ObjectiveTo observe clinical effectiveness and safety of lumbar oscillatory manipulation in the treatment of patients with lumbar disc herniation. MethodsThis study recruited 90 lumbar disc herniation patients who were randomly divided into 45 cases each in the treatment group and the control group. The treatment group was given lumbar oscillatory manipulation， while the control group was given traditional lumbar obliquely pulling manipulation， and both groups were treated twice a week for 4 weeks. The Oswestry dysfunction index （ODI） score， lumbar spine mobility， and the absolute values of difference in hardness between the left and right sides of the lumbar erector spinae muscle were compared between groups of patients before treatment and after 2 and 4 weeks of treatment； the shear wave elastic modulus of multifidus muscle and abdominal muscle thickness were compared between groups before treatment and after 4 weeks of treatment； the clinical effectiveness of the treatment was compared， and the safety evaluation was carried out. ResultsCompared with the group before treatment， the ODI scores and the the absolute values of difference in hardness between the left and right sides of the lumbar erector spinae muscle decreased after 2 and 4 weeks treatment in both groups， and the mobility of the lumbar vertebrae in all directions of anterior flexion， posterior extension， left lateral flexion， and right lateral flexion increased； the shear wave elastic modulus of bilateral multifidus muscles of the fourth lumbar vertebral segments decreased， and the thickness of abdominal muscle increased after 4 weeks of treatment in both groups （P＜0.05）. Compared with the control group， the ODI score of the treatment group decreased after 2 weeks of treatment， and the shear wave elastic modulus value of bilateral multifidus muscle of the fourth lumbar vertebral segment decreased and the thickness of abdominal muscle increased after 4 weeks of treatment （P＜0.05）. The total effective rate was 90.48% （38/42） in the treatment group and 71.43% （30/42） in the control group， and the clinical effectiveness of the treatment group was better than that of the control group （P＜0.05）. No adverse events occurred in both groups during the study. ConclusionLumbar oscillatory manipulation is superior to traditional lumbar obliquely pulling manipulation in relieving symptoms of lumbar disc herniation and improving lumbar spine function， which may be related to its improvement in the elasticity of the multifidus muscle.

OBJECTIVES: To investigate the risk factors of overall postoperative complications in elderly patients undergoing gastrointestinal surgeries. METHODS: This study was conducted among a total of 1388 elderly patients, who underwent elective gastrointestinal surgeries at 17 centers across China between April, 2020 and April, 2022. The primary outcome was the incidence of postoperative complications within 30 days, including procedure-related, neuropsychiatric, respiratory, cardiovascular, and gastrointestinal complications as well as acute kidney injury. Baseline characteristics, preoperative psychological and functional status, intraoperative anesthesia and surgical factors, intraoperative medication, use of nerve block, and postoperative analgesia methods were compared between the patients experiencing one or more postoperative complications and those without complications. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for postoperative complications. The relationship between postoperative acute pain and each type of complication were explored. RESULTS: The incidence of overall postoperative complications was 50.8% (705/1388) in these patients. Multivariate analysis showed that age (OR: 1.026; 95% CI: 1.006-1.046), prognostic nutritional index (OR: 0.998; 95% CI: 0.997-1.000), preoperative EuroQol-5 dimensions score (OR: 0.094; 95% CI: 0.018-0.500), blood loss (OR: 1.002; 95% CI: 1.001-1.003), and acute postoperative pain (OR: 1.308; 95% CI: 1.033-1.657) were significantly associated with the occurrence of postoperative complications. Specifically, patients experiencing severe postoperative pain had a significantly higher incidence of neuropsychiatric (27.2% vs 19.8%), procedure-related (17.3% vs 10.2%), and cardiovascular complications (3.6% vs 1.7%). CONCLUSIONS An advanced age, a low preoperative nutritional index, a poor quality of life score, a greater volume of intraoperative blood loss, and acute postoperative pain are independent risk factors for postoperative complications in elderly patients undergoing gastrointestinal surgeries. There is a significant association between acute postoperative pain and multi-system complications.
Humans ; Postoperative Complications/etiology* ; Aged ; Risk Factors ; Digestive System Surgical Procedures/adverse effects* ; Male ; Female ; China/epidemiology* ; Pain, Postoperative/epidemiology* ; Incidence ; Aged, 80 and over

Objective:To understand the current status, hotspots and trends of hospice care education for nursing staff at home and abroad, so as to provide the reference for follow-up research.Methods:Literatures related to hospice care education for nursing staff were retrieved from China National Knowledge Infrastructure and Web of Science database from January 1, 2000 to October 8, 2023. EndNote21 was used for bibliometric analysis. CiteSpace6.2.R2 software was used to draw and interpret the knowledge map of keywords.Results:A total of 445 and 3 637 articles were included in China National Knowledge Infrastructure and Web of Science database. The number of publications was on the rise. A total of 11 clusters and 12 emerging keywords were obtained from China National Knowledge Infrastructure database. A total of 11 clusters and 25 emerging keywords were obtained from Web of Science database.Conclusions:The construction of standardized and homogeneous curriculum system and feedback evaluation system of hospice care education has been a research hotspot at home and abroad in recent years. For nurses with multi-level education, the use of multidisciplinary, multi-center, in-depth intervention research and evidence-based research to explore the hospice care education model in line with China′s national conditions is the development trend in the future.

ObjectiveTo investigate the association between estimated glucose disposal rate （eGDR） and the severity of coronary heart disease. MethodsWe conducted a hospital-based cross-sectional study that included 1258 patients （mean age： 62（53-68） years） who underwent coronary angiography for suspected coronary artery disease （53.9% were male）. Insulin resistance level （IR） was calculated according to eGDR formula： eGDR = 21.158 - （0.09 × WC） - （3.407 × hypertension） - （0.551 × HbA1c） ［hypertension （yes = 1 / no = 0）， HbA1c = HbA1c （%）］. Subjects were grouped according to the eGDR quantile. CAD severity was determined by the number of narrowed vessels： no-obstructive CAD group （all coronary stenosis were<50%， n=704）， Single-vessel CAD group （only one involved major coronary artery stenosis≥50%， n=205）， Multi-vessel CAD group （two or more involved major coronary arteries stenosis≥50%， n=349）； Multivariate logistic regression model was used to analyze the association between eGDR and CAD severity. The linear relationship between eGDR and CAD in the whole range of eGDR was analyzed using restricted cubic spline. Subgroup analyses were used to assess the association between eGDR and CAD severity in different diabetic states. Receiver operating characteristic （ROC） curve analysis were used to evaluate the value of eGDR in improving CAD recognition. ResultsA decrease in the eGDR index was significantly associated with an increased risk of CAD severity （OR： 2.79； 95%CI： 1.72~4.55； P<0.001）. In multivariate logistic regression models， individuals with the lowest quantile of eGDR （T1） were 2.79 times more likely to develop multi-vessel CAD than those with the highest quantile of eGDR （T3） （OR： 2.79； 95%CI： 1.72~4.55； P<0.001）. Multivariate restricted cubic spline analysis showed that eGDR was negatively associated with CAD and multi-vessel CAD （P-nonlinear>0.05）. In non-diabetic patients， compared with the reference group （T3）， the T1 group had a significantly increased risk of CAD （OR： 1.42； 95% CI： 1.00~2.01； P<0.05） and multi-vessel CAD （OR： 1.86； 95%CI： 1.21~2.86； P<0.05）. No statistical association was found between eGDR and CAD in diabetic patients. In ROC curve analysis， when eGDR was added to traditional model for CAD， significant improvements were observed in the model's recognition of CAD and multi-vessel CAD. ConclusionOur study shows eGDR levels are inversely associated with CAD and CAD severity. eGDR， as a non-insulin measure to assess IR， could be a valuable indicator of CAD severity for population.

Objective Pertussis cases have increased markedly since 2018 in Guangxi.The aim of this study was to evaluate antibody levels and the infection status of pertussis in the resident population. Method A total of 10,215 serum samples from residents were collected from August-November 2018 and tested for anti-pertussis IgG and toxin IgG using the enzyme-linked immunosorbent assay(ELISA). Results Of the collected samples,1,833(17.94%)tested positive for anti-pertussis IgG,with the median concentration of 16.06 IU/mL.Antibody level<10 IU/mL accounted for more than 60%in children under 4 years of age,but declined with age,whereas the percentages of the other three levels(10-40,40-50,and≥50 IU/mL)increased almost with age(P<0.001).Moreover,7,924 samples were selected for anti-pertussis toxin IgG,of which 653(8.24%)tested positive(≥40 IU/mL)with the median concentration of 5.89 IU/mL,and 204 participants(2.56%)had recent pertussis infection(≥100 IU/mL).Among the different age groups,the highest rates of positivity and recent infection were observed at 11-20 years of age,the lowest positivity rate at 5 years of age,and the lowest recent infection rate at 4 years of age(P<0.001,P=0.005,respectively). Conclusion The survey results showed that all age groups in Guangxi lacked immunity against pertussis,which was one of the main factors contributing to the resurgence of pertussis in 2018.In addition,the prevalence of pertussis is relatively high in Guangxi,and its incidence is seriously underestimated,especially in adolescents and adults.

Objective To explore the characteristics of white matter lesions(WMLs)causing cognitive function change in the patients with asymptomatic middle cerebral artery(MCA)stenosis,and to analyze the diagnostic efficiency of related indexes.Methods Thirty-nine patients diagnosed with asymptomatic MCA ste-nosis and presenting with WMLs in the department of neurology of the hospital from 2021 to 2022 were in-cluded as the observation group,and 34 healthy people were included as the control group.The two groups conducted the behavioral assessment of cognitive function,such as the Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),Test of Connectivity Type A(TMT),Digit Symbol Test(SDMT),Digit Breadth Test(DST),Drawing the Clock Test(CDT),and Verbal Fluency Test(VFT).The receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficiency of related indica-tors.Results In the single cognitive function assessment scales,the scores of TMT in the observation group were significantly higher than those in the control group(P＜0.01),the scores of SDMT,DST,CDT and VFT in the observation group were significantly lower than those in the control group and the differences were sta-tistically significant(P＜0.01).In the comprehensive cognitive function assessment scales,the total scores of MMSE and MoCA in the observation group were significantly lower than those in the control group(P＜0.01).In the scores of each factor of the MMSE scale,the verbal ability in the observation group was signifi-cantly lower than that in the control group(P＜0.01),but the scores of orientation,memory,attention,calcu-lation and recall were had no statistically significant differences between the two groups(P＞0.05).In the scores of each factor of MoCA,the visuospatial and executive ability,delayed memory,attention and abstrac-tion ability in the observation group were significantly lower than those in the control group(P＜0.01),but the scores of naming ability,attention ability and orientation ability had no statistically difference(P＞0.05).The area under the ROC curve(AUC),sensitivity and specificity of MoCA and MMSE were 0.80,0.73,0.52,0.71,0.92 and 0.74 respectively.The efficiency of MoCA for diagnosing cognitive function disorders caused by asymptomatic MCA stenosis was higher.Conclusion Compared with single cognitive function assessment scale,the comprehensive cognitive function assessment scales could more comprehensively and accurately screen the cognitive function disorders caused by WMLs in the patients with asymptomatic MCA stenosis,in which the diagnostic efficiency of MoCA is the highest.

As the window of the hospital,the emergency department's medical quality determines the medical quality of the entire hospital.Emergency medical safety is the key to hospital construction.However,due to problems such as staffing and medical technology in the department of emergency of Chinese Medicine Hospitals,the development of medical quality is highly unbalanced.Aiming at the medical safety problems in the department of emergency of Chinese Medicine Hospitals in our country,the department of emergency of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine analyzed the current situation at home and abroad,examined the causes of medical errors,and put forward suggestions for the reform of medical safety in the department of emergency of Chinese Medicine Hospitals.It is recommended to effectively reduce medical errors through a series of reform measures such as hardware transformation and upgrading,standardization of standard procedures,establishing a sound communication mechanism,and creating a safety culture.

Objective This study aimed to investigate the therapeutic efficacy of Sanjie Quban recipe in a keloid nude mice model and its impact on transforming growth factor-β 1(TGF-β1).Methods Keloid tissue after surgical resection was subcutaneously transplanted into the backs of healthy SPF BALB/C female nude mice,aged 6～8 weeks,and a keloid nude mice model was thus established.The mice were randomly divided into three groups,the Sanjie Quban recipe group,the Asiaticoside tablet group and the control gnup,with five in each group.They were respectively treated with Sanjie Quban recipe,Asiaticoside tablets,or sterile pure water.After 28 days of continuous gavage,the keloid tissue was exfoliated and weighed,and HE staining,Masson staining,and immunohistochemical staining for TGF-β1 were conducted.Differences in keloid weight between the three groups before and after treatment were compared,as were the differences in collagen fiber,fibroblast numbers,and TGF-β1 expression between the three groups after treatment.Results The difference in keloid weight before and after treatment in the Asiaticoside tablet group was greater than that of the control group,and the weight difference before and after treatment keloid treatment was the largest in the Sanjie Quban recipe group(P＜0.01).Compared with the control group,collagen fibers in the Sanjie Quban recipe group were looser and less numerous,and fibroblasts were decreased in number.The expression of TGF-β1 in the Sanjie Quban recipe group was decreased compared with that of the control group(P＜0.01).Conclusions Sanjie Quban recipe has certain therapeutic effects on keloids.The mechanism may involve reducing the expression of TGF-βl in keloid tissue and thereby reducing the proliferation of fibroblasts and the synthesis of extracellular matrix.This study provides experimental and theoretical bases for the clinical treatment of keloids with Chinese medicine.

Objective:To conduct a network meta-analysis comparing the efficacy and safety of various drug injections for treating keloids.Methods:The search terms of "triamcinolone acetonide, 5-fluorouracil, verapamil, botulinum toxin, platelet rich plasma, keloid, scar, drug injection" were retrieved in PubMed, Embase, Web of Science, CNKI and Wanfang database to obtain the publicly published randomized controlled trials comparing single or combined drug injection for treating keloid from January 2010 to February 2023. The outcome index was the effective proportion of treatment, incidence proportion of adverse reactions, and recurrence proportion. NoteExpress, RevMan 5.4, and Stata 16.0 statistical software were utilized to perform a network meta-analysis of eligible studies that met the inclusion and exclusion criteria.Results:A total of 1 679 patients were enrolled in 21 studies that evaluated nine treatment modalities: triamcinolone (TAC), 5-fluorouracil (5-FU), botulinum toxin type A (BTA), platelet-rich plasma (PRP), Verapamil, BTA+ 5-FU, TAC+ 5-FU, TAC+ BTA, and TAC+ PRP. The network diagram revealed that there were 36 pairwise comparisons among the 9 treatment measures, with direct comparisons in 13 of them. The funnel plot demonstrated a symmetrical distribution of effect size points, and both Beggs test and Eggers test yielded P values greater than 0.05, indicating a low likelihood of publication bias. Nine treatment measures formed five closed loops with good consistency. The result of the network meta-analysis indicated that BTA+ 5-FU was more effective than TAC, 5-FU, or PRP alone; TAC+ 5-FU was more effective than TAC, 5-FU, or PRP alone; TAC+ BTA was more effective than TAC, 5-FU, BTA, or PRP alone; Verapamil was more effective than 5-FU and BTA was more effective than 5-FU. All result were found to be statistically significant ( P<0.05). A surface under the cumulative ranking area (SUCRA) map was generated, displaying the efficacy ranking and corresponding SUCRA values for each treatment: BTA+ 5-FU (85.6%)>TAC+ 5-FU (84.8%)>BTA+ TAC (76.7%)>Verapamil (48.9%)>BTA (45.0%)>TAC+ PRP (43.8%)>PRP (32.1%)>TAC (24.7%)>5-FU(8.3%). In terms of recurrence rate, the incidence of recurrence was higher with 5-FU compared to BTA or TAC+ 5-FU, and the incidence of recurrence was higher with TAC compared to TAC+ 5-FU; these differences were statistically significant ( P<0.05). A SUCRA map was generated with the ranking and SUCRA value for each treatment as follows: 5-FU (80.4%)>TAC (73.5%)>Verapamil (65.7%)>TAC+ BTA (52.5%)>PRP (34.8%)>BTA+ 5-FU (33.7%)>TAC+ 5-FU (30.2%)>BTA (29.3%). The qualitative analysis revealed a significantly lower incidence of systemic and local adverse reactions following combined drug injection compared to single drug injection. Conclusion:In the treatment of keloids using drug injection, combination therapy utilizing multiple drugs has demonstrated superior efficacy, lower recurrence rates, and fewer adverse reactions in comparison to single-drug therapy. Notably, the utilization of BAT, 5-FU, and TAC in combination may yield the most favorable outcomes.

Objective:To conduct a network meta-analysis comparing the efficacy and safety of various drug injections for treating keloids.Methods:The search terms of "triamcinolone acetonide, 5-fluorouracil, verapamil, botulinum toxin, platelet rich plasma, keloid, scar, drug injection" were retrieved in PubMed, Embase, Web of Science, CNKI and Wanfang database to obtain the publicly published randomized controlled trials comparing single or combined drug injection for treating keloid from January 2010 to February 2023. The outcome index was the effective proportion of treatment, incidence proportion of adverse reactions, and recurrence proportion. NoteExpress, RevMan 5.4, and Stata 16.0 statistical software were utilized to perform a network meta-analysis of eligible studies that met the inclusion and exclusion criteria.Results:A total of 1 679 patients were enrolled in 21 studies that evaluated nine treatment modalities: triamcinolone (TAC), 5-fluorouracil (5-FU), botulinum toxin type A (BTA), platelet-rich plasma (PRP), Verapamil, BTA+ 5-FU, TAC+ 5-FU, TAC+ BTA, and TAC+ PRP. The network diagram revealed that there were 36 pairwise comparisons among the 9 treatment measures, with direct comparisons in 13 of them. The funnel plot demonstrated a symmetrical distribution of effect size points, and both Beggs test and Eggers test yielded P values greater than 0.05, indicating a low likelihood of publication bias. Nine treatment measures formed five closed loops with good consistency. The result of the network meta-analysis indicated that BTA+ 5-FU was more effective than TAC, 5-FU, or PRP alone; TAC+ 5-FU was more effective than TAC, 5-FU, or PRP alone; TAC+ BTA was more effective than TAC, 5-FU, BTA, or PRP alone; Verapamil was more effective than 5-FU and BTA was more effective than 5-FU. All result were found to be statistically significant ( P<0.05). A surface under the cumulative ranking area (SUCRA) map was generated, displaying the efficacy ranking and corresponding SUCRA values for each treatment: BTA+ 5-FU (85.6%)>TAC+ 5-FU (84.8%)>BTA+ TAC (76.7%)>Verapamil (48.9%)>BTA (45.0%)>TAC+ PRP (43.8%)>PRP (32.1%)>TAC (24.7%)>5-FU(8.3%). In terms of recurrence rate, the incidence of recurrence was higher with 5-FU compared to BTA or TAC+ 5-FU, and the incidence of recurrence was higher with TAC compared to TAC+ 5-FU; these differences were statistically significant ( P<0.05). A SUCRA map was generated with the ranking and SUCRA value for each treatment as follows: 5-FU (80.4%)>TAC (73.5%)>Verapamil (65.7%)>TAC+ BTA (52.5%)>PRP (34.8%)>BTA+ 5-FU (33.7%)>TAC+ 5-FU (30.2%)>BTA (29.3%). The qualitative analysis revealed a significantly lower incidence of systemic and local adverse reactions following combined drug injection compared to single drug injection. Conclusion:In the treatment of keloids using drug injection, combination therapy utilizing multiple drugs has demonstrated superior efficacy, lower recurrence rates, and fewer adverse reactions in comparison to single-drug therapy. Notably, the utilization of BAT, 5-FU, and TAC in combination may yield the most favorable outcomes.