Objective:This study aimed to evaluate the association between obstructive sleep apnea-hypopnea syndrome (OSAHS) and reflux esophagitis (RE).Methods:This cross-sectional study retrospectively analyzed 218 patients diagnosed with OSAHS by polysomnography (PSG) and who also had undergone gastroscopy at the First People′s Hospital of Yunnan Province from January 2021 to December 2021. The cohort comprised 91 males and 127 females, aged from 19 to 78 years (40.7±13.2). Clinical data, PSG parameters, and gastroscopy findings were collected. The prevalence of RE among OSAHS patients was calculated, potential risk factors for RE were evaluated. Differences in PSG parameters between patients with and without RE were analyzed. Statistical analyses were conducted using SPSS 26.0.Results:The prevalence of RE in OSAHS patients was 20.6% (45/218). Males had a significantly higher RE prevalence than females (31.9% vs. 12.6%, χ2=12.02, P<0.05). The difference remained significant after adjusting for confounding factors (34.9% vs. 11.1%, χ2=10.08, P<0.05). No significant variation in RE prevalence was observed across age groups. However, after adjusting for confounding factors, a significant difference was found between overweight and obese BMI groups (12.5% vs. 29.2%, χ2=4.04, P<0.05). When stratified by apnea-hypopnea index (AHI) severity, RE prevalence increased progressively in mild (7.1%), moderate (18.8%), and severe (30.1%) groups, with statistically significant differences ( χ2=11.45, P<0.05). Positive correlations were found between RE and male sex, AHI, longest apnea time (LAT), and time spent with oxygen saturation below 90% (TS90%) ( rs=0.24, 0.18, 0.17, 0.14, respectively, P<0.05). Regression analysis showed that identified male sex was the primary independent predictor of RE. Patients with RE exhibited higher AHI, TS90%, and LAT compared to those without RE ( P<0.05) .Conclusion:This single-center hospital-based study revealed a relatively high prevalence of reflux esophagitis (20.6%) among patients with OSAHS. Male sex was identified as the main independent factor associated with RE. Furthermore, RE prevalence increased with greater AHI, BMI, LAT and TS90%.

Objective To explore the short-term prognosis and risk factors for in-hospital mortality in patients with fulminant myocarditis induced refractory cardiogenic shock(FM-RCS)receiving veno-arterial extracorporeal membrane oxygenation(VA-ECMO)treatment,and to construct an early prognosis prediction model using relevant indicators.Methods A total of 61 FM-RCS patients treatment by VA-ECMO in the department of intensive care unit of the Second Affiliated Hospital of Zhengzhou University from January 2017 to February 2024,excluding 15 cases with age less than 18 years and 3 cases with ECMO treatment duration less than 24 hours,a total of 43 patients were finally included.Participants were stratified into survival(n=19)and mortality(n=24)groups according to discharge outcomes.Demographic data,chronic disease history,early laboratory indicators,left ventricular function indicators,and basic reference values of hemodynamics were systematically compared between the two groups.Variable selection was performed using LASSO regression,followed by multivariate COX regression analysis to screen independent risk factors for in-hospital mortality in ECMO-treatment FM-RCS patients.A nomogram prediction model was subsequently developed using R software and validated through calibration curves,concordance index(C-index),and receiver operator characteristic curve(ROC curve)analysis.Results The overall survival rate of the 43 enrolled patients was 44.2%,with 19 cases in the survival group and 24 cases in the mortality group.In early laboratory indicators,the survival group exhibited significantly lower levels of initial lactic acid(Lac),24-hour Lac(Lac 24 h),24-hour MB isoenzyme of creatine kinase(CK-MB 24 h),24-hour cardiac troponin T(cTnT 24 h),24-hour total bilirubin(TBil 24 h),24-hour serum creatinine(SCr 24 h),and lactate albumin ratio(LAR)compared to the mortality group[initial Lac(mmol/L):2.7(1.3,7.6)vs.9.2(5.9,14.0),Lac 24 h(mmol/L):2.4(2.0,3.6)vs.5.4(3.3,9.2),CK-MB 24 h(U/L):58.0(28.0,115.0)vs.167.7(68.5,280.3),cTnT 24 h(μg/L):0.53(0.37,2.41)vs.3.92(3.10,8.86),TBil 24h(μmol/L):18.3(9.9,37.8)vs.40.2(24.6,67.0),SCr 24 h(μmol/L):90.63±42.49 vs.177.76±70.76,LAR:0.09(0.04,0.23)vs.0.31(0.20,0.38),all P<0.05],serum albumin(Alb)levels were significantly higher in the survival group[g/L:36.0(31.9,39.2)vs.31.7(26.4,34.4),P<0.05].The mortality group had a higher incidence of malignant arrhythmias[66.7%(16/24)vs.31.6%(6/19),P<0.05].The LASSO regression model identified four non-zero coefficient variables-Lac 24 h,CK-MB 24 h,cTnT 24 h,and SCr 24 h-which were included in the subsequent multivariate COX regression analysis.The results demonstrated that Lac 24 h[hazard ratio(HR)and 95%confidence interval(95%CI)was 1.186(1.074-1.310),P<0.001]and cTnT 24 h(HR=1.230,95%CIwas 1.078-1.404,P=0.002)were independent risk factors for in-hospital mortality in VA-ECMO treatment FM-RCS patients.A predictive model constructed using these two indicators showed a C-index of 0.812,area under the curve(AUC)=0.941,with 91.7%sensitivity and 94.7%specificity.Furthermore,compared to the survival group,the mortality group exhibited significantly higher incidences of acute kidney injury[91.7%(22/24)vs.36.8%(7/19)]and hypoxic-ischemic encephalopathy[62.5%(15/24)vs.10.5%(2/19),both P<0.05].The mortality group also required greater transfusion volumes[mL:3 800(1 420,8 515)vs.1 200(400,3 020),P<0.05],but had shorter total hospitalization durations[days:7(3,13)vs.23(20,44),P<0.05].Conclusion For FM-RCS patients receiving VA-ECMO treatment,Lac 24 h and cTnT 24 h after ECMO initiation are independent predictors of in-hospital mortality.Clinicians should be vigilant about poor prognosis in FM-RCS patients with high Lac 24 h hours(>2.5 mmol/L)and cTnT 24 hours(>3.01 μg/L)after ECMO treatment.

Objective:To explore the risk factors of deaths caused by influenza-associated encephalopathy (IAE) in children.Methods:A case control study was conducted.The clinical data (including baseline fata, organ function indices, inflammatory factors, imaging data, treatment, and outcomes) of IAE children hospitalized in the pediatric intensive care unit (PICU) of Shanghai Children′s Hospital, School of Medicine, Shanghai Jiao Tong University from January 2020 to December 2023 were retrospectively analyzed.The children were divided into a survival group and a death group.The Logistic regression and receiver operating characteristic (ROC) curve were used to analyze the risk factors of death in IAE children.Results:A total of 46 cases were included, with an onset age of 74.8(46.0, 92.5) months.The main cause of IAE was influenza A virus infection, which was detected in 45 cases(97.8%), and 32 cases (69.6%) of them had H3N2.One child (2.2%) was infected by influenza B virus.Eight children died, showing a mortality of 17.4%.There was significant difference in Glasgow Coma Scale between the survival and death groups when they were admitted into the PICU [10 (9, 11) points vs.3 (3, 5) points] ( Z=-4.510, P<0.05).All patients in the death group had multiple organ dysfunction syndrome, respiratory failure and circulatory system failure.Serum procalcitonin (PCT)[15.7 (3.3, 37.4) μg/L], interleukin-6 (IL-6)[1 039.1 (319.3, 2 884.3) ng/L], and cerebrospinal fluid protein(CSFP)[13 050.0 (5 865.0, 21 100.0) mg/L] in the death group compared with those in the survival group [0.2 (0.1, 0.8) μg/L, 15.5 (7.9, 44.8) ng/L, 227.0 (190.0, 332.0) mg/L]were highly increased ( Z=-3.364, -4.088, -3.757, all P<0.001).Logistic regression analysis showed that PCT ( OR=0.660, P<0.05), IL-6 ( OR=1.014, P<0.05) and CSFP ( OR=1.001, P<0.05) were risk factors of death in IAE.The areas under the ROC curve for these three factors were 0.88 (95% CI: 0.77-0.97), 0.96 (95% CI: 0.86-1.00) and 0.93 (95% CI: 0.76-1.00), respectively.When a cutoff value of 2.50 μg/L, 269.67 ng/L and 5 240.00 mg/L was taken, PCT achieved a sensitivity of 0.875 and a specificity of 0.816, IL-6 achieved a sensitivity of 0.875 and specificity of 0.974, and CSFP achieved a sensitivity of 0.875 and specificity of 0.974, respectively. Conclusions:High levels of serum PCT, IL-6 and CSFP at PICU admission are risk factors of poor prognosis in children with IAE.

Objective To explore the short-term prognosis and risk factors for in-hospital mortality in patients with fulminant myocarditis induced refractory cardiogenic shock(FM-RCS)receiving veno-arterial extracorporeal membrane oxygenation(VA-ECMO)treatment,and to construct an early prognosis prediction model using relevant indicators.Methods A total of 61 FM-RCS patients treatment by VA-ECMO in the department of intensive care unit of the Second Affiliated Hospital of Zhengzhou University from January 2017 to February 2024,excluding 15 cases with age less than 18 years and 3 cases with ECMO treatment duration less than 24 hours,a total of 43 patients were finally included.Participants were stratified into survival(n=19)and mortality(n=24)groups according to discharge outcomes.Demographic data,chronic disease history,early laboratory indicators,left ventricular function indicators,and basic reference values of hemodynamics were systematically compared between the two groups.Variable selection was performed using LASSO regression,followed by multivariate COX regression analysis to screen independent risk factors for in-hospital mortality in ECMO-treatment FM-RCS patients.A nomogram prediction model was subsequently developed using R software and validated through calibration curves,concordance index(C-index),and receiver operator characteristic curve(ROC curve)analysis.Results The overall survival rate of the 43 enrolled patients was 44.2%,with 19 cases in the survival group and 24 cases in the mortality group.In early laboratory indicators,the survival group exhibited significantly lower levels of initial lactic acid(Lac),24-hour Lac(Lac 24 h),24-hour MB isoenzyme of creatine kinase(CK-MB 24 h),24-hour cardiac troponin T(cTnT 24 h),24-hour total bilirubin(TBil 24 h),24-hour serum creatinine(SCr 24 h),and lactate albumin ratio(LAR)compared to the mortality group[initial Lac(mmol/L):2.7(1.3,7.6)vs.9.2(5.9,14.0),Lac 24 h(mmol/L):2.4(2.0,3.6)vs.5.4(3.3,9.2),CK-MB 24 h(U/L):58.0(28.0,115.0)vs.167.7(68.5,280.3),cTnT 24 h(μg/L):0.53(0.37,2.41)vs.3.92(3.10,8.86),TBil 24h(μmol/L):18.3(9.9,37.8)vs.40.2(24.6,67.0),SCr 24 h(μmol/L):90.63±42.49 vs.177.76±70.76,LAR:0.09(0.04,0.23)vs.0.31(0.20,0.38),all P<0.05],serum albumin(Alb)levels were significantly higher in the survival group[g/L:36.0(31.9,39.2)vs.31.7(26.4,34.4),P<0.05].The mortality group had a higher incidence of malignant arrhythmias[66.7%(16/24)vs.31.6%(6/19),P<0.05].The LASSO regression model identified four non-zero coefficient variables-Lac 24 h,CK-MB 24 h,cTnT 24 h,and SCr 24 h-which were included in the subsequent multivariate COX regression analysis.The results demonstrated that Lac 24 h[hazard ratio(HR)and 95%confidence interval(95%CI)was 1.186(1.074-1.310),P<0.001]and cTnT 24 h(HR=1.230,95%CIwas 1.078-1.404,P=0.002)were independent risk factors for in-hospital mortality in VA-ECMO treatment FM-RCS patients.A predictive model constructed using these two indicators showed a C-index of 0.812,area under the curve(AUC)=0.941,with 91.7%sensitivity and 94.7%specificity.Furthermore,compared to the survival group,the mortality group exhibited significantly higher incidences of acute kidney injury[91.7%(22/24)vs.36.8%(7/19)]and hypoxic-ischemic encephalopathy[62.5%(15/24)vs.10.5%(2/19),both P<0.05].The mortality group also required greater transfusion volumes[mL:3 800(1 420,8 515)vs.1 200(400,3 020),P<0.05],but had shorter total hospitalization durations[days:7(3,13)vs.23(20,44),P<0.05].Conclusion For FM-RCS patients receiving VA-ECMO treatment,Lac 24 h and cTnT 24 h after ECMO initiation are independent predictors of in-hospital mortality.Clinicians should be vigilant about poor prognosis in FM-RCS patients with high Lac 24 h hours(>2.5 mmol/L)and cTnT 24 hours(>3.01 μg/L)after ECMO treatment.

Objective To investigate the effect of total paeony glycoside(TPG)on cerebral ischemia-reperfusion injury(CI/RI)of rats.Methods The rats were randomly divided into sham surgery(sham)group,CI/RI model group(simple CI/RI group),positive control group(nimodipine group,5 mg/kg),low-dose TPG group(TPG-L group,27 mg/kg),a high-dose TPG group(TPG-H group,54 mg/kg)and a high-dose TPG+NOD-like receptor thermal protein domain associated protein 3(NLRP3)activator diethyl dithiocarbamate(DDC)group(TPG-H+DDC group,54 mg/kg TPG and 30 mg/kg DDC),with 18 rats in each,administered once a day for 7 consecutive days.After the administration,the neurological deficit score of the rats was evaluated.Nissl staining microscopy was applied to observe neuronal activity in brain tissue.2,3,5-triphenyltetrazolium chloride(TTC)staining microscopy was applied to detect the area of cerebral infarction in rats.The level of interleukin-1β and IL-18 in brain tissue was measured by ELISA method.Western blot was applied to detect the expression of purinergic receptor P2X ligand-gated ion channel 7(P2X7R)/NLRP3 signaling pathway related proteins and pyroptosis related proteins such as apoptosis associated speck like protein containing a CARD(ASC)and cysteine protease 1(caspase-1)proteins in brain tissue.Results Compared with the sham group,the neurological deficit score,infarct area,level of IL-1β and IL-18 in brain tissue and protein expression of P2X7R,NLRP3,ASC,and caspase-1 in brain tissue of rats in the simple CI/RI group were significantly increased(P<0.05),while the proportion of Nissl body positive cells in brain tissue was significantly reduced(P<0.05).The change in corresponding indicators of rats in the nimodipine group,TPG-L group,and TPG-H group was opposite to those in the simple CI/RI group(P<0.05).NLRP3 acti-vator DDC antagonized the inhibitory effect of TPG on cell pyroptosis in CI/RI rats.Conclusions TPG may inhibit brain injury in CI/RI rats by down-regulating the P2X7R/NLRP3 pathway.

Health management is highly complex due to interactions across multiple levels and factors. System dynamics model (SDM) offers a holistic perspective and a dynamic analytical framework for understanding such complex systems. It has been applied across various domains of health management, including psychological interventions, chronic disease management, rehabilitation, optimization of medical services, and health policy development. By identifying key factors and pathways influencing health behaviors, determining critical targets for interventions, conducting cost-benefit analyses and process optimization, and simulating the long-term effects of health policies, SDM provides quantitative support for decision-making from individual-level interventions to macro-level policies. This article reviews the application of SDM in these four major areas within health management, discusses its advantages and limitations, and serves as a reference for researchers and practitioners aiming to utilize SDM in future studies. The goal is to advance health management toward greater personalization and precision, thereby offering stronger support for health interventions and policy development.
Humans ; Health Policy ; Models, Theoretical

Background With the continuous development of the healthcare industry, healthcare workers face increasing pressure, including long-term shift work and workplace violence from patients or their relatives. This not only affects the physical and mental health of healthcare workers but may also negatively impact the quality of patient care and the efficiency of medical services. Objectives To analyze the pathways through which shift work and workplace violence affect healthcare workers' self-rated health and depression symptoms, explore potential mediating role of job burnout, and conduct subgroup analyses to reveal differences among various groups. Methods Data were collected from 3706 frontline healthcare workers across 23 provinces from January 10 to February 5, 2019, using a snowball sampling method. The survey included basic demographic information, self-rated health, depression symptoms [assessed using the Patient Health Questionnaire-2 (PHQ-2)], workplace violence experience assessed using the Workplace Violence Scale), and job burnout (assessed using the Chinese Maslach Burnout Inventory). Data were analyzed using logistic regression, structural equation modeling (for mediating effects), and subgroup analysis to examine the impacts of shift work and workplace violence on health and depression symptoms. Results Among the subjects, 2700 workers (73.29%) reported shift work experience, 2079 workers (56.43%) experienced workplace violence, 633 workers (17.18%) reported poor self-rated health, and 687 workers (18.65%) reported depression symptoms. Shift work was associated with self-rated health (OR=0.572, 95%CI: 0.461, 0.710) and depression symptoms (OR=1.519, 95%CI: 1.190, 1.938), while workplace violence also associated with self-rated health (OR=0.566, 95%CI: 0.471, 0.681) and depression symptoms (OR=2.096, 95%CI: 1.740, 2.525). Job burnout significantly mediated the effects of shift work and workplace violence on self-rated health (indirect effects: −0.023, −0.027) and depression symptoms (indirect effects: 0.032, 0.037) (all P < 0.001). The subgroup analysis revealed that age, marital status, physical exercise, smoking, and alcohol consumption influenced the impacts of shift work and workplace violence on health. Conclusion Shift work and workplace violence significantly affect healthcare workers' self-rated health and depression symptoms, with job burnout playing a key mediating role in this process. This suggests that healthcare institutions should improve resource allocation, provide flexible scheduling systems, ensure adequate rest time, and increase psychological support and safety measures to help healthcare workers better cope with work-related stress and violence.

Objective:This study aimed to evaluate the association between obstructive sleep apnea-hypopnea syndrome (OSAHS) and reflux esophagitis (RE).Methods:This cross-sectional study retrospectively analyzed 218 patients diagnosed with OSAHS by polysomnography (PSG) and who also had undergone gastroscopy at the First People′s Hospital of Yunnan Province from January 2021 to December 2021. The cohort comprised 91 males and 127 females, aged from 19 to 78 years (40.7±13.2). Clinical data, PSG parameters, and gastroscopy findings were collected. The prevalence of RE among OSAHS patients was calculated, potential risk factors for RE were evaluated. Differences in PSG parameters between patients with and without RE were analyzed. Statistical analyses were conducted using SPSS 26.0.Results:The prevalence of RE in OSAHS patients was 20.6% (45/218). Males had a significantly higher RE prevalence than females (31.9% vs. 12.6%, χ2=12.02, P<0.05). The difference remained significant after adjusting for confounding factors (34.9% vs. 11.1%, χ2=10.08, P<0.05). No significant variation in RE prevalence was observed across age groups. However, after adjusting for confounding factors, a significant difference was found between overweight and obese BMI groups (12.5% vs. 29.2%, χ2=4.04, P<0.05). When stratified by apnea-hypopnea index (AHI) severity, RE prevalence increased progressively in mild (7.1%), moderate (18.8%), and severe (30.1%) groups, with statistically significant differences ( χ2=11.45, P<0.05). Positive correlations were found between RE and male sex, AHI, longest apnea time (LAT), and time spent with oxygen saturation below 90% (TS90%) ( rs=0.24, 0.18, 0.17, 0.14, respectively, P<0.05). Regression analysis showed that identified male sex was the primary independent predictor of RE. Patients with RE exhibited higher AHI, TS90%, and LAT compared to those without RE ( P<0.05) .Conclusion:This single-center hospital-based study revealed a relatively high prevalence of reflux esophagitis (20.6%) among patients with OSAHS. Male sex was identified as the main independent factor associated with RE. Furthermore, RE prevalence increased with greater AHI, BMI, LAT and TS90%.

Objective:To explore the risk factors of deaths caused by influenza-associated encephalopathy (IAE) in children.Methods:A case control study was conducted.The clinical data (including baseline fata, organ function indices, inflammatory factors, imaging data, treatment, and outcomes) of IAE children hospitalized in the pediatric intensive care unit (PICU) of Shanghai Children′s Hospital, School of Medicine, Shanghai Jiao Tong University from January 2020 to December 2023 were retrospectively analyzed.The children were divided into a survival group and a death group.The Logistic regression and receiver operating characteristic (ROC) curve were used to analyze the risk factors of death in IAE children.Results:A total of 46 cases were included, with an onset age of 74.8(46.0, 92.5) months.The main cause of IAE was influenza A virus infection, which was detected in 45 cases(97.8%), and 32 cases (69.6%) of them had H3N2.One child (2.2%) was infected by influenza B virus.Eight children died, showing a mortality of 17.4%.There was significant difference in Glasgow Coma Scale between the survival and death groups when they were admitted into the PICU [10 (9, 11) points vs.3 (3, 5) points] ( Z=-4.510, P<0.05).All patients in the death group had multiple organ dysfunction syndrome, respiratory failure and circulatory system failure.Serum procalcitonin (PCT)[15.7 (3.3, 37.4) μg/L], interleukin-6 (IL-6)[1 039.1 (319.3, 2 884.3) ng/L], and cerebrospinal fluid protein(CSFP)[13 050.0 (5 865.0, 21 100.0) mg/L] in the death group compared with those in the survival group [0.2 (0.1, 0.8) μg/L, 15.5 (7.9, 44.8) ng/L, 227.0 (190.0, 332.0) mg/L]were highly increased ( Z=-3.364, -4.088, -3.757, all P<0.001).Logistic regression analysis showed that PCT ( OR=0.660, P<0.05), IL-6 ( OR=1.014, P<0.05) and CSFP ( OR=1.001, P<0.05) were risk factors of death in IAE.The areas under the ROC curve for these three factors were 0.88 (95% CI: 0.77-0.97), 0.96 (95% CI: 0.86-1.00) and 0.93 (95% CI: 0.76-1.00), respectively.When a cutoff value of 2.50 μg/L, 269.67 ng/L and 5 240.00 mg/L was taken, PCT achieved a sensitivity of 0.875 and a specificity of 0.816, IL-6 achieved a sensitivity of 0.875 and specificity of 0.974, and CSFP achieved a sensitivity of 0.875 and specificity of 0.974, respectively. Conclusions:High levels of serum PCT, IL-6 and CSFP at PICU admission are risk factors of poor prognosis in children with IAE.