Objective:To investigate the association between exposure to major air pollutants (including PM 2.5, PM 10, NO 2, SO 2, O 3 and CO) and 28-day all-cause mortality in patients admitted to the intensive care unit (ICU). Methods:The electronic medical records of critically ill patients admitted to the ICU in Hubei Province General Hospital and Jingzhou Central Hospital were collected from August 2018 to August 2019 and from May 2021 to May 2022. Patients' exposure to air pollutants was assessed based on the average concentrations at their place of residence during the previous two months. A generalized linear regression model was used to estimate the association between air pollutant exposure and 28-day all-cause mortality in critically ill patients. Subgroup analysis was then conducted to examine the impact of individual air pollutant exposure on 28-day mortality, which served as the primary outcome in this study. The effect size and confidence interval were adjusted for patient characteristics including age, gender, smoking or drinking habits, length of hospital stay, and SOFA score. Additionally, mediation analysis was conducted using the mediation package (Bruce R) in R software. The direct effect represented the association between exposure to air pollutants and risk of mortality, while the indirect effect aimed to assess whether neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte- lymphocyte ratio (MLR) served as mediating variables in the correlation between exposure to air pollutants and mortality risk.Results:The study included a total of 3 772 critically ill patients admitted to the ICU, with a 28-day all-cause mortality rate of 40.0% (1 509/3 772). A significant positive correlation was observed between an incremental increase of 1 μg/m 3 in air pollutants (specifically PM 2.5, NO 2 and CO) and an elevated risk of mortality within 28 days among critically ill patients. Conversely, there is an inverse relationship between O 3 levels and mortality risk. Additionally, male gender and SOFA rating >3 scores were identified as independent risk factors for all-cause mortality in ICU patients exposed to NO 2 or CO. The Neutrophil/lymphocyte ratio (NLR) played a mediating role in the correlation between PM 2.5 or CO exposure and mortality risk, accounting for 9.09% or 4.71% of the correlations, respectively. Conclusions:The exposure to air pollutants (PM 2.5, NO 2, CO) significantly associate with a high risk of 28-day all-cause mortality in ICU patients. Even at low levels of air pollution, NO 2, CO remains positively correlate with the mortality risk in critically ill patients, who belong to a vulnerable population.

Objective To investigate the effect of magnetic resonance diffusion tensor imaging(DTI)combined with Buyang Huanwu decoction on limb rehabilitation of patients with spontaneous hypertensive cerebral hemorrhage in basal ganglia.Methods A total of 68 patients with spontaneous hypertensive intracerebral hemorrhage in basal from March 2022 to March 2023 were selected from the department of neurosurgery of the First People's Hospital of Huzhou as research object.According to the random number table method,the patients were divided into control group(30 cases)and experimental group(38 cases).The control group was diagnosed with hypertensive intracerebral hemorrhage and received conventional therapy,and the experimental group was treated with DTI combined with Buyang Huanwu decoction.After 4 weeks of treatment,the overall treatment effect of the two groups was compared,and the differences of Fugl-Meyer assessment(FMA),National Institutes of Health Stroke Scale(NIHSS),Berg balance scale(BBS),and modified Barthel index(MBI)scores were compared.Results The overall therapeutic effect of experimental group was significantly higher than that of control group[86.8%(33/38)vs.56.7%(17/30),P<0.05].After 4 weeks of treatment,FMA,BBS and MBI scores were significantly increased in both groups,NIHSS scores were significantly decreased in both groups,and the improvement degree of the experimental group was significantly better than that of the control group(FMA score:74.21±9.07 vs.66.73±12.76,NIHSS score:15.16±3.73 vs.20.27±6.15,MBI score:69.29±14.68 vs.60.63±19.10,BBS score:43.55±4.30 vs.36.90±3.86,all P<0.05).Conclusion DTI combined with Buyang Huanwu decoction can improve the motor function of the limbs of patients in the basal ganglia area and enhance their ability to perform activities of daily living.

Objective To explore the health promotion behaviors among patients with pulmonary tuberculosis(TB),and to analyze its relationship with health locus of control,in order to provide scientific references for improving TB patients'health-promotion behaviors in clinical nursing care.Methods The interpretive sequence mixed method design was utilized.A convenient sampling was used to enroll 300 TB patients from 2 TB specialized tertiary hospitals in Xi'an as research subjects from January to April 2023.General information questionnaire,Health promoting lifestyle profile-Ⅱ,and Multidimensional health locus of control scale were used to collect data,and single-factor analysis and multiple linear regression analysis were conducted.Purposeful sampling was used to select 11 TB patients for a semi-structured interview,and the Colaizzi 7-step method was used to extract themes.Results In the quantitative study,the total score of health promoting behaviors in 294 TB patients was(110.26±15.74).Patients'intemal health locus of control,chance health locus of control,and occupational status significantly influenced their health-promotion behaviors(P＜0.05).In the qualitative study,4 themes were extracted,including awakening self-awareness of health,the desire to establish a normal life,the distress of multiple uncertainties,and the immediate effect of authoritative guidance.The qualitative and quantitative studies complemented each other and further verified the relationship between health promotion behaviors and health locus of control of TB patients.Conclusion The level of health-promotion behaviors in TB patients needs to be further improved.Nurses need to take systematic health education as an opportunity by the catalytic effect of individual health awareness,to improve their internal locus of control,reduce their opportunity control tendency due to multiple uncertainties,with the ultimate purpose of helping TB patients form and maintain health promotion behaviors.

Objective:To explore the causes of blood supply disorder of the pedicled rectus abdominis flap.Methods:Between January 2019 and May 2021, a cohort of 61 female patients, aged 25 to 70 years with a mean age of (46.9±2.1) years, underwent surgical repair for extensive thoracic wall defects at Hunan Province Cancer Hospital. These defects, resulting from thoracic wall tumor resection, were addressed using a combination of pedicled rectus abdominis myocutaneous flaps and free inferior abdominal artery perforator flaps. The patient cohort included 39 cases of locally advanced breast cancer, 12 cases of recurrent breast cancer, 6 cases of lobular cell sarcoma, and 4 cases of soft tissue sarcoma. The patients were divided into two groups according to the order of revascularization sequence of free inferior abdominal artery perforator flap: 31 cases in the group of anastomosing the artery first and then the accompanying vein (group A), and 30 cases in the group of anastomosing the vein first and then the artery (group B). The main reasons for the blood supply disorders of the pedicled rectus abdominis flap were analysed in the two groups.Results:In all 61 patients, the pedicled rectus abdominis myocutaneous flap showed immediate red and purple plaques and other blood supply disorders. Further anastomosis of the free inferior abdominal wall artery perforating the flap vessel tip was conducted to achieve pressurization. The vascular selection for the recipient area included the intrathoracic vessels in 26 cases, the thoracic acromion vessels in 15 cases, the thoracodorsal vessels in 9 cases, the anterior serratus branch of the thoracodorsal vessels in 7 cases, and the lateral thoracic arteries and veins in 4 cases. The flap length measured (29.1±0.6) cm, while the width of the skin island was (12.9±0.6) cm. The follow-up period was from 9 to 16 months, with a mean of 12.7 months.In the Group A, the flap blood supply was significantly relieved before further anastomosing the vein in 7 cases, and the flap blood supply returned to normal in the other 24 cases after further anastomosing the vein. In the Group B, the flap blood supply was significantly relieved before further anastomosing the artery in 27 cases, and the flap blood supply returned to normal in the other 3 cases after further anastomosing the artery.61 flaps survived completely, the shape of reconstructed chest wall was satisfactory, and there was no flap contracture and deformation; only linear scar was left in the donor area of the flap, and there was no significant effect on the function of the abdominal wall. The patients were followed-up for 9-16 months, with an average of 12.7 months.Conclusions:The main reason for the blood supply obstacle of the rectus abdominis flap is the venous return obstacle, in order to ensure the reliable blood supply of the flap, the venous return should be increased as a priority.

Objective:To investigate the relationship between cerebrovascular variation and the occurrence and recurrence of cerebral infarction, and provide a theoretical basis for the precise prevention and treatment of cerebral infarction.Methods:Totally 13 939 patients who underwent magnetic resonance imaging(MRI) and magnetic resonance angiography(MRA) examination at the Second Affiliated Hospital of Shandong First Medical University from January 2020 to December 2021 were grouped according to clinical symptoms combined with the imaging report, including 4 412 cases in the cerebral infarction group and 9 527 cases in the control group.2 048 patients in the cerebral infarction group were eventually enrolled in the study according to the inclusion and exclusion criteria, including 1 479 cases of initial cerebral infarction and 569 cases of recurrent cerebral infarction.SPSS 25.0 statistical software was used for data analysis.The χ2 test was used to compare the incidence of cerebral infarction with different cerebrovascular variations.Univariate analysis of suspected risk factors for recurrent cerebral infarction was performed with χ2 test, nonparametric test and t test.The binary logistic regression was used to analyze independent risk factors of recurrent cerebral infarction. Results:The incidence of cerebral infarction in the dual-system cerebrovascular variant patients, the single-system cerebrovascular variant patients, and the non-cerebrovascular variant patients were 40.9%, 30.7% and 31.8% respectively.The incidence of cerebral infarction in the dual-system cerebrovascular variant patients was the highest compared with those in the single-system cerebrovascular variant patients and the non-cerebrovascular variant patients (both P<0.05). The incidence rates of embryonic posterior cerebral artery, vertebral artery dominance, and bilateral common origin anterior cerebral arteries were 14.09%, 10.76% and 5.32%, respectively.The incidence of bilateral common origin anterior cerebral arteries in the cerebral infarction group was significantly higher than that in the control group and the difference was statistically significant.Patients with cerebral infarction who were familial aggregation ( OR=2.207, 95% CI=1.591-3.062), hyperhomocysteinemia ( OR=1.262, 95% CI=1.014-1.570), hypertension ( OR=1.461, 95% CI=1.114-1.918), diabetes mellitus ( OR=1.348, 95% CI=1.072-1.694), coronary heart disease ( OR=1.491, 95% CI=1.196-1.858) were more likely to recurrent cerebral infarction ( P<0.05), and patients with cerebral infarction had a significantly increased risk of recurrent cerebral infarction with age ( OR=1.031, 95% CI=1.020-1.042, P<0.05). Conclusion:Dual-system cerebrovascular variation and bilateral common origin anterior cerebral arteries are risk factors for cerebral infarction.

BACKGROUND: Intensive phototherapy (IPT) and exchange transfusion (ET) are the main treatments for extreme hyperbilirubinemia. However, there is no reliable evidence on determining the thresholds for these treatments. This multicenter study compared the effectiveness and complications of IPT and ET in the treatment of extreme hyperbilirubinemia. METHODS: This retrospective cohort study was conducted in seven centers from January 2015 to January 2018. Patients with extreme hyperbilirubinemia that met the criteria of ET were included. Patients were divided into three subgroups (low-, medium-, and high- risk) according to gestational week and risk factors. Propensity score matching (PSM) was performed to balance the data before treatment. Study outcomes included the development of bilirubin encephalopathy, duration of hospitalization, expenses, and complications. Mortality, auditory complications, seizures, enamel dysplasia, ocular motility disorders, athetosis, motor, and language development were evaluated during follow-up at age of 3 years. RESULTS: A total of 1164 patients were included in this study. After PSM, 296 patients in the IPT only group and 296 patients in the IPT plus ET group were further divided into the low-, medium-, and high-risk subgroups with 188, 364, and 40 matched patients, respectively. No significant differences were found between the IPT only and IPT plus ET groups in terms of morbidity, complications, and sequelae. Hospitalization duration and expenses were lower in the low- and medium-risk subgroups in the IPT only group. CONCLUSIONS In this study, our results suggest that IPT is a safe and effective treatment for extreme hyperbilirubinemia. The indication of ET for patients with hyperbilirubinemia could be stricter. However, it is necessary to have a contingency plan for emergency ET as soon as IPT is commenced especially for infants with risk factors. If IPT can be guaranteed and proved to be therapeutic, ET should be avoided as much as possible.
Child, Preschool ; Exchange Transfusion, Whole Blood/adverse effects* ; Humans ; Hyperbilirubinemia, Neonatal/therapy* ; Infant ; Infant, Newborn ; Kernicterus/therapy* ; Phototherapy/methods* ; Retrospective Studies

Objective:To build a health education scheme related to discharge planning for adolescent idiopathic scoliosis surgery patients, and provide systematic and standardized health education related to discharge planning for adolescent idiopathic scoliosis surgery patients.Methods:From January to June 2021, through literature review and semi-structured interviews, the first draft of health education scheme for discharge planning of adolescent idiopathic scoliosis surgery patients was formulated. The Delphi method was used to conduct 2 rounds of consultation with 15 experts, and the final version of the health education scheme for the discharge plan was determined according to the expert consultation.Results:The effective recovery rates of the 2 rounds of expert consultation questionnaires were both 100.0%, the coefficients of expert authority were 0.93 and 0.94, and the Kendall's harmony coefficients of expert opinions were 0.251 and 0.273 ( P<0.01) . Finally, the health education program was constructed according to the health needs of patients and caregivers at 7 time periods including admission day, 1 day before surgery, operation day, postoperative day 1, 1 day before discharge, discharge day and 1 week after discharge, including 7 first-level items, 24 second-level items, and 78 third-level items. Conclusions:The health education scheme related to the discharge plan for adolescent idiopathic scoliosis surgery patients constructed in this study is scientific and reasonable in design, comprehensive, reliable and clinically practical. It is of great significance for the effective implementation of the discharge plan for adolescent idiopathic scoliosis surgery patients .

Objective:To study the effect of health management based on the transtheoretical model and stages of change on patients with diabetes mellitus complicated by obesity.Methods:A total of 122 patients with type 2 diabetes mellitus (T2DM) complicated by obesity and admitted to Guangdong Second Provincial General Hospital between January 2019 and June 2020 were recruited to participate in the study. They were divided into two equal groups at random, the observation group and the control group —with 61 patients in each group. Both groups were subjected to individualized health management based on conventional drug treatment. The control group received routine health education and psychological support, while the observation group was subjected to the transtheoretical model and stages of change interventions for six months. The independent-samples t-test was used to compare blood glucose, body weight, and self-efficacy in the two groups after interventions, and the χ 2 test or Fisher′s precise test was used to compare behavior habit compliance rates in the two groups after interventions. Results:FBG with (6.27±0.92) mmol/L and (6.58±0.91) mmol/L, 2hPG with (8.53±1.39) mmol/L and (8.53±1.39) mmol/L, and HbA1c with (6.49±0.91)% and (6.78±0.96)% in the two groups were significantly lower at six months of interventions than those before ( P<0.05), but the differences between the two groups were not statistically significant ( P>0.05). BMI, waist circumference, and body fat rate with (30.46±2.51) kg/m 2, (91.72±10.45) cm, and (34.09±3.84)% of the observation group at six months of interventions were significantly lower than those before interventions ( P<0.05), whereas there were no significant changes in the control group before and after interventions ( P>0.05). The observation group′s BMI and body fat rate were lower than those of the control group ( P<0.05). The General Self-Efficacy Scale (GSES) scores in the two groups were (31.62±2.59) points and (28.75±2.48) points, which were significantly higher than those before interventions ( P<0.05). The observation group′s GSES score was higher than that of the control group ( P<0.05). At six months of interventions, the compliance rates of diet control (92.98% and 77.97%), reasonable exercise (87.72% and 71.19%), adherence to medication (98.25% and 91.53%), quitting smoking and alcohol (94.74% and 81.36%), blood glucose monitoring (91.23% and 94.92%), and regular review (100.00% and 98.31%) were all significantly higher in the two groups than those before interventions ( P<0.05). Additionally, the compliance rates of diet control, reasonable exercise, and quitting smoking and alcohol in the observation group were higher than those of the control group ( P<0.05). Conclusion:The use of the transtheoretical model and stages of change for the self-management intervention of diabetes mellitus patients with obesity is beneficial to improve self-efficacy, behavioral habits, and weight control effectiveness.

Objective:To evaluate any effect of transcranial pulsed current stimulation (tPCS) on the motor functioning of rats modelling stroke using the Catwalk gait analysis system.Methods:A stroke model was induced in 24 rats using middle cerebral artery embolization. They were then randomly divided into a sham operation group, a model group and a tPCS group, each of 8. Neurological deficit scores were assigned 1 day after the modeling. Beginning two days after the modeling the tPCS group was given 20 minutes of tPCS daily with an intensity of 0.2mA at 10Hz for 7 days. Gait data were collected using the Catwalk gait system 1 day before, as well as 1 and 9 days after the modeling.Results:Nine days after the modeling the average Bederson neuroethology score of the tPCS group was significantly lower than one day after the modelling and significantly lower than the model group′s average. One day after the modelling significant differences were observed in the model and tPCS groups in the average contact area of the affected limb′s paw prints, limb swing speed, stride length, limb speed, swing time, average running speed and standing time compared with before the operation. After nine days the average standing time on the affected fore and hind limbs, as well as the paw contact areas were significantly better in the tPCS group than in the model group.Conclusion:tPCS can promote improvements in gait after ischemia and reperfusion, at least in rats.

Objective:To evaluate the recurrence and progression of patients with pT1 high grade urothelial carcinoma of bladder (UCB) and glandular differentiation.Methods:We retrospectively analyzed the clinical and pathological information of 208 patients diagnosed as pT1 high grade urothelial carcinoma in the Fifth Central Hospital of Tianjin from January 2006 to February 2019.Among them, 78 cases were diagnosed as glandular differentiation (UCGD), the other 130 patients without histologic variants were served as control. The UCGD group included 62 male and 16 female, whose median age was 67 years old (range 38-81 years old). The control group contained 105 male and 25 female, whose median age was 66 years old (range 40-82 years old). Kaplan-Meier and Cox proportional hazard regression analyses were used to evaluate the predictors of oncologic outcomes.Results:The disease recurrence rate and progression rate in UCGD group were 65.4% (51/78) and 28.2% (22/78), higher than 38.5%(50/130) and 14.6%(19/130) of control group ( P<0.05). The median recurrence time in UCGD group was 41 months while 55 months in the control group. The median progression time in UCGD group was 39 months while 54 months in the control group. According to the univariate analysis, largest tumor size ( P=0.030), UCGD ( P=0.003) and lymphovascular invasion (LVI) ( P=0.032) were associated with disease recurrence. UCGD ( P=0.036) and LVI ( P=0.011) were associated with progression. Additionally, Cox multivariate analysis revealed that UCGD ( P=0.001), LVI ( P=0.038) were the independent factors of disease recurrence. UCGD ( P=0.007) and LVI ( P=0.037) were also found to be the independent factors of disease progression. Conclusions:Patients with T1 stage UCB and UCGD are at higher risk of disease recurrence and progression. Therefore, these patients should be followed up closely after being diagnosed and undergo individual treatment according to the situation.