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

ObjectiveTo explore the impact of blood-invigorating and stasis-dissolving medicinals combined with conventional western medicine on the major adverse cardiovascular events （MACE） in patients with coronary heart disease （CHD） after percutaneous coronary intervention （PCI）. MethodsA prospective cohort study was conducted to collect data on consecutive cases of CHD after PCI. According to whether blood-invigorating and stasis-dissolving medicinals were used， the cases were divided into a Chinese herbal medicinals （CHM） group and control group. The primary outcome was the incidence of MACE one year after PCI， while the secondary outcomes included TCM syndrome score and echocardiography left ventricular ejection fraction （LVEF）. Logistic regression analysis was performed to explore the influencing factors of MACE. ResultsA total of 844 patients who met the criteria were included， with 617 in the CHM group and 227 in the control group. The main blood-invigorating and stasis-dissolving medicinals being used were Danshen （Radix et Rhizoma Salviae Miltiorrhizae， 46.35%）， Chuanxiong （Rhizoma Chuanxiong， 45.87%）， and Chishao （Radix Paeoniae Rubra， 42.30%）. After a median follow-up of 12.73 months， the incidence of MACE in the CHM group （142/617， 23.01%） was significantly lower than that in the control group （68/227， 29.96%） with significant difference （OR=0.70， 95%CI 0.50 to 0.98， P = 0.04）. The LVEF of the CHM group ［（60.06±6.13）%］ was higher than that of the control group ［（58.27±7.36）%］ with significant difference （t = 0.356， P＜0.01）. The TCM syndrome score in the CHM group decreased to 12.66±4.47， while that in the control group increased to 13.81±3.88， with the results favoring the CHM group （t = 2.78， P＜0.01）. Univariate analysis showed correlations between the incidence of MACE after PCI and the use of blood-invigorating and stasis-dissolving medicinals， LVEF， usage of renin-angiotensin-aldosterone system （RAAS） inhibitors， TCM syndrome score， and usage of β blockers （P＜0.05）. Multivariate analysis showed that the use of blood-invigorating and stasis-dissolving medicinals was significantly associated with the reduction of MACE （P＜0.01）， while the baseline LVEF decline， TCM syndrome score increase， no use of RAAS inhibitors or β blockers were the risk factors of MACE after PCI （P＜0.05）. ConclusionThe use of blood-invigorating and stasis-dissolving medicinals based on the conventional western medicine can reduce the risk of MACE one year after PCI of CHD， improve the TCM syndromes and protect heart function.

Objective:To investigate psychological resilience of inpatients with extracranial arteriovenous malformation (AVM) and analyze the related factors, in order to provide scientific basis for improving the psychological resilience of patients.Methods:A cross-sectional study was conducted to include patients with extracranial AVM who were hospitalized in the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from October 2020 to December 2021. The general information questionnaire, Cornor-Davidon resilience scale, Herth hope index, medical coping modes questionnaire and family APGAR scale were used to investigate them. SPSS 21.0 software was used. The t-test, one-way ANOVA, Pearson correlation analysis and multiple linear regression analysis were used for statistical analysis. Results:In total, 177 patients with extracranial AVM were included in our study. The total mean score of the resilience scale was 65.94±13.90, and the mean scores of the three dimensions of resilience, optimism and strength were 33.02±7.67, 10.38±2.75 and 22.54±4.67. The mean scores of Herth hope index was 37.50±3.56, positive coping style was 24.89±6.65, and family APGAR scale was 8.19±2.41. In univariate analysis, gender, ethnicity and family relationship had significant differences in psychological resilience (all P<0.05). Among these patients, female’s mental resilience score was significantly lower than that of male’s. Correlation analysis showed that the scores of the Herth hope index, positive coping style, and family APGAR scale were positively correlated with the total scores of resilience and the scores of each dimension (all P<0.01). Multiple linear regression analysis showed that gender, the scores of Herth hope index, positive coping mode, family APGAR scale were main influencing factors of resilience ( P<0.05). Conclusion:Female patients with extracranial AVM need more attention to their psychological problems and psychological reactions. Herth hope, positive coping mode, family-centered care are the protective factors of resilience of patients with extracranial AVM.

Objective:To investigate psychological resilience of inpatients with extracranial arteriovenous malformation (AVM) and analyze the related factors, in order to provide scientific basis for improving the psychological resilience of patients.Methods:A cross-sectional study was conducted to include patients with extracranial AVM who were hospitalized in the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from October 2020 to December 2021. The general information questionnaire, Cornor-Davidon resilience scale, Herth hope index, medical coping modes questionnaire and family APGAR scale were used to investigate them. SPSS 21.0 software was used. The t-test, one-way ANOVA, Pearson correlation analysis and multiple linear regression analysis were used for statistical analysis. Results:In total, 177 patients with extracranial AVM were included in our study. The total mean score of the resilience scale was 65.94±13.90, and the mean scores of the three dimensions of resilience, optimism and strength were 33.02±7.67, 10.38±2.75 and 22.54±4.67. The mean scores of Herth hope index was 37.50±3.56, positive coping style was 24.89±6.65, and family APGAR scale was 8.19±2.41. In univariate analysis, gender, ethnicity and family relationship had significant differences in psychological resilience (all P<0.05). Among these patients, female’s mental resilience score was significantly lower than that of male’s. Correlation analysis showed that the scores of the Herth hope index, positive coping style, and family APGAR scale were positively correlated with the total scores of resilience and the scores of each dimension (all P<0.01). Multiple linear regression analysis showed that gender, the scores of Herth hope index, positive coping mode, family APGAR scale were main influencing factors of resilience ( P<0.05). Conclusion:Female patients with extracranial AVM need more attention to their psychological problems and psychological reactions. Herth hope, positive coping mode, family-centered care are the protective factors of resilience of patients with extracranial AVM.

The 2022 Fudan university doctorate academic public health forum hosted by the graduate school of Fudan university， the graduate work department of the party committee of Fudan university， and the school of public health of Fudan university was successfully held on December 10， 2022 in the school of public health of Fudan university. In the early stage， a total of 53 manuscripts from nationwide universities and research institutes were received， and 10 were selected as excellent papers to participate in the forum report. More than 100 teachers and students attended the forum. Focusing on the theme of " Adhering to the original ambition of scientific research to serve the country and practicing the mission of public health youth"， the major contents of the forums included excellent paper reports in the morning and round-table discussion in the afternoon. Experts and students conducted discussions and communications on prevention， control and management of public health emergencies. It is of great benefit for students to uphold the original intention，practice the mission and further improve public health research.

Objective:To explore the resistance of common clinical isolates to chlorhexidine gluconate (CHG) and the clinical characteristics of patients with the infections.Methods:A total of 1 000 isolates from the First Affiliated Hospital of Wenzhou Medical University in 2018 (from January to May) were collected, which included 200 strains each of Escherichia coli ( E. coli), Acinetobacter baumanii ( A. baumanii), Pseudomonas aeruginosa ( P. aeruginosa), Staphylococcus aureus ( S. aureus), and Enterococcus spp.. Minimum inhibitory concentration (MIC) of CHG against 1 000 isolates were determined by the agar dilution method. The correlation between the resistance of isolates and clinical characteristics of infected patients was analyzed. Chi-square test or Fisher exact probability test were used for statistical analysis. Results:A total of 57 CHG resistant strains were detected in 1 000 clinical isolates. These CHG-resistant strains were mainly isolated from sputum and intensive care unit ward, accounting for 49.1%(28/57)and 38.6%(22/57), respectively. The resistance rates of P. aeruginosa, A. baumanii, Enterococcus spp., S. aureus, and E. coli to CHG were 16.0%(32/200), 7.0%(14/200), 3.0%(6/200), 1.5%(3/200) and 1.0%(2/200), respectively. The CHG-resistant rates of P. aeruginosa to ceftazidime, ciprofloxacin, levofloxacin and gentamicin were 53.1%(17/32), 78.1%(25/32), 65.6%(21/32) and 50.0%(16/32), respectively, which were all higher than those of CHG-sensitive P. aeruginosa (25.0%(8/32), 25.0%(8/32), 21.9%(7/32) and 15.6%(5/32), respectively), with statistical significance ( χ2=5.317, 18.080, 12.444 and 8.576, respectively, all P<0.05). The hospital mortality was 22.8%(13/57) in patients infected with CHG-resistant bacteria, which was higher than that in patients infected with CHG-sensitive bacteria ((7.0%(4/57); Fisher exact probability test, P=0.018)). CHG-resistant group had a higher history of CHG exposure and antimicrobial treatment (61.4%(35/57) and 70.2%(40/57), respectively), which were both higher than those with CHG-susceptible isolates (17.5%(10/57) and 47.4%(27/57), respectively), the differences were both statistically significant ( χ2=22.947 and 6.118, respectively, both P<0.05). In addition, the multi-drug resistance rate of CHG-resistant strains was 54.4%(31/57), which was higher than that of CHG-susceptible strains (35.1%(20/57)), the difference was statistically significant ( χ2=4.293, P=0.039). Conclusions:CHG resistant strains have higher antimicrobial resistance. Hospital mortality in patients infected with CHG-resistant bacteria is higher than patients infected with CHG-sensitive bacteria. The important risk factors are CHG exposure and antimicrobial therapy.

Objective:To explore the effect of atractylenolide-1 (ATL-Ⅰ) on alveolar macrophages in silicosis patients.Methods:In December 2019, 12 male silicosis patients treated in Beidaihe Sanatorium for Chinese Coal Miners from July to September 2019 were selected by random sampling. Their alveolar macrophages were collected and divided into control group, ATL-Ⅰ group (100 μmol/L) and dimethyl sulfoxide (DMSO) group (100 μmol/L) . The exprossion levels of inflammatory factor interleukin-1β (IL-1β) , interleukin-6 (IL-6) , tumor necrosis factor α (TNF-α) were detected by enzyme-linked immunosorbent assay. The expression levels of autophagy associated protein microtubule associated protein light chain 3 (LC3) , autophagy substrate protein p62, lysosome associated membrane protein 2 (LAMP2) , apoptosis associated protein Cleaved caspase-3, nuclear factor kappa B (NF-κB) and its phosphorylated form (p-NF-κB) were detected by Western blot.Results:Compared with the control group and DMSO group, the expression levels of IL-1β, IL-6, TNF-α in alveolar macrophages decreased significantly in the ATL-Ⅰ group ( P<0.05) , and the expression levels of p-NF-κB, the ratio of LC3-Ⅱ/LC3-Ⅰ also decreased significantly in the ATL-Ⅰ group ( P<0.05) . However, the expression levels of NF-κB, LAMP2, p62 and Cleaved caspase-3 in the ATL-Ⅰ group were not statistically different from those in the control group and DMSO group ( P>0.05) . There was no statistically significant differences in the expression of the above indexes between the control group and DMSO group ( P>0.05) . Conclusion:ATL-Ⅰ may reduce the release of inflammatory factors from alveolar macrophages and inhibit the activity of autophagy in silicosis patients, but it may not reduce the level of apoptosis.

Selective autophagy keeps cell homeostasis by degrading aggregated proteins, damaged or over-abundant organelles, and other cytoplasmic substances. The maintenance of its normal function needs to ensure that the autophagy receptor can effectively recognize and isolate undegraded substances. As an important autophagy receptor protein, p62 participates in the process of selective autophagy by mediating multiple signaling pathways. Fibrosis is a pathological feature of most chronic inflammatory diseases. When fibrosis develops for a long time, it will cause substantial scar formation and eventually lead to cell dysfunction and organ failure. The accumulation, overexpression and ectopic expression of p62 can aggravate the occurrence and development of lung, liver and kidney fibrosis diseases. Therefore, it is very critical to explore the effect of selective autophagy receptor p62 on fibrotic diseases.

Objective:To explore the effect of atractylenolide-1 (ATL-Ⅰ) on alveolar macrophages in silicosis patients.Methods:In December 2019, 12 male silicosis patients treated in Beidaihe Sanatorium for Chinese Coal Miners from July to September 2019 were selected by random sampling. Their alveolar macrophages were collected and divided into control group, ATL-Ⅰ group (100 μmol/L) and dimethyl sulfoxide (DMSO) group (100 μmol/L) . The exprossion levels of inflammatory factor interleukin-1β (IL-1β) , interleukin-6 (IL-6) , tumor necrosis factor α (TNF-α) were detected by enzyme-linked immunosorbent assay. The expression levels of autophagy associated protein microtubule associated protein light chain 3 (LC3) , autophagy substrate protein p62, lysosome associated membrane protein 2 (LAMP2) , apoptosis associated protein Cleaved caspase-3, nuclear factor kappa B (NF-κB) and its phosphorylated form (p-NF-κB) were detected by Western blot.Results:Compared with the control group and DMSO group, the expression levels of IL-1β, IL-6, TNF-α in alveolar macrophages decreased significantly in the ATL-Ⅰ group ( P<0.05) , and the expression levels of p-NF-κB, the ratio of LC3-Ⅱ/LC3-Ⅰ also decreased significantly in the ATL-Ⅰ group ( P<0.05) . However, the expression levels of NF-κB, LAMP2, p62 and Cleaved caspase-3 in the ATL-Ⅰ group were not statistically different from those in the control group and DMSO group ( P>0.05) . There was no statistically significant differences in the expression of the above indexes between the control group and DMSO group ( P>0.05) . Conclusion:ATL-Ⅰ may reduce the release of inflammatory factors from alveolar macrophages and inhibit the activity of autophagy in silicosis patients, but it may not reduce the level of apoptosis.

Selective autophagy keeps cell homeostasis by degrading aggregated proteins, damaged or over-abundant organelles, and other cytoplasmic substances. The maintenance of its normal function needs to ensure that the autophagy receptor can effectively recognize and isolate undegraded substances. As an important autophagy receptor protein, p62 participates in the process of selective autophagy by mediating multiple signaling pathways. Fibrosis is a pathological feature of most chronic inflammatory diseases. When fibrosis develops for a long time, it will cause substantial scar formation and eventually lead to cell dysfunction and organ failure. The accumulation, overexpression and ectopic expression of p62 can aggravate the occurrence and development of lung, liver and kidney fibrosis diseases. Therefore, it is very critical to explore the effect of selective autophagy receptor p62 on fibrotic diseases.