotripsy(P-ESWL),with the aim of optimizing the anesthesia regimen for this procedure.Methods Clinical data were retrospectively collected from patients who underwent P-ESWL for pancreatic stones under general anesthesia at The First Affiliated Hospital of Xi'an Jiaotong University from January 2021 to December 2024.A total of 307 patients were recruited,with 103 in the remimazolam group and 204 in the propofol group.Inverse probability of treatment weighting(IPTW)based on propensity scores was used to balance baseline characteristics and confounding factors between the two groups.The incidence of PONV and anesthesia recovery time were compared between the two groups.Results Before IPTW,there were statistically significant differences between the remimazolam and propofol groups in gender[male/female:51/52 vs.155/49],smoking history(27.2％vs.42.6％),intraoperative sufentanil use[25(10)μg vs.30(10)μg],remifentanil use[429.00(177)μg vs.480.50(209)μg],rocuronium use[36(6)mg vs.38(7)mg],and intraoperative dexamethasone use(62.1％vs.49.0％)(all P＜0.05).After IPTW,the baseline characteristics and confounding factors were balanced and comparable between the two groups(P＞0.05).Before IPTW,the incidence of PONV was higher in the remimazolam group than in the propofol group(24.3％vs.14.7％,P=0.039).After IPTW,the two groups did not significantly differ in the incidence of PONV(21.5％vs.17.5％,P=0.215),and the anesthesia recovery time was significantly shorter in the remimazolam group than in the propofol group[3(3)min vs.9(4)min,P＜0.001].Conclusion Compared to propofol anesthesia,remimazolam does not increase the incidence of PONV in patients undergoing P-ESWL for pancreatic stones and can effectively reduce anesthesia recovery time.

Postoperative acute pain can significantly hinder early postoperative recovery if inadequately managed,and may even progress to chronic postsurgical pain(CPSP).The current clinical practice primarily relies on multimodal analgesia strategies,with intravenous opioids being the cornerstone.Although effective in alleviating postoperative pain,the associated adverse effects of opioids have limited their widespread use.In recent years,with the development of integrative medicine combining Western and traditional Chinese medicine,numerous studies have demonstrated that incorporating transcutaneous electrical acupoint stimulation(TEAS)into multimodal analgesia protocols confers significant benefits for postoperative pain management.TEAS not only reduces postoperative pain and opioid consumption but also mitigates opioid-related side effects,thereby facilitating patient recovery.This review aims to provide a comprehensive overview of the analgesic mechanisms of TEAS,its application within multimodal analgesia for postoperative pain,and its potential to serve as a valuable reference for clinicians seeking to optimize postoperative pain management strategies.

Objective To investigate the relationship between calcium-sensing receptor(CaSR)gene rs17251221,rs60388563 loci polymorphisms and the genetic susceptibility of breast cancer(BC).Methods A total of 122 patients with breast cancer admitted to Hengshui Second People's Hospital from January 2022 to June 2024 were selected as the BC group,and 100 healthy women without blood relationship at the same time were selected as the control group.The polymorphisms of CaSR gene rs17251221,rs60388563 loci were detected by polymerase chain reaction(PCR).The clinical data,genotype distribution and allele frequency were compared between the two groups.Non-conditional Logistic regression model was used to analyze the correlation between CaSR gene polymorphism and genetic susceptibility of BC patients.Results Comparing the general data of the two group,the proportion of family history of cancer in the BC group was significantly higher than that in the control group,and the difference was statistically significant(t=12.246,P<0.05).The genotype distribution of CaSR gene rs17251221 and rs60388563 loci in the control group and the BC group was consistent with the Hardy-Weinberg equilibrium law(χ2=0.087～1.202,P＞0.05),which was representative of the population.Under the co-dominant model of rs17251221 and rs60388563 loci,the risk of BC in GG genotype was significantly increased(OR=1.493,95%CI=1.070～2.108;OR=1.483,95%CI=1.034～2.121).Under the dominant model(AA vs GA+GG)and recessive model(GG vs GA+AA),the rs17251221 locus carrying G allele(OR=1.371,95%CI=1.023～1.824)and A allele(OR=0.524,95%CI=0.221～0.926)was significantly associated with the risk of BC(P<0.05).Under the dominant model(CC vs GC+GG)and recessive model(GG vs GC+CC),the rs60388563 locus carrying G allele(OR=1.245,95%CI=1.107～1.461)and C allele(OR=0.682,95%CI=0.523～0.974)was significantly associated with the risk of BC(P<0.05).Conclusion The rs17251221,rs60388563 loci polymorphisms of CaSR gene are closely related to BC susceptibility,and the risk of BC is high in individuals carrying G allele.

Nanopore sequencing,as a representative of third-generation sequencing technology,is widely used in molecular biology research.It offers several advantages,including high throughput,ultra-long read lengths,real-time sequencing,and the absence of amplification and labeling requirements.This technology has been applied for the detection of various pathogens,genomic typing,structural variation analysis,and personalized treatment guidance,making it valuable for pathogen monitoring and medical research.This article focuses on the principles of nanopore sequencing technology,its advantages,and its applications in molecular biology and molecular medicine.The limitations of nanopore sequencing and its future development directions are also summarized,providing new perspectives for further research in this field.

Objective To investigate the safety and efficacy of zero-ischemia and sutureless laparoscopic partial nephrectomy using thulium laser for the treatment of localized renal cell carcinoma.Methods A retrospective analysis was performed on the clinical data of 28 patients with localized renal cell carcinoma admitted to our hospital from January 2020 to March 2023.Laparoscopic zero-ischemia suturing thulium laser partial nephrectomy was adopted.The surgical data,postoperative changes in renal function,perioperative complications,and prognosis were analyzed.Results Three patients underwent traditional partial nephrectomy immediately by blocking the renal arteries during the operation due to poor hemostasis.The remaining 25 patients successfully completed zero-ischemia and sutureless laparoscopic partial nephrectomy using thulium laser,without intraoperative blood transfusion or open surgery.The surgical time ranged from 85 to 135 min,with an average of(108.4±14.7)min,the estimated blood loss was 50-250 ml,with an average of(117.7±51.7)ml.The drainage tube was removed 4-7 days postoperative,with an average of(5.6±0.9)days.The postoperative hospital day was 6～10 days,with an average of(7.7±0.9)days.There were no severe complications such as urinary fistula or secondary bleeding occurred.Preoperative serum creatinine was 60.4-116.0 μmol/L,with an average of(74.0±20.5)μmol/L.One week after the operation,the creatinine was 58.6-120.8 μmol/L,with an average of(73.5±21.8)μmol/L,which was not significant compared with that before surgery(P＞0.05).Postoperative pathology revealed 23 cases of clear cell renal cell carcinoma,4 cases of papillary renal cell carcinoma,and 1 case of chromophobe cell carcinoma.All cases was shown negative margins and there was no recurrence or metastasis during a follow-up period of 12 to 24 months.Conclusion Zero-ischemia and sutureless laparoscopic partial nephrectomy using thulium laser can better preserve kidney function without ischemia reperfusion injury.It is a safe and feasible surgical option for patients with localized renal cell carcinoma.

BACKGROUND:The lower-limb muscle strength shows a significant physiological decline with aging.There may be a certain correlation between sedentary behavior,fear of falling,age and lower-limb muscle strength,but the influence path and effect relationship among them are not yet clear.OBJECTIVE:To examine the relationship between sedentary behavior and lower-limb muscle strength,and to explore the influences of fear of falling and age in such an association among community-dwelling older adults.METHODS:This cross-sectional study recruited 331 community-dwelling older adults(aged≥60 years)in Shanghai.A questionnaire survey was conducted to collect basic information,demographic data,etc.The Short Form of the International Physical Activity Questionnaire was applied to measure sedentary time.Lower-limb muscle strength was assessed by the 30-second chair-stand test.Fear of falling was measured by the Chinese version of Fall Efficacy Scale-International.Descriptive statistics analysis,correlation analysis,regression-based path analysis and mediation analyses were performed on the data.RESULTS AND CONCLUSION:Valid data from 318 community-dwelling older adults[78.9%females,mean age(67.8±5.5)years old]were finally included in the analysis.There were 185 with sedentary time≥3 hours and 133 with sedentary time<3 hours.(1)There was a positive correlation between sedentary behavior and fear of falling(P<0.01),and there were negative correlations between lower-limb muscle strength and sedentary behavior(P<0.01)and between lower-limb muscle strength and fear of falling(P<0.001).(2)Sedentary behavior negatively predicted lower-limb muscle strength(β=-0.125,P<0.05),and positively predicted fear of falling(β=0.182,P<0.01).Fear of falling negatively predicted lower-limb muscle strength(β=-0.293,P<0.001).(3)Fear of falling mediated the relationship between sedentary behavior and lower-limb muscle strength(β=-0.053,95%confidence interval:-0.100 to-0.018).(4)Sedentary behavior had a statistically significant predictive effect on fear of falling(β=0.164,P<0.01),indicating that age moderates the effect of sedentary behavior on fear of falling.