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*

Objective:To develop a prediction model using machine learning to identify anxiety and depression in elderly individuals.Methods:This study collected data from 15079 elderly individuals in Shanxi Province, including their social demographic factors and disease status.Anxiety and depression were evaluated using GAD-7 and PHQ-9 scales to understand the characteristics of mental illness in the elderly.The evaluation indexes included accuracy, recall, precision, F1 score, Receiver Operating Characteristic Curve(ROC), and area under the curve(AUC), which were derived from the confusion matrix and several models.Results:The output of our study clearly demonstrates that the full feature prediction based on LightGBM is highly accurate, with an AUC of 0.805[95% CI: 0.794-0.811]. This outperforms the Random Forest model, which achieved an AUC of 0.730[95% CI: 0.702-0.741], and the XGboost model, which achieved an AUC of 0.802[95% CI: 0.780-0.807]. Therefore, LightGBM algorithm proves to be a strong prediction model.Our simplified model, based on eight selected features, also achieves a respectable AUC of approximately 0.75. Conclusions:The new prediction model for anxiety and depression specifically designed for the elderly can be effectively utilized in grassroots health surveys or for self-examinations to efficiently predict anxiety and depression levels among the elderly population in the community.

Objective To investigate the relationship between the expression of programmed death ligand 1(PD-L1)and hypoxia inducible factor-1α(HIF-1 α)with the clinical pathological characteristics and prognosis of gastric cancer patients.Methods The cancer tissues of 100 gastric cancer patients who underwent radical gastrectomy at the First Hospital of Handan City from July 2019 to July 2020 were selected as the research subjects,and their adjacent tissues(normal tissues ≥ 5 cm from the cancer tissues)were as the control group.Immunohistochemical detection of PD-L1 and HIF-1 α was performed by SP method.Spearman correlation analysis was used to analyze PD-L1 and HIF-1 α in gastric cancer tissues.Kaplan-Meier method was used to analyze the 3-year survival relationship of gastric cancer patients.The influencing factors of prognosis and death in patients with gastric cancer were analyzed by univariate and multivariate Cox regression.Results Among 100 gastric cancer patients,52 were PD-L1 positive and 48 were negative;67 were HIF-1 α positive and 33 were HIF-1 α negative,the positive expression rates of PD-L1 and HIF-1α in gastric cancer tissues were 52.00％and 67.00％,respectively,which were obviously higher than those in adjacent tissues(11.00％、18.00％),the difference was statistically significant(P＜0.05).Spearman correlation analysis showed that the expression of PD-L1 was positively correlated with that of HIF-1α in gastric cancer tissues(r=0.730,P＜0.001).The expressions of PD-L1 and HIF-1α in patients with gastric cancer were correlated with TNM stage,lymph node metastasis and local invasion(P＜0.05).The 3-year overall survival rate of gastric cancer patients was 48.00％after surgery,and the 3-years survival rate of patients with positive expression of PD-L1 and HIF-1α were 28.85％and 31.34％,which were lower than those of patients with negative expression of PD-L1 and HIF-1α(68.75％and 81.82％)(Log rank x2=25.155,P＜0.001.Log rank x2=24.552,P＜0.001).Moreover,positive expression of PD-L1 and HIF-1α,TNM staging of Ⅲ-Ⅳ,lymph node metastasis,and local infiltration were independent risk factors for prognosis and death in gastric cancer patients(P＜0.05).Conclusion Both PD-L1 and HIF-1α are highly expressed in cancer tissues of gastric cancer patients,and they are positively correlated.They are also associated with clinical pathological features such as TNM staging,lymph node metastasis,and poor prognosis.

Objective:To compare the clinical effects of hip arthroplasty through direct anterior approach (DAA) in lateral decubitus in the treatment of hip osteoarthritis caused by Kaschin-Beck disease and congenital acetabular dysplasia.Methods:The prospective study method was used to select the patients who needed hip arthroplasty in the Fourth Department of Orthopedics, the Second Affiliated Hospital of Harbin Medical University from January 2015 to December 2019. All of them were operated with lateral decubitus DAA. According to the inclusion criteria, they were divided into Kacshin-Beck disease hip osteoarthritis group (group A) and congenital acetabular dysplasia hip osteoarthritis group (group B). Hip Harris score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, visual analogue scale (VAS) score were conducted, and hip abduction angle and flexion angle were measured before surgery, 3, 14 days and 1, 3, and 12 months after surgery.Results:Nineteen and twenty-two patients were included in group A and group B, respectively. All patients successfully completed the surgery. There was no significant difference in Harris score between the two groups before surgery, 3, 14 days, and 1, 12 months after surgery ( P > 0.05). There were no significant differences in WOMAC score, VAS score, hip abduction angle and hip flexion angle between the two groups before surgery and each time point after surgery ( P > 0.05). In the same group, there were significant differences in Harris score, WOMAC score, VAS score, hip abduction angle and hip flexion angle at different time points ( P < 0.001). All postoperative indicators were significantly improved compared with those before surgery. Conclusions:There is no significant difference in the clinical effects of hip arthroplasty through lateral decubitus DAA in the treatment of hip osteoarthritis caused by Kaschin-Beck disease and congenital acetabular dysplasia. This surgical method has good therapeutic effect on both types of hip osteoarthritis.

Objective:To understand the current status of health education competency of nursing staff in Anhui Province and explore its influencing factors, so as to provide a basis for nursing managers to improve the training effect of health education and do a good job in patient health education.Methods:This study was a cross-sectional study. The convenient sampling method was used to investigate 10 239 nursing staff from 23 ClassⅠ hospitals, 56 Class Ⅱ hospitals and 54 Class Ⅲ hospitals in Anhui Province from July to September in 2020 by using the general information questionnaire, Health Education Competency Self-Rating Scale for Nursing Staff, Self-efficacy Scale and Organizational Support Scale through electronic questionnaires. Totally 10 239 questionnaires were issued and 9 182 were effectively returned, with an effective recovery rate of 89.68%. Independent sample t test, variance analysis, Pearson correlation analysis and multiple linear regression analysis were used for data analysis. Results:The total score of health education competency of 9 182 nursing staff in Anhui Province was (347.47±50.66) , and the standard score was (78.08±11.38) . The total scores of Self-efficacy Scale and Organizational Support Scale were (29.45±6.16) , (48.49±11.26) , respectively. Multiple linear regression showed that initial degree, nursing level, teaching time, learning experience of school health education, training experience of hospital health education, work plan for health education, self-efficacy and organizational support were the factors influencing health education competency of nursing staff (adjusted R2=0.218, F=151.553, P<0.001) . Conclusions:The health education competency of nursing staff in Anhui Province is at the middle level, which still needs to be improved. Nursing managers should focus on improving the self-efficacy of nursing staff, and at the same time provide good organizational support for their clinical health education work, so as to improve the health education competency of nursing staff and provide better services to patients.

Objective:To observe the efficacy and safety of intravitreal injection of conbercept in the treatment of proliferatived diabetic retinophathy (PDR) complicated with vitreous hemorrhage by minimally invasive vitreoretinal surgery.Methods:Prospective clinical study. A total of 50 patients with PDR complicated with vitreous hemorrhage clinically diagnosed in Tianjin Medical University Eye Hospital who needed vitrectomy were recruited in this study. According to the principle of informed consent, the patients were divided into two groups: postoperative injection group and the control group. Twenty-five eyes of 25 patients in each group were examined before operation. No significant proliferative changes in the posterior pole and traction retinal detachment were observed. There was significant difference of age between two groups ( t=-24.697, P=0.030), but no significant difference of sex ( χ2=0.330, P=0.564), duration of diabetes ( t=-1.144, P=0.258), logMAR BCVA ( t=-0.148, P=0.883), lens state ( χ2=0.397, P=0.529), panretinal laser photocoagulation ( χ2=1.333, P=0.248). The postoperative injection group was treated with intravitreous injection of 0.05 ml conbercept (10 mg/ml) immediately after 27G minimally invasive vitrectomy. The other treatment and follow-up were the same as those in the postoperative injection group except for conbercept injection. All patients underwent routine slit-lamp examination, indirect ophthalmoscope and B-ultrasound examination before operation. The main outcome measure included the time of operation, the incidence rate of iatrogenic retinal holes and silicone oil filling. The recurrence of vitreous hemorrhage, BCVA, intraocular pressure, central retinal thickness (CRT), postoperative complications and progression were recorded 1 week, 1 month, 3 months and 6 months after operation. Results:At 1 week and 1, 3, 6 months after operation, there was significant difference of logMAR BCVA between the two groups ( t=-4.980, -4.840, -4.892, -5.439; P<0.001). At 3 and 6 months after operation, the recurrence of vitreous hemorrhage in the postoperative injection group was lower than that in the control group, but there was no statistical difference between two groups ( χ2=3.030, 4.153; P=0.192, 0.103). At 1 week and 1, 3, 6 months after operation, the CRT in the postoperative injection group was lower than that in the control group, the difference was significant ( t=-2.622, -2.638, -3.613, -3.037; P=0.012, 0.010, 0.001, 0.004, 0.005). There was no complications such as choroid detachment, proliferative vitreoretinopathy, retinal detachment, iris redness and neovascular glaucoma in all the eyes after operation. Conclusions:Intravitreal injection of conbercept in the treatment of PDR after operation is safe and effective. It can reduce the recurrence of vitreous hemorrhage after vitrectomy, improve the BCVA.

Objective:To explore the key genes and pathways that may play an important role in the pathogenesis of acne by bioinformatics analysis.Methods:GSE6475 and GSE53795 datasets were collected from GEO database, and 18 acne lesions tissues and 18 normal skin tissues were compared. David database was used to analyze the gene ontology (GO) and the key pathway (Kyoto Encyclopedia of genes and genomes, KEGG) of the differential genes, to establish the protein interaction network of the differential genes, and to obtain the most relevant key genes and important clusters.Results:A total of 314 up-regulated genes and 62 down-regulated genes were filtered from those GEO profiles. KEGG pathway analysis showed that these differential genes were mainly enriched in Staphylococcus aureus infection, osteoclast differentiation, pentose and glucuronate interconversions. In addition, 379 nodes and ten key genes (CXCL8, PTPRC, IL1B, ITGB2, CXCR4, ICAM1, CCR5, SELL, C3AR1 and PLEK) were screened out by protein interaction network.Conclusions:The key genes and pathways identified in this study may be new targets for intervention in the development of acne.

OBJECTIVE： To provide reference for improving emergency capacity of the hospital pharmacy department in response to the novel coronavirus pneumonia （COVID-19） epidemic. METHODS ：According to the related regulations and requirements of Law of the People ’s Republic of China on the Prevention and Control of Infectious Diseases ，combined with the situation of COVID- 19 epidemic prevention and control ，and management experience of relevant hospitals ，on the basis of in-depth analysis of drug supply and quality assurance ，drug dispensing management ，provision of clinical pharmaceutical services and other related material support of hospital pharmacy department，integrated emergency management model was constructed for COVID- 19 epidemic prevention and control ，and the precautions and response measures of each link were sorted out. RESULTS ：Integruted emergency management mode for COVID-19 epidemic prevention and control in hospital pharmacy department included but was not limited to human resource management，drug and disinfection products supply management （mainly including key treatment drugs and disinfection product list formulation，control，inventory increase ，etc.）；drug dispensing management （mainly including prescription ，pharmacy window ， planning quantitative reserve ， drug return ， etc.）；clinical pharmaceutical care management （mainly including providing pharmaceutical information support ，online pharmaceutical service ，monitoring drug safety ，etc.）；personnel protection and disinfection （mainly including personnel protection ，environment and window ，equipment and container ，paper prescription disinfection，etc.）；special management of donated drugs ；prevention and control knowledge training ；pharmaceutical education and scientific research management ，etc. CONCLUSIONS ：The integrated emergency management model for epidemic prevention and control is helpful for hospital pharmacy to manage public health emergencies. During the outbreak of COVID- 19，hospital pharmacy department should start integrated emergency management mode for epidemic prevention and control ，strengthen the risk control of each link ，and play a good role in the key functional departments in the special period.

Objective To investigate the effect of genetic factors on the occurrence of chronic post-thoracotomy pain syndrome ( PTPS) from the perspective of genetic polymorphisms. Methods Two hun-dred patients of both sexes, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, aged 18-80 yr, scheduled for elective video-assisted thoracoscopic radical lung cancer surgery, were enrolled in this study. Blood samples were taken before operation for genotype analysis of 20 SNP loci, such as rs4073 and rs3774932, after DNA extraction. Postoperative multimodal analgesia was applied to maintain the visual an-alogue scale score ＜3. All the patients were followed up for 2-4 months after operation to record the occur-rence of PTPS. The patients were divided into 2 groups according to whether PTPS occurred: non-PTPS group (group N) and PTPS group (group P). Results The incidence of PTPS was 38. 7％ after surgery, and there were 114 patients in group N and 72 cases in group P . There was significant difference in A/T al-lele and genotype frequency at interleukin-8 rs4073 site and NF-κB1 rs3774932 site between the two groups (P＜0. 05). Conclusion Interleukin-8 and NF-kappa B1 genetic polymorphisms are associated with the occurrence of PTPS.

OBJECTIVE: To explore the genetic basis for a fetus featuring growth restriction and validate the effectiveness of a novel noninvasive prenatal testing (NIPT) technique for the detection of chromosomal microdeletions. METHODS: Next-generation sequencing(NGS) and fluorescence in situ hybridization(FISH) were used to analyze the DNA of the fetus. Conventional G-banding was used to analyze the karyotypes of the fetus and its parents. High-throughput sequencing was used to analyze free fetal DNA. RESULTS: NGS analysis has revealed a 4.88 Mb deletion at 15q11.2-q13.1 region in the fetus, which has a 99% overlap with the critical region of Prader-Willi syndrome (Type 2) and Angelman syndrome (Type 2) and encompassed critical genes including SNRPN and UBE3A. NIPT also revealed a 4.6 Mb deletion at 15q12, which was consistent with the results of fetal cord blood and amniotic DNA testing. FISH assay has confirmed the result of NGS. By karyotying, all subjects showed a normal karyotypes at a level of 320~400 bands. CONCLUSION It is quite necessary to carry out genetic testing on fetuses showing growth restriction. NIPT for fetal chromosomal microdeletions/microduplication syndromes is highly accurate for the diagnosis of Prader-Willi/Angelman syndrome.
Angelman Syndrome ; Chromosome Banding ; Chromosomes, Human, Pair 15 ; Female ; Fetus ; Humans ; In Situ Hybridization, Fluorescence ; Prader-Willi Syndrome ; Pregnancy