Objective:To explore the clinical characteristics and treatment methods of middle ear cholesteatoma with intracranial and extracranial complications as the first diagnosis. Methods:A total of 244 patients were initially diagnosed with intracranial and/or extracranial complications associated with middle ear cholesteatoma at the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2022, and medical records were collected and retrospectively analyzed. Results:Among 244 patients with intracranial and extracranial complications of middle ear cholesteatoma, 203 cases had one complication, 34 cases had 2 complications, and 7 cases had 3 or more complications. One hundred and eighty-six cases presented labyrinthitis, 41 cases had peripheral facial paralysis, 27 cases had periauricular abscess, 12 cases had meningitis, 10 cases had brain abscess, 7 cases had sigmoid sinus lesions, 6 cases had epidural abscess, and 4 cases demonstrated hydrocephalus. Conclusion:The destructive nature of middle ear cholesteatoma can lead to intracranial and extracranial complications. The incidence rate of extracranial complications is highest for labyrinthitis. Patients with otitis media who complained dizziness should raise clinical suspicion for potential labyrinthitis. The second most prevalent extracranial complication is peripheral facial paralysis, and early facial nerve decompression surgery is critical for better recovery of facial paralysis symptoms. Brain abscess is the most common intracranial complications, which has the highest fatality rate. Clinicians should be alert to otogenic brain abscess. Otolaryngology and neurosurgery teams should cooperate and evaluate patients' middle ear lesions and brain abscess, and jointly develop personalized treatment plans.
Humans ; Cholesteatoma, Middle Ear/surgery* ; Retrospective Studies ; Facial Paralysis/etiology* ; Brain Abscess/diagnosis* ; Male ; Female ; Otitis Media/complications* ; Meningitis/etiology* ; Labyrinthitis/etiology* ; Adult ; Middle Aged ; Young Adult

OBJECTIVE: To explore the clinical features of patients with necrotizing soft tissue infection (NSTI) and the related factors for sepsis, so as to provide a basis for early intervention and improvement of patients' prognosis. METHODS: A retrospective case series study was conducted to analyze the clinical data of NSTI patients admitted to the department of burns and wound repair surgery of Guangdong Provincial People's Hospital from October 2021 to December 2024. Demographic information, underlying diseases, infection characteristics, laboratory test results and etiological findings at admission, treatment status, occurrence of complications (including sepsis) and prognosis were collected. Univariate and multivariate Logistic regression analyses were used to identify the associated factors for sepsis in NSTI patients. Receiver operator characteristic curves (ROC curves) were plotted to evaluate the predictive value of individual and combined factors for sepsis. RESULTS: A total of 159 NSTI patients were enrolled, mainly middle-aged and elderly males. Most patients had comorbidities, including diabetes mellitus (110 cases, 69.2%) and hypertension (67 cases, 42.1%). The main infection site was the lower extremities (104 cases, 65.4%). Common symptoms included redness (96 cases, 60.4%), swelling (129 cases, 81.1%), local heat (60 cases, 37.7%), pain (100 cases, 62.9%), and skin ulceration or necrosis (9 cases, 5.7%). Imaging findings included soft tissue swelling (66 cases, 57.9%), gas accumulation (41 cases, 36.0%), and abnormal signal/density shadows (50 cases, 43.9%). Staphylococcus aureus was the main pathogenic bacterium [12.0% (31/259)], and drug-resistant Escherichia coli had the highest detection rate among drug-resistant bacteria [35.1% (13/37)]. Regarding debridement and repair, most patients (80 cases, 50.3%) underwent debridement ≥ 72 hours after admission, while only 10.1% (16 cases) received debridement within 6 hours. Most patients underwent multiple debridements, with 2 times of debridements being the most common (68 cases, 42.8%), and the maximum times of debridements reached 6. The largest number of patients received secondary suture (44 cases, 27.7%). In terms of complications, sepsis was the most common (66 cases, 41.51%), followed by acute kidney injury, respiratory failure requiring mechanical ventilation, and multiple organ dysfunction syndrome (MODS), while disseminated intravascular coagulation (DIC) was the least common. During the follow-up period, 9 patients (5.66%) were readmitted within 90 days, and 11 patients died, with a mortality rate of 6.92%. Univariate analysis showed that diabetes, coronary heart disease, gout, body temperature, heart rate, C-reactive protein, platelet count, total bilirubin, albumin, creatinine, out-of-hospital treatment, and out-of-hospital use of antimicrobial agents were significantly associated with sepsis in NSTI patients (all P < 0.05). Multivariate Logistic regression analysis showed that coronary heart disease [odds ratio (OR) = 30.085, 95% confidence interval (95%CI) was 2.105-956.935], C-reactive protein (OR = 1.026, 95%CI was 1.009-1.054), and total bilirubin (OR = 1.436, 95%CI was 1.188-1.948) were independent associated factors for sepsis in NSTI patients (all P < 0.05). ROC curve analysis revealed that the combination of the three predictors yielded the highest AUC for predicting sepsis in NSTI patients compared to any individual predictor [area under the curve (AUC) = 0.799 (95%CI was 0.721-0.878)]. CONCLUSIONS The clinical features of NSTI patients show certain regularity. Coronary heart disease, C-reactive protein, and total bilirubin are independent associated factors for sepsis in NSTI patients.
Humans ; Retrospective Studies ; Male ; Sepsis ; Soft Tissue Infections/microbiology* ; Female ; Middle Aged ; Aged ; Adult ; Prognosis ; Risk Factors ; Necrosis ; Logistic Models ; Fasciitis, Necrotizing

To explore the impact of an airway stepwise management strategy in the treatment of hospital acquired pneumonia (HAP) in the ultra elderly critically ill patients.

Following the principles of evidence-based medicine,in accordance with the structure and drafting rules of standardized documents,based on literature research,according to the characteristics of chronic cough in children and issues that need to form a consensus,the TCM Guidelines for Diagnosis and Treatment of Chronic Cough in Children was formulated based on the Delphi method,expert discussion meetings,and public solicitation of opinions.The guideline includes scope of application,terms and definitions,eti-ology and diagnosis,auxiliary examination,treatment,prevention and care.The aim is to clarify the optimal treatment plan of Chinese medicine in the diagnosis and treatment of this disease,and to provide guidance for improving the clinical diagnosis and treatment of chronic cough in children with Chinese medicine.

Objective:To investigate the concern about pollen broadcasting in Chinese population from multiple dimensions and to understand the information about allergic rhinitis (AR) in China by analyzing related factors.Methods:From March 1 to September 30, 2022, a large-scale multi-center cross-sectional survey was conducted based on the Questionnaire Star platform in 21 Chinese hospitals. A total of 7 056 subjects from 7 regions in China: Northeast, North, East, Central, South, Southwest, and Northwest China were included. Basic characteristics (including social demographic characteristics and disease characteristics of AR patients), concern about pollen broadcasting, the willingness of pollen-induced AR (PiAR) patients to receive pollen broadcasting, and the treatment satisfaction rate of AR patients were collected. The chi-square test, multivariate linear regression model, and Logistic regression analysis were used to analyze the concern about pollen broadcasting in the Chinese population and related factors from multiple dimensions.Results:Among 7 056 subjects, 23.02% were concerned about pollen broadcasting. Among 3 176 self-reported AR and 1 019 PiAR patients, 25.60% and 39.16% were concerned about pollen broadcasting, respectively, which was higher than that of non-AR or non-PiAR subjects ( χ2 value was 21.74 and 175.11, respectively, both P<0.001). Among AR patients, the proportion of spring and autumn allergen-positive patients concerned about pollen broadcasting was higher than that in perennial allergen-positive patients ( χ2 value was 20.90 and 19.51, respectively, both P<0.001). The proportion of AR patients with asthma, sinusitis, allergic conjunctivitis, and cardiovascular and cerebrovascular diseases was higher than those without complications ( χ2 value was 50.83, 21.97, 56.78, 7.62, respectively, all P<0.05). The proportion of AR patients in North China who could find pollen broadcasting locally was 31.01%, significantly higher than those in other regions (all P<0.05). Multivariate linear regression model analysis showed that among PiAR patients, those with higher per capita household income and higher AR disease cognition levels had been concerned about pollen broadcasting in the past, and those complicated with allergic conjunctivitis had stronger intention to receive pollen broadcasting (B value was 0.24, 0.13, 0.66, 0.47, respectively, all P<0.05). The higher the disease cognition level of PiAR patients, the stronger their willingness to actively participate in treatment ( R2=0.72, P<0.001). Only 18.89% of AR patients felt satisfied with the treatment effect. Logistic regression analysis showed that in AR patients, the treatment satisfaction rate was significantly higher among those concerned about pollen broadcasting compared to those who were not ( OR=1.83, P<0.001). Conclusions:Currently, the dissemination of pollen broadcasting in China is hindered by various factors such as disease cognition level. The treatment satisfaction among AR patients remains unsatisfactory.

Purpose To explore the influence of different spin-locking frequencies on T1ρ values based on a 3.0T MR system.Materials and Methods Thirty-eight healthy adult volunteers underwent cardiac magnetic resonance imaging at the First Affiliated Hospital of Anhui Medical University from July to September 2023.T1ρ mapping and short-axis cine imaging with steady-state free precession sequences were performed with 3.0T MR system.T1ρ mapping sequence in three short-axis slices with three spin-lock frequencies at the amplitude of 5 Hz,300 Hz,400 Hz,and 500 Hz was scanned,respectively.T1ρ relaxation times and myocardial fibrosis index were quantified for each slice and each myocardial segment,the difference in T1ρ of different spin-locking frequencies and myocardial fibrosis index was analyzed using one-way repeated-measures analysis of variance method.Results T1ρ of 5 Hz,300 Hz,400 Hz,and 500 Hz were(33.9±2.8)ms,(43.4±2.1)ms,(45.4±2.6)ms and(46.5±2.4)ms,respectively;and T1ρ values showed a significant progressive increase from the low spin-lock frequency to the high spin-lock frequency of the heart(300 Hz vs.400 Hz:P<0.001;300 Hz vs.500 Hz:P<0.001;400 Hz vs.500 Hz:P=0.043).In addition,the measured myocardial fibrosis index at 300 Hz,400 Hz and 500 Hz were(9.4±2.2)ms,(11.3±2.9)ms and(12.6±2.7)ms,respectively.Statistical analysis underscored significant variations among these measurements(300 Hz vs.400 Hz:P<0.001;300 Hz vs.500 Hz:P<0.001;400 Hz vs.500 Hz:P=0.033).Conclusion In this prospective study,myocardial T1ρ values for the specific cardiac magnetic resonance setting are provided,and we found that spin-lock frequency can affect the T1ρ values.

Polycystic ovary syndrome (PCOS) is a common disease among women of childbearing age, and hyperandrogenism (HA) is a typical clinical feature of PCOS patients. In recent years, research has found that HA is closely related to the liver function of PCOS patients, in addition to causing reproductive, endocrine, and metabolic disorders. This article provides a review from four aspects: the relationship between PCOS and HA, the impact of HA on liver function in PCOS patients, the mechanism of HA affecting liver function in PCOS, and the intervention of HA on improving liver function in PCOS. The aim is to further raise awareness of the multi system effects of HA on PCOS patients and provide a basis and approach for improving liver function and clinical prognosis in PCOS patients.

Objective To analyze the effect of extended care in patients with gestational heart disease under the mode of multi-disciplinary team(MDT).Methods A total of 116 patients with gestational heart disease admitted to Liaocheng Second People's Hospital from June 2020 to June 2022 were selected as the study objects,and the patients were divided into observation group and control group according to nursing method,with 58 patients in each group.All the patients delivered in our hospital,and the control group received routine clinical intervention after delivery.The observation group was given continuous nursing intervention under MDT mode,including team building,intervention implementation and psychological nursing.First,a management team was established and a WeChat group was formed.The team members include 1 deputy chief physician of obstetrics,1 deputy chief physician of cardiology,1 dietitian,1 psychotherapist,1 head nurse of obstetrics,1 head nurse of cardiology,3 responsible nurses of obstetrics and 3 responsible nurses of cardiology.Then the nursing intervention was divided into 3 stages:prenatal,postpartum,and postpartum.Finally,in the hospital and during the follow-up,we communicated with the patients to understand their basic situation,provided targeted guidance,and directed them to shift their attention from negative emotions.Both groups were treated for 6 months.The self-rated abilities for health practices scale(SRAHP)was used to evaluate the patient's health behavior ability(including nutrition status,exercise,health responsibility,and psychological well-being),and atrial fibrillation-quality of life-18(AF-QoL-18)was used to evaluate the patient's quality of life(including physiological,psychological,and sexual function).Cervical local microcirculation(including blood perfusion,capillary tube diameter,microvascular tube diameter),postpartum blood loss at 2 hours and 24 hours,postpartum hospital stay,maternal and infant adverse outcomes(including postpartum hemorrhage,heart failure,maternal death,neonatal death)of the two groups were observed.Results After intervention,all SRAHP scores,AF-QoL-18 scores and cervical local microcirculation levels in both groups were significantly improved compared to before intervention,and the above indexes in the observation group were significantly higher than those in the control group after intervention[nutrition score:25.06±2.31 vs.19.72±2.68,exercise score:25.54±1.45 vs.19.14±3.65,health responsibility score:24.17±2.33 vs.20.54±2.52,psychological well-being score:25.03±1.62 vs.21.34±3.35,blood perfusion(mL/min):1.10±0.18 vs.0.44±0.15,capillary tube diameter(μm):5.94±0.45 vs.3.41±0.67,microvascular tube diameter(μm):56.59±2.13 vs.44.12±3.78,physiological score:3.86±1.13 vs.3.41±1.04,psychological score:4.13±0.64 vs.3.67±1.42,sexual function score:4.02±0.67 vs.3.78±0.75,all P<0.05].The amount of postpartum blood loss at 2 hours and 24 hours in the observation group was reduced compared to the control group[2 hours postnatal(mL):95.26±10.53 vs.142.74±18.45,24 hours postnatal(mL):183.61±17.54 vs.262.19±38.56,both P<0.05],and the postpartum hospital stay was shorter than the control group(days:5.07±1.48 vs.8.12±2.45,P<0.05),the total incidence of adverse outcomes was lower than that of the control group[1.72%(1/58)vs.12.07%(7/58),P<0.05].Conclusion The continuous nursing intervention under the mode of MDT cooperation can enhance the ability of healthy behavior,improve cervical local microcirculation,promote postpartum recovery,reduce adverse outcomes of maternal and infant,and improve the quality of life of pregnant heart disease patients to a certain extent.

Objective:To investigate the application of cardiac magnetic resonance (CMR) quantitative techniques in evaluating myocardial involvement differences between new onset and longstanding systemic lupus erythematosus (SLE) patients.Methods:From August 2020 to April 2023, 14 new onset and 15 longstanding SLE patients treated at the First Affiliated Hospital of Anhui Medical University were prospectively included as the study group. Additionally, 18 age-, gender-, body surface area-, and body mass index-matched healthy volunteers were included as the control group. Clinical baseline data, electrocardiograms, and CMR results including left ventricular ejection fraction (LVEF), left ventricular end-systolic volume index (LVESVI), left ventricular end-diastolic volume index (LVEDVI), cardiac index (CI), left ventricular stroke volume index (LVSVI), left ventricular mass index (LVMI), myocardial strain, native T 1 values, and T 2 values were collected. One-way analysis of variance (ANOVA) or Kruskal-Wallis H test was used to compare the quantitative parameters among the three groups. Bonferroni correction was applied for pairwise group comparisons. Results:The native T 1 values [1 114.50 (1 089.33, 1 150.39) ms, 1 085.32 (1 051.31, 1 129.75) ms] and T 2 values [(55.9±3.4) ms, (53.3±1.5) ms] of new onset and longstanding SLE patients were higher than those of the healthy control group [native T 1 values 1052.62 (1024.75, 1077.59) ms, H=17.72, P<0.001; T 2 values (51.2±1.3) ms, F=18.70, P<0.001]. The T 2 values of the new onset SLE group was higher than that of the longstanding SLE group ( P<0.05). The LVEDVI[86.87 (80.80, 93.55) ml/m 2], LVSVI [54.63 (50.42, 59.03) ml/m 2], and LVMI [48.39 (41.65, 53.26) g/m 2] of the new onset SLE group were higher than those of the control group [LVEDVI: 71.11 (65.80, 81.28) ml/m 2, Z=3.02, P=0.003; LVSVI: 42.17 (40.36, 51.33) ml/m 2, Z=2.76, P=0.006; LVMI: 38.48 (35.22, 43.83) g/m 2, Z=3.10, P=0.002]. The LVEDVI and LVSVI of the new onset SLE group were also higher than those of the longstanding SLE group [LVEDVI: 73.30 (69.87, 84.71) ml/m 2, Z=1.97, P=0.048; LVSVI: 45.53 (42.28, 50.98) ml/m 2, Z=2.34, P=0.020]. Conclusion:Myocardial involvement is more severe in new onset SLE patients, whereas acute myocardial injury is alleviated in longstanding SLE patients. Therefore, early detection of cardiac involvement in SLE patients is crucial for improving prognosis.

Objective:To analyze the current mental health status of employees in large public hospitals and its correlation with factors such as social support.Methods:A cross-sectional study was conducted in November 2023. Using cluster sampling, employees from Beijing Hospital, China-Japan Friendship Hospital, and the Cancer Hospital of the Chinese Academy of Medical Sciences were surveyed. An electronic questionnaire was used to collect indicators related to mental health. Mental health status was assessed using a self-evaluation questionnaire, with scores ≤6 indicating good mental health and scores ≥7 indicating the need for attention. A total of 3 828 questionnaires were distributed, and 3 803 valid responses were included in the final analysis. The study analyzed the current mental health status and its correlation with factors such as social support among the included employees. Social support indicators included living alone, frequency of contact with relatives or friends, and participation in group activities. Other factors included job type (physicians, nurses, medical technicians and researchers, and administrative and logistical employees), gender, professional title, education level, and satisfaction with workplace benefits.Results:The study included 3 803 respondents, comprising 874(23.0%) males and 2 929 (77.0%) females; 743 (19.5%) aged ≤30 years, 2 177 (57.2%) aged 31-45 years, and 883 (23.2%) aged >45 years. Among them, 1 238 (32.6%) employees needed attention for their mental health. The female, nurse, unmarried, post-graduate degree or less, and employees with low satisfaction with unit welfare need to pay attention to their mental health (all P<0.05), their total social support score ( t=138.59, P<0.001) and grade ( χ2=255.25, P<0.001) are lower. In terms of social support factors, non-living alone, frequent communication with relatives and friends and participation in group activities were independent protective factors for mental health (all P<0.05). The protective association between education and mental health of female workers was stronger than that of male workers (female OR=0.348, 95% CI: 0.198-0.614 vs male OR=0.653, 95% CI: 0.430-0.994). Non-living alone was the only protective factor for nurses′ mental health ( OR=0.515, 95% CI: 0.367-0.723); However, high professional title ( OR=0.362, 95% CI: 0.182-0.720) and educational background ( OR=0.365, 95% CI: 0.175-0.758) were only protective factors for physicians′ mental health (all P<0.05). Conclusions:The mental health of employees in large public hospitals is differentiated among different subgroups, such as gender, position and educational background, which needs attention in general. In terms of social support factors, non-living alone, frequent communication with relatives and friends, and participation in group activities were associated with good mental health. Hospital trade unions and other departments should carry out more targeted help and support to create a better mental health environment for employees.