Azvudine and nirmatrelvir/ritonavir (Paxlovid) are recommended for COVID-19 treatment in China, but their safety and efficacy in the elderly population are not fully known. In this multicenter, retrospective, cohort study, we identified 5131 elderly hospitalized COVID-19 patients from 32,864 COVID-19 patients admitted to nine hospitals in Henan Province, China, from December 5, 2022, to January 31, 2023. The primary outcome was all-cause death, and the secondary outcome was composite disease progression. Propensity score matching (PSM) was performed to control for confounding factors, including demographics, vaccination status, comorbidities, and laboratory tests. After 2:1 PSM, 1786 elderly patients receiving azvudine and 893 elderly patients receiving Paxlovid were included. Kaplan-Meier and Cox regression analyses revealed that compared with Paxlovid group, azvudine could significantly reduce the risk of all-cause death (log-rank P = 0.002; HR: 0.71, 95% CI: 0.573-0.883, P = 0.002), but there was no difference in composite disease progression (log-rank P = 0.52; HR: 1.05, 95% CI: 0.877-1.260, P = 0.588). Four sensitivity analyses verified the robustness of above results. Subgroup analysis suggested that a greater benefit of azvudine over Paxlovid was observed in elderly patients with primary malignant tumors (P for interaction = 0.005, HR: 0.32, 95% CI: 0.18-0.57) compared to patients without primary malignant tumors. Safety analysis revealed that azvudine treatment had a lower incidence of adverse events and higher lymphocyte levels than Paxlovid treatment. In conclusion, azvudine treatment is not inferior to Paxlovid treatment in terms of all-cause death, composite disease progression and adverse events in elderly hospitalized COVID-19 patients.

Objective:To compare the value of different quantification methods for intraoperative hypotension in predicting postoperative acute kidney injury (AKI) in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods:The medical records of American Society of Anesthesiologists Physical Status classification Ⅲ-Ⅳ patients of either sex, aged 18-80 yr, with a body mass index of 18-30 kg/m 2, scheduled for elective OPCABG, were retrospectively collected at Tianjin Chest Hospital from September 2021 to October 2023. Intraoperative hypotension was quantified using the methods such as the number of occurrence, average decrease in magnitude, duration, and the area under the threshold (mean arterial pressure <65 mmHg, 1 mmHg = 0.133 kPa). Patients were divided into AKI group and non-AKI group based on the occurrence of AKI within 7 days postoperatively. The extended logistic regression model was used to adjust for confounding factors, and the receiver operating characteristic curves were plotted to compare the accuracy of different methods for intraoperative hypotension in predicting postoperative AKI. Results:The results of multivariate logistic regression analysis showed that the frequency of hypotension ( OR=1.03, 95% confidence interval [ CI] 1.01-1.05, P=0.010), duration of hypotension ( OR=1.04, 95% CI 1.01-1.08, P=0.007), and area under the threshold ( OR=1.03, 95% CI 1.01-1.06, P=0.023) were risk factors for postoperative AKI. The areas under the curve for the quantification methods predicting the occurrence of postoperative AKI within 7 days, including the duration of hypotension, area under the threshold, frequency of hypotension, and mean decrease in blood pressure, were 0.751, 0.652, 0.647 and 0.513, respectively. Conclusions:The duration of hypotension, area under the threshold and frequency of hypotension are independent risk factors for postoperative AKI in patients undergoing OPCABG. The duration of hypotension has a higher accuracy in predicting the occurrence of postoperative AKI.

Objective:To compare the value of different quantification methods for intraoperative hypotension in predicting postoperative acute kidney injury (AKI) in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods:The medical records of American Society of Anesthesiologists Physical Status classification Ⅲ-Ⅳ patients of either sex, aged 18-80 yr, with a body mass index of 18-30 kg/m 2, scheduled for elective OPCABG, were retrospectively collected at Tianjin Chest Hospital from September 2021 to October 2023. Intraoperative hypotension was quantified using the methods such as the number of occurrence, average decrease in magnitude, duration, and the area under the threshold (mean arterial pressure <65 mmHg, 1 mmHg = 0.133 kPa). Patients were divided into AKI group and non-AKI group based on the occurrence of AKI within 7 days postoperatively. The extended logistic regression model was used to adjust for confounding factors, and the receiver operating characteristic curves were plotted to compare the accuracy of different methods for intraoperative hypotension in predicting postoperative AKI. Results:The results of multivariate logistic regression analysis showed that the frequency of hypotension ( OR=1.03, 95% confidence interval [ CI] 1.01-1.05, P=0.010), duration of hypotension ( OR=1.04, 95% CI 1.01-1.08, P=0.007), and area under the threshold ( OR=1.03, 95% CI 1.01-1.06, P=0.023) were risk factors for postoperative AKI. The areas under the curve for the quantification methods predicting the occurrence of postoperative AKI within 7 days, including the duration of hypotension, area under the threshold, frequency of hypotension, and mean decrease in blood pressure, were 0.751, 0.652, 0.647 and 0.513, respectively. Conclusions:The duration of hypotension, area under the threshold and frequency of hypotension are independent risk factors for postoperative AKI in patients undergoing OPCABG. The duration of hypotension has a higher accuracy in predicting the occurrence of postoperative AKI.

Objective:To analyze the risk factors for the development of moderate to severe liver fibrosis in male metabolic syndrome (MetS) patients.Methods:In this study, a single-center retrospective study was conducted to select 414 male patients with MetS who were diagnosed by physical examination at the First Affiliated Hospital of Zhengzhou University from January 2022 to November 2023. The patients were classified into MetS with no/slight hepatic fibrosis group (MetS F0-1 group, 294 cases) and MetS with moderate to severe hepatic fibrosis group (MetS F2-4 group, 120 cases) according to the results of liver hardness test. The independent risk factors for the development of moderate-to-severe liver fibrosis in male MetS patients were explored by univariate and multivariate analyses of whether they had diabetes, and the levels of body mass index (BMI), serum glutamate aminotransferase (ALT), aspartate aminotransferase (AST), glutamyltransferase (GGT), and uric acid.Results:Compared with the MetS F0-1 group, theMets F2-4 group had the characteristics of high obesity rate, high diabetes rate and high serum ALT, AST. GGT and uric acid levels (all P<0.05). One-way regression analysis revealed that those with diabetes mellitus ( OR=2.891, 95% CI: 1.627-5.138), high BMI ( OR=1.276, 95% CI: 1.191-1.368), high level of serum ALT ( OR=1.024, 95% CI: 1.015-1.034), AST ( OR=1.052, 95% CI: 1.032-1.072), GGT ( OR=1.011, 95% CI: 1.005-1.016) and uric acid ( OR=1.003, 95% CI: 1.001-1.006) were the risk factors for the development of moderate-to-severe hepatic fibrosis in male patients with MetS, whereas a multifactorial regression analysis found that the presence of diabetes ( OR=5.561, 95% CI: 2.706-11.428), high BMI ( OR=1.271, 95% CI: 1.177-1.372) and high serum uric acid ( OR=1.004, 95% CI: 1.001-1.007) were the independent risk factors for the development of moderate-to-severe hepatic fibrosis in male MetS patients. Conclusion:Diabetes, high BMI and high level of serum uric acid are independent risk factors for the development of moderate-to-severe hepatic fibrosis in male patients with MetS.

Objective:To identify the risk factors for intraoperative hemorrhage and transfusion in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods:A total of 1, 442 patients, regardless of gender, of American Society of Anesthesiologists Physical Status classification≥Ⅱ, scheduled for elective OPCABG from June 7, 2021 to March 8, 2023, were enrolled in a prospective, observational study. Patients′ general characteristics, preoperative hemodynamics, preoperative blood routine, duration of operation, the number of transplanted vessels, intraoperative application of vasoactive agents, intraoperative consumption of crystalloid and colloid, urine volume, blood products, use of tranatemic acid and ulinastatin were collected. Univariable and multiple linear regression models were used to screen the risk factors for intraoperative blood loss and infusion volume of concentrated red blood cell (CRBC), and univariable and multivariable logistic regression models were used to screen the risk factors for intraoperative CRBC infusion requirement.Results:One thousand four hundred and twenty patients were finally included. Prolonged operation duration, increased number of transplanted vessels and older age were risk factors for intraoperative blood loss, while male, increased intraoperative usage of fresh frozen plasma (FFP), increased urine volume, and application of ulinastatin and tranexamic acid were protective factors for intraoperative blood loss in OPCABG patients ( P<0.05). Prolonged operation duration and increased intraoperative usage of FFP were risk factors for intraoperative CRBC transfusion volume, while elevation of preoperative hemoglobin levels was a protective factor for intraoperative CRBC transfusion volume in OPCABG patients ( P<0.05). Prolonged operation duration and increased intraoperative usage of FFP were risk factors for intraoperative CRBC infusion requirement, while increased body mass index, elevation of preoperative hemoglobin levels and application of ulinastatin were protective factors for CRBC infusion requirement ( P<0.05). Conclusions:Prolonged operation duration, increased number of transplanted vessels and older age are risk factors for intraoperative blood loss, and increased intraoperative usage of FFP, increased urine volume, and application of ulinastatin and tranexamic acid are protective factors for intraoperative blood loss in OPCABG patients. Prolonged operation duration and increased intraoperative usage of FFP are risk factors for intraoperative CRBC infusion requirement and transfusion volume, elevation of preoperative hemoglobin levels is a protective factor for intraoperative CRBC infusion volume, and increased body mass index, elevation of preoperative hemoglobin levels and intraoperative application of ulinastatin are protective factors for intraoperative CRBC infusion requirement in patients undergoing OPCABG.

Objective:To investigate the intention to stay on among primary health care workers (PHWs) during the COVID-19 epidemics and its influencing factors.Methods:An online questionnaire survey was conducted among PHWs from 62 primary health institutions in 31 provinces, autonomous regions and municipalities across China selected by multi-stage whole cluster random sampling method between May and October 2022. According to the job position, the PHWs were divided into 5 categories: general practitioners (GPs), nurses, public health doctors, managers and support staff. Intention to stay was measured using the Chinese version of the Intention to Stay Questionnaire. Multiple linear regression model was used to analyze the influencing factors of the intention to stay in PHWs of different occupational categories, including personal factors, work factors, factors related to the COVID-19 and psychological reactions.Results:A total of 3 769 PHWs from 44 community health service centers, 18 township hospitals of 27 provinces/autonomous regions and 4 municipalities participated in this survey. The mean age of participants was (37.4±9.2) years, including 2 971(78.8%) women. The mean score of intention to stay of participants was 21.7±4.1. Compared with GPs, managers had lower intention to stay ( P=0.004). Age, female, in marriage, monthly income, years of primary care service, self-evaluation of unit support function, MSQ-SF score, and PA score were positively correlated with the score of intention to stay (all P<0.05), while PHQ-9 score, EE score, and DP score were negatively correlated with the score of intention to stay (all P<0.05). The MSQ-SF scores of all occupational categories were positively correlated with the scores of intention to stay (all P<0.01). In addition, among GPs, monthly income, years of service in primary care, self-evaluation of unit support function, and PA scores were positively correlated with the score of intention to stay (all P<0.05), while PHQ-9 scores and EE scores were negatively correlated with the score of intention to stay (all P<0.05). Among nurses, age, female gender, monthly income, self-evaluation of unit support function, and PA score were positively correlated with the score of intention to stay (all P<0.05), while EE scores and retention will score were negatively associated with ( P<0.001). Among public health doctors, in marriage was positively correlated with the score of intention to stay ( P=0.018). Among managers, DP score was negatively correlated with the score of intention to stay ( P=0.001). Among support staff, female gender, monthly income, years of primary care service, self-evaluation of unit support function, and PA scores were positively correlated with the score of intention to stay (all P<0.05), while EE score and DP score were negatively correlated with intention to stay (all P<0.05). Conclusions:The intention to stay of PHWs in China during the COVID-19 was at an intermediate level, which was affected by many factors. Among them, job satisfaction was positively correlated with the intention to stay of all occupational categories, and the influencing factors of different occupational categories have some variations.

Objective To explore the clinical efficacy of Chaiqi Ningshen Anmian Decoction(CNAD)combined with wrist ankle acupuncture(WAA)in treating chronic insomnia(CI)patients with heart and spleen deficiency.Methods CI patients diagnosed and treated at the Beijing Huairou Hospital of Traditional Chinese Medicine from April 2022 to April 2023 were selected,and patients were randomly divided into the Eszolam(ET)group and the combination group(CNAD combined with WAA)according to the random number table method,with 50 cases in each group.The primary outcome was clinical efficacy[evaluated by the Traditional Chinese Medicine Syndrome Integral(TCMSI)].Secondary outcomes included changes in cognitive function[assessed by the Montreal Cognitive Assessment(MoCA)],anxiety level[assessed by the Hamilton Anxiety Scale(HAMA)],sleep quality[assessed by the Pittsburgh Sleep Quality Index(PSQI)],glycated serum albumin(GA),serotonin(5-HT),interleukin-1 β(IL-1β),and C-reactive protein(CRP)before and after treatment in both groups.Results Before treatment,there was no significant differences in total TCMSI between the two groups(P＞0.05).After treatment,the total TCMSI of the combination group was significantly lower than that of the ET group(P＜0.05),and the treatment effectiveness rate was significantly higher in the combination group(P＜0.05).Before treatment,there were no significant differences in MoCA score,HAMA score,PSQI score,serum GA level,serum 5-HT level,serum IL-1 level and serum CRP level between the groups(P＞0.05).After treatment,the MoCA score,serum GA level,and serum 5-HT level in the combination group were significantly higher than those in the ET group(P＜0.05),while the HAMA score,PSQI score,serum IL-1β level,and serum CRP level were significantly lower in the combination group(P＜0.05).Conclusion Compared with ET,CNAD combined with WAA significantly improves insomnia symptoms in CI patients with heart and spleen deficiency,enhances cognitive function and sleep quality,and reduces anxiety levels.This may be related to the upregulation of serum 5-HT,IL-1 β and the inhibition of the inflammatory response.

Chronic pain is a disease that seriously affects people′s health and quality of life. Solving the challenges faced by chronic pain management, finding effective treatment methods, and improving the quality of life of chronic pain patients are important clinical issues that urgently need to be addressed. This article summarizes the etiology diagnosis, multidimensional evaluation, personalized treatment, prevention, and translation of pain research results for chronic pain, and looks forward to future treatment strategies for chronic pain.

Objective:To compare the clinical efficacy of ultrasound-guided spinal nerve block (SNB) and paraverteral nerve block (PVB) in treating postherpetic neuralgia.Methods:A total of 52 patients with postherpetic neuralgia who visited the Pain Clinic of the Xiangya Hospital, Central South University from February 2020 to December 2022 were selected and randomly divided into an ultrasound-guided SNB group and a PVB group using a random number table method, with 26 patients in each group. Patients in the SNB group received ultrasound-guided spinal nerve block therapy; The PVB group received ultrasound-guided paraverteral nerve block treatment. Visual Analog Scale (VAS) scores, 36-Item Short Form Survey (SF-36) scores, and total effective rate were observed in two groups of patients before treatment, 2 weeks after treatment, 1 month after treatment, 3 months after treatment, and 6 months after treatment. Complications during treatment were also observed.Results:The total effective rates of SNB group patients at 1, 3, and 6 months after treatment were significantly higher than those of PVB group (all P<0.05). After treatment, the VAS scores of both groups of patients at each time point were significantly reduced compared to before treatment (all P<0.05); The VAS scores of patients in the SNB group were lower than those in the PVB group at 1, 3, and 6 months after treatment, but the difference was not statistically significant (all P>0.05). There was no statistically significant difference in Physical Component Summary (PCS) and Mental Component Summary (MCS) scores between SNB and PVB groups before nerve block treatment (all P>0.05). The MCS and PCS scores of the two groups of patients were significantly higher than before treatment at 2 weeks, 1 month, 3 months, and 6 months after treatment (all P<0.05). The MCS scores of the SNB group were significantly higher than those of the PVB group at 2 weeks, 1 month, 3 months, and 6 months after treatment (all P<0.05), but there was no statistically significant difference in PCS scores between the two groups (all P>0.05). Both groups of patients did not experience any serious complications related to the treatment in this study during the follow-up period. Conclusions:Both ultrasound-guided spinal nerve block and paraverteral nerve block can safely and effectively treat postherpetic neuralgia. The clinical effect of ultrasound-guided spinal nerve block in treating postherpetic neuralgia is better than that of paraverteral nerve block.

A 56-year male patient was implanted with a third generation magnetic levitation HeartCon left ventricular assist device (LVAD) for refractory heart failure through a left antero-lateral thoracotomy. Inflow cannula of the HeartCon blood pump was inserted via the left apex and outflow tract with the artificial blood vessel was sutured to the descending aorta. The operation process was smooth, the LVAD worked stably, and results of left ventricular assist was good. Implantation of HeartCon LVAD through the left antero-lateral thoracotomy is an alternative technique with less surgical complications, less trauma and satisfactory results.