Objective Summarize the clinical application and elevating the caudal end of suspension laryngoscope to deal with severe glottis exposure difficulties.Method A retrospective analysis was conducted on the clinical data of 25 patients with severe dystotic glottic exposure(Cormack-Lehane grade Ⅲ or Ⅳ)who underwent laryngoscopy support surgery from January 2021 to January 2024,then analyze the intraoperative management and outcomes.Results In all the patients,after the angle of the suspension laryngoscope was adjusted to the maximum and the glottis could not be exposed satisfactorily,the caudal end of the suspension laryngoscope stent was lifted to obtain a larger tilt angle and field of view.After the caudal end of the stent was elevated by(11.50±6.31)cm,the glottis was exposed satisfactorily in 23 cases and the operation was performed successfully;In 2 cases,the laryngeal mask airway was used in conjunction with a fibrolaryngoscope and laryngeal forceps were used to extract the lesion step by step.Pharyngeal mucosal tearing and oozing of blood occurred in 24 cases,and the bleeding stopped after electrocoagulation;one case had loose and dislodged teeth.There were no significant changes in blood pressure and heart rate of patients before and after stent lifting(P＞0.05).Conclusion For the severe difficulty of glottis exposure during suspension laryngoscopic surgery,it can be dealt with by lifting the caudal end of the stent,which is a simple and effective method that does not cause serious complications and is worth clinical application.

Objective Heart failure(HF)complicated by acute kidney injury(AKI)significantly impacts patient outcomes,and it is crucial to make early predictions of short-term mortality.This study is focused on developing an interpretable machine learning model to enhance early prediction accuracy in such clinical scenarios.Methods This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care Ⅳ(MIMIC-Ⅳ,version 2.0)database.Data from the first 24 hours after admission to the ICU were extracted and divided into a training set(70％)and a validation set(30％).We utilized the SHapley Additive exPlanation(SHAP)method to interpret the workings of an extreme gradient boosting(XGBoost)model and identify key prognostic factors.The XGBoost model's predictive ability was evaluated against three other machine learning models using the area under the curve(AUC)metric,and its interpretation was enhanced using the SHAP method.Results The study included 8 028 patients with HF complicated by AKI.The XGBoost model outperformed the other models,achieving an AUC of 0.93(95％confidence interval[CI]:0.78-0.94;accuracy=0.89),while neural network model showed the worst performance(AUC=0.79,95％CI:0.77-0.82;accuracy=0.82).Decision curve analysis showed the superior net benefit of the XGBoost model within the 9％to 60％threshold probabilities.SHAP analysis was performed to identify the top 20 predictors,with age(mean SHAP value 1.29)and Glasgow Coma Scale score(mean SHAP value 1.24)emerging as significant factors.Conclusions Our interpretable model offers an enhanced ability to predict mortality risk in HF patients with AKI in ICUs.This model can be used to assist in formulating effective treatment plans and optimizing resource allocation.

The theory of " heart governing the exterior" derives from Prohibition of Pricking in Suwen, which has an important position in the clinical practice of traditional Chinese medicine. This article sorts out the interpretation of " heart governing the exterior" of physicians in the past dynasties, and summarizes the clinical application of " heart governing the exterior" in chest painful impediment, warm disease, dermatosis, allergic rhinitis, tic disorder, and diabetic neuropathy. It is found that the theory of " heart governing the exterior" is widely used in clinical practice and has good effects. This paper further expands and enhances its theoretical connotation, that is, the physiological and pathological connection and clinical application of the three dimensions of heart yang, heart blood, and heart spirit with the life and mental activities dominated by it, as well as the overall external performance. In addition, by exploring the relationship between " heart governing the exterior" and " brain-heart axis" , " brain-skin axis" in Western medicine, it indirectly confirms the rationality of " heart governing the exterior" in Western medicine, and lays the foundation for the further development and application of the theory of " heart governing the exterior" .

Objective To explore the effect of 3D printing auxiliary stent on the operation of laryngeal microsurgery instrument.Methods Auxiliary stent of suspension laryngoscope was design and 3D printed.30 standardized training residents as experimental participants were randomly divided into conventional group and auxiliary stent group(15 in each group).The pig's larynx was used as a specimen,and the vocal folds were marked with localized staining.Participants performed operation on the stained areas of the vocal folds under suspension laryngoscope(60 times of grasping in 1 h).The conventional group performed operation unaided;The auxiliary stent group performed operation with the auxiliary stent as a support.Two senior chief physicians scored the participants'stability and accuracy.Results The operational stability scale score of the conventional group and the auxiliary stent group were(5.03±4.33)and(8.99±3.42),respectively;The operation accuracy rates were 58.4%(526/900)and 78.9%(710/900),respectively.The operation accuracy rate,operation stability of the auxiliary stent group were significantly higher than those in the conventional group,and the differences were significant(P<0.01).Conclusion The auxiliary stent can significantly improve the stability and accuracy of operation,which has highly application value.

Objective To explore the optimal body position of patients during rigid laryngoscopy.Methods 120 outpatients who underwent rigid laryngoscopy from December 2023 to March 2024 were divided into the conventional body position group(58 cases)and the anterior tilted position group(62 cases)by the random number table method.Patients in the conventional body position group were examined in the conventional body position(upright lower head position)and patients in the anterior tilted position group were examined in the anterior tilted position(body tilted forward by 60° and jaw lifted).The vocal folds were scored on the Friedman scale,the visual analogue scale(VAS)score was used to evaluate the comfortable degree of patients during the examination,the incidence of gag reflex sensitivity and the rate of complete pharyngeal exposure were compared between the two groups of patients.Results In the conventional body position group,there were 26 cases of Friedman's difficult exposure and 32 cases of easy exposure.The VAS scores of difficult exposure and easy exposure patients were 2.5(1.0,5.8)and 1.0(1.0,3.0),respectively;The incidence of gag reflex sensitivity was 42.3%and 34.4%,respectively;and the rates of complete pharyngeal exposure were 76.9%and 100.0%,respectively.In the anterior tilted position group,there were 28 cases of Friedman difficult exposure and 34 cases of easy exposure.The VAS scores of patients with difficult and easy exposure were 1.5(1.0,7.0)and 2.0(1.0,4.0),respectively;The incidence of gag reflex sensitivity was 46.4%and 29.4%,respectively;And the rates of complete pharyngeal exposure were 82.1%and 91.2%,respectively;The differences were not statistically significant(P>0.05).Conclusion When rigid laryngoscopy is performed in the upright lower head position or anteriorly tilted position,there is no significant difference in the comfortable degree scores,incidence of gag reflex sensitivity,and the rate of complete pharyngeal exposure in the patients in the two positions,and the examiners can choose the appropriate position according to their own examination habits.

Objective To explore the optimal body position of patients during rigid laryngoscopy.Methods 120 outpatients who underwent rigid laryngoscopy from December 2023 to March 2024 were divided into the conventional body position group(58 cases)and the anterior tilted position group(62 cases)by the random number table method.Patients in the conventional body position group were examined in the conventional body position(upright lower head position)and patients in the anterior tilted position group were examined in the anterior tilted position(body tilted forward by 60° and jaw lifted).The vocal folds were scored on the Friedman scale,the visual analogue scale(VAS)score was used to evaluate the comfortable degree of patients during the examination,the incidence of gag reflex sensitivity and the rate of complete pharyngeal exposure were compared between the two groups of patients.Results In the conventional body position group,there were 26 cases of Friedman's difficult exposure and 32 cases of easy exposure.The VAS scores of difficult exposure and easy exposure patients were 2.5(1.0,5.8)and 1.0(1.0,3.0),respectively;The incidence of gag reflex sensitivity was 42.3%and 34.4%,respectively;and the rates of complete pharyngeal exposure were 76.9%and 100.0%,respectively.In the anterior tilted position group,there were 28 cases of Friedman difficult exposure and 34 cases of easy exposure.The VAS scores of patients with difficult and easy exposure were 1.5(1.0,7.0)and 2.0(1.0,4.0),respectively;The incidence of gag reflex sensitivity was 46.4%and 29.4%,respectively;And the rates of complete pharyngeal exposure were 82.1%and 91.2%,respectively;The differences were not statistically significant(P>0.05).Conclusion When rigid laryngoscopy is performed in the upright lower head position or anteriorly tilted position,there is no significant difference in the comfortable degree scores,incidence of gag reflex sensitivity,and the rate of complete pharyngeal exposure in the patients in the two positions,and the examiners can choose the appropriate position according to their own examination habits.

Objective Summarize the clinical application and elevating the caudal end of suspension laryngoscope to deal with severe glottis exposure difficulties.Method A retrospective analysis was conducted on the clinical data of 25 patients with severe dystotic glottic exposure(Cormack-Lehane grade Ⅲ or Ⅳ)who underwent laryngoscopy support surgery from January 2021 to January 2024,then analyze the intraoperative management and outcomes.Results In all the patients,after the angle of the suspension laryngoscope was adjusted to the maximum and the glottis could not be exposed satisfactorily,the caudal end of the suspension laryngoscope stent was lifted to obtain a larger tilt angle and field of view.After the caudal end of the stent was elevated by(11.50±6.31)cm,the glottis was exposed satisfactorily in 23 cases and the operation was performed successfully;In 2 cases,the laryngeal mask airway was used in conjunction with a fibrolaryngoscope and laryngeal forceps were used to extract the lesion step by step.Pharyngeal mucosal tearing and oozing of blood occurred in 24 cases,and the bleeding stopped after electrocoagulation;one case had loose and dislodged teeth.There were no significant changes in blood pressure and heart rate of patients before and after stent lifting(P＞0.05).Conclusion For the severe difficulty of glottis exposure during suspension laryngoscopic surgery,it can be dealt with by lifting the caudal end of the stent,which is a simple and effective method that does not cause serious complications and is worth clinical application.

Objective To explore the effect of 3D printing auxiliary stent on the operation of laryngeal microsurgery instrument.Methods Auxiliary stent of suspension laryngoscope was design and 3D printed.30 standardized training residents as experimental participants were randomly divided into conventional group and auxiliary stent group(15 in each group).The pig's larynx was used as a specimen,and the vocal folds were marked with localized staining.Participants performed operation on the stained areas of the vocal folds under suspension laryngoscope(60 times of grasping in 1 h).The conventional group performed operation unaided;The auxiliary stent group performed operation with the auxiliary stent as a support.Two senior chief physicians scored the participants'stability and accuracy.Results The operational stability scale score of the conventional group and the auxiliary stent group were(5.03±4.33)and(8.99±3.42),respectively;The operation accuracy rates were 58.4%(526/900)and 78.9%(710/900),respectively.The operation accuracy rate,operation stability of the auxiliary stent group were significantly higher than those in the conventional group,and the differences were significant(P<0.01).Conclusion The auxiliary stent can significantly improve the stability and accuracy of operation,which has highly application value.

Objective To understand the timeliness of antiretroviral therapy (ART) in newly reported HIV/AIDS cases in Yichang from 2016 to 2022 and its influencing factors, and to provide a scientific basis for improving the timeliness of ART in Yichang City. Methods HIV/AIDS cases data from January 1, 2016 to December 31, 2022 were collected, and chi-square tests and logistic regression were used to analyze the factors influencing the timeliness of ART. Results A total of 1 126 HIV/AIDS cases were collected, with local reported cases accounting for 83.13%. The male to female ratio was 5.15:1. The median age was 42 years old (28-53 years old). 41.03% of the cases were unmarried. 38.99% of cases had a first-time CD4+T lymphocytes (CD4 cells) count < 200 cells/µL. Cases with timely first CD4 cell test accounted for 67.85%. The overall timely rate of ART from 2016 to 2022 was 57.19%, with a median time from diagnosis to initiation of ART of 20 days. There was no statistically significant difference in the trend of ART timely rate from 2016 to 2022 (P=0.251). Cases with timely first CD4 cell test were more likely to initiate ART in time (OR=3.831, 95% CI:2.454-5.981), while cases reported from other areas (OR=0.497, 95% CI:0.345-0.716) and cases with higher first CD4 cell count levels (OR_≥500=0.473, 95% CI:0.312-0.718) were less likely to initiate ART in time. Conclusion The timely rate of antiviral treatment in Yichang City needs to be further improved. High attention should be paid to cases reported from other places, cases with delayed CD4 cell testing, and cases with high CD4 cell count levels. Treatment mobilization and referral should be done well, and early detection services should be provided in time.

Objective To analyze the characteristics of traditional Chinese medicine(TCM)in the prevention and treat-ment of schistosomiasis using data mining techniques and summarize the evolution trend.Methods Using keywords including"schistosomiasis"and"traditional Chinese medicine"or"TCM treatment"or"TCM university"or"TCM syndrome differentia-tion"or"TCM clinical practice",we systematically retrieved and screened relevant literature from the China National Knowledge Infrastructure(CNKI)and WanFang Database from the inception to April 21,2024.Data mining techniques were employed to conduct a descriptive analysis and a correlation analysis on the included literature.Results A total of 381 articles that met the criteria were screened,with the highest number of publications occurring in January.Academic journals were the main source of information,accounting for approximately 88.98％of the total.Additionally,541 authors were involved,with hospitals being the most predominant author affiliations.Keyword co-occurrence analysis showed that the main research hotspots included schistoso-miasis,liver fibrosis,public health,and prevention.Conclusion Based on statistical research of the literature using data min-ing techniques,this study provided an in-depth analysis of the characteristics and development trend of TCM in prevention and treatment of schistosomiasis.It offers theoretical guidance and practical references for future related research and practices.