Objective To investigate the effect of a modified chest drainage management protocol on rapid recovery in patients undergoing thoracoscopic lung resection.Methods A retrospective analysis was conducted on clinical data of 218 patients who underwent segmentectomy,lobectomy,or combined lobectomy surgeries between July 2022 and December 2023 in our department.One medical group utilized the traditional chest drainage management protocol(control group,109 cases),while the other medical group employed the modified chest drainage management protocol(modified group,109 cases).The control group had a large chest tube(20-24F)placed at the mid-axillary line of the 7th intercostal space leading to the apex of the pleural cavity(removed when drainage volume＜300 ml/24 h and air leak＜20 ml/min).In contrast,the modified group had a large tube placed from the anterior axillary line between the 3rd and 4th intercostal spaces leading to the apex of the pleural cavity(removed when air leak＜20 ml/min),and a small tube(7F)placed at the posterior axillary line between the 7th and 8th intercostal spaces near the diaphragm surface(removed when drainage volume＜300 ml/24 h).Comparisons were made between the two groups regarding duration of large tube placement and total duration tube placement,total drainage volume,postoperative hospital stay,and postoperative complications.The pain scores,number of cases with moderate to severe pain(pain score ≥4),analgesic pump drug usage,and functional activity score(FAS)were recorded on the 1st and 2nd day after surgery.Results The duration of large tube placement was shorter in the modified group than in the control group[(2.1±1.6)dvs.(2.7±1.8)d,t=-2.715,P=0.007].and the total duration of tube placement was longer in the modified group than in the control group[(3.3±2.0)dvs.(2.7±1.8)d,t=2.308,P=0.022].without increasing postoperative hospital stay[(4.2±2.2)dvs.(4.1±2.1)d,t=0.247,P=0.805].On the postoperative day 2,the modified group showed lower pain scores during activity than the control group[(2.1±1.1)points vs.(2.6±1.3)points,t=-2.885,P=0.004].fewer cases with moderate to severe pain(5 cases vs.14 cases,x2=4.670,P=0.031),and less analgesic pump drug usage[(17.9±16.2)ml vs.(27.4±29.4)ml,t=-2.951,P=0.004].No significant differences were observed in other indicators between the two groups(P＞0.05).Additionally,the proportion of patients with FAS grade A(no activity limitation due to pain)was higher in the modified group than in the control group on the postoperative day 2[61.5％(67/109)vs.46.8％(51/109),Z=-2.170,P=0.030].There were no significant differences in postoperative complications and incision healing rates between the two groups(P＞0.05).Conclusion The modified chest drainage management protocol not only ensures adequate drainage but also reduces the degree of pain and improves activity status,aligning with the principles of enhanced recovery after surgery(ERAS).

Objective To investigate the relationship between ventricular arterial coupling(VAC)and haemodynamics of patients with sepsis and the predictive value for the 28-day prognosis.Methods A total of 164 patients with sepsis were selected and given fluid resuscitation treatment(infusion of 30 mL/kg of crystalloid over 3 h),and changes of VAC[effective aortic elasticity(Ea)/ventricular end-systolic elasticity(Ees)]values and hemodynamic parameters of patients resuscitated for 0 h,24 h and 72 h were observed.The difference between Ea/Ees for 24 h and 72 h of resuscitation and 0 h was calculated.Pearson method was used to analyze the correlation between Ea/Ees and Δcentral venous pressure(CVP),Δspiratory volume index(SVI)and Δcardiac index(CI).According to the 28-day prognosis,patients were divided into two groups:the survival group(123 cases)and the death group(41 cases).General information was collected in two groups of patients.The predictive values of 24 h ΔEa/Ees and 72 h ΔEa/Ees for 28-day death in sepsis patients were analyzed by multivariate Cox regression models and receiver operating characteristics(ROC)curve.Results The Ea/Ees of 164 patients resuscitated for 24 h and 72 h were lower than those of 0 h,and the Ea/Ees of 72 h was lower than that of 24 h(all P<0.05).CVP,SVI and CI of 164 patients resuscitated for 24 h and 72 h were higher than those of 0 h,and the CVP,SVI and CI of 24 h was higher than that of 72 h(all P<0.05).The 24 h ΔEa/Ees was significantly lower than that of 72 h ΔEa/Ees(P<0.05),and 24 h ΔCVP,SVI and CI were higher than those of 72 h(P<0.05).There was a negative correlation between 24 h ΔEa/Ees and 24 h ΔCVP,24 h ΔSVI and 24 h ΔCI(P<0.05).Acute Physiology and Chronic Health Status Score II(APACHE Ⅱ)≥20 points,Sequential Organ Failure Score(SOFA)≥10 points,24 h ΔEa/Ees and 72 h ΔEa/Ees were higher in the death group than those in the survival group(P<0.05).Elevated APACHE Ⅱ,SOFA,24 h ΔEa/Ees and 72 h ΔEa/Ees were risk factors affecting the 28-day prognosis of patients with sepsis(P<0.05).The 24-hour ΔEa/Ees and 72-hour ΔEa/Ees were more effective in predicting the 28 d prognosis of patients with sepsis(P<0.05).Conclusion Changes of Ea/Ees can better reflect the haemodynamic changes in sepsis patients in the early stages of treatment and help to predict the 28-day prognosis of sepsis patients.

Objective:To explore the mediating effect of sense of coherence (SOC) on the utilization of chronic disease resources and symptom distress in liver cancer patients after transarterial chemoembolization (TACE), so as to provide a basis for comprehensive management strategies from a new perspective.Methods:A convenience sampling method was used to select 260 inpatients who underwent TACE in Xinxiang Central Hospital and Henan Provincial People's Hospital from September 2023 to October 2024 as the research objects. The Basic Information Questionnaire, Sense of Coherence Scale-13 (SOC-13), Chronic Illness Resource Survey (CIRS), and the Rotterdam Symptom Checklist (RSCL) were used to investigate the patients. Pearson correlation was used to analyze the relationships among SOC, chronic disease resource utilization, and symptom distress in patients after TACE. Structural equation modeling was established using AMOS 21.0 software to verify the mediating effect.Results:A total of 260 questionnaires were distributed, and 249 valid questionnaires were recovered, with a valid recovery rate of 95.77% (249/260). The SOC-13 score of 249 patients after TACE was (44.30±7.64), the CIRS score was (46.84±7.02), and the RSCL score was (93.61±8.85). The SOC-13 score was positively correlated with the CIRS score ( P<0.01) and negatively correlated with the RSCL score ( P<0.01). The CIRS score was negatively correlated with the RSCL score ( P<0.01). SOC had a direct negative effect on symptom distress (β'=-0.382, P<0.01), chronic disease resource utilization had a direct negative effect on symptom distress (β'=-0.176, P<0.01), and SOC played a partial mediating role between chronic disease resource utilization and symptom distress (β'=-0.148, P<0.01), with the mediating effect accounting for 45.68% of the total effect. Conclusions:There are certain deficiencies in the sense of coherence and chronic disease resource utilization in patients after TACE, and the phenomenon of symptom distress is obvious. SOC plays a partial mediating role between chronic disease resource utilization and symptom distress.

Objective To investigate the relationship between ventricular arterial coupling(VAC)and haemodynamics of patients with sepsis and the predictive value for the 28-day prognosis.Methods A total of 164 patients with sepsis were selected and given fluid resuscitation treatment(infusion of 30 mL/kg of crystalloid over 3 h),and changes of VAC[effective aortic elasticity(Ea)/ventricular end-systolic elasticity(Ees)]values and hemodynamic parameters of patients resuscitated for 0 h,24 h and 72 h were observed.The difference between Ea/Ees for 24 h and 72 h of resuscitation and 0 h was calculated.Pearson method was used to analyze the correlation between Ea/Ees and Δcentral venous pressure(CVP),Δspiratory volume index(SVI)and Δcardiac index(CI).According to the 28-day prognosis,patients were divided into two groups:the survival group(123 cases)and the death group(41 cases).General information was collected in two groups of patients.The predictive values of 24 h ΔEa/Ees and 72 h ΔEa/Ees for 28-day death in sepsis patients were analyzed by multivariate Cox regression models and receiver operating characteristics(ROC)curve.Results The Ea/Ees of 164 patients resuscitated for 24 h and 72 h were lower than those of 0 h,and the Ea/Ees of 72 h was lower than that of 24 h(all P<0.05).CVP,SVI and CI of 164 patients resuscitated for 24 h and 72 h were higher than those of 0 h,and the CVP,SVI and CI of 24 h was higher than that of 72 h(all P<0.05).The 24 h ΔEa/Ees was significantly lower than that of 72 h ΔEa/Ees(P<0.05),and 24 h ΔCVP,SVI and CI were higher than those of 72 h(P<0.05).There was a negative correlation between 24 h ΔEa/Ees and 24 h ΔCVP,24 h ΔSVI and 24 h ΔCI(P<0.05).Acute Physiology and Chronic Health Status Score II(APACHE Ⅱ)≥20 points,Sequential Organ Failure Score(SOFA)≥10 points,24 h ΔEa/Ees and 72 h ΔEa/Ees were higher in the death group than those in the survival group(P<0.05).Elevated APACHE Ⅱ,SOFA,24 h ΔEa/Ees and 72 h ΔEa/Ees were risk factors affecting the 28-day prognosis of patients with sepsis(P<0.05).The 24-hour ΔEa/Ees and 72-hour ΔEa/Ees were more effective in predicting the 28 d prognosis of patients with sepsis(P<0.05).Conclusion Changes of Ea/Ees can better reflect the haemodynamic changes in sepsis patients in the early stages of treatment and help to predict the 28-day prognosis of sepsis patients.

Objective To investigate the effect of a modified chest drainage management protocol on rapid recovery in patients undergoing thoracoscopic lung resection.Methods A retrospective analysis was conducted on clinical data of 218 patients who underwent segmentectomy,lobectomy,or combined lobectomy surgeries between July 2022 and December 2023 in our department.One medical group utilized the traditional chest drainage management protocol(control group,109 cases),while the other medical group employed the modified chest drainage management protocol(modified group,109 cases).The control group had a large chest tube(20-24F)placed at the mid-axillary line of the 7th intercostal space leading to the apex of the pleural cavity(removed when drainage volume＜300 ml/24 h and air leak＜20 ml/min).In contrast,the modified group had a large tube placed from the anterior axillary line between the 3rd and 4th intercostal spaces leading to the apex of the pleural cavity(removed when air leak＜20 ml/min),and a small tube(7F)placed at the posterior axillary line between the 7th and 8th intercostal spaces near the diaphragm surface(removed when drainage volume＜300 ml/24 h).Comparisons were made between the two groups regarding duration of large tube placement and total duration tube placement,total drainage volume,postoperative hospital stay,and postoperative complications.The pain scores,number of cases with moderate to severe pain(pain score ≥4),analgesic pump drug usage,and functional activity score(FAS)were recorded on the 1st and 2nd day after surgery.Results The duration of large tube placement was shorter in the modified group than in the control group[(2.1±1.6)dvs.(2.7±1.8)d,t=-2.715,P=0.007].and the total duration of tube placement was longer in the modified group than in the control group[(3.3±2.0)dvs.(2.7±1.8)d,t=2.308,P=0.022].without increasing postoperative hospital stay[(4.2±2.2)dvs.(4.1±2.1)d,t=0.247,P=0.805].On the postoperative day 2,the modified group showed lower pain scores during activity than the control group[(2.1±1.1)points vs.(2.6±1.3)points,t=-2.885,P=0.004].fewer cases with moderate to severe pain(5 cases vs.14 cases,x2=4.670,P=0.031),and less analgesic pump drug usage[(17.9±16.2)ml vs.(27.4±29.4)ml,t=-2.951,P=0.004].No significant differences were observed in other indicators between the two groups(P＞0.05).Additionally,the proportion of patients with FAS grade A(no activity limitation due to pain)was higher in the modified group than in the control group on the postoperative day 2[61.5％(67/109)vs.46.8％(51/109),Z=-2.170,P=0.030].There were no significant differences in postoperative complications and incision healing rates between the two groups(P＞0.05).Conclusion The modified chest drainage management protocol not only ensures adequate drainage but also reduces the degree of pain and improves activity status,aligning with the principles of enhanced recovery after surgery(ERAS).

Objective:To explore the mediating effect of sense of coherence (SOC) on the utilization of chronic disease resources and symptom distress in liver cancer patients after transarterial chemoembolization (TACE), so as to provide a basis for comprehensive management strategies from a new perspective.Methods:A convenience sampling method was used to select 260 inpatients who underwent TACE in Xinxiang Central Hospital and Henan Provincial People's Hospital from September 2023 to October 2024 as the research objects. The Basic Information Questionnaire, Sense of Coherence Scale-13 (SOC-13), Chronic Illness Resource Survey (CIRS), and the Rotterdam Symptom Checklist (RSCL) were used to investigate the patients. Pearson correlation was used to analyze the relationships among SOC, chronic disease resource utilization, and symptom distress in patients after TACE. Structural equation modeling was established using AMOS 21.0 software to verify the mediating effect.Results:A total of 260 questionnaires were distributed, and 249 valid questionnaires were recovered, with a valid recovery rate of 95.77% (249/260). The SOC-13 score of 249 patients after TACE was (44.30±7.64), the CIRS score was (46.84±7.02), and the RSCL score was (93.61±8.85). The SOC-13 score was positively correlated with the CIRS score ( P<0.01) and negatively correlated with the RSCL score ( P<0.01). The CIRS score was negatively correlated with the RSCL score ( P<0.01). SOC had a direct negative effect on symptom distress (β'=-0.382, P<0.01), chronic disease resource utilization had a direct negative effect on symptom distress (β'=-0.176, P<0.01), and SOC played a partial mediating role between chronic disease resource utilization and symptom distress (β'=-0.148, P<0.01), with the mediating effect accounting for 45.68% of the total effect. Conclusions:There are certain deficiencies in the sense of coherence and chronic disease resource utilization in patients after TACE, and the phenomenon of symptom distress is obvious. SOC plays a partial mediating role between chronic disease resource utilization and symptom distress.

ObjectiveTo systematically evaluate the safety of Tianzhi granules used in the treatment of mild-to-moderate vascular dementia. MethodA randomized， double-blind， double-simulated， positive drug/placebo parallel controlled multi-center phase Ⅳ clinical trial and an open multi-center phase Ⅳ clinical trial of Tianzhi granules in the treatment of mild-to-moderate vascular dementia were conducted. Safety data of 1 492 patients were included and analyzed according to inclusion and exclusion criteria. The main evaluation measures were the incidence rate of adverse events/adverse reactions， laboratory indicators， vital signs， and electrocardiogram （ECG） results. ResultA total of six adverse events possibly related to the test drug occurred in 520 patients of the double-blind trial， and the symptoms were all mild and recovered. The incidence of adverse events was not statistically different among Tianzhi granules， donepezil， and placebo groups. Nine adverse events possibly related to the test drug were observed in 972 patients of the open trial， and the symptoms were mild and recovered. Laboratory tests （blood routine， urine routine， liver function， kidney function， and coagulation） and vital signs were compared before treatment （baseline） and after treatment of 12 and 24 weeks， respectively. There was no statistical significance in the main indicators before and after treatment. In the double-blinded trial， there was no significant difference in safety indicators between different groups before and after treatment. The most frequent adverse reaction was gastrointestinal discomfort， with an incidence rate of 6.64‰. ConclusionAdverse reactions occasionally occur in patients using Tianzhi granules， and it is safe to use Tianzhi granules to treat mild-to-moderate vascular dementia clinically.

OBJECTIVE: Based on metabonomics technology of high-performance liquid chromatography-mass spectrometry (HPLC-MS/MS) and hydrogen nuclear magnetic resonance spectroscopy (¹H NMR), the pharmacokinetic characteristics and therapeutic mechanism of Rhei Radix et Rhizoma (RhRR, Dahuang in Chinese), Eupolyphaga Steleophaga (EuS, Tubiechong in Chinese) combined with RhRR acting on acute liver injury were explored. METHODS: Models of acute liver injury were established, and the pharmacokinetic methods of five components of RhRR-EuS in rats were found by HPLC-MS/MS. The liver tissues of different groups of mice were analyzed by ¹H NMR spectroscopy combined with multivariate statistical analysis to investigate the metabolomics of RhRR-EuS and RhRR. RESULTS: Pharmacokinetic results showed there were different levels of bimodal phenomenon in different groups, and the absorption of free anthraquinone in RhRR increased after compatibility with EuS. In addition, the pathological state of acute liver injury in rats can selectively promote the absorption of emodin, chrysophanol, physcion and aloe emodin. Through 15 differential metabolites in the liver tissue of acute liver injury mice, it was revealed that RhRR-EuS and RhRR could protect the liver injury by regulating the metabolism of glutamine and glutamic acid, alanine, aspartic acid and glutamic acid, and phosphoinositide. However, the regulation of RhRR was weaker than that of RhRR-EuS. CONCLUSION For the first time, we studied the pharmacokinetics and metabolomics differences of RhRR-EuS and RhRR in rats and mice with acute liver injury, in order to provide theoretical reference for clinical treatment of liver disease by DHZCP.

Objectives:To investigate the association between normal-weight central obesity with new-onset cardiovascular disease and all-cause mortality risk. Methods:A prospective cohort study was conducted,selecting a total of 93885 participants from the Kailuan Study who had their first physical examination in 2006-2007.According to waist circumference (central obesity:male waist circumference ≥90 cm,female waist circumference ≥85 cm;no central obesity:male waist circumference<90 cm,female waist circumference<85 cm) and body mass index (BMI,normal weight:18.5 kg/m2≤BMI<24.0 kg/m2;overweight/obesity:BMI ≥24.0 kg/m2),the participants were divided into 4 groups:normal weight no central obesity group (G1 group),normal weight central obesity group (G2 group),overweight/obesity no central obesity group (G3 group) and overweight/central obesity group (G4 group);Using the Kaplan-Meier method,the cumulative incidence of new-onset cardiovascular diseases (including hemorrhagic stroke,ischemic stroke and myocardial infarction) and all-cause mortality in different groups was calculated,and the Log-rank test was used for intergroup comparisons.Furthermore,the associations between the different groups and the risk of new-onset cardiovascular diseases and all-cause mortality were analyzed using the multivariate Cox proportional hazard regression model. Results:After a median follow-up of 14.97 (14.55,15.17) years,the cumulative incidence of new-onset cardiovascular diseases in G1 group,G2 group,G3 group and G4 group was 7.62％,10.84％,8.67％,12.91％ respectively (log-rank P<0.05) and the cumulative incidence of all-cause mortality was 12.83％,19.72％,10.65％,16.33％ respectively (log-rank P<0.01).After adjusting for confounding factors,Cox regression analysis showed that the HR (95％CI) of new-onset cardiovascular diseases in G2 group,G3 group and G4 group were 1.14 (1.04-1.25),1.07 (1.01-1.14),1.27 (1.21-1.34),respectively compared with G1 group (all P<0.05).The HR (95％CI) of all-cause mortality were 1.06 (1.00-1.14),0.90 (0.85-0.95),0.97 (0.93-1.01) compared with G1 group,and P values were 0.07,<0.01,0.15,respectively.The results of sensitivity analysis were consistent with the above major studies after excluding overweight/obesity and cancer participants during follow-up. Conclusions:Normal-weight central obesity increases the risk of new-onset cardiovascular diseases and all-cause mortality.

Objective:To analyze the clinical efficacy and prognostic factors of comprehensive treatment for atypical teratoid / rhabdomyoma tumor (AT/RT).Methods:Clinical data of children diagnosed with AT/RT who underwent radiotherapy in Department of Oncology of Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine from November 2012 to September 2022 were retrospectively analyzed. Pearson Chi-square test or continuous-corrected Chi-square test or Fisher's exact probability method were used for inter-group comparison of categorical variables. Independent sample t-test or Wilcoxon rank-sum test were used for inter-group comparison of continuous variables. Kaplan-Meier method was used to calculate the 1-year and 2-year overall survival (OS) rate and progression free survival (PFS) rate. Univariate and multivariate Cox regression analyses were employed to determine relevant prognostic factors. Results:A total of 45 patients were included, with a male/female ratio of 1.65:1, including 27 children aged ≥3 years old. All patients received surgery and radiotherapy in which 39 patients received chemotherapy, 41 craniospinal irradiation (CSI), and 4 whole brain or focal radiation therapy. The median follow-up was 28 (13.5, 49) months. A total of 14 patients died after comprehensive treatment. The 1-year OS rate was 80.0% and the PFS rate was 71.1%. The 2-year OS rate was 75.5% and the PFS rate was 65.7%. Survival prognostic analysis showed negative imaging assessment after radiotherapy ( HR=0.087, 95% CI: 0.011-0.697, P=0.022) was a favorable factor for PFS. The primary tumor<4.8 cm ( HR=0.221, 95% CI: 0.052-0.935, P=0.040) and CSI ( HR=0.085, 95% CI: 0.011-0.651, P=0.018) were favorable factors for OS. In subgroup analysis, CSI also improved OS in children aged ≥3 years ( HR=0.014, 95% CI: 0-0.470, P=0.017), but there was no significant difference in PFS. In children without cerebrospinal fluid dissemination, negative radiographic results after radiotherapy ( HR=0.066, 95% CI: 0.009-0.481, P=0.007; HR=0.076, 95% CI: 0.008-0.695, P=0.024, respectively) and CSI (HR=0.105, 95% CI: 0.012-0.937, P=0.044; HR=0.054, 95% CI: 0.005-0.629, P=0.020, respectively) were favorable factors for PFS and OS in children, and the primary tumor<4.8 cm also suggested a longer OS ( HR=0.094, 95% CI: 0.013-0.690, P=0.020). Conclusions:Comprehensive treatment including radiotherapy improves clinical prognosis of children with AT/RT. Our study shows that negative imaging results after radiotherapy are associated with PFS improvement. The primary tumor<4.8 cm and CSI are favorable factors for OS. CSI is also a significantly positive prognostic factor in children aged ≥3 years and those without cerebrospinal fluid dissemination.