BACKGROUND: While emotional distress, encompassing anxiety and depression, has been associated with negative clinical outcomes, its impact across various clinical departments and general hospitals has been less explored. Previous studies with limited sample sizes have examined the effectiveness of specific treatments (e.g., antidepressants) rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients. To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals, this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay (LOS) and rate of long LOS (LLOS, i.e., LOS >30 days) in a large sample of non-psychiatric inpatients. METHODS: This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital. They were divided, according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index (HEI) for brief screening with grading psychological services (BS-GPS), into BS-GPS ( n = 178,883) and non-BS-GPS ( n = 308,988) cohorts. The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression (CSAD, i.e., HEI score ≥11 on admission to the hospital) in the BS-GPS cohort were compared using univariable analyses, multilevel analyses, and/or propensity score-matched analyses, respectively. RESULTS: The detection rate of CSAD in the BS-GPS cohort varied from 2.64% (95% confidence interval [CI]: 2.49%-2.81%) to 20.50% (95% CI: 19.43%-21.62%) across the 20 departments, with a average rate of 5.36%. Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD (12.7 days, 535/9590) and without CSAD (9.5 days, 3800/169,293) and between the BS-GPS (9.6 days, 4335/178,883) and non-BS-GPS (10.8 days, 11,483/308,988) cohorts. These differences remained significant after controlling for confounders using propensity score-matched comparisons. A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge. CONCLUSION Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals. These impacts were moderated by the implementation of BS-GPS. Thus, BS-GPS has the potential as an effective, resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
Humans ; Retrospective Studies ; Male ; Length of Stay/statistics & numerical data* ; Female ; Middle Aged ; Adult ; Psychological Distress ; Inpatients/psychology* ; Aged ; Anxiety/diagnosis* ; Depression/diagnosis*

Occupational noise-induced hearing loss (NIHL) is an irreversible sensorineural hearing loss that severely endangers workers’ health, making early screening crucial. This article reviewed the research progress on early screening methods for occupational NIHL, introduced the testing mechanisms of three core screening methods—tympanometry, otoacoustic emissions, and extended high-frequency audiometry —and summarized their clinical application advantages and limitations. It is proposed that multimodal combined detection (e.g., the combination of tympanometry, otoacoustic emissions, and extended high-frequency audiometry) can significantly improve the accuracy and comprehensiveness of early screening. Meanwhile, future studies with prospective cohort design are encouraged to verify the long-term monitoring value of each method and to strengthen the joint development of screening technologies with cutting-edge approaches such as machine learning, in order to further improve screening efficiency and provide stronger protection for workers’ hearing health.

AIM: To analyze the correlation between ocular surface status and serum lipids in patients with meibomian gland dysfunction(MGD)during pregnancy, and to provide new ideas for the management and treatment of MGD during pregnancy.METHODS: Totally 120 pregnant women(240 eyes)treated in our hospital from May 2021 to May 2022 were selected and they were divided into MGD group(60 cases, 120 eyes)and control group(60 cases, 120 eyes)according to the presence or absence of MGD. All subjects received the ocular surface disease index scores(OSDI)and underwent examinations of meibomian gland morphology and function, tear film and blood lipid.RESULTS: The scores of OSDI, the related indexes of meibomian gland, corneal fluorescein staining(FL)scores, total cholesterol(TC), triglyceride(TG)and low density lipoprotein-cholesterol(LDL-C)in the MGD group were significantly higher than those in the control group(P<0.05). The scores of fluorescein breakup time(FBUT), Schirmer Ⅰ test(SIt)and high-density lipoprotein cholesterol(HDL-C)in the MGD group were significantly lower than those in the control group(P<0.05). Correlation analysis showed that the scores of TG, TC, LDL-C were negatively correlated with the values of FBUT(rs =-0.702, -0.647, -0.710, all P<0.001).CONCLUSION: The level of blood lipids in pregnant patients with MGD is significantly increased, and the levels of TC, TG and LDL-C may be related to the stability of tear film.

Eyelid and surrounding tissue injury caused by trauma, burn, infection and other reasons will lead to different degrees of eyelid ectropion and incomplete eyelid closure after scar formation. At present, surgical treatment is the main treatment for cicatricial ectropion, but there is still the risk of scar formation again after operation. We used early ion beam drug introduction to treat 1 case of cicatricial ectropion after trauma, and achieved satisfactory result.

Eyelid and surrounding tissue injury caused by trauma, burn, infection and other reasons will lead to different degrees of eyelid ectropion and incomplete eyelid closure after scar formation. At present, surgical treatment is the main treatment for cicatricial ectropion, but there is still the risk of scar formation again after operation. We used early ion beam drug introduction to treat 1 case of cicatricial ectropion after trauma, and achieved satisfactory result.

OBJECTIVE: In order to further decrease and reduce the serious adverse events of silicone rubber endotracheal intubation in clinical use, especially in anesthesia and intensive care. METHODS: Through the first stage analysis on the registration and certification of endotracheal intubation products in China, adverse events of products in recent five years in Zhejiang province, domestic and foreign literature of adverse events of products, retrieval of product citation standards, content integrity of product instructions, and expert seminar on serious adverse events, combined with the air leakage of endotracheal intubation products in recent two years, product material and clinical application with normative aspects. RESULTS: Silicone rubber endotracheal intubation products in clinical intensive care have certain clinical safety risks, especially for long-term use of critically ill patients. CONCLUSIONS According to the four cases of serious adverse events of silicone rubber endotracheal intubation in the clinical intensive care unit, we put forward some suggestions for the manufacturers, clinical users and regulatory agencies to further decrease and reduce the serious adverse events of silicone rubber endotracheal intubation.
China ; Critical Care ; Critical Illness ; Humans ; Intensive Care Units ; Intubation, Intratracheal/adverse effects*

Objective To investigate the application of liver three-dimensional (3D) visualized reconstruction technique in hepatectomy for children with complicated hepatoblastoma. Methods A retrospective analysis was performed for the clinical data of 30 children with hepatoblastoma who underwent hepatectomy for radical resection in PLA Rocket Force Characteristic Medical Center from January 2018 to October 2020, and according to whether liver 3D visualization with IQQA-Liver system was performed before surgery, the children were divided into 3D reconstruction group with 15 children and control group with 15 children. The two groups were compared in terms of perioperative parameters, short-term prognosis, and follow-up conditions. The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the Fisher's exact test was used for comparison of categorical data between two groups. Results Compared with the control group, the 3D reconstruction group had a significantly higher mean age (55.7±10.2 years vs 28.2±2.7 years, P < 0.05) and a significantly higher number of patients with POSTTEXT stage III/VI hepatoblastoma (12 vs 5, P < 0.05) or involvement of the hepatic vein or the inferior vena cava (11 vs 3, P < 0.05). All children completed the surgery successfully, and there were no significant differences between the two groups in blood loss, time of operation, number of times and duration of hepatic portal occlusion, and number of children receiving segmental hepatectomy or partial hepatectomy (all P > 0.05). The median follow-up after surgery was 9.5 months. In the 3D reconstruction group, 2 children experienced recurrence and were diagnosed at 10 and 12 months, respectively, after surgery, and they were treated with chemotherapy at the moment; in the control group, 4 children experienced recurrence, which was higher than that in the 3D reconstruction group ( P =0.651), and among these 4 children, 2 had recurrence at 7 months after surgery, received liver transplantation, and survived up to now, and the other 2 children died shortly after recurrence. Conclusion 3D visualized reconstruction technique helps to perform hepatectomy for children with complicated hepatoblastoma more safely and accurately, especially extended hepatectomy for patients with stage POST TEXT III/IV hepatoblastoma, thereby avoiding liver transplantation.

OBJECTIVE： To investigate the improvement effects of water extract of Astragalus membranaceus on chronic renal failure （CRF） model rats and its effects on MAPK signaling pathway， and to investigate possible mechanism. METHODS： Male SD rats were randomly divided into control group （10 rats） and model group （50 rats）. CRF model was established by intragastric administration of 25％ Adenine suspension 200 mg/kg （once a day， for consecutive 28 d）. After modeling， modeling group was randomly divided into model group， benazepril group （positive control， 2 mg/kg）， A. membranaceus water extract low-dose， medium-dose and high-dose groups （1.5， 3， 6 g/kg，by crude drug）， with 10 rats in each group. Control group and model group were given constant volume of normal saline intragastrically， and administration groups were given relevant medicine intragastrically， once a day， for consecutive 28 d. Twelve hours after last medication， the contents of serum renal function indexes （serum creatinine， urea nitrogen， uric acid） were determined by colorimetry. ELISA method was used to detect the levels of serum inflammatory factors （IL-1β， IL-6 and TNF-α）. The activity or content of oxidative stress related indexes （SOD， CAT and MDA）in renal tissue of rats were determined by hydroxylamine method， visible spectrophotometry method and thiobarbituric acid method. The mRNA expression of apoptosis-related factors （Bax， Bcl-2， Caspase-3） in renal tissue， MAPK signaling pathway-related regulatory protein p38 MAPK， phosphorylated p38 MAPK（p-p38 MAPK）， ERK1/2， phosphorylated ERK1/2 （p-ERK1/2）， JNK and phosphorylated JNK （p-JNK） were determined by real- time PCR and Western blotting assay. RESULTS： Compared with control group， the contents of renal function indexes and the levels of inflammatory factors in serum， MDA content， mRNA expression ratio of Bax and Bcl-2 （Bax/Bcl-2）， mRNA related expression of Caspase-3， related expression of phosphorylation product of MAPK signaling pathway-related regulatory proteins （p-p38 MAPK， p-JNK， p-ERK1/2） in renal tissue were increased significantly in model group， while the activities of SOD and CAT were decreased significantly in renal tissue （P＜0.01）. Compared with model group， the contents of renal function indexes and the levels of inflammatory factors in serum， Bax/Bcl-2， related expression of phosphorylation product of MAPK signaling pathway-related regulatory proteins in renal tissue were decreased significantly in administration groups as well as MDA content and mRNA related expression of Caspase-3 were decreased significantly in benazepril group and A. membranaceus water extract medium-dose and high-dose groups； the activities of SOD and CAT in renal tissue were increased significantly in benazepril group and A. membranaceus water extract medium-dose and high-dose groups （P＜0.05 or P＜0.01）. MDA content and Bax/Bcl-2 of benazepril group were significantly lower than those of A. membranaceus water extract high-dose group （P＜0.05）. CONCLUSIONS： A. membranaceus water extract has a certain improvement effect on CRF model rats， and inhibit its inflammatory reaction， oxidant stress and cell apoptosis， the mechanism of which may be associated with inhibiting the expression of MAPK signaling pathway-related regulatory proteins.

The mammalian central nervous system (CNS) is considered an immune privileged system as it is separated from the periphery by the blood brain barrier (BBB). Yet, immune functions have been postulated to heavily influence the functional state of the CNS, especially after injury or during neurodegeneration. There is controversy regarding whether adaptive immune responses are beneficial or detrimental to CNS injury repair. In this study, we utilized immunocompromised SCID mice and subjected them to spinal cord injury (SCI). We analyzed motor function, electrophysiology, histochemistry, and performed unbiased RNA-sequencing. SCID mice displayed improved CNS functional recovery compared to WT mice after SCI. Weighted gene-coexpression network analysis (WGCNA) of spinal cord transcriptomes revealed that SCID mice had reduced expression of immune function-related genes and heightened expression of neural transmission-related genes after SCI, which was confirmed by immunohistochemical analysis and was consistent with better functional recovery. Transcriptomic analyses also indicated heightened expression of neurotransmission-related genes before injury in SCID mice, suggesting that a steady state of immune-deficiency potentially led to CNS hyper-connectivity. Consequently, SCID mice without injury demonstrated worse performance in Morris water maze test. Taken together, not only reduced inflammation after injury but also dampened steady-state immune function without injury heightened the neurotransmission program, resulting in better or worse behavioral outcomes respectively. This study revealed the intricate relationship between immune and nervous systems, raising the possibility for therapeutic manipulation of neural function via immune modulation.

Objective The aim of this study was to explore the correlation between postoperative aromatase inhibitor(AIs) -based bone metabolism and ERα gene rs9340799,rs2234693 single nucleotide polymorphisms(SNPs)in breast cancer.Methods One hundred and sixty-six breast cancer patients who underwent AIs treatment(≤2 years)were enrolled and hospitalized in our hospital from October 2015 to April 2017.The ERα gene rs9340799 and rs2234693 sites were sequenced and compared subtype of lumbar spine and femur,bone mineral density BMD value and the relationship between BMD value and T value.Results The BMD of lumbar spine in patients with ERα gene rs9340799 was significantly different when compared to those of A/A,A/G and G/G(P<0.01).The BMD of lumbar spine in patients with A/A and A/G genotypes were significantly higher than those in G/G genotypes(P<0.05).The BMD of lumbar spine in patients with ERα gene rs2234693 was significantly different when compared to those of T/T,T/C and C/C(P<0.01). The BMD of lumbar spine in patients with T/T and C/T genotypes were significantly higher than those in C/C genotypes(P<0.05). However,there was no difference in femoral BMD,lumbar spine,and femur T between the 2 subtypes of patients with genotypes(P>0.05).Conclusion Aromatase inhibitor-related bone loss(AIBL)may be related to ERα gene phenotype.In ERα gene rs9340799 and rs2234693 loci,C and G alleles may be susceptible genes for aromatase inhibitor-related bone loss(AIBL).