Objective To investigate the efficacy and safety of artificial liver support therapy with an Evanure-4A selective membrane plasma separator and its influence on platelet count in the treatment of patients with acute-on-chronic liver failure(ACLF)patients with different platelet counts.Methods A total of 302 patients with ACLF who were hospitalized in Department of Hepatology,Chengdu Public Health Clinical Medical Center,from January 2021 to May 2023,were enrolled,and according to the platelet count(PLT),they were divided into group A(25×109/L—50×109/L)with 101 patients,group B(51×109/L—80×109/L)with 98 patients,and group C(81×109/L—100×109/L)with 103 patients.In addition to medical treatment,all patients received different modes of artificial liver support therapy based on their conditions,including plasma perfusion combined with plasma exchange,double plasma molecular adsorption combined with plasma exchange,and bilirubin system adsorption combined with plasma exchange.The paired t-test was used for comparison of continuous data before and after treatment in each group;an analysis of variance was used for comparison between multiple groups,and the SNK-q test was used for further comparison between two groups;the chi-square test was used for comparison of categorical data between multiple groups.Results Of all 302 patients,268(88.74%)achieved varying degrees of improvement in clinical symptoms after artificial liver support therapy.After treatment,all three groups had varying degrees of reductions in alanine aminotransferase(t=14.755,21.614,and 15.965,all P＜0.001),aspartate aminotransferase(t=11.491,19.301,and 13.919,all P＜0.001),total bilirubin(t=19.182,17.486,and 21.75,all P＜0.001),and international normalized ratio(INR)(t=3.497,3.327,and 4.358,all P＜0.05).After artificial liver support therapy with an Evanure-4A selective membrane plasma separator,PLT in group A decreased from(37.73±6.27)×109/L before treatment to(36.59±7.96)×109/L after treatment,PLT in group B decreased from(66.97±7.64)×109/L before treatment to(62.59±7.37)×109/L after treatment,and PLT in group C decreased from(93.82±5.38)×109/L before treatment to(85.99±12.49)×109/L after treatment;groups B and C had significant reductions in PLT after treatment(t=12.993 and 8.240,both P＜0.001),but there was no significant difference in group A(P＞0.05).There was no significant difference in the incidence rate of adverse reactions during artificial liver support therapy between the three groups(P＞0.05).Conclusion Artificial liver support therapy can improve liver function and INR in patients with ACLF.The use of Evaure-4A selective membrane plasma separator during artificial liver support therapy has little influence on platelets,and it is safe in the treatment of ACLF patients with a significantly lower level of platelets.

Objective:To evaluate the impact of preemptive analgesia with ibuprofen on postoperative pain following the extraction of impacted mandibular third molars in a Chinese population, aiming to provide a clinical reference for its application.Methods:This multicenter, randomized, double-blind, placebo-controlled parallel-group trial was conducted from April 2022 to October 2023 at the Capital Medical University School of Stomatology (40 cases), Beijing TianTan Hospital, Capital Medical University (22 cases), and Beijing Chao-Yang Hospital, Capital Medical University (20 cases). It included 82 patients with impacted mandibular third molars, with 41 in the ibuprofen group and 41 in the control group. Participants in the ibuprofen group received 300 mg of sustained-release ibuprofen capsules orally 15 min before surgery, while the control group received a placebo. Both groups were instructed to take sustained-release ibuprofen capsules as planned for 3 days post-surgery. Pain intensity was measured using the numerical rating scale at 30 min, 4 h, 6 h, 8 h, 24 h, 48 h, and 72 h after surgery, and the use of additional analgesic medication was recorded during days 4 to 6 postoperatively.Results:All 82 patients completed the study according to the protocol. No adverse events such as nausea, vomiting, or allergies were reported in either group during the trial. The ibuprofen group exhibited significantly lower pain scores at 4 h [2.0 (1.0, 4.0) vs. 4.0 (3.0, 5.0)] ( Z=-3.73, P<0.001), 6 h [2.0 (1.0, 4.0) vs. 5.0(2.5, 6.0)] ( Z=-3.38, P<0.001), and 8 h [2.0 (1.0, 4.0) vs. 5.0 (2.0, 6.0)] ( Z=-2.11, P=0.035) postoperatively compared to the control group. There were no statistically significant differences in pain scores between the groups at 30 min, 24 h, 48 h, and 72 h postoperatively ( P>0.05). Additionally, 11 out of 41 patients (26.8%) in the ibuprofen group and 23 out of 41 patients (56.1%) in the control group required extra analgesic medication between days 4 and 6 post-surgery, with the ibuprofen group taking significantly fewer additional pills [0.0 (0.0, 1.0) vs. 1.0 (0.0, 3.0)] ( Z=-2.81, P=0.005). Conclusions:A pain management regimen involving 300 mg of oral sustained-release ibuprofen capsules administered 15 minutes before surgery and continued for 3 d postoperatively effectively reduces pain levels and the total amount of analgesic medication used after the extraction of impacted mandibular third molars. Considering its efficacy, safety, and cost-effectiveness, ibuprofen is recommended as a first-line drug for perioperative pain management, enhancing patient comfort during diagnosis and treatment in a feasible manner.

Objective:To evaluate the effect of preemptive analgesia with ibuprofen on postoperative pain following single posterior tooth implantation, aiming to provide a clinical reference for its application.Methods:A multicenter, randomized, double-blind, placebo-controlled parallel-group trial was conducted. A total of 82 participants were included in the trial, meeting the eligibility criteria from April 2022 to April 2024 at the Capital Medical University School of Stomatology (40 cases), Beijing TianTan Hospital, Capital Medical University (22 cases), Beijing Chao-Yang Hospital, Capital Medical University (20 cases). Participants were randomly assigned in a 1∶1 ratio to either the ibuprofen group or the control group, with each group comprising 41 individuals. Participants in the ibuprofen group received 300 mg of sustained-release ibuprofen capsules orally 15 min before surgery, while the control group received a placebo. Both groups received the same postoperative analgesic regimen for 3 days. Pain scores were assessed using the numerical rating scale at 30 min, 4 h, 6 h, 8 h, 24 h, 48 h, and 72 h postoperatively, and the additional use of analgesic medication was recorded from days 4 to 6 postoperatively.Results:A total of 82 participants were initially enrolled in the study, with 7 dropouts (4 from the control group and 3 from the ibuprofen group), resulting in 75 participants (37 in the control group and 38 in the ibuprofen group) completing the trial. There were no reports of adverse events such as nausea or vomiting among the participants. The ibuprofen group exhibited significantly lower pain scores at 4 h, 6 h and 8 h [1.0 (0.0, 2.0), 1.0 (0.0, 2.0), 1.5 (0.0, 3.0) ] postoperatively compared to the control group 4 h, 6 h and 8 h [2.0 (1.0, 3.0), 3.0 (1.5, 4.0), 2.0 (1.0, 4.0)] ( Z=-1.99, P=0.047; Z=-3.01, P=0.003; Z=-2.10, P=0.036). The proportions of patients requiring additional analgesic medication between days 4 and 6 post-surgery were 18.4% (7/38) in the ibuprofen group and 27.0% (10/37) in the control group, with no significant difference (χ 2=0.79, P=0.373). The median additional medication usage postoperatively was [0.0 (0.0, 0.0) pills] in the ibuprofen group and [0.0 (0.0, 1.0) pills] in the control group, with no significant difference ( Z=-0.78, P=0.439). Conclusions:Preemptive analgesia with ibuprofen effectively reduces postoperative pain following tooth implantation, representing a safe and effective perioperative pain management strategy.

Objective:To analyze the risk factors associated with hemorrhagic complications at the puncture site after femoral artery access cerebrovascular interventions and construct a bleeding risk scale.Methods:Two hundred and fifteen patients who underwent femoral artery puncture interventions in the neurointerventional department ward of the First Affiliated Hospital of Zhengzhou University from April to October 2020 were selected for the study, including 60 cases in the complication group and 155 cases in the control group. The patients′ general data, interventional procedure-related data and laboratory tests were analyzed univariately and then incorporated into a binary multi-factor logistic regression analysis to determine independent risk factors, and a bleeding risk scale was constructed according to the regression model.Results:Compared with the control group, there was a statistically significant increase in the incidence of women, diabetes mellitus, use of glucose-lowering drugs, proportion of (anticoagulant/antiplatelet drugs) use and irritability in the complication group ( χ2 values were 4.94-15.81, all P<0.05); age, BMI, HbA1c, prothrombin time activity, and sheath size and operative time were higher than those of the control group, and prothrombin time and creatinine values were lower than those of the control group, with statistically significant differences ( t values of -6.25 to 2.80, respectively, all P<0.05). Multifactorial logistic regression analysis showed that gender ( OR=0.09, 95% CI 0.025-0.302), BMI ( OR=1.736, 95% CI 1.462-2.115), HbA1c ( OR=1.775, 95% CI 1.107-2.845), and use of anticoagulant/antiplatelet drugs ( OR= 0.082, 95% CI 0.015- 0.448) and time to surgery ( OR=1.031, 95% CI 1.012-1.052) were independent risk factors for bleeding complications. In the risk scale: the total score was -3 to 13, and risk existed for a score ≥5. The sensitivity of this scale was 83.3%, the specificity was 92.3%, and the area under the ROC curve was 0.878 ( P<0.001, 95% CI 0.818 to 0.938). Conclusions:Female, high BMI, high HbA1c, anticoagulant/antiplatelet drug use, and long procedure time can increase the risk of bleeding complications at the femoral artery puncture. The predictive model has good predictive performance and can be extended for use.

Objective:To develop a prototype artificial intelligence image recognition system for detecting dental caries, especially those without cavities, in children.Methods:Seven hundred and twelve intraoral photos, which were taken by dental professionals using a digital camera from October 2013 to June 2020 in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, were collected from the children who received dental treatment under general anesthesia. The well-documented post-treatment electronic dental record of each child was identified as label standard to determine whether the teeth were carious and the type of caries types such as caries that had become cavities (caries with cavities), pit and fissure caries that had not become cavities (pit and fissure caries) and proximal caries which the marginal ridge enamel had not been destroyed (proximal caries). The various teeth and caries types were labeled by pediatric dentists using VoTT software (Windows 2.1.0, Microsoft, U S A). There were five labeled groups: pit and fissure caries, approximal caries, non-carious approximal surfaces, caries with cavities and teeth without caries (including intact fillings). Each group was randomly divided into training dataset, validation dataset and test dataset at a ratio of 6.4∶1.6∶2.0 by using random number table. After using the labeled training dataset for deep learning training, a deep learning-based artificial intelligence (AI) image recognition system for detecting dental caries was established, with the caries probability greater than 50.0% as the criterion for determining caries. Sensitivity and accuracy were used as indicators of recognition specificity.Results:Seven hundred and twelve single-jaw intraoral photographs were segmented and annotated into 953 pit and fissure caries, 1 002 approximal caries, 3 008 caries with cavities, 3 189 teeth without caries and 862 non-carious approximal surfaces, totaly 9 014 labels. The sensitivities and specificities of the test set were 96.0% and 97.0% for caries with cavities, 95.8% and 99.0% for pit and fissure caries and 88.1% and 97.1% for approximal caries.Conclusions:The current AI system developed based on deep learning of the intra-oral photos in the present study showed the ability to detect dental caries. Furthermore, the AI system could accurately verify different types of dental caries such as caries with cavities, pit and fissure caries and proximal caries.

Objective:To explore the effect of remote pulmonary rehabilitation management in chronic obstructive pulmonary disease (COPD) patients.Methods:From May 2017 to May 2019, convenience sampling was used to select 114 COPD outpatients in the Respiratory Department of the First Affiliated Hospital of Zhengzhou University. All patients were randomly divided into control group ( n=57) using conventional pulmonary rehabilitation management and observation group ( n=57) using remote pulmonary rehabilitation management, respectively, and the management period was one year. We compared the differences in COPD self-management ability, body mass index, airflow obstruction, dyspnea, exercise capacity (BODE) index, and average annual hospital admission rate between the two groups. Results:After intervention, the scores and the total score of self-management of observation group were higher than those of control group, and the differences were statistically significant ( P<0.01) . The dimension scores and the total score of self-management of observation group after the intervention were higher than those before intervention, and the differences were statistically significant ( P<0.05) . After intervention, the observation group's percentage of forced vital capacity in the first second to predicted value and the 6 minutes walking distance were higher than those of control group, and the dyspnea score and BODE index were lower than those of control group, and the differences were statistically significant ( P<0.05) . The average annual admission rate of the observation group and the control group were 5.41% and 9.06%, respectively. The average annual hospital admission rate of observation group was lower than that of control group, and the difference was statistically significant (χ 2=6.806, P=0.009) . Conclusions:Remote pulmonary rehabilitation management can improve the self-management ability of COPD patients, improve pulmonary function and reduce the admission rate of patients, which is worthy of clinical promotion.

Objective To observe the safety and efficacy of submaximal balloon dilation combined with Enterprise stent in the treatment of complex symptomatic intracranial atherosclerotic stenosis (ICAS).Methods Clinical data of 70 patients with complicated symptomatic ICAS treated in our hospital from February 2015 to September 2018 were retrospectively analyzed, and any stroke (cerebral infarction or transient ischemic attack [TIA] or cerebral hemorrhage), or death within 30 days were observed, as well as the recurrence of ischemic events and stent restenosis in the vascular supply area after 30 d of follow-up.Results Among the 70 patients, the success rate of operation was 100％; the preoperative stenosis rate was (81.4±10.2)％ and the postoperative stenosis rate was (18.3±6.4)％, with significant difference (P<0.05). Perioperative complications occurred in 4 patients (5.7％): two were subacute thrombosis in stent two d after operation; one had cerebral hemorrhage 10 h after operation, and one had perforator artery occlusion leading to pontine infarction. Nine patients (14.5％) had restenosis in stent during the follow-up period; symptomatic restenosis occurred in 3 (4.8％).Conclusion It is safe and effective to treat complex symptomatic ICAS with submaximal balloon dilatation combined with Enterprise stent, which can obviously decrease the incidences of postoperative complications and recent in-stent restenosis.

Objective: To assess the incidence and independent risk factors for clinical anastomotic leakage (AL) in patients undergoing anterior resection (AR) or low anterior resection, (LAR) for rectal cancer. Methods: This was a retrospective case-control study of 550 patients with rectal cancer who underwent AR or LAR from April 2007 to March 2017 in Beijing Friendship Hospital, Capital Medical University. The relationship between the incidence of AL and clinicopathological manifestations was analyzed by Chi-squared test and Fisher exact test, and the independent risk factors of AL were analyzed using logistic regression analysis. AL is defined as a defect (including necrosis or abscess formation) of the intestinal wall at the anastomotic site, leading to a communication between the intra- and extra-luminal compartments. AL can be divided into three grades. Grade A anastomotic leakage results in no change in the management of patients, whereas grade B leakage requires active therapeutic intervention but is manageable without re-laparotomy. Grade C anastomotic leakage requires re-laparotomy. Results: AL was noted in 32 (5.8%) of 550 patients with rectal cancer who underwent AR or LAR, including 15 (46.9%) , 4 (12.5%) , and 13 patients (40.6%) with Grades A, B, and C, respectively. Five patients (0.9%, 5/550) died peri-operatively. AL- and non-AL-related deaths occurred in 3 (9.4%, 3/32, all cases were Grade C) and 2 patients (0.4%, 2/518) , respectively, with the two mortality rates being significant difference (P = 0.002) . Chi-squared test or Fisher exact test showed that the incidence of AL was associated with neoadjuvant chemoradiotherapy (P = 0.011) , intraoperative bleeding (≥100 ml) (χ² = 11.980, P = 0.001) , and tension-reducing suture of anastomosis (P = 0.015) . The results of logistic regression analysis showed that the independent risk factors of AL were neoadjuvant chemoradiotherapy (OR = 2.402, 95%CI: 1.004 - 5.749, P = 0.049) , intraoperative bleeding (≥100 ml) (OR = 2.971, 95%CI: 1.269 - 6.957, P = 0.012) and tension-reducing suture of anastomosis (OR = 2.304, 95%CI: 1.008 - 5.263, P = 0.048) . Conclusion The incidence of AL in patients undergoing AR for rectal cancer is 5.8%. The high-risk factors for AL are neoadjuvant chemoradiotherapy, intraoperative bleeding (≥100 ml) , and tension-reducing suture of anastomosis. Patients with these three risk factors have a high risk of AL rate, and a defunctioning stoma should be performed.

Objective To construct mobile-health APP intervention program and investigate effects of mobile-health APP on the treatment compliance and quality of life in patients with chronic rhinosinusitis after endoscopic sinus surgery. Methods From March 2016 to May 2017,a total of 83 chronic rhinosinusitis patients hospitalized in the First Affiliated Hospital of Zhengzhou University were randomly divided into observation group and control group, with 42 cases in the observation group and 41 cases in the control group. Patients in the control group were treated with standard discharged nursing, while patients in the observation group received additional mobile-health APP. The Sinonasal Outcome Test-22 (SNOT-22), Treatment Compliance Questionnaire and Visual Analogue Scale (VAS) were used to evaluate patients in two groups before and after the intervention. Results At 3 months after discharge, SNOT-22 and VAS scores of patients in the observation group were lower than the control group; treatment compliance score of patients in the observation group was higher than the control group; there were statistically significant differences between two groups (P<0.01). Conclusions The mobile-health APP can improve treatment compliance, alleviate the nasal symptoms, and increase the quality of life of patients with chronic rhinosinusitis after endoscopic sinus surgery.