To develop and validate a model for predicting intensive care unit (ICU) mortality risk in patients with malignant tumors complicated by acute respiratory failure (ARF) based on an explainable machine learning framework.

Humanistic caring for patients in the operating room refers to providing the whole process of caring medical services for patients in the operating room. In order to standardize humanistic caring services for patients in the operating room of medical institutions, improve the comprehensive service level of the operating room, and enhance the surgical experience of patients, the Chinese Association for Life Care released the group standard " Humanistic Caring Management Standards for Patients in the Operating Room" in December 2023. This article interpreted the basic requirements for humanistic caring of patients in the operating room, the environment and facilities for humanistic caring, the procedures and measures for humanistic caring, and the quality management framework, aiming to assist administrators and clinical practitioners across various levels of medical institutions in accurately understanding and effectively implementing the standard, and to provide essential textual reference and practical guidance for promoting the application of the standard.

Objective:To study the risk factors for combined bacterial/fungal infections in patients with severe fever with thrombocytopenia syndrome (SFTS) and to develop a novel and validated prediction model.Methods:The basic data and the results of the first laboratory examination after admission were retrospectively collected from patients diagnosed with SFTS who were hospitalized in the First Affiliated Hospital, Nanjing Medical University from January 2018 to December 2022. The patients were categorized into co-infected and non-co-infected groups according to whether they had co-infections with bacterial/fungal infections or not.Independent risk factors were screened by multivariate logistic regression analyses. A novel prediction model was constructed, and the predictive value of the model was assessed using receiver operating characteristic curve. Non-parametric tests and chi-square test were used for statistical analysis.Results:A total of 294 patients were included, and 62 cases were in the combined infection group including 39 cases of simple respiratory tract infections, 11 cases of simple bloodstream infections, four cases of simple urinary tract infections, four cases of respiratory tract combined with bloodstream infection, and four cases of respiratory tract combined with urinary tract infection. Acinetobacter baumannii was mostly found in bacterial infections, with a total of 19 strains, followed by Escherichia coli and Pseudomonas aeruginosa, both with seven strains. Aspergillus were mostly common in fungi, with a total of 16 strains which were all collected from patients with pulmonary infections. Compared with the non-co-infected group, patients in the co-infected group had longer hospital stays, with statistically significant differences ( Z=-6.18, P<0.001). The patients also had higher frequencies of bleeding symptoms, neurological symptoms, severe illness, and death, with statistically significant differences ( χ2=23.91, 16.37, 15.51 and 15.58, respectively, all P<0.001). The aspartate transaminase-to-platelet ratio index (APRI) was also higher in patients with coinfection, with a statistically significant difference ( Z=-4.64, P<0.001). Multivariate binary logistic regression showed that severe illness (odds ratio ( OR)=2.567, 95% confidence interval ( CI) 1.344 to 4.904, P=0.004), blood glucose level higher than 7.782 mmol/L ( OR=4.766, 95% CI 2.493 to 9.109, P<0.001), procalcitonin level higher than 0.228 μg/L ( OR=2.487, 95% CI 1.289 to 4.799, P=0.007), and APRI value higher than 6.268 ( OR=3.032, 95% CI 1.404 to 6.548, P=0.005) were the independent risk factors for co-infections in SFTS patients. Disease severity, blood glucose, procalcitonin, and APRI were combined to construct a novel predictive model: Infect-risk score=-3.331+ 0.654×severity (severe=1, non-severe=0)+ 0.160×blood glucose+ 0.066×procalcitonin+ 0.013×APRI. The AUC for this score was 0.764 (95% CI 0.698 to 0.830, P<0.001), with Youden index of 0.416, sensitivity of 0.839, and specificity of 0.578. Conclusions:Severe illness, blood glucose levels higher than 7.782 mmol/L, procalcitonin levels above 0.228 μg/L, and APRI values above 6.268 are independent risk factors for bacterial/fungal coinfection in SFTS patients. The constructed Infect-risk score model has good predictive value for bacterial/fungal coinfection in SFTS patients.

Objective To explore the current situation and influencing factors of post-intensive care syndrome(PICS)in critically ill patients a month after their transfer out,and to provide a basis for formulating individualized intervention measures.Methods By the convenience sampling method,550 patients who were transferred out of the ICU of a tertiary A hospital in Guizhou Province for a month from April to November 2024 were selected as the survey subjects.The general information of the patients was collected and sorted out.During their stay in the ICU,the Barthel Index,the Richards Campbell Sleep Scale,and the Perceived Social Support Scale were employed for evaluation.A month after the patients were transferred out of the ICU,the assessment was completed through telephone follow-up using the Chinese version of the Brain Care Monitoring Questionnaire for Healthy Aging.According to the assessment a month after the patients were transferred out,they were divided into a PICS group and a non-PICS group.Univariate analysis and binary Logistic regression analysis were completed based on the data of the 2 groups.Results A total of 550 questionnaires were distributed,and 442 valid questionnaires were ultimately collected,with a valid questionnaire collection rate of 80.3％.Among them,194 cases(43.9％)were high-risk patients with PICS.Binary logistic regression analysis showed that advanced age,pulmonary infection,total hospitalization time＞15 days,and internal environment disorder were the risk factors for PICS in ICU patients(P＜0.05).Conclusion The risk of PICS is relatively high in critically ill patients a month after the transfer.Medical staff need to pay attention to patients who are older,have pulmonary infections and internal environment disorders,and formulate personalized intervention measures for different disease types to improve the long-term health prognosis of patients.

Sneddon syndrome is a rare neurocutaneous disorder that primarily affects small-and medium-sized arteries.Its clinical manifestations include livedo racemosa and recurrent cerebral ischemic events,and it may also involve multiple organs such as the heart,spleen,and kidneys.This disease can lead to early-onset stroke,making it a rare cause of stroke in young adults.This article reported a case of a young female patient who experienced two cerebral infarctions within one month.Genetic testing identified a homozygous mutation in the adenosine deaminase 2 gene,confirming the diagnosis of Sneddon syndrome.This case serves as a reference to improve clinical recognition of this disease.

[Objective]To explore the effects of ZHANG's empirical formula directional drug delivery combined with auricular acupressure in treatment for postoperative pain in hand trauma due to Qi stagnation and blood stasis.[Methods]A total of 152 postoperative patients with hand trauma with Qi stagnation and blood stasis who were hospitalized in the Department of Hand and Foot Surgery at Hangzhou Fuyang Hospital of Orthopedics of Traditional Chinese Medicine from September 2023 to January 2024 were selected.The patients were randomly divided into control group,directed group,acupressure group and combined group,with 38 cases in each group.The control group received routine nursing care;the directed group received ZHANG's empirical formula for directed transdermal medication in addition to the regular care;the acupressure group received auricular acupressure treatment in addition to the regular care;and the combined group received both ZHANG's empirical formula for directed transdermal medication and auricular acupressure treatment in addition to the regular care.The numerical rating scale(NRS)pain scores,peripheral blood circulation levels of the affected limb at different time points before and after intervention,clinical efficacy,cumulative use of analgesics within 72 hours post-surgery and the occurrence of adverse reactions were compared among the four groups.[Results]Thirty minutes after intervention,the NRS scores of both combined group and acupressure group were lower than those of the other groups(P<0.05).From 12 to 72 hours after intervention,the NRS scores of combined group remained significantly lower than those of the other groups(P<0.05).The effective rates were 80.6%in control group,85.7%in directed group,88.9%in acupressure group and 91.4%in combined group,with statistically significant differences among the four groups(P<0.05).After intervention,statistically significant differences were observed in peripheral blood circulation of the affected limbs among the four groups(P<0.05),and combined group demonstrated superior outcomes compared with the others.Additionally,significant differences were found in cumulative analgesic consumption within 72 hours of post-surgery(P<0.05),where the control group showed the highest usage while the acupressure group and combined group exhibited the lowest.No adverse reactions were observed in any enrolled patients.[Conclusion]ZHANG's empirical formula directional drug delivery combined with auricular acupressure can effectively alleviate post-operative pain due to Qi stagnation and blood stasis in hand trauma,reduce the cumulative analgesic consumption within 72 hours post-surgery,and improve peripheral blood circulation in the affected limb,making it worthy of further promotion and application in clinical practice.

Objective To observe the effect of specialist team-led walking-cognition dual-task train-ing combined with active self-disclosure on control and balance abilities in elderly patients with acute ischemic stroke(AIS).Methods A total of 90 elderly AIS patients treated in our hospital from January 2022 to January 2024 were enrolled and randomly assigned into the control group and the observation group,with 45 cases in each group.The control group received routine walk-ing training,while the observation group received specialist team-led walking-cognition dual-task training combined with active self-disclosure intervention.Control ability,balance ability,walking ability,cognitive function and psychological status were compared between the two groups.Results After intervention,the scores of Sheikh Trunk Control Scale and Fugl-Meyer Assessment(FMA),and the static balance score,dynamic balance score and total score of Berg Balance Scale(BBS)were significantly increased in both the observation and the control groups(P＜0.05),and all above scores were obviously higher in the former group than the latter one(P＜0.01).The two groups also obtained notably shorter single-and dual-task walking time after intervention,but there were no statistical difference in the single-task walking time in both groups before and after intervention(P＞0.05).After intervention,the observation group had significantly shorter dual-task walking time(22.87±7.36 s vs 27.52±8.71 s,P=0.008)and lower walking time cost of dual task[(11.16±4.07)％vs(25.61±7.82)％,P=0.000]when compared with the control group.After intervention,the scores of Mini-Mental Status Examination were increased,and the scores of Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale were decreased in the two groups(P＜0.05).Conclusion Specialist team-led walking-cognition dual-task training com-bined with active self-disclosure intervention can effectively improve trunk control ability,balance ability,walking ability,cognitive function and psychological state in elderly AIS patients,has cer-tian clinical application value.

OBJECTIVE To explore the effects of piperacillin/tazobactam combined with acetylcysteine solution on severe pneumonia after cerebral infarction,and to analyze its impact on cardiopulmonary and neurological function.METHODS A total of 86 patients with severe pneumonia after cerebral infarction admitted to Yulin Xingyuan Hos-pital from Jan.2022 to Jun.2024 were selected and divided into a control group and a study group using the ran-dom number table method(single blind),with 43 cases in each group.The control group was treated with intrave-nous drip of piperacillin/tazobactam,while the study group received additional inhalation of acetylcysteine solution based on the control group's treatment.The levels of inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6)and procalcitonin(PCT)],lung function indicators[forced vital capacity(FVC),peak expiratory flow rate(PEF),forced expiratory volume in one second(FEV1)and mean maximal expiratory flow rate(MMEF)],cardiac function indicators[left ventricular ejection fraction(LVEF),cardiac output(CO),cardiac index(CI)and stroke volume(SV)],NIH Stroke Scale(NIHSS)score,clinical efficacy,and the occurrence of adverse reactions were compared before and after treatment.RESULTS Compared with the control group,the study group had low levels of CRP,IL-6,PCT and NIHSS scores after treatment(P<0.05),and high levels of FVC,PEF,FEV1,MMEF,LVEF,CO,CI,and SV after treatment(P<0.05).The overall response rate in the study group was 95.35%,higher than 81.40%in the control group(χ2=4.074,P=0.044).There was no statistically significant difference in the incidence of adverse reactions between the control group and the study group during treatments(χ2=0.179,P=0.672).CONCLUSION Piperacillin/tazobactam combined with inhaled acetylcysteine solution for the treatment of severe pneumonia after cerebral infarction can improve clinical efficacy,reduce levels of inflamma-tory factors,and enhance cardiopulmonary and neurological functions in patients,which has a high safety profile.

Objective:To explore the latent categories of barriers to PhaseⅡ cardiac rehabilitation in patients after coronary artery bypass grafting (CABG), and to analyze the influencing factors of different latent classes.Methods:A total of 340 CABG patients in PhaseⅡ cardiac rehabilitation were recruited by convenience sampling from two Class Ⅲ Grade A hospitals in Shanghai between January and August 2024. Data were collected using a general information questionnaire, the Cardiac Rehabilitation Barriers Scale (CRBS), and the Fear of Exercise Scale for Cardiac Patients. Latent profile analysis was used to classify the cardiac rehabilitation barriers, and multinomial Logistic regression was conducted to identify influencing factors for different latent classes.Results:Of the 340 questionnaires distributed, 319 valid responses were obtained after excluding incomplete or patterned questionnaires, with a valid response rate of 93.82% (319/340). The cardiac rehabilitation barriers among the 319 CABG patients were classified into three latent profiles: low-barrier, active rehabilitation type; moderate-barrier, poor-functioning type; and moderate-barrier, insufficient-perception type. Multinomial logistic regression analysis indicated that smoking, comorbidities, age, educational level, and fear of exercise were statistically significant influencing factors for different barrier profiles ( P<0.05) . Conclusions:Cardiac rehabilitation barriers in CABG patients exhibit heterogeneity. Medical staff should adopt targeted intervention strategies based on the specific barrier profiles, reduce patients' fear of exercise, and thereby improve rehabilitation outcomes.

Objective:To investigate the application of 18F-FDG PET/MR and its derived parameters in the diagnosis and staging of bladder cancer. Methods:Forty patients (32 males, 8 females; age (66.8±11.2) years) with suspected bladder cancer between December 2019 and March 2022 were retrospectively included and underwent 18F-FDG PET/MR in Nanjing First Hospital. Parameters including SUV max, SUV mean, maximum tumor diameter and mean of apparent diffusion coefficient (ADC mean) were obtained, and bladder cancer muscle invasiveness and lymph node involvement were determined. The efficacy of 18F-FDG PET/MR and its derived parameters for tumor diagnosis and staging was analyzed using transurethral resection of bladder tumor (TUR-BT) or radical cystectomy (RC) and extended pelvic lymph node dissection (ePLND) histopathology as the " gold standard". Independent-sample t test, Mann-Whitney U test or χ2 test was used to analyze the data, and Delong test was used to compare different AUCs. Results:Of 40 patients, 8 were non-muscle invasive bladder cancer (NMIBC), 32 were muscle invasive bladder cancer (MIBC), and 5 were pathologically confirmed to have lymph node metastasis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 18F-FDG PET/MR for identifying MIBC were 96.9%(31/32), 7/8, 96.9%(31/32), 7/8, 95.0%(38/40), respectively, and those for lymph node metastasis were 4/5, 90.0%(18/20), 4/6, 18/19, 88.0%(22/25), respectively. For pathological tumor (pT) staging, significant differences were observed between pT2-3 and pT1 groups in maximum tumor diameter ( t=-2.37, P=0.024), SUV mean( Z=-2.11, P=0.035), and ADC mean( t=2.91, P=0.006). The AUCs of maximum tumor diameter, SUV mean and ADC mean in distinguishing MIBC were 0.781, 0.746, and 0.825, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of MRI alone in identifying MIBC were 87.5%(28/32), 1/8, 80.0%(28/35), 1/5 and 72.5%(29/40), respectively, with the AUC of 0.500. The AUC of 18F-FDG PET/MR in identifying MIBC was 0.796, which was better than MRI alone ( Z=5.54, P<0.001), and the accuracy of PET/MR was also higher than MRI alone ( χ2=7.44, P=0.006). Conclusion:Compared with MRI alone, 18F-FDG PET/MR significantly improves the diagnostic efficacy of bladder cancer and the accuracy of pT staging.