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*

Traditional Chinese medicine (TCM) exerts integrative effects on complex diseases owing to the characteristics of multiple components with multiple targets. However, the syndrome-based system of diagnosis and treatment in TCM can easily lead to bias because of varying medication preferences among physicians, which has been a major challenge in the global acceptance and application of TCM. Therefore, a standardized TCM prescription system needs to be explored to promote its clinical application. In this study, we first developed a gradient weighted disease-target-herbal ingredient-herb network to aid TCM formulation. We tested its efficacy against intracerebral hemorrhage (ICH). First, the top 100 ICH targets in the GeneCards database were screened according to their relevance scores. Then, SymMap and Traditional Chinese Medicine Systems Pharmacology (TCMSP) databases were applied to find out the target-related ingredients and ingredient-containing herbs, respectively. The relevance of the resulting ingredients and herbs to ICH was determined by adding the relevance scores of the corresponding targets. The top five ICH therapeutic herbs were combined to form a tailored TCM prescriptions. The absorbed components in the serum were detected. In a mouse model of ICH, the new prescription exerted multifaceted effects, including improved neurological function, as well as attenuated neuronal damage, cell apoptosis, vascular leakage, and neuroinflammation. These effects matched well with the core pathological changes in ICH. The multi-targets-directed gradient-weighting strategy presents a promising avenue for tailoring precise, multipronged, unbiased, and standardized TCM prescriptions for complex diseases. This study provides a paradigm for advanced achievements-driven modern innovation in TCM concepts.

Objective To observe the effect of remazolam besylate on oxidative stress,inflammatory factors and CD4+/CD8+levels after gastric surgery in rats.Methods The rats were randomly divided into blank group(without anesthesia and operation treatment),control group(tail vein injection of 9 mg·kg-1 propofol injection,3 mg·kg-1 each time as required during operation),experimental-L,-M,-H groups(tail vein injection of 22,44 and 88 mg·kg-1 remazolam besylate injection,respectively,during the operation,15 mg was added each time according to the situation).Serum malondialdehyde(MDA)levels were detected by thiobarbituric acid method;the ratio of CD4+and CD8+T lymphocytes in peripheral blood were detected by flow cytometry;serum tumor necrosis factor-α(TNF-α)levels were detected by enzyme-linked immunosorbent assay;the expression levels of serum p50 and nuclear factor suppressor protein(IKBα)were detected by Western blotting.Results The levels of MDA in blank group,control group and experimental-L,-M,-H groups were(0.81±0.11),(2.37±0.20),(1.86±0.28),(1.32±0.19)and(1.05±0.23)mmol·g-1;the proportions of CD4+T lymphocytes were(29.24±2.81)％,(17.98±2.14)％,(20.96±3.47)％,(23.84±2.01)％and(26.41±2.95)％;the proportions of CD8+T lymphocyte were(17.28±2.13)％,(26.13±2.45)％,(23.85±3.04)％,(21.26±2.10)％and(19.32±1.98)％;TNF-α level were(62.54±7.47),(189.14±21.61),(127.42±14.52),(103.35±16.47)and(82.21±10.62)pg·mL-1;the levels of p50 protein in peripheral blood were 0.25±0.04,0.86±0.04,0.69±0.07,0.52±0.06 and 0.39±0.05;the levels of IκBα protein were 0.19±0.04,0.73±0.08,0.61±0.07,0.49±0.06 and 0.32±0.05,respectively.There were statistically significant differences between blank group and control group(all P＜0.05);there were statistically significant differences between experimental-L,-M,-H groups and control group(all P＜0.05).Conclusion Remazolam benzosulfonate may reduce oxidative stress and inflammation,and improve immune function in rats after gastric surgery by reducing the activity of nuclear factor-κB(NF-κB)signaling pathway.

Objective To evaluate the efficacy and safety of brexpiprazole in treating acute schizophrenia.Methods Patients with schizophrenia were randomly divided into treatment group and control group.The treatment group was given brexpiprozole 2-4 mg·d-1 orally and the control group was given aripiprazole 10-20 mg·d-1orally,both were treated for 6 weeks.Clinical efficacy of the two groups,the response rate at endpoint,the changes from baseline to endpoint of Positive and Negative Syndrome Scale(PANSS),Clinical Global Impression-Improvement(CGI-S),Personal and Social Performance scale(PSP),PANSS Positive syndrome subscale,PANSS negative syndrome subscale were compared.The incidence of treatment-related adverse events in two groups were compared.Results There were 184 patients in treatment group and 186 patients in control group.After treatment,the response rates of treatment group and control group were 79.50％(140 cases/184 cases)and 82.40％(150 cases/186 cases),the scores of CGI-I of treatment group and control group were(2.00±1.20)and(1.90±1.01),with no significant difference(all P＞0.05).From baseline to Week 6,the mean change of PANSS total score wese(-30.70±16.96)points in treatment group and(-32.20±17.00)points in control group,with no significant difference(P＞0.05).The changes of CGI-S scores in treatment group and control group were(-2.00±1.27)and(-1.90±1.22)points,PSP scores were(18.80±14.77)and(19.20±14.55)points,PANSS positive syndrome scores were(-10.30±5.93)and(-10.80±5.81)points,PANSS negative syndrome scores were(-6.80±5.98)and(-7.30±5.15)points,with no significant difference(P＞0.05).There was no significant difference in the incidence of treatment-related adverse events between the two group(69.00％vs.64.50％,P＞0.05).Conclusion The non-inferiority of Brexpiprazole to aripiprazole was established,with comparable efficacy and acceptability.

Objective To observe the clinical efficacy and safety of alteplase combined with rivaroxaban in the treatment of acute deep vein thrombosis(DVT)in elderly obese patients.Methods Elderly obese patients with DVT were divided into control group and treatment group according to random number table method.The control group was treated with 10 mg·d-1 rivaroxaban tablets orally.The treatment group was treated with 0.9 mg·kg-1·d-1 alteplase on the basis of the control group.Both groups were treated for 1 week.Clinical efficacy,coagulation function indexes,lower limb venous blood flow mechanics indexes,inflammatory factors and vascular endothelial function related indexes,relative expression level of miR-374b-5p,occurrence of adverse drug reactions and recurrence within 3 months were compared between the two groups.Results A total of 80 patients were enrolled in the treatment group and the control group,respectively.After treatment,the total effective rate of treatment group and control group were 92.50％(74 cases/80 cases)and 81.25％(65 cases/80 cases),respectively,and the difference was statistically significant(P＜0.05).After treatment,the fibrinogen levels of treatment group and control group were(3.58±0.83)and(3.91±1.04)g·L-1,respectively;D-dimer levels were(2.18±0.74)and(2.49±0.93)μg·mL-1,respectively;platelet activating factor were(115.42±10.43)and(119.74±11.37)μg·L-1,respectively;prothrombin time were(12.95±1.16)and(13.41±1.27)s,respectively;the maximum blood flow velocity were(29.19±6.74)and(26.93±4.58)cm·s-1,respectively;the blood flow were(92.17±9.61)and(88.63±8.75)mL·min-1,respectively;endothelial vasoconstricting peptide-1 were(51.97±4.86)and(54.02±4.92)pg·mL-1;the relative expression levels of miR-374b-5p were 2.18±0.73 and 2.49±0.85,respectively.The above indexes of the treatment group were statistically significant compared with the control group(all P＜0.05).Bleeding symptoms were the main adverse drug reactions in both groups.The total incidence of adverse drug reactions in treatment group and control group was 10.00％and 13.75％,respectively,with no statistical significance(P＞0.05).The 3-month recurrence rates of treatment group and control group was 6.25％and 16.25％,respectively,and the difference was statistically significant(P＜0.05).Conclusion Alteplase combined with rivaroxaban has good clinical efficacy in the treatment of elderly obese patients with DVT,which can improve the blood flow of patients,reduce inflammatory response,and has high safety.

With the rapid development and expansion of the scale of the industry of Chinese materia medica,a large number of by-products in the process industrialization of Chinese materia medica have been produced,among which,the solid by-products of Chinese materia medica have been favoured by researchers due to the fact that they are rich in a large number of proteins,cellulose,hemicellulose,lignin,etc.,which can be used in the preparation of high value-added products.Therefore,the authors elaborated on the research on biochemical conversion,thermochemical conversion,resource oriented chemical components,preparation of biomass fuel,new composite materials and high-efficiency adsorbent of solid by-products in the process of industrialization of Chinese materia medica in recent years,aiming to provide theoretical basis for the comprehensive and high-value utilization of the solid by-products of Chinese materia medica and extension of the industrial chain.

Objective To investigate the clinical effect of transhepatic arterial chemoembolization(TACE)combined with tyrosine kinase inhibitors(TKIs)and programmed death receptors-1(PD-1)inhibitors(TACE+TKIs+PD-1 antibody)in the treatment of moderate advanced unresectable hepatocellular carcinoma(HCC).Methods The clinical data of 65 patients with moderate advanced unresectable hepatocellular carcinoma admitted to the Affiliated Hospital of North Sichuan Medical College from January 2020 to January 2022 were analyzed retrospectively.65 patients were treated with TACE+TKIs+PD-1 antibody.The observation indexes were tumor response,objective response rate(ORR),disease control rate(DCR),total survival time,progression free survival time,conversion operation rate and adverse drug reaction.Results The ORR of 65 p-atients with hepatocellular carcinoma was 49.2％(32/65),and the DCR was 89.2％(58/65).Among them,there were 2 patients with complete remission(CR),30 patients with partial remission(PR),26 patients with stable disease(SD),and 7 patients with progression disease(PD).Among 65 patients with hepatocellular carcinoma,18 patients were transformed into resectable hepatocell-ular carcinoma and underwent RO surgery.The conversion rate was 27.6％(18/65).65 patients were followed up for 3 to 22.4 months,The median follow-up time was 16.5 months.The median overall survival time and median disease progression free survival time of 65 patients were 14.5 months(95％CI:12.3～16.6 months)and 8.8 months(95％CI:6.9～10.6 months),respectively.After treatment,65 patients all had post embolism syndrome(abdominal pain,fever,nausea,vomiting and other symptoms),and some patients had transient abnormal liver function.Adverse drug reactions below grade 3 recovered within a few days.Some patients were associated with multiple adverse drug reactions.1 patient(1.5％)stopped using TACE because of stubborn vomiting,and 5 patients(7.6％)stopped using Lenvatinib because of severe liver function damage during treatment,2 patients(3％)stopped using Camrelizumab because of severe reactive capillary hyperplasia,one patient(1.5％)stopped using Tislelizumab because of severe hypothyroidism,one patient(1.5％)stopped the treatment of Lenvatinib and Sintilimab due to severe gastrointestinal bleeding.The adverse drug reactions of grade 3～4 occurred in other patients were alleviated after drug reduction,symptomatic treatment and hormone treatment.Conclusion TACE+TKIs+PD-1 antibody can obtain reliable clinical efficacy and anti-tumor activity in the treatment of moderate advanced unresectable hepatocellular carcinoma.

Objective:To investigate the application value of major anatomical structure recognition model of minimally invasive liver resection based on deep learning.Methods:The retrospective and descriptive study was conducted. The 31 surgical videos of laparoscopic left lateral sectionectomy performed in Zhujiang Hospital of Southern Medical University from January 2019 to April 2023 were collected. Video clips containing the surgical procedure of left lateral lobe liver pedicle and left hepatic vein were screened by 2 liver surgeons. After quality control, screening and frame extraction, the major anatomical structures on the images of these clips were annotated. After pre-processing, these images were transported to the DeepLab v3+neural network framework for model training. Observation indicators: (1) video annotation and classification; (2) results of arti-ficial intelligence anatomical recognition model testing. Measurement data with normal distribution were represented as Mean± SD, and count data were described as absolute numbers. Results:(1) Video annotation and classification. A total of 4 130 frames of images were annotated in the 31 surgical videos, including 2 083 frames of annotated images for the left lateral lobe liver pedicle, 1 578 frames of annotated images for the left hepatic vein and 469 frames of annotated images for both the left lateral lobe liver pedicle and left hepatic vein. (2) Results of artificial intelligence anatomical recognition model testing. In four application scenarios (clean scene, bloodstain scene, partially obstruction by instrument scene, and small exposed area scene), the model was able to successfully recognize the left lateral lobe liver pedicle and left hepatic vein, with a recognition speed for anatomical markers >13 frames/s. When performing anatomical recognition on images with only the left lateral lobe liver pedicle, the Dice coefficient, intersection over union, accuracy, sensitivity and specificity of the model were 0.710±0.110, 0.560±0.120, 0.980±0.010, 0.640±0.030, and 0.980±0.010, respectively. The above indicators of the model were 0.670±0.180, 0.530±0.200, 0.980±0.010, 0.600±0.040, and 0.990±0.010 when performing anatomical recognition on images with only the left hepatic vein, and 0.580±0.180, 0.430±0.190, 0.980±0.010, 0.580±0.020, and 0.990±0.010 when per-forming anatomical recognition on images with both the left lateral lobe liver pedicle and left hepatic vein.Conclusion:The major anatomical structure recognition model of minimally invasive liver resection based on deep learning can be applied in identifying liver pedicle and hepatic vein.

Objective:To explore the effects of short-term particulate matter(PM)exposure and the melatonin receptor 1B(MTNR1B)gene on triglyceride-glucose(TyG)index utilizing data from Fang-shan Family-based Ischemic Stroke Study in China(FISSIC).Methods:Probands and their relatives from 9 rural areas in Fangshan District,Beijing,were included in the study.PM data were obtained from fixed monitoring stations of the National Air Pollution Monitoring System.TyG index was calculated by fasting triglyceride and glucose concentrations.The associations of short-term PM exposure and rs10830963 polymorphism of the MTNR1B gene with the TyG index were assessed using mixed linear models,in which covariates such as age,sex,and lifestyles were adjusted for.Gene-environment inter-action analysis was furtherly performed using the maximum likelihood methods to explore the potential effect modifier role of rs10830963 polymorphism in the association of PM with TyG index.Results:A total of 4 395 participants from 2 084 families were included in the study,and the mean age of the study participants was(58.98±8.68)years,with 53.90％females.The results of association analyses showed that for every 10 μg/m3 increase in PM2.5 concentration,TyG index increased by 0.017(95％CI:0.007-0.027),while for per 10 μg/m3 increment in PM1o,TyG index increased by 0.010(95％CI:0.003-0.017).And the associations all had lagged effects.In addition,there was a positive association between the rs10830963 polymorphism and the TyG index.For per increase in risk allele G,TyG index was elevated by 0.040(95％CI:0.004-0.076).The TyG index was 0.079(95％CI:0.005-0.152)higher in carriers of the GG genotype compared with carriers of the CC genotype.The inter-action of rs10830963 polymorphism with PM exposure had not been found to be statistically significant in the present study.Conclusion:Short-term exposure to PM2.5 and PM10 were associated with higher TyG index.The G allele of rs10830963 polymorphism in the MTNR1B gene was associated with the elevated TyG index.

Objective To develop an intelligent model for differential diagnosis of atrioventricular nodal re-entrant tachycardia(AVNRT)and atrioventricular re-entrant tachycardia(AVRT)using 12-lead wearable electrocardiogram devices.Methods A total of 356 samples of 12-lead supraventricular tachycardia(SVT)electrocardiograms recorded by wearable devices were randomly divided into training and validation sets using 5-fold cross validation to establish the intelligent classification model,and 101 patients with the diagnosis of SVT undergoing electrophysiological studies and radiofrequency ablation from October,2021 to March,2023 were selected as the testing set.The changes in electrocardiogram parameters before and during induced tachycardia were compared.Based on multiscale deep neural network,an intelligent diagnosis model for classifying SVT mechanisms was constructed and validated.The 3-lead electrocardiogram signals from Ⅱ,Ⅲ,and V1 were extracted to build new classification models,whose diagnostic efficacy was compared with that of the 12-lead model.Results Of the 101 patients with SVT in the testing set,68 were diagnosed with AVNRT and 33 were diagnosed with AVRT by electrophysiological study.The pre-trained model achieved a high area under the precision-recall curve(0.9492)and F1 score(0.8195)for identifying AVNRT in the validation set.The total F1 scores of the lead Ⅱ,Ⅲ,V1,3-lead and 12-lead intelligent diagnostic models in the testing set were 0.5597,0.6061,0.3419,0.6003 and 0.6136,respectively.Compared with the 12-lead classification model,the lead-Ⅲ model had a net reclassification index improvement of-0.029(P=0.878)and an integrated discrimination index improvement of-0.005(P=0.965).Conclusion The intelligent diagnostic model based on multiscale deep neural network using wearable electrocardiogram devices has an acceptable accuracy for classifying SVT mechanisms.