Objective To explore the clinical application value of respiratory function rehabilitation training combined with traditional Chinese medicine acupuncture therapy in the weaning and extubation of critically ill patients with respiratory failure.Methods A total of 82 patients with critical respiratory failure who had been treated with endotracheal intubation and ventilator therapy in the department of critical care of the Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine from August 2021 to August 2024 were enrolled.The patients were divided into control group(40 cases)and observation group(42 cases)according to different treatment methods.The control group was treated with the original underlying disease according to the condition,and was given symptomatic support and other active rescue treatment when there was an acute progressive exacerbation of respiratory failure and heart failure.On the basis of the treatment of the control group,the observation group was trained by a professional respiratory function rehabilitation therapist to conduct respiratory rehabilitation training on the patients.Acupuncture treatment was performed by acupuncturists specializing in traditional Chinese medicine who have undergone special training.The differences of general data[including gender,age,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)],laboratory tests indicators[including white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),oxygenation index(PaO2/FiO2)],prognosis(including the success rate of weaning and extubation,28-day respiratory failure recurrence rate,90-day mortality,incidence of lung infection,and incidence of right heart failure)between the two groups were compared.Results There were no significant differences in gender,age,APACHE Ⅱ score,WBC,CRP,PCT,and PaO2/FiO2 between the two groups(all P>0.05).After treatment,WBC,CRP,and PCT in both groups were significantly lower than before treatment,while PaO2/FiO2 was significantly higher than before treatment,compared with the control group,the observation group showed significantly decreased WBC,CRP and PCT,and significantly increased PaO2/FiO2 after treatment[WBC(×109/L):8.09±4.28 vs.14.63±5.07,CRP(mg/L):79.11±51.22 vs.117.49±49.24,PCT(μg/L):5.46±4.29 vs.10.56±8.64,PaO2/FiO2(mmHg,1 mmHg≈0.133 kPa):193.12±2.88 vs.190.83±3.90,all P<0.05],the success rate of weaning extubation in the observation group was significantly increased[57.1％(24/42)vs.35.0％(14/40)],and the 28-day respiratory failure recurrence rate,90-day mortality,the incidence of lung infection,and the incidence of right heart failure were significantly reduced[28-day respiratory failure recurrence rate:23.8％(10/42)vs.45.0％(18/40),and the 90-day mortality:28.6％(12/42)vs.50.0％(20/40),incidence of pulmonary infection:23.8％(10/42)vs.45.0％(18/40),incidence of right heart failure:14.3％(6/42)vs.35.0％(14/40),all P<0.05].Conclusion Through respiratory rehabilitation training combined with acupuncture treatment,it is possible to improve the blood oxygen supply to the vital organs of patients with critical respiratory failure who are on mechanical ventilation,reduce inflammatory responses,and thereby improve the prognosis of the patients.

Objective:To identify the relevant factors for the first-course remission of acute myeloid leukemia (AML) and to develop a predictive model as well as assess its predictive capability.Methods:Clinical data of 749 patients newly diagnosed with AML admitted to the Department of Hematology, the First Affiliated Hospital, Zhejiang University, School of Medicine from January 1, 2019, to April 30, 2023, were collected and randomly divided into training and validation sets. Multivariate logistic regression analysis was conducted to determine variables associated with complete remission in the first course of induction therapy, and a predictive model was established based on these variables. The receiver operating characteristic (ROC) curve of the predictive model was plotted, and the area under the curve (AUC) was calculated.Results:The indicators predicting the first remission course included peripheral blood white blood cell count during onset, CBF::MYH11 fusion gene, CEBPA bZIP region mutation, myelodysplastic syndrome-related gene mutation, and induction chemotherapy regimen selection as independent factors for the first remission course. The model’s area under the training and validation curves was 0.738 (95% CI: 0.696-0.780) and 0.726 (95% CI: 0.650-0.801), respectively. The Hosmer-Lemeshow test results yielded P-values of 0.993 and 0.335, respectively. Conclusion:In this study, the developed model demonstrates a strong predictive capability for the efficacy of the first course of patients with AML, providing valuable guidance to clinicians in assessing patient prognosis and selecting appropriate treatment strategies.

Objective:To identify the relevant factors for the first-course remission of acute myeloid leukemia (AML) and to develop a predictive model as well as assess its predictive capability.Methods:Clinical data of 749 patients newly diagnosed with AML admitted to the Department of Hematology, the First Affiliated Hospital, Zhejiang University, School of Medicine from January 1, 2019, to April 30, 2023, were collected and randomly divided into training and validation sets. Multivariate logistic regression analysis was conducted to determine variables associated with complete remission in the first course of induction therapy, and a predictive model was established based on these variables. The receiver operating characteristic (ROC) curve of the predictive model was plotted, and the area under the curve (AUC) was calculated.Results:The indicators predicting the first remission course included peripheral blood white blood cell count during onset, CBF::MYH11 fusion gene, CEBPA bZIP region mutation, myelodysplastic syndrome-related gene mutation, and induction chemotherapy regimen selection as independent factors for the first remission course. The model’s area under the training and validation curves was 0.738 (95% CI: 0.696-0.780) and 0.726 (95% CI: 0.650-0.801), respectively. The Hosmer-Lemeshow test results yielded P-values of 0.993 and 0.335, respectively. Conclusion:In this study, the developed model demonstrates a strong predictive capability for the efficacy of the first course of patients with AML, providing valuable guidance to clinicians in assessing patient prognosis and selecting appropriate treatment strategies.

Objective To explore the clinical application value of respiratory function rehabilitation training combined with traditional Chinese medicine acupuncture therapy in the weaning and extubation of critically ill patients with respiratory failure.Methods A total of 82 patients with critical respiratory failure who had been treated with endotracheal intubation and ventilator therapy in the department of critical care of the Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine from August 2021 to August 2024 were enrolled.The patients were divided into control group(40 cases)and observation group(42 cases)according to different treatment methods.The control group was treated with the original underlying disease according to the condition,and was given symptomatic support and other active rescue treatment when there was an acute progressive exacerbation of respiratory failure and heart failure.On the basis of the treatment of the control group,the observation group was trained by a professional respiratory function rehabilitation therapist to conduct respiratory rehabilitation training on the patients.Acupuncture treatment was performed by acupuncturists specializing in traditional Chinese medicine who have undergone special training.The differences of general data[including gender,age,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)],laboratory tests indicators[including white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),oxygenation index(PaO2/FiO2)],prognosis(including the success rate of weaning and extubation,28-day respiratory failure recurrence rate,90-day mortality,incidence of lung infection,and incidence of right heart failure)between the two groups were compared.Results There were no significant differences in gender,age,APACHE Ⅱ score,WBC,CRP,PCT,and PaO2/FiO2 between the two groups(all P>0.05).After treatment,WBC,CRP,and PCT in both groups were significantly lower than before treatment,while PaO2/FiO2 was significantly higher than before treatment,compared with the control group,the observation group showed significantly decreased WBC,CRP and PCT,and significantly increased PaO2/FiO2 after treatment[WBC(×109/L):8.09±4.28 vs.14.63±5.07,CRP(mg/L):79.11±51.22 vs.117.49±49.24,PCT(μg/L):5.46±4.29 vs.10.56±8.64,PaO2/FiO2(mmHg,1 mmHg≈0.133 kPa):193.12±2.88 vs.190.83±3.90,all P<0.05],the success rate of weaning extubation in the observation group was significantly increased[57.1％(24/42)vs.35.0％(14/40)],and the 28-day respiratory failure recurrence rate,90-day mortality,the incidence of lung infection,and the incidence of right heart failure were significantly reduced[28-day respiratory failure recurrence rate:23.8％(10/42)vs.45.0％(18/40),and the 90-day mortality:28.6％(12/42)vs.50.0％(20/40),incidence of pulmonary infection:23.8％(10/42)vs.45.0％(18/40),incidence of right heart failure:14.3％(6/42)vs.35.0％(14/40),all P<0.05].Conclusion Through respiratory rehabilitation training combined with acupuncture treatment,it is possible to improve the blood oxygen supply to the vital organs of patients with critical respiratory failure who are on mechanical ventilation,reduce inflammatory responses,and thereby improve the prognosis of the patients.

Objective:To explore the clinical significance of negative fluid balance and infection management in the treatment of acute respiratory distress syndrome (ARDS) caused by severe novel coronavirus infection.Methods:A retrospective survey was conducted. Patients with ARDS caused by severe novel coronavirus infection who were hospitalized in the department of critical care medicine of the Third Affiliated Hospital of Gansu University of Chinese Medicine and received non-invasive ventilator assisted ventilation were selected as the research objects. The fluid intake and output of all patients were accurately counted every day, and the fluid intake of the next day was adjusted according to the output of the previous day. According to the fluid negative balance, and whether the hospital infection management measures were complied with during the treatment and inspection of the patients, 45 patients with a negative fluid balance of more than 200 mL/d and strict management of nosocomial infection were taken as the observation group, and 48 patients with a negative fluid balance of less than 200 mL/d and no strict management of nosocomial infection were taken as the control group. The general data, weaning success rate, endotracheal intubation rate, mortality, as well as laboratory indicators such as white blood cell count (WBC), procalcitonin (PCT), C-reactive protein (CRP) after treatment were compared between the two groups.Results:There were no significant differences in gender (male: 51.1% vs. 52.1%), age (years old: 66.31±15.92 vs. 67.50±13.59), acute physiology and chronic health evalution Ⅱ (APACHEⅡ: 18.98±4.81 vs. 18.54±4.35) between the observation group and the control group (all P > 0.05), indicating that the baseline data were balanced and comparable. Compared with the control group, the weaning success rate of the observation group significantly increased [53.3% (24/45) vs. 31.2% (15/48), P = 0.031], endotracheal intubation rate significantly decreased [22.2% (10/45) vs. 43.8% (21/48), P = 0.028], mortality significantly reduced [20.0% (9/45) vs. 41.7% (20/48), P = 0.024], laboratory indicators WBC, PCT and CRP levels were significantly reduced [WBC (×10 9/L): 8.085±4.136 vs. 16.898±7.733, CRP (mg/L): 82.827±52.680 vs. 150.679±74.625, PCT (μg/L): 3.142±2.323 vs. 7.539±5.939, all P < 0.01]. Conclusion:Fluid negative balance and infection management have significant clinical significance in the treatment of severe novel coronavirus infection with ARDS.

OBJECTIVE: To prepare customized porous silicone orbital implants using embedded 3D printing and assess the effect of surface modification on the properties of the implants. METHODS: The transparency, fluidity and rheological properties of the supporting media were tested to determine the optimal printing parameters of silicone. The morphological changes of silicone after modification were analyzed by scanning electron microscopy, and the hydrophilicity and hydrophobicity of silicone surface were evaluated by measuring the water contact angle. The compression modulus of porous silicone was measured using compression test. Porcine aortic endothelial cells (PAOECs) were co-cultured with porous silicone scaffolds for 1, 3 and 5 days to test the biocompatibility of silicone. The local inflammatory response to subcutaneous porous silicone implants was evaluated in rats. RESULTS: The optimal printing parameters of silicone orbital implants were determined as the following: supporting medium 4% (mass ratio), printing pressure 1.0 bar and printing speed 6 mm/s. Scanning electron microscopy showed that the silicone surface was successfully modified with polydopamine and collagen, which significantly improved hydrophilicity of the silicone surface (P < 0.05) without causing significant changes in the compression modulus (P > 0.05). The modified porous silicone scaffold had no obvious cytotoxicity and obviously promoted adhesion and proliferation of PAOECs (P < 0.05). In rats bearing the subcutaneous implants, no obvious inflammation was observed in the local tissue. CONCLUSION Poprous silicone orbital implants with uniform pores can be prepared using embedded 3D printing technology, and surface modification obviously improves hydrophilicity and biocompatibility of the silicone implants for potential clinical application.
Animals ; Rats ; Swine ; Silicon ; Orbital Implants ; Endothelial Cells ; Porosity ; Silicones ; Printing, Three-Dimensional

To investigate the research status and trends of application of objective structured clinical examination (OSCE) in medical education in China and globally, and to provide a reference for clinical teaching and medical education research. CNKI and Web of Science Core Collection were searched to identify journal articles related to OSCE published up to the present day. CtieSpace V software was used to visually analyze the research institutions, authors, highly cited literature, and keyword changes of the articles based on scientific knowledge maps. The overall number of publications on OSCE published in China and globally showed an increasing trend, but foreign publications were significantly more than Chinese publications. The institutions and authors were widely distributed. Comprehensive universities were the main institutions in foreign publications, with relatively little cooperation between each other. Domestic research primarily focused on medical education in the early stage, SP training and standardization in the middle stage, and clinical competence for resident physicians, nurses, and other clinical professionals in the late stage. Early foreign research focused mainly on medical education and clinical competence, while later research focused primarily on communication with patients and ability assessment. It is expected that future domestic research will focus on building clinical competence evaluation systems based on the OSCE model, while future foreign research will focus on patient communication and humanistic care assessment.

Homeostasis ; Taste/physiology* ; Zinc

Objective:To explore the influences of times of venous thromboembolism (VTE) drug prophylaxis in formation of deep vein thrombosis (DVT) in patients with severe craniocerebral injury after surgical treatment.Methods:Ninety patients with severe craniocerebral injury, admitted to our hospital from February 2021 to December 2021, were chosen in our study; they were divided into early group ( n=47, less than 48 h from the time of admission) and late group ( n=43, more than 48 h from the time of admission) according to the times of initiation for VTE drug prophylaxis (low molecular weight heparin calcium injection [LMWH] 100 IU/Kg was injected subcutaneously once a d). One week after injection, the DVT formation in the lower limbs, intracranial rebleeding, gastrointestinal bleeding and death were compared in the two groups. Results:The times of initiation for drug prophylaxis in the early group and late group were (28.91±4.50) h and (71.56±8.89) h. The DVT formation in the early group was significantly lower than that in the late group (12.8% vs. 34.9%, P<0.05). There was no difference in the incidence of intracranial rebleeding, mortality or gastrointestinal bleeding between the two groups ( P>0.05). Conclusion:Early initiation of VTE drug prophylaxis can significantly reduce the incidence of DVT in patients with severe craniocerebral injury after surgical treatment, enjoying high safety.

Objective:To explore the effect of self-made protective clothing in tracheal intubation for the patients with respiratory infectious diseases.Methods:Self-made protective clothing were made by adult model plastic raincoat with sleeve lets and goggles. A prospective randomized controlled study was conducted. Patients with severe respiratory infectious diseases who needed tracheal intubation admitted to the department of intensive medicine of the Third Affiliated Hospital of Gansu University of Chinese Medicine from January 1st 2018 to March 31st 2020 were enrolled. According to the random number table method, they were divided into two groups. The control group was wearing standard protective clothing, while the test group was wearing self-made protective clothing for endotracheal intubation. The wearing time, infection rate of operators and costs of protective clothing were compared between the two groups. The patients were sprayed with trypanosome blue diluent before tracheal intubation, and the whole body of the operator was photographed with fluorescence before wearing self-made protective clothing and after doing tracheal intubation to take off the self-made protective clothing, in order to evaluate the permeability resistance of self-made protective clothing.Results:A total of 86 patients were enrolled. There were 46 cases in the test group, included 28 cases of influenza A (H1N1) virus infection, 11 cases of influenza B virus infection and 7 cases of adenovirus infection. There were 40 cases in the control group, included 15 cases of H1N1 virus infection, 10 cases of influenza B virus infection, 10 cases of adenovirus infection and 5 cases of unknown pathogen. There was no significant difference in respiratory etiology between the two groups ( χ2 = 3.789, P = 0.435). The wearing protective clothing time of the control group was 11.6 times than that of the test group (minutes: 22.23±1.45 vs. 1.86±0.24, χ2 = 19.023, P < 0.001). The cost of standard protective clothing was 12.5 times than that of self-made protective clothing (Yuan/set: 500 vs. 40). Fluorescent photography showed that the whole body of the operator was not stained after tracheal intubation, indicating that the protective clothing had good anti permeability and achieved the protective effect. There was no operator infection in the test group and the control group. Conclusion:Self-made protective clothing has short wearing time, low cost and equivalent isolation effect compared with standard protective clothing, which is worthy of clinical promotion.