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*

OBJECTIVES: This study aimed to evaluate the effect of disc morphology and disc-condyle angle on the treatment of anterior repositioning splint (ARS) for anterior disc displacement with reduction (ADDwR). METHODS: On the basis of the inclusion and exclusion criteria, a total of 11 patients diagnosed with ADDwR were included. The effects of changes in disc length, thickness, and morphology classifications on the clinical symptoms, disc morphology parameters, and disc-condyle angles after ARS treatment were evaluated using magnetic resonance imaging and the Helkimo index. RESULTS: After ARS treatment, the Ai and Di of all patients with ADDwR decreased, the disc length increased, and the thickness decreased. The Ai of patients with slight ADDwR and those with type 1 joint discs was reduced to 0, with the most significant decrease observed in Di. The disc length of mild ADDwR (increased to 8.65 mm±1.79 mm) and type 5 disc (increased to 10.71 mm±2.62 mm) significantly increased the most. The disc thickness of slight ADDwR decreased to 3.08 mm±0.51 mm significantly. CONCLUSIONS The therapeutic effect of ARS is correlated with the displacement degree and morphological features of the disc, providing evidence for clinical treatment decisions.
Humans ; Magnetic Resonance Imaging ; Conservative Treatment ; Temporomandibular Joint Disc/diagnostic imaging* ; Male ; Adult ; Female ; Intervertebral Disc Displacement/pathology* ; Middle Aged

OBJECTIVE Exploring the effects of juvenile-onset recurrent respiratory papillomatosis on growth and development,intellectual level,and psychological status.METHODS The clinical data of 40 patients with JORRP who attended Beijing Tongren Hospital of Capital Medical University from January to December 2023(observation group)and 40 healthy adolescents who had medical checkups at the hospital during the same period(control group)were retrospectively analyzed.The body mass index(BMI),Raven's standard progressive matrices(SPM),and the feelings of inadequacy scale(FIS)were used to evaluate the growth and development,intelligence level,and psychological status of the enrolled population.RESULTS BMI was(21.320±3.609)kg/m2 in the observation group and(22.250±2.685)kg/m2 in the control group.The difference between the two groups was not statistically significant(U=668.000,P>0.05).According to the standard conversion of SPM scores,the proportion of observation group with good intelligence level was 5%(2/40),average level was 55%(22/40),below average level was 35%(14/40),and low level was 5%(2/40),while 5%(2/40)of the control group had good intelligence,90%(36/40)had average intelligence,and 5%(2/40)had below average intelligence.The differences in SPM total scores and scores of perceptual discrimination ability in group A,series relationship ability in group D and abstract reasoning ability in group E between the two groups were statistically significant(P<0.05).The intelligence levels of both groups were related to their living areas(|r|>0.3,P<0.05).The difference in FIS scores between the observation group and the control group was statistically significant(86.650±21.680 vs.62.250±9.446,U=270.000,P<0.001).The age of first onset in the observation group was negatively correlated with its sense of inferiority(|r|>0.3,P<0.05).There was no correlation between the number of surgeries in the observation group and their intelligence level and FIS scores(|r|<0.3,P>0.05).CONCLUSION JORRP does not affect the growth and development of patients,but can increase their sense of inferiority to a certain extent,which has a negative impact on their mental health.

OBJECTIVE To observe the long-term efficacy of type-Ⅰ thyroplasty under general anesthesia in the treatment of glottal insufficiency caused by unilateral vocal cord paralysis.METHODS A total of 52 patients with unilateral vocal cord paralysis who underwent type-Ⅰ thyroplasty under general anesthesia at Beijing Tongren Hospital from January 2017 to June 2023 were followed up for more than one year to analyze their efficacy.RESULTS All 52 patients underwent surgery successfully under general anesthesia,and hoarseness improved after operation.Coughing caused by drinking water was reduced or disappeared,and the vocal cords moved inward with improved glottal closure.One year after operation,there was no significant change in the position of the affected vocal cords compared to one week after surgery.The visual analog scale(VAS)scores of all patients with voice disorders decreased sequentially before surgery,one week after surgery,and one year after surgery(80.28±13.49 vs.37.78±19.15 vs.26.26±21.29,P<0.05).The preoperative and one-year postoperative voice perception assessment(GRBAS)showed statistically differences in grade(G),rough(R),breathy(B),and asthenia(A)scores(2.70±0.47 vs.1.09±0.66,2.52±0.54 vs.0.85±0.67,2.85±0.36 vs.0.67±0.65,2.74±0.44 vs.0.61±0.80,P<0.05)except for strain(S).Compared with preoperative results,one-year postoperatively showed a significant decrease in jitter and shimmer(4.61±2.61 vs.3.05±2.37,9.52±3.91 vs.7.11±2.78,P<0.05),and a significant prolongation of maximum phonation time(MPT)[(5.87±2.70)s vs.(14.50±4.30)s,P<0.05].No patients experienced perioperative adverse events.CONCLUSION Type-Ⅰ thyroplasty is an effective surgical method for treatment of vocal cord paralysis.The type-Ⅰ thyroplasty under general anesthesia is safe and effective,which not only significantly improves the symptoms of hoarseness in patients,but also has stable therapeutic effects and can maintain the results for a long time.At the same time,the patient has no pain during the procedure.

Objective    To investigate effectiveness and safety of transcatheter aortic valve replacement in the treatment of aortic regurgitation. Methods     PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang Data and VIP were searched from inception to August 2021. According to the criteria of inclusion and exclusion, two reviewers independently screened the literature, extracted the data and evaluated the quality of the included studies. Then, Stata 16.0 software was used for meta-analysis. Subgroup meta-analysis of valve type used and study type was performed. Results    Twenty-five studies (12 cohort studies and 13 single-arm studies) were included with 4 370 patients. Meta-analysis results showed that an incidence of device success was 87% (95%CI 0.81-0.92). The success rate of the new generation valve subgroup was 93% (95%CI 0.89-0.96), and the early generation valve subgroup was 66% (95%CI 0.56-0.75). In addition, the 30-day all-cause mortality was 7% (95%CI 0.05-0.10), the 30-day cardiac mortality was 4% (95%CI 0.01-0.07), the incidence of pacemaker implantation was 10% (95%CI 0.08-0.13), and the incidence of conversion to thoraco-tomy was 2% (95%CI 0.01-0.04). The incidence of moderate or higher paravalvular aortic regurgitation was 6% (95%CI  0.03-0.09). Conclusion     Transcatheter aortic valve replacement for aortic regurgitation is safe and yields good results, but some limitations can not be overcome. Therefore, multicenter randomized controlled trials are needed to confirm our results.

Objective    To systematically review the efficacy and safety of transfemoral transcatheter aortic valve replacement (TFTAVR) under local anesthesia (LA) and general anesthesia (GA). Methods    Electronic databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang and CBM were searched to collect randomized controlled trial and cohort studies on clinical outcomes of TFTAVR under LA and GA from inception to September 2020. Two authors independently screened literature, extracted data and assessed the quality of studies, and a meta-analysis was performed by using Stata 16.0 software. Results    A total of 30 studies involving 52 087 patients were included in this study. There were 18 719 patients in the LA group and 33 368 patients in the GA group. The results of meta-analysis showed that the in-hospital all-cause mortality rate [RR=0.65, 95%CI (0.45, 0.94), P=0.021], 30-day all-cause mortality rate [RR=0.73, 95%CI (0.62, 0.86), P<0.001], 30-day stroke [RR=0.82, 95%CI (0.68, 0.98), P=0.025], cardiac arrest [RR=0.50, 95%CI (0.34, 0.73), P<0.001], ICU stay time [RR=−6.86, 95%CI (−12.31, −1.42), P=0.013], and total hospital stay  time [RR=−2.02, 95%CI (−2.59, −1.45), P<0.001] in the LA group were all better than those in the GA group. There was no significant difference in the in-hospital stroke [RR=0.83, 95%CI (0.69, 1.00), P=0.053], in-hospital myocardial infarction (MI) [RR=1.74, 95%CI (0.43, 7.00), P=0.434], or 30-day MI [RR=0.77, 95%CI (0.42, 1.42), P=0.404] between the two groups. Conclusion    LA provides a safe and effective way to induce sedation without intubation, and may be a good alternative to GA for TFTAVR.

【Objective】 To explore the effect of cilostazol on intestinal barrier function in type 2 diabetes (T2DM). 【Methods】 The GSE142153 dataset was downloaded from GEO database to analyze gene changes in diabetic patients. Eight-week-old male db/db mice and control m/m mice were randomly divided into m/m+cmc, m/m+cilo, db/db+cmc, and db/db+cilo groups. Mice in different groups were given cilostazol and corresponding solvents for 4 weeks. We detected the levels of serum sCD40L and the expression of CD40 in intestinal tissue, and evaluated the mice’s intestinal barrier function by examining intestinal permeability, water content, bacterial number, and tight junction protein expression in different groups. 【Results】 Differential expressed genes were enriched in platelet activation and endothelial barrier function pathways in diabetic patients. Compared with those in the control group, the levels of serum sCD40L in db/db diabetic mice elevated significantly, and the CD40 expression, permeability, water content and bacterial number in intestinal tissue increased obviously, while the expression of tight junction protein decreased. Cilostazol treatment in diabetic mice decreased the levels of serum sCD40L and CD40, and alleviated significantly the intestinal barrier dysfunction. 【Conclusion】 Cilostazol attenuated the damage of intestinal barrier function in T2DM, and its protective effect may be related to the inhibition of platelet activation in diabetic mice.

Objective    To systematically review the clinical outcome of patients with new-onset left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR). Methods    Electronic search was performed in PubMed, EMbase, Cochrane Library, Web of Science, CNKI, Wanfang and CBM databases to identify studies about the new-onset LBBB after TAVR from inception to March 19, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 15.0 software. Results    A total of 17 cohort studies were included, covering 9 205 patients, including 2 202 patients with new-onset LBBB and 7 003 without new-onset LBBB after TAVR. The results of meta-analysis showed that patients with new-onset LBBB after TAVR at 30-day (RR=1.65, 95%CI 1.30 to 2.10, P<0.001) and 1-year (RR=1.30, 95%CI 1.16 to 1.45, P<0.001) all-cause mortality was higher than no new-onset LBBB group. One-year cardiovascular mortality was higher in the new-onset LBBB group (RR=1.47, 95%CI 1.21 to 1.79, P<0.001). In the occurrence of 30-day (RR=1.51, 95%CI 1.10 to 2.08, P=0.011) and 1-year (RR=1.34, 95%CI 1.14 to 1.58, P=0.001) rehospitalization rate, 30-day (RR=3.05, 95% CI 1.49 to   6.22, P=0.002) and 1-year (RR=2.15, 95%CI 1.52 to 3.03, P<0.001) pacemaker implantation, the incidence of patients with new-onset LBBB was higher than that of the no new-onset LBBB group. Conclusion    Compared with the patients without LBBB after TAVR, the clinical prognosis of patients with new-onset LBBB after TAVR is poor. In the future, the management and follow-up of the patients with LBBB after TAVR should be further strengthened to improve the prognosis of patients.

Objective    To systematically review the impact of chronic kidney disease (CKD) at different stages on prognosis of transcatheter aortic valve replacement (TAVR). Methods    Databases including PubMed, the Cochrane Library, EMbase, Web of Science, CNKI, Wanfang and the Chinese Biomedical Literature Database (CBM) were searched by computer to collect cohort studies on impact of different stages of CKD on prognosis of TAVR from inception to July 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, and then, meta-analysis was performed by using Stata 15.0 software. Risk of study bias was assessed using the Newcastle-Ottawa Scale (NOS). Results    A total of 17 cohort studies were included with NOS score≥6 points. The results of meta-analysis indicated that: compared with the patients without CKD, all-cause mortality of CKD stage 3 patients at 30 day (RR=1.29, 95%CI 1.22-1.37, P<0.001) and 1 year (RR=1.24, 95%CI 1.19-1.28, P<0.001), all-cause mortality of CKD stage 4 patients at 30 day (RR=2.10, 95%CI 1.90-2.31, P<0.001) and 1 year (RR=1.89, 95%CI 1.62-2.19, P<0.001), and all-cause mortality of CKD stage 5 patients at 30 day (RR=2.22, 95%CI 1.62-2.19, P<0.001) and 1 year (RR=2.24, 95%CI 1.75-2.87, P<0.001) were significantly increased and were associated with the severity of CKD. The occurrence rates of 1-year cardiovascular mortality, postoperative acute kidney injury and bleeding events were all higher in patients with CKD. Conclusion    CKD at stages 3, 4 and 5 is associated with increased all-cause mortality after TAVR, and the higher the stage of CKD is, the higher the risk of all-cause mortality at 30-day and 1-year follow-up is. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.

Objective: To study the diagnostic accuracy and the distance between the root of maxillary posterior tooth and the maxillary sinus using panoramic radiography and cone beam computer tomography; to provide basic information for clinicians to treat diseases in the maxillary posterior region. Methods: Eighty patients were included in this study. A total of 671 specimens were measured for the distance between the root tip and the maxillary sinus floor in both imaging modalities. Results : The roots that did not contact the sinus floor or contacted but did not project into the sinus cavity showed an agreement of 82% and 70% when using panoramic radiography. Forty-eight percent of the roots that projected into the sinus cavity in panoramic radiography showed protrusion into the sinus with cone beam computer tomography (CBCT). For panoramic radiography and CBCT showing root projections into the sinus cavity, the average distances were 2.19 ± 1.82 mm and 1.47 ± 1.01 mm, respectively. There was a significant difference between the two values (P ＜ 0.05). Conclusion Panoramic radiography is more accurate when roots of maxillary posterior teeth do not contact the sinus floor or contact it. However, it has a lower accuracy rate when the tooth roots protrude into the sinus.