BackgroundIndividuals with chronic multimorbidity exhibit a high prevalence of sleep disturbances， which impair their physical and psychological well-being and impede chronic disease management. Although sleep quality is closely influencing with psychological functioning， empirical evidence regarding the longitudinal trajectories of sleep quality and their influencing factors in this population remains insufficient. ObjectiveTo investigate the longitudinal trajectories of sleep quality and associated factors among patients with chronic multimorbidity from hospitalization through 6 months post-discharge， aiming to facilitate the early identification of high-risk individuals and the development of personalized sleep interventions. MethodsA total of 228 inpatients with chronic multimorbidity， primarily with cardiovascular and metabolic chronic conditions， were enrolled via random sampling at The Third People's Hospital of Fuyang from January 2023 to September 2024. Baseline assessments were conducted during hospitalization using the general socio-demographic questionnaire， the Sleep Dysfunction Rating Scale （SDRS）， the Ruminative Response Scale （RRS）， and the Hospital Anxiety and Depression Scale （HADS）. Sleep quality was further evaluated using the SDRS at 1-， 3-， and 6-month post-discharge. Latent class growth model was employed to delineate trajectories of sleep quality. Multivariate logistic regression analysis was subsequently performed to identify influencing factors of sleep quality. ResultsA total of 201 patients with chronic diseases were included.Based on four predefined assessment time points （baseline， 1 month， 3 months， 6 months post-discharge）， the latent class growth model identified three distinct trajectories of sleep quality： persistent high sleep disturbance （n=72， 35.82%）， moderate sleep disturbance-progression （n=73， 36.32%）， and low sleep disturbance （n=56， 27.86%）. Multivariate logistic regression analysis revealed that， compared with the low sleep disturbance group， multiple factors increased the odds of membership in the persistent high sleep disturbance group： per capita monthly household income of <3 000 yuan （β=13.131， P<0.01） or 3 000–5 000 yuan （β=5.913， P<0.05）， aged 45–65 years （β=9.536， P<0.05）， presence of 3 （β=7.792， P<0.05） or >3 comorbid chronic conditions （β=6.626， P<0.05）， as well as higher RRS （β=0.334， P<0.01） and HADS score （β=1.628， P<0.01）. Additionally， patients aged 45–65 years （β=2.777， P<0.05）， with 3 （β=3.802， P<0.01） or >3 comorbid chronic conditions （β=2.463， P<0.01）， and with higher RRS （β=0.111， P<0.01） and HDAS scores （β=0.350， P<0.05） also demonstrated significantly increased odds of belonging to the moderate sleep disturbance–progression group. ConclusionThere is significant population heterogeneity in sleep quality trajectories among patients with chronic multimorbidity， with age， per capita household monthly income， number of comorbidities， rumination， and anxiety/depression symptoms being identify as the primary influencing factors.

OBJECTIVE To study the effect of different doses of aspirin on clinical efficacy in acute stage of Kawasaki’s disease, and to explore the optimal dose of aspirin. METHODS A total of 150 patients suffered from Kawasaki’s disease were randomly selected by hospital information system from March to May 2022 for retrospective analysis. According to different doses of aspirin, they were divided into three groups: high dose group(>50 mg·kg−1·d−1), medium dose group(30−50 mg·kg−1·d−1) and low dose group(<30 mg·kg−1·d−1). The antipyretic time, the incidence of non-response to intravenous human immunoglobulin, the improvement of laboratory indexes and prevalence of adverse drug reaction were compared among the three groups. RESULTS There was no significant difference in body temperature recovery among the three groups under different doses of aspirin. There was no significant difference in patients with non-response to intravenous human immunoglobulin among the three groups. Before treatment, there were no significant differences in white blood cell(WBC) count, blood platelet(PLT) count and C-reactive protein(CRP) concentration among the three groups. After treatment, the count of WBC, PLT and CRP in the three groups was significantly improved compared with that before treatment, and the difference was statistically significant(P<0.05). However, there was no significant difference in the above indexes among the three groups after treatment. There was a higher incidence of adverse reactions in children treated with medium or high dose aspirin. CONCLUSION Different doses of aspirin combined with intravenous human immunoglobulin have good therapeutic effect on Kawasaki’s disease, but considering the safety and economy of aspirin, low dose administration is recommended.

Objective To explore the clinical efficacy of Chaiqi Ningshen Anmian Decoction(CNAD)combined with wrist ankle acupuncture(WAA)in treating chronic insomnia(CI)patients with heart and spleen deficiency.Methods CI patients diagnosed and treated at the Beijing Huairou Hospital of Traditional Chinese Medicine from April 2022 to April 2023 were selected,and patients were randomly divided into the Eszolam(ET)group and the combination group(CNAD combined with WAA)according to the random number table method,with 50 cases in each group.The primary outcome was clinical efficacy[evaluated by the Traditional Chinese Medicine Syndrome Integral(TCMSI)].Secondary outcomes included changes in cognitive function[assessed by the Montreal Cognitive Assessment(MoCA)],anxiety level[assessed by the Hamilton Anxiety Scale(HAMA)],sleep quality[assessed by the Pittsburgh Sleep Quality Index(PSQI)],glycated serum albumin(GA),serotonin(5-HT),interleukin-1 β(IL-1β),and C-reactive protein(CRP)before and after treatment in both groups.Results Before treatment,there was no significant differences in total TCMSI between the two groups(P＞0.05).After treatment,the total TCMSI of the combination group was significantly lower than that of the ET group(P＜0.05),and the treatment effectiveness rate was significantly higher in the combination group(P＜0.05).Before treatment,there were no significant differences in MoCA score,HAMA score,PSQI score,serum GA level,serum 5-HT level,serum IL-1 level and serum CRP level between the groups(P＞0.05).After treatment,the MoCA score,serum GA level,and serum 5-HT level in the combination group were significantly higher than those in the ET group(P＜0.05),while the HAMA score,PSQI score,serum IL-1β level,and serum CRP level were significantly lower in the combination group(P＜0.05).Conclusion Compared with ET,CNAD combined with WAA significantly improves insomnia symptoms in CI patients with heart and spleen deficiency,enhances cognitive function and sleep quality,and reduces anxiety levels.This may be related to the upregulation of serum 5-HT,IL-1 β and the inhibition of the inflammatory response.

Objective:To compare the preventive effects of different doses of esketamine on remifentanil-induced hyperalgesia(RIH)in the patients underwent thoracoscopic pnlmonary lobectomy,and to provide the basis for the multimodal analgesia and rapid postoperative recovery.Methods:The prospective,double-blind,parallel-designed randomized controlled trial(RCT)were conducted,and 107 patients who underwent visual-assisted thoracoscopic pulmonary lobectomy were included.The patients were randomly divided into normal control group,low dose of esketamine group,and high dose of esketamine group using random number methods.Except the patients who were eliminated and those who dropped out of the study,there were 31 patients in normal control group,33 patients in low dose of esketamine group,and 33 patients in high dose of esketamine group.The patients in low dose of esketamine group were given the intravenous injection of 0.25 mg·kg-1 esketamine(diluted to 5 mL)during anesthesia induction;the patients in high dose of esketamine group were given the intravenous injection of 0.50 mg·kg-1 esketamine(diluted to 5 mL),and the patients in normal control group were given 5 mL intravenous injection of saline.The mechanical pain thresholds of the non-dominant forearm skin and skin around the surgical incision at different time points,numeric rating scale(NRS)scores,Ramsay sedation scores,perioperative analgesic drug dosages,and the incidences of adverse reactions such as postoperative delirium,nausea,and vomiting of the patients in various groups were recorded.Results:Compared with normal control group,the mechanical pain thresholds around the surgical incision skin of the patients in low and high doses of esketamine groups were increased(P＜0.05);compared with low dose of esketamine group,the extubation time of the patients in high dose of esketamine group was increased(P＜0.05).Two minutes after anesthesia induction administration,compared with normal control group,the mean arterial pressure(MAP)and heart rate(HR)of the patients in low and high doses of esketamine groups were increased(P＜0.05),but there were no significant differences in the MAP and HR of the patients between low dose of esketamine and high dose of esketamine group(P＞0.05);compared with normal control group,the incidences of hallucinations and delirium among the patients in high dose of esketamine group were increased(P＜0.05),while there were no significant differences in the incidences of above adverse reactions in low dose of esketamine group(P＞0.05);compared with low dose of esketamine group,the incidences of hallucinations and delirium among the patients in high dose of esketamine group were increased(P＜0.05).Conclusion:Intravenous administration of esketamine with a dosage of 0.25 mg·kg-1 during anesthesia induction improves the postoperative mechanical pain threshold of the patients undergoing thoracoscopic pulmonary lobectomy,which exhibits effective prevention of RIH without an increase in incidences of adverse reactions during the perioperative period.

Objective:To investigate the differences in the incidence of QT interval prolongation between moxifloxacin and levofloxacin in anti-infective therapy among cardiology intensive care unit (CCU) patients, and to analyze the risk factors for QT interval prolongation.Methods:The data of patients who received anti-infective treatments with moxifloxacin and levofloxacin in CCU of Xiaogan Central Hospital from January 2020 to December 2022 were collected and analyzed retrospectively. The clinical characteristics in the 2 groups were compared. Potential influencing factors of QT interval prolongation were analyzed using univariate regression analysis. Variables with P<0.2 were included in a logistic regression model for multivariate analysis. The effect values were expressed as odds ratio ( OR) and its 95% confidence interval ( CI). Results:A total of 146 patients were included in the study, with 76 patients in the moxifloxacin group and 70 patients in the levofloxacin group. In the moxifloxacin group, 18 out of 76 patients (23.68%) experienced QT interval prolongation, while in the levofloxacin group, 6 out of 70 patients (8.57%) experienced QT interval prolongation; the difference between the 2 groups was statistically significant ( P=0.025). There were no statistically significant differences in other factors between the 2 groups. Univariate regression analysis showed that female ( OR=2.958, 95% CI: 1.144-7.647, P=0.025), myocardial infarction ( OR=2.958, 95% CI: 1.144-7.647, P=0.025), concomitant use of amiodarone ( OR=2.569, 95% CI: 1.042-6.337, P=0.040) and escitalopram were influencing factors of QT interval prolongation. Factors with P<0.2 were entered in the multivariate logistic regression analysis, and the results showed that female ( OR=3.616, 95% CI: 1.240-10.538, P=0.019), hypokalemia ( OR=2.953, 95% CI: 1.263-6.905, P=0.012), and myocardial infarction ( OR=3.026, 95% CI: 1.057-8.666, P=0.039) were independent risk factors for QT interval prolongation. Conclusions:Moxifloxacin is associated with a higher incidence of QT interval prolongation compared to levofloxacin. Female and patients with hypokalemia and myocardial infarction have high risks for QT interval prolongation.

Objectives:To explore the dynamic changes of right ventricular global longitudinal strain (RVGLS) on echocardiography during the process of right ventricular fibrosis with right ventricular pressure overload.Methods:Animal models with RV pressure overload (n=5) were established by main pulmonary artery (PA) banding in piglets.The ratio of RV pressure to left ventricular (LV) pressure was greater than 60％ as assessed by the pressure measuring needle during the operation.Pre-and post-operative echocardiography were performed.Histopathological examination of RV tissues was performed at the end of the experiment.Results:During the establishment of the animal models,2 piglets died due to hemorrhagic shock,while 3 piglets survived and were included in the analysis.Systolic RV pressure,systolic PA pressure and mean PA pressure(measured at the proximal end of the constriction) were significantly increased immediately after PA banding,mean RV pressure and mean PA pressure were significantly inreased at 14 weeks postopseratively (all P<0.05).Tricuspid annulus plane systolic excursion and peak early diastolic velocity of tricuspid annulus (TV e') decreased immediately after operation (all P<0.05).They returned to the pre-operative level in the following three weeks.The absolute values of RVGLS were reduced after PA banding (all P>0.05).The RVGLS of the inner membrane layer began to recover after 3 weeks,and the RVGLS of the middle and outer membrane layers began to recover after 7 weeks.However,the time to peak RVGLS was significantly prolonged and could not be restored even untill the end of the experiment (14 weeks after surgery)(all P<0.05).At the end of the experiment,pathological examination revealed fibrous tissue hyperplasia in both the myocardial interstitium and endocardium.Conclusions:The measurement of intracardiac pressure and pathological results confirmed the success of the establishment of the animal model of increased right ventricular afterload.Both stress and strain cannot truly represent the intrinsic characteristics of the myocardium under pressure overload.The prolonged time to peak of longitudinal strain might indirectly reflect the progression of myocardial injury more persistently during the process of increased right ventricular afterload and myocardial injury.

Centralized monitoring is a risk-based remote monitoring mode that can effectively improve monitoring efficiency and quality. From July to September 2023, this study developed a centralized monitoring scheme for investigator initiated trials(IIT). This scheme utilized electronic data collection system and clinical research document management system, using programming techniques to compare the consistency of key project processes and data, monitor data filling, distribution trends, logical relationships, as well as documents such as informed consent forms, protocol violation records, and adverse event reports. It could timely identify problems in clinical trials and develop targeted response measures. From October to December 2023, 6 experts conducted centralized monitoring for 153 IIT projects using this scheme and found common issues in program execution(86 projects), ethical approvals(68 projects), and informed consent forms(67 projects), and so on. At the scome time, corresponding measures were developed. The process took a total of 20 days, with an average time of 6.27 hours per project. Compared with traditional on-site monitoring, the centralized monitoring scheme developed in this study had shown certain advantages in terms of timeliness, which could help guide the efficient implementation of on-site monitoring work and provide references for tertiary public hospitals to improve the quality of clinical trials.

Objectives:To explore the dynamic changes of right ventricular global longitudinal strain (RVGLS) on echocardiography during the process of right ventricular fibrosis with right ventricular pressure overload.Methods:Animal models with RV pressure overload (n=5) were established by main pulmonary artery (PA) banding in piglets.The ratio of RV pressure to left ventricular (LV) pressure was greater than 60％ as assessed by the pressure measuring needle during the operation.Pre-and post-operative echocardiography were performed.Histopathological examination of RV tissues was performed at the end of the experiment.Results:During the establishment of the animal models,2 piglets died due to hemorrhagic shock,while 3 piglets survived and were included in the analysis.Systolic RV pressure,systolic PA pressure and mean PA pressure(measured at the proximal end of the constriction) were significantly increased immediately after PA banding,mean RV pressure and mean PA pressure were significantly inreased at 14 weeks postopseratively (all P<0.05).Tricuspid annulus plane systolic excursion and peak early diastolic velocity of tricuspid annulus (TV e') decreased immediately after operation (all P<0.05).They returned to the pre-operative level in the following three weeks.The absolute values of RVGLS were reduced after PA banding (all P>0.05).The RVGLS of the inner membrane layer began to recover after 3 weeks,and the RVGLS of the middle and outer membrane layers began to recover after 7 weeks.However,the time to peak RVGLS was significantly prolonged and could not be restored even untill the end of the experiment (14 weeks after surgery)(all P<0.05).At the end of the experiment,pathological examination revealed fibrous tissue hyperplasia in both the myocardial interstitium and endocardium.Conclusions:The measurement of intracardiac pressure and pathological results confirmed the success of the establishment of the animal model of increased right ventricular afterload.Both stress and strain cannot truly represent the intrinsic characteristics of the myocardium under pressure overload.The prolonged time to peak of longitudinal strain might indirectly reflect the progression of myocardial injury more persistently during the process of increased right ventricular afterload and myocardial injury.

Objective:To investigate the differences in the incidence of QT interval prolongation between moxifloxacin and levofloxacin in anti-infective therapy among cardiology intensive care unit (CCU) patients, and to analyze the risk factors for QT interval prolongation.Methods:The data of patients who received anti-infective treatments with moxifloxacin and levofloxacin in CCU of Xiaogan Central Hospital from January 2020 to December 2022 were collected and analyzed retrospectively. The clinical characteristics in the 2 groups were compared. Potential influencing factors of QT interval prolongation were analyzed using univariate regression analysis. Variables with P<0.2 were included in a logistic regression model for multivariate analysis. The effect values were expressed as odds ratio ( OR) and its 95% confidence interval ( CI). Results:A total of 146 patients were included in the study, with 76 patients in the moxifloxacin group and 70 patients in the levofloxacin group. In the moxifloxacin group, 18 out of 76 patients (23.68%) experienced QT interval prolongation, while in the levofloxacin group, 6 out of 70 patients (8.57%) experienced QT interval prolongation; the difference between the 2 groups was statistically significant ( P=0.025). There were no statistically significant differences in other factors between the 2 groups. Univariate regression analysis showed that female ( OR=2.958, 95% CI: 1.144-7.647, P=0.025), myocardial infarction ( OR=2.958, 95% CI: 1.144-7.647, P=0.025), concomitant use of amiodarone ( OR=2.569, 95% CI: 1.042-6.337, P=0.040) and escitalopram were influencing factors of QT interval prolongation. Factors with P<0.2 were entered in the multivariate logistic regression analysis, and the results showed that female ( OR=3.616, 95% CI: 1.240-10.538, P=0.019), hypokalemia ( OR=2.953, 95% CI: 1.263-6.905, P=0.012), and myocardial infarction ( OR=3.026, 95% CI: 1.057-8.666, P=0.039) were independent risk factors for QT interval prolongation. Conclusions:Moxifloxacin is associated with a higher incidence of QT interval prolongation compared to levofloxacin. Female and patients with hypokalemia and myocardial infarction have high risks for QT interval prolongation.

Centralized monitoring is a risk-based remote monitoring mode that can effectively improve monitoring efficiency and quality. From July to September 2023, this study developed a centralized monitoring scheme for investigator initiated trials(IIT). This scheme utilized electronic data collection system and clinical research document management system, using programming techniques to compare the consistency of key project processes and data, monitor data filling, distribution trends, logical relationships, as well as documents such as informed consent forms, protocol violation records, and adverse event reports. It could timely identify problems in clinical trials and develop targeted response measures. From October to December 2023, 6 experts conducted centralized monitoring for 153 IIT projects using this scheme and found common issues in program execution(86 projects), ethical approvals(68 projects), and informed consent forms(67 projects), and so on. At the scome time, corresponding measures were developed. The process took a total of 20 days, with an average time of 6.27 hours per project. Compared with traditional on-site monitoring, the centralized monitoring scheme developed in this study had shown certain advantages in terms of timeliness, which could help guide the efficient implementation of on-site monitoring work and provide references for tertiary public hospitals to improve the quality of clinical trials.