OBJECTIVE: To compare the efficacy and safety of intravenous colistin sulfate combined with nebulized inhalation versus intravenous monotherapy for pulmonary infections caused by carbapenem-resistant organism (CRO). METHODS: A multicenter retrospective cohort study was conducted. Clinical data were collected from patients admitted to the intensive care unit (ICU) of 10 tertiary class-A hospitals in Henan Province between July 2021 and May 2023, who received colistin sulfate for CRO pulmonary infections. Data included baseline characteristics, inflammatory markers [white blood cell count (WBC), neutrophil count (NEU), procalcitonin (PCT), C-reactive protein (CRP)], renal function indicators [serum creatinine (SCr), blood urea nitrogen (BUN)], life support measures, anti-infection regimens, clinical efficacy, microbiological clearance rate, and prognostic outcomes. Patients were divided into two groups: intravenous group (colistin sulfate monotherapy via intravenous infusion) and combination group ((intravenous infusion combined with nebulized inhalation of colistin sulfate). Changes in parameters before and after treatment were analyzed. RESULTS: A total of 137 patients with CRO pulmonary infections were enrolled, including 89 in the intravenous group and 48 in the combination group. Baseline characteristics, life support measures, daily colistin dose, and combination regimens (most commonly colistin sulfate plus carbapenems in both groups) showed no significant differences between two groups. The combination group exhibited higher clinical efficacy [77.1% (37/48) vs. 59.6% (52/89)] and microbiological clearance rate [60.4% (29/48) vs. 39.3% (35/89)], both P < 0.05. Pre-treatment inflammatory and renal parameters showed no significant differences between two groups. Post-treatment, the combination group showed significantly lower WBC and CRP [WBC (×10⁹/L): 8.2±0.5 vs. 10.9±0.6, CRP (mg/L): 14.0 (5.7, 26.6) vs. 52.1 (24.4, 109.6), both P < 0.05], whereas NEU, PCT, SCr, and BUN levels showed no significant between two groups. ICU length of stay was shorter in the combination group [days: 16 (10, 25) vs. 21 (14, 29), P < 0.05], although mechanical ventilation duration and total hospitalization showed no significant differences between two groups. CONCLUSIONS Intravenous colistin sulfate combined with nebulized inhalation improved clinical efficacy and microbiological clearance in CRO pulmonary infections with an acceptable safety profile.
Humans ; Colistin/therapeutic use* ; Retrospective Studies ; Administration, Inhalation ; Anti-Bacterial Agents/therapeutic use* ; Carbapenems/pharmacology* ; Male ; Female ; Middle Aged ; Gram-Negative Bacteria/drug effects* ; Aged ; Treatment Outcome ; Respiratory Tract Infections/drug therapy*

Objectives:Quantitative flow ratio(QFR)is a coronary angiography-derived functional test without the need of guidewire use.Fractional flow reserve(FFR)is used as the reference standard to verify the diagnostic value of QFR in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS)with coronary critical lesion(40%-70%stenosis)and functional stenosis. Methods:This retrospective analysis included patients with NSTE-ACS who were admitted to Fuwai Central China Cardiovascular Hospital from June 1,2018 to February 1,2023 and underwent coronary FFR examination.QFR values of target vessels were analyzed offline by AngioPlus(Shanghai Pulsation Medical Imaging Technology Co.,LTD.),the second-generation QFR detector,and anatomical parameters of the diseased vessels were recorded as follows:minimal luminal diameter(MLD),percent diameter stenosis(DS%),minimal luminal area(MLA),percent area stenosis(AS%).Functional coronary artery stenosis is defined as FFR≤0.80. Results:Using FFR as the gold standard,the AUC values of contrast-flow QFR(cQFR)and fixed-flow QFR(fQFR)for identifying functional coronary artery stenosis in NSTE-ACS patients were 0.829(95%CI:0.773-0.885,P<0.001)and 0.821(95%CI:0.766-0.875,P<0.001),respectively.The diagnostic accuracy,sensitivity and specificity of cQFR and fQFR were 81.30%,56.00%,98.63%and 76.83%,59.00%,99.04%,respectively.DeLong test showed that diagnostic performance of cQFR was significantly better than fQFR in diagnosing functional stenosis of coronary critical lesions in patients with NSTE-ACS. Conclusions:With FFR as the gold standard,QFR(especially cQFR)has certain diagnostic value in patients with NSTE-ACS with functional stenosis of coronary critical lesions.

Objective:To explore the risk factors for peripherally inserted central catheter (PICC) related bloodstream infections in elderly acute leukemia patients during chemotherapy, and construct and validate relevant predictive models.Methods:This study selected 291 patients from the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2020 as the modeling group, and 277 patients from January 2021 to December 2022 as the validation group. Multivariate Logistic regression was used to determine the risk factors for PICC related bloodstream infections during chemotherapy in elderly acute leukemia patients, and a prediction model was constructed and validated based on the analysis results.Results:The incidence of PICC related bloodstream infections in the modeling group was 8.2% (24/291). Multivariate Logistic regression analysis showed that chemotherapy frequency, single catheterization puncture frequency, whether catheterization maintenance frequency was standardized, and catheterization retention time were risk factors for PICC related bloodstream infections in elderly acute leukemia patients during chemotherapy. Based on this result, a prediction model was constructed, and the area under the receiver operating characteristic curve ( AUC) of the modeling group's prediction model was 0.798 [95% CI (0.734, 0.869) ], while the AUC of the validation group's prediction model was 0.745 [95% CI (0.712, 0.844) ]. The calibration curves of the modeling and validation groups showed that the prediction model had high predictive performance. Conclusions:A prediction model for PICC related bloodstream infections in elderly acute leukemia patients during chemotherapy is constructed based on the results of multiple factor analysis, and the predictive performance of the model is verified. Nursing staff can quantify the risk of PICC related bloodstream infections in patients based on this prediction model and implement targeted nursing measures.

Objective:To explore the current status of readiness for young and middle-aged maintenance hemodialysis (MHD) patients to return to work and analyze its influencing factors, with the aim of providing reference for the evaluation and intervention of patients returning to work.Methods:From October to December 2022, convenience sampling was used to select 425 patients from six hospitals in the urban area of Yangzhou as the subject. A cross-sectional survey was conducted using the General Information Questionnaire, Readiness for Return-To-Work Scale (RRTWS), Distress Disclosure Index (DDI) and Perceived Social Support Scale (PSSS). Binary Logistic regression was used to analyze the influencing factors of returning to work.Results:Among 425 young and middle-aged patients undergoing MHD, 105 (24.7%) returned to work, of which 79 (75.2%) were in the uncertain maintenance stage and 26 (24.8%) were in the active maintenance stage. 320 did not return to work, including 148 (46.3%) in the pre-intention stage, 86 (26.9%) in the intention stage, 42 (13.1%) in the action preparation self-evaluation stage, and 44 (13.8%) in the action preparation behavior stage. Age, per capita monthly income of the family, number of comorbidities, level of self-disclosure, and level of perceived social support were factors that affected patients' readiness to return to work.Conclusions:The rate of young and middle-aged MHD patients returning to work needs to be improved. The return of patients to work is influenced by multiple factors. Medical and nursing staff should focus on patients who are old, have low per capita monthly income of the family, and have a large number of comorbidities. Targeted interventions and guidance should be provided to patients, such as self-disclosure training and improving their perceived social support, in order to increase the rate of patients returning to work rate.

Glass ionomer cement (GIC) is widely used as a common filling material in dentistry but still exhibits problems with secondary caries and fractures. Thus, the antibacterial and anti-caries performance of GIC needs to be further improved. In recent years, natural antimicrobial components have become more desirable due to their good biological properties and low drug resistance. In this review, the natural antimicrobial ingredients in GIC modification are classified, reviewed and summarized according to the different sources of antimicrobial ingredients. In terms of animal origin, chitosan and casein phosphopeptide-amorphous calcium phosphate exhibit antimicrobial properties without affecting the mechanical properties of materials; propolis and bioactive enzymes have good biocompatibility; in terms of plant origin, polyphenols help improve the antimicrobial and mechanical properties of the material; arginine has a good remineralization effect; and plant essential oils have a certain ion release effect. In terms of microbial origin, antibiotics greatly improve the antibacterial properties of materials; in addition, the combined application of natural antimicrobial ingredients also exhibited excellent performance. Despite these advantages, the optimal addition concentration and biocompatibility in vivo are questions that need to be further explored before clinical applications can be achieved.

Objective:To summarize the effect of reverse homodigital dorsal thumb flap in repairing thumb pulp defect.Methods:A retrospective case series study was conducted to analyze the clinical data of patients with thumb pulp defects admitted to the People's Hospital of Renqiu from March 2010 to June 2020. The dorsal homodigital island flap of the proximal phalanx was designed and harvested. During the procedure, the proximal digital artery of the perforator vessels of the flap was cut off and ligated. The digital artery pedicled flap was retrograde transferred to cover the thumb pulp defect. 9-0 line was used to anastomose the dorsal digital nerve with the proper digital nerve. The donor site was repaired with a free skin graft.Results:A total of 68 cases of thumb pulp defects were enrolled, all of whom were accompanied by exposure of the tendon of the distal phalanx. There were 39 males and 29 females, aged from 18 to 63 years (average of 35.8 years). The size of the proximal dorsal island flap was 2.0 cm × 3.0 cm to 3.1 cm × 4.2 cm. All flaps and skin grafts survived, and wounds healed primarily. All patients were followed up for 6 to 28 months (mean, 10.6 months). The color, texture, and contour of the flaps were good. All repaired thumbs got the normal function of extension and flexion. At the last follow-up, the two-point discrimination of flaps was 4-11 mm.Conclusions:It has the advantages of small trauma, simple operation, and good curative effect, using the homodigital dorsal thumb flap to repair the thumb pulp defect.

Objective:To summarize the effect of reverse homodigital dorsal thumb flap in repairing thumb pulp defect.Methods:A retrospective case series study was conducted to analyze the clinical data of patients with thumb pulp defects admitted to the People's Hospital of Renqiu from March 2010 to June 2020. The dorsal homodigital island flap of the proximal phalanx was designed and harvested. During the procedure, the proximal digital artery of the perforator vessels of the flap was cut off and ligated. The digital artery pedicled flap was retrograde transferred to cover the thumb pulp defect. 9-0 line was used to anastomose the dorsal digital nerve with the proper digital nerve. The donor site was repaired with a free skin graft.Results:A total of 68 cases of thumb pulp defects were enrolled, all of whom were accompanied by exposure of the tendon of the distal phalanx. There were 39 males and 29 females, aged from 18 to 63 years (average of 35.8 years). The size of the proximal dorsal island flap was 2.0 cm × 3.0 cm to 3.1 cm × 4.2 cm. All flaps and skin grafts survived, and wounds healed primarily. All patients were followed up for 6 to 28 months (mean, 10.6 months). The color, texture, and contour of the flaps were good. All repaired thumbs got the normal function of extension and flexion. At the last follow-up, the two-point discrimination of flaps was 4-11 mm.Conclusions:It has the advantages of small trauma, simple operation, and good curative effect, using the homodigital dorsal thumb flap to repair the thumb pulp defect.

Objective:To explore the effect of breathing exercises on motor, balance, respiration and ability in the activities of daily living (ADL) of patients with Parkinson′s disease.Methods:Sixty patients with idiopathic Parkinson′s disease who met the inclusion criteria were divided at random into a control group and a treatment group, each of 30. Both groups received routine drug therapy and 60 minute of rehabilitation training daily, including core muscle group control training, relaxation training, joint motion training, posture training, balance function training, gait training and facial muscle control training. There were 3 sessions a week for 24 weeks. The treatment group was also given breathing exercises, including training in abdominal breathing with the expiration time twice the inspiration time and inspiratory muscle training. The abdominal breathing training included 15 abdominal breaths, repeated twice after a 2-minute break; the inspiratory muscle training required 10 respirations and expirations at the maximum volume, repeated twice after an interval of 2 minutes. The training lasted 24 weeks, five times a week. The subjects′ motor functioning, balance, walking, respiration and daily living ability were evaluated before the treatment and after 12 and 24 weeks of treatment using the Parkinson′s Disease Rating Scale (part III) (UPDRS ⅲ), the Berg Balance Scale (BBS), the 6-minute walk test (6MWT), walking distance and the modified Barthel Index (MBI). Forced expiratory volume in the first second (FEV 1), forced vital capacity (FVC) and their ratio (FEV 1%) were also observed. Results:After 12 weeks of treatment, significant improvement was observed in the average UPDRS iii, BBS, 6MWT, MBI, FEV 1, FVC and FEV 1% results of both groups, but the improvement in the treatment group was significantly greater on average. After another twelve week the average UPDRS iii, BBS, 6MWT, MBI, FEV 1, FVC and FEV 1% results of the treatment group had improved significantly more than those of the control group. Conclusion:Breathing exercises can significantly improve the motor function, balance, walking, respiratory function and ADL ability of persons with Parkinson′s disease.

Objective:To investigate the therapeutic effect of reverse proximal segment dorsal flap of radial digital artery of the thumb in repairing thumb tip defects.Methods:A retrospective case series study was conducted to analyze the clinical data of 56 patients with thumb tip defects admitted to Renqiu People 's Hospital from February 2010 to October 2020. There were 37 males and 19 females，aged 17-66 years［（37.8±12.2）years］. The injury on the right side was observed in 35 patients and on the left side in 21 patients. All of them were thumb tip defects with exposed distal phalanx. Dimension of skin defects was 2.9 cm×1.8 cm-3.3 cm×2.6 cm.The reverse proximal segment dorsal flap of thumb radial digital artery was used，with the dorsal digital nerve sutured with the proper digital nerve. The donor site was repaired with free skin graft from the ulnar side of the affected forearm. The time of flap harvesting，operation time and healing of the flap were measured. At the last follow-up，the shape，texture，sensory recovery and complications of the flap were observed. One month after operation and at the latest follow-up，the upper limb function evaluation standard set up by hand surgery branch of Chinese Medical Association and Vancouver Scar Scale（VSS）score were used to evaluate the recovery of sensory function of the flap and scar formation of the donor sites，respectively. Results:All patients were followed up for 6-26 months［（13.2±6.4）months］. The time of flap harvesting ranged from 20 to 35 minutes［（26.0±5.3）minutes］. The operation time was 1-2 hours［（1.3±0.3）hours］. Blisters appeared at the distal end of the flap in 2 patients after operation，but they were not treated. After 7 days，the blisters subsided and the flaps survived. The other flaps survived successfully. The donor sites healed by first intention. At the last follow-up，the flaps showed relatively cosmetic appearance，similarities in texture，elasticity and color to the surrounding area and good sensory recovery，without scar contracture and dystrophy of interphalangeal joint. According to the upper limb function evaluation standard set up by hand surgery branch of Chinese Medical Association，56 patients exceeded S3 grade compared to none at postoperative 1 month（ P<0.01），and the VSS score was 3-7 points［（5.0±1.4）points］compared to 6-12 points［（8.8±1.5）points］at postoperative 1 month（ P<0.01）. The donor site left a linear scar，which had no significant effect on its shape and function. Conclusion:The reverse proximal segment dorsal flap of the radial digital artery of the thumb can be used to repair thumb tip defects，for it has advantages of easy operation，a high survival rate as well as good appearance and sensory function recovery，with less damage to the donor area.