OBJECTIVE: To analyze the risk factors for ventilator-associated pneumonia (VAP) and its prognosis in patients with severe craniocerebral injury. METHODS: A prospective observational study was conducted. Patients with severe craniocerebral injury admitted to the Second Affiliated Hospital of Xingtai Medical College from January 2020 to December 2022 were enrolled as the study subjects. Patients were divided into VAP group and non-VAP group based on the occurrence of VAP. VAP patients were further stratified into low-risk group [sequential organ failure assessment (SOFA) score 0-5], moderate-risk group (SOFA score 6-8), and high-risk group (SOFA score ≥ 9). General data, serological indicators [interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and signal transducer and activator of transcription 3 (STAT3)], and 28-day prognosis (with mortality as the endpoint event) were compared. Multivariate Logistic regression was used to identify risk factors for VAP and 28-day mortality. Linear regression was applied to analyze the correlations between risk factors and outcomes. RESULTS: A total of 140 patients with severe craniocerebral injury were enrolled, including 49 in the VAP group and 91 in the non-VAP group. The primary cause of injury was traffic accidents, followed by falls and heavy object impacts. Among VAP patients, 38 survived and 11 died within 28 days; 112 were classified as low-risk, 25 as moderate-risk, and 12 as high-risk. Significant differences were observed in age, body mass index (BMI), smoking history, hypertension, diabetes, hyperlipidemia, length of hospital stay, duration of mechanical ventilation, serum albumin levels, and frequency of sputum suction among different subgroups. Serologically, IL-1β, TNF-α, IL-6, and STAT3 mRNA expression levels in the VAP group were significantly higher than those in the non-VAP group. Deceased VAP patients exhibited higher IL-1β, TNF-α, IL-6, and STAT3 mRNA levels compared to survivors. These biomarkers progressively increased from low-risk to high-risk subgroups. Multivariate Logistic regression identified age [odds ratio (OR) were 0.328 and 0.318], BMI (OR were 0.340 and 0.268), hypertension (OR were 0.275 and 0.245), diabetes (OR were 0.319 and 0.307), hyperlipidemia (OR were 0.228 and 0.235), smoking history (OR were 0.255 and 0.240), length of hospital stay (OR were 0.306 and 0.230), duration of mechanical ventilation (OR were 0.247 and 0.219), frequency of sputum suction (OR were 0.325 and 0.228), IL-1β (OR were 0.231 and 0.259), TNF-α (OR were 0.308 and 0.235), IL-6 (OR were 0.298 and 0.277), and STAT3 (OR were 0.259 and 0.265) as independent risk factors for both VAP occurrence and 28-day mortality (all P < 0.05). Correlation analysis revealed that serum albumin levels were negatively correlated with VAP occurrence and mortality (all P < 0.01), while other factors showed positive correlations (all P < 0.01). CONCLUSIONS Age, BMI, length of hospital stay, duration of mechanical ventilation, frequency of sputum suction, hypertension, diabetes, hyperlipidemia, smoking history, IL-1β, TNF-α, and IL-6/STAT3 signaling pathway activation are significantly associated with VAP development and poor prognosis in patients with severe craniocerebral injury, providing a scientific basis for targeted clinical interventions.
Humans ; Risk Factors ; Pneumonia, Ventilator-Associated ; Prognosis ; Prospective Studies ; Craniocerebral Trauma/complications* ; Interleukin-6/blood* ; Male ; Female ; STAT3 Transcription Factor/blood* ; Interleukin-1beta/blood* ; Tumor Necrosis Factor-alpha/blood* ; Middle Aged ; Adult ; Logistic Models

Objective:Health education program based on information-motivation-behavioral skills model (IMB model) was developed, and its application effect in functional exercise after autogenous arteriovenous fistula (AVF) in hemodialysis patients was explored.Methods:Using the convenient sampling method, 100 patients undergoing AVF surgery in hemodialysis center of Qingdao Municipal Hospital from June 2020 to June 2021 were selected as the study objects. The patients were numbered according to the order of visit. The single number was the observation group, and the double number was the control group. There were 50 patients in each group. The control group was given routine AVF function exercise education, and the observation group was given AVF function exercise education based on the IMB model. Patients′ compliance with functional exercise, cephalic vein diameter, fistula maturation time, and the incidence of complications were compared between the two groups.Results:Finally, 49 cases in the control group and 50 cases in the observation group finished the research. The compliance of function exercise of the observation group was 94.0%(47/50), which was higher than 73.5%(36/49) in the control group, and the difference was statistically significant ( χ2=7.70, P<0.05). The maturation time of plasty in the observation group was (5.18 ± 1.14) weeks, shorter than that in the control group (5.94 ± 1.39) weeks, and the difference was statistically significant ( t=2.98, P<0.05). The cephalic vein diameter and blood flow controlled by hemodialysis pump in the observation group were (5.19 ± 0.28) mm and (218.40 ± 24.19) ml/min, respectively, higher than those in the control group (4.99 ± 0.34) mm and (200.41 ± 23.89) ml/min, the differences were statistically significant ( t=-3.21, -3.72, both P<0.05). The incidence of fistula complications in the observation group was 6.0%(3/50), lower than 22.4%(11/49) in the control group, and the difference was statistically significant ( χ2=5.52, P<0.05). Conclusions:The application of IMB model in hemodialysis patients with functional exercise after AVF plasty can effectively improve patients′ compliance, increase the diameter of cephalic vein and the blood flow controlled by dialysis pump, shorten the maturation time of internal fistula, and reduce the incidence of complications of AVF.

Sepsis-induced cardiomyopathy(SICM)is a reversible cardiac insufficiency in the early stage of sepsis, and mainly manifests as left ventricular dilation, decreased ejection fraction, and recovery within 7~10 days.Although it is reversible, the incidence and mortality in sepsis are high.The specific mechanism is still unclear.Inflammatory reaction, mitochondrial dysfunction, apoptosis and other pathophysiological processes play an important role.Its process is complex and involves the interaction between organism and pathogen.The management of SICM is still based on the etiologic treatment of septic shock guided by hemodynamic monitoring and tissue perfusion, with cardio-protective therapy and specific measures.This review summarizes the literatures on the mechanisms and treatments of SICM.

Objective:To analyze the incidence and high-risk factors of lymph node metastasis in the retropharyngeal region of hypopharyngeal squamous cell carcinoma based on magnetic resonance imaging (MRI), aiming to guide the delineation of clinical target area.Methods:Clinical data of patients who were pathologically diagnosed with hypopharyngeal carcinoma from January 2012 to September 2018 in our center were retrospectively analyzed. All patients received head and neck MRI before treatment. The diagnosis of lymph node metastasis and the delineation of primary gross target volume (GTV p) and lymph nodes target volume (GTV nd) were determined by all the radiation oncologists in head and neck group through twice weekly general round discussion. The cut-off points of GTV p and GTV nd were defined by establishing the receiver operating characteristic curve. All patients were divided into the high GTV p, low GTV p and high GTV nd and low GTV nd groups. Chi-square test was used for univariate analysis and logistic regression was utilized for multivariate analysis to analyze the high-risk factors of patients with retropharyngeal lymph node metastasis. Results:A total of 326 patients were included in this study, 295 of whom were diagnosed with cervical lymph node metastasis, accounting for 90.5%. The most common involved area was Level Ⅱ a, followed by Level Ⅲ, Level Ⅱ b, Level IV, Level Ⅶ a (retropharyngeal), Level V a, and Level V b. The incidence of retropharyngeal lymph node metastasis was 21.5%, and the incidence was 53.1% in patients with primary tumor located in the posterior pharyngeal wall. Univariate and multivariate analyses showed that patients with tumor originated from the posterior pharyngeal wall ( P=0.002), bilateral cervical lymph node metastasis ( P=0.020), larger GTV p (greater than 47 cm 3, P=0.003), and larger GTV nd (greater than 22 cm 3, P=0.023) were significantly associated with the occurrence of retropharyngeal lymph node metastasis. Conclusions:The incidence of retropharyngeal lymph node metastasis is high in hypopharyngeal carcinoma, especially in patients with primary tumors in the posterior pharyngeal wall, bilateral cervical lymph node metastasis and larger primary burden. Therefore, for patients with these risk factors, it is highly recommended that the clinical target area should be delineated to include the retropharyngeal lymph node drainage area.

Objective:To analyze the temporal and spatial trends of maternal mortality in China, and to predict the future situation of maternal mortality.Methods:Taking the national maternal mortality rate in 1991-2018 and the maternal mortality rate in 2009-2018 in various provinces and cities of China as the research objects, using the statistical description analysis method to analyze the changes of time and space of maternal mortality, and using ARIMA time series model to predict the future situation of maternal mortality in China, rural areas and cities.Results:Regarding to the spatial and temporal distribution of maternal mortality, the maternal mortality rate in China generally showed a certain decline trend. In 1991, the maternal mortality rate was 80.0/100 000, and in 2018, China′s maternal mortality rate was 18.3/100 000, 77.1% lower than that in 1991, with an average annual growth rate of-5.3%; In 2009, Tibet′s maternal mortality rate was the highest, 232.2/100 000, and Jiangsu′s maternal mortality rate was the lowest, 5.2/100 000, with a difference of 44.7times After nine years of development, Tibet is still the province with the highest maternal mortality rate in China, which is 56.5/100 000, while Shanghai has the lowest maternal mortality rate, which is 1.4/100 000, with a difference of 40.4times. In 1991, the rural and urban maternal mortality rates were 46.3/100, 000 and 100.0/100, 000, respectively, and the urban-rural mortality rate was 1∶2.16. By 2022, the urban-rural mortality rate in China was 1∶0.95. Regarding the prediction of maternal mortality for the future, the national maternal mortality rate in 2022 is 10.1/100 000, the urban maternal mortality rate is 16.0/100 000, and the rural maternal mortality rate is 15.0/100 000.Conclusion:The maternal mortality rate in China has been greatly reduced, and the gap between urban and rural areas has decreased from 53.7/100 000 in 1991 to 0.7/100 000 in 2022, showing a downward trend. However, from the model prediction results, there is a slight rebound in the urban maternal mortality rate, while the rural maternal mortality rate remains stable, which suggests that the government and the health administration should pay more attention to the growing trend of urban maternal mortality while taking reasonable measures to reduce the rural maternal mortality rate, so as to avoid the rebound of urban maternal mortality rate.

For patients with acute respiratory distress syndrome, the use of lung protective ventilation strategy is currently recognized, and the setting of positive end expiratory pressure(PEEP)is an important part of lung protective ventilation.PEEP titration techniques are diverse, but the selection of the best PEEP is still difficult in clinical work.

Objective:To develop scientific and practical sensitive indicators with its own characteristics for nursing quality of breast specialty.Methods:A research team was established in August 2018, which searched the databases both at home and abroad, screened and identified relevant literatures according to John Hopkins' evidence level and quality evaluation standards. A sensitive indicator framework for nursing quality of breast specialty was preliminarily formed based on the indicators involved in the literatures. In January 2019, the expert correspondence questionnaire was prepared. Twenty experts were randomly selected from the Qingdao Medical Doctors Association and the Nursing Experts Committee and received two rounds of correspondence consultations using the Delphi method in order to build, modify and confirm the sensitive indicator system for nursing quality of breast specialty.Results:The authority coefficients of the experts in the two rounds of consultation were 0.815 and 0.858; the expert authority coefficient was> 0.80; and the coefficient of variation of each indicator was< 0.30. Eleven sensitive indicators for nursing quality of breast specialty including the awareness rate of functional exercise of the affected limb and lymphedema prevention measures were developed.Conclusions:The sensitive indicators of nursing quality of breast specialty based on the Delphi method is highly practical and credible, which have distinctive specialty characteristics, may be used for the overall care quality assessment and management of breast disease patients, and provide accurate and scientific evaluation for clinical nursing work.

Objective: To analyze the clinical features, diagnosis and prognosis of patients with primary lymphoepithelial carcinoma of the parotid gland. Methods: Clinical data of 13 patients diagnosed with lymphoepithelial carcinoma of the parotid gland in our hospital from 2009 to 2017 were retrospectively analyzed. The median follow-up time was 38.5 months. All patients received radiotherapy after operation. Results: Of 13 patients, 9 cases were male and 4 female. The median age was 33 years. At the initial diagnosis, 9 cases had primary lesions limited to the parotid gland, and 4 cases of lymph node metastases located in Ⅰ_b and Ⅱ regions of the neck. According to UICC2010 staging, 1 case was classified as stage Ⅰ, 1 as stage Ⅱ, 6 as stage Ⅲ and 5 as stage Ⅳ, respectively. Eleven surgically pathological specimens were tested with EBER in-situ, and 10 cases were positive for EBER. No patient died in the whole group. The 3-year overall survival rate was 100%. The 3-year progression-free survival rate was 76%. The 3-year local control rate was 92%. The 3-year metastasis-free survival rate was 84%. Conclusions The incidence of lymphoepithelial carcinoma of the parotid gland is relatively low. The pathological features are associated with EB virus. It is prone to present with cervical lymph node metastasis. The possibility of lymph node metastasis of nasopharyngeal carcinoma to the parotid gland should be excluded before treatment. At present, surgery combined with postoperative radiotherapy is the main treatment. The overall survival is favorable. Local recurrence and distant metastasis are the main causes of treatment failure.

Objective: We analyzed the clinical data of 89 septic shock in children retrospectively to provide evidence of early diagnosis, treatments and improving prognosis for children who had septic shock and acute kidney injury(AKI). Methods: Eighty-nine children were selected from June 2013 to December 2018 in the PICU of Children′s Hospital Affiliated to the Capital Institute of Pediatrics.According to whether accompanied by AKI or not, they were divided into two groups: 56 cases of patients with septic shock accompanied by AKI in the research group, and 33 cases of patients without AKI in the control group.Then we used SPSS25.0 software to analyze the clinical data with univariate and multivariate analysis. Results: The mortality of research group and control group were 46.4%(26/56) and 39.4% (13/33), respectively.There were obvious differences between two groups in pediatric critical illness score(PCIS), the number of organ failure, nervous failure, hepatic failure, circulatory failure, lactic acid, γ-glutamyltransferase, creatinine, urea, total bilirubin, direct bilirubin(P<0.05). Logistic regression showed that hepatic failure(OR 0.099, 95%CI 0.018~0.549), PCIS<80(OR 0.223, 95%CI 0.064~0.774), lactic acid>4.1 mmol/L(OR 0.221, 95%CI 0.055~0.885) were independent risk factors for septic shock with AKI. Conclusion The mortality of septic shock with AKI is high.Hepatic failure, PCIS<80, lactic acid>4.1 mmol/L are independent risk factors.Septic shock is a systemic inflammation which can influence all organs.In order to reduce the incidence of AKI, it′s necessary to pay early attention to the changes of microcirculation such as lactic acid.

Objective: To investigate the relationship of stigma, coping style and psychosocial adjustment in young patients with breast cancer after operation, and the mediating effect of different coping style between stigma and psychosocial adjustment. Methods: The general information questionnaire, Social Impact Scale (SIS), Medical Coping Style Questionnaire (MCMQ) and psychosocial adjustment questionnaire for breast cancer were used to investigate the stigma, coping style and psychosocial adjustment of 292 young patients with breast cancer after operation in the affiliated hospital of Qingdao University. Results: There was a negative correlation between stigma and confrontation coping, psychosocial adjustment(r=-0.687--0.519, all P<0.01), but a positive correlation with yield coping and avoidance coping (r=0.426-0.500, all P<0.01).There was a positive correlation between psychosocial adjustment and confrontation coping(r=0.594, P<0.01), and was a negative correlation between psychosocial adjustment and avoidance copying, yield copying(r=-0.643--0.519, all P<0.05). The mediating effects of confrontation coping and avoidance coping were 32.86% and 18.81% respectively. Conclusions The stigma and coping style of young patients with breast cancer after operation were closely related to psychosocial adjustment. Nursing staff should guide the patients to adopt positive coping style, reduce the stigma, promote the psychosocial adjustment, and help the patients to return to normal life as soon as possible.